Infecção pelo vírus da hepatite B em população privada de liberdade de Mato Grosso do Sul

Abstract

Hepatitis B virus (HBV) infection is a major public health problem worldwide, being one of the leading causes of liver disease. The prison population is considered to be at high risk for the acquisition of infections related to the conditions of confinement, such as HBV infection, consumption of illegal drugs, irregular use of condoms, making tattoos and sharing contaminated sharps. This cross-sectional study aimed to estimate the prevalence, incidence and risk factors associated to HBV infection, as well as to identify the main circulating HBV genotypes/subtypes in prisoners from Mato Grosso do Sul. A total of 3.368 prisoners distributed in 12 closed prisons institutions in the cities of Campo Grande, Corumbá, Dourados, Ponta Porã, and Três Lagoas were randomly recruited and underwent an interview and blood collection for the detection of HBV serological markers. HBsAg-positive samples were tested for HBV-DNA by real time PCR (polymerase chain reaction), and were genotyped by sequencing of the Pré-S/S regions. Of the 3,368 prisoners who participated in the study, 520 (15.4%) were female and 2,848 (84.6%) were male. The overall prevalence of HBV infection was 9.8% (95% CI: 8.8 to 10.8); 11.2% in female and 9.6% in male prisoners. The estimated positivity for HBsAg was 0.6%. Only 31.4% of the participants had serological evidence of hepatitis B vaccination (anti-HBs alone), being higher in females than in males (30.4% vs. 36.8%; p=0.004). The majority of the studied population was susceptible to HBV infection, which was higher in male prisoners when compared with female (60.2% vs. 52.2%, p=0.001). Isolates of HBV DNA were classified as belonging to genotypes A (45.4%), D (27.3%) and F (27.3%). In male prisoners, HBV infection was associated with increased age, self-reported active tuberculosis and anti-HCV positivity, whereas among female prisoners the risk factor associated with HBV infection was anti-T. pallidum positivity. The result of the present study indicates a high prevalence of HBV infection in prisoners compared to the general population. In addition, despite the low incidence of this infection, the occurrence of new cases within the prison environment indicates the urgent need to implement individual and collective preventive measurements such as health education, periodic serological screening, hepatitis B vaccination, and treatment of chronic hepatitis B carriers.