R e v i s t a d a S o c i e d a d e B r a s i l e i r a d e M e d i c i n a T r o p i c a l 2 0 ( 4 ) : 2 2 5 - 2 2 6 , O u t - D e z , 1 9 8 7
C A R T A A O E D I T O R
H U M A N I M M U N O D E F I C I E N C Y V I R U S I N F E C T I O N I N S E L E C T E D H E M O D I A L Y S I S P A T I E N T S I N B E L O H O R I Z O N T E , B R A Z I L
Information about Human Immunodeficiency Virus (HIV) seropositivity in hemodialysis patients is
rare. Peterman e t a l 2 studied 520 hemodialysis in
dividuals in Boston and verified by means of Elisa (enzyme-linked immunosorbent assay) and W es tern blot analysis that only four (0.8% ) were sero positive for HIV. These workers suggested that HIV infection is not transmitted in dialysis centers and that the infection in those patients is related with frequent blood transfusions.
As of February, 1987 there were 41 notified cases of Acquired Immunodeficiency Syndrome (A ID S) in M inas Gerais State, Brazil. From these, 34 were homo or bisexual men, 2 were hemophiliacs, 2 had received multiple blood transfusions, 1 was an intravenous drug addict and 2 had no identified risk factors1. U ntil this period, examinations in blood donors for detecting antibody against HIV were not obligatory in Brazil.
We studied in March, 1987 237 patients (99.2% of the total) from three private dialysis centers in Belo Horizonte, capital of the Minas Gerais State. Information about age, sex, number of blood trans fusions and number of hemodialysis were obtained from the three centers. The sera of all patients were tested by Elisa (Salk D upont Laboratories). W hen the serum was positive and/or borderline in at least two
out o f three of these examinations, they were retested by means of W estern blot analysis (Biotech D upont Laboratories). The serum tested by W estern blot was considered positive if they reacted with proteins p24, p31 and gp41 or gpl60. The examinations were carried out according to the manufacturers’ instruc tions.
Our findings show that (Table 1): a) there were statistically significant differences among the patients from the three centers in relation to age, sex, number of blood transfusions and number of hemodialysis; b)
Table 1 - S e x , a g e , n u m b e r o f b l o o d tr a n s f u s io n s , n u m b e r o f h e m o d ia ly s e s , a n d h u m a n im m u n o d e f ic ie n c y v ir u s r e a c t i v i t y in th r e e h e m o d i a l y s i s c e n te r s in B e lo H o r iz o n te , B r a z i l .
V a r ia b l e s
C e n te r A
( n = 1 2 9 )
C e n te r B
( n — 7 0 )
C e n te r C
( n = 3 8 )
T o t a l
( n = 2 3 7 )
p v a lu e * * *
1) M ean years of age ± SD 39.1±15.0 43.1±14.8 40.6±13.0 40.5+ 14.7 p < 0.05
(range) (9-75) (2 0 - 7 5 ) (1 4 - 7 9 ) ( 9 - 7 9 )
2) Sex
Males 61(47.3% ) 45( 64.3% ) 26( 68.4% ) 132(55.7% )
Females 68 ( 52.7% ) 25( 35.7%) 12( 31.6%) 105(44.3% ) p < 0.05
3) Np of blood transfusions during all life*
0 13(10.1%) 16( 22.9% ) 3( 7.9%) 32(13.5% )
1 - 4 53(41.1% ) 33( 41.1% ) 18( 47.4% ) 104(43.9%)
> 5 63(48.9% ) 21( 30.0%) 17( 44.7% ) 101(42.6% ) p < 0.05
(n) M ean + SD (1 16)5.2±3.9 (54)5.4±5.6 (35)7.3±8.2 (205)5.6 ± 5 .3
-4) N.° of hemodialysis during all life
1 - 9 9 62(48.1% ) 33( 47.1% ) 7( 18.4%) 102(43.0%)
1 0 0 -4 9 9 53(41.0% ) 32( 45.7% ) 18( 47.4% ) 103(43.5%)
> 5 0 0 14(10.9%) 5( 7.1%) 13( 34.2%) 32(13.5% ) p < 0.05
M ean + SD 199.7+215.5 177.0±228.3 366.8+ 329.2 219.8±248.3
_
5) HIV reactivity (ELISA )
Negative 128(99.2%) 70(100.0% ) 38(100.0% ) 236(99.6% )
Positive** 1( 0.8% ) 0( 0.0% ) 0( 0.0% ) 1( 0.4% ) —
n = np o f patients
*: 176 (74,0%) received at least one blood transfusion in the previous year (1986) positive and/or borderline in at least two examinations
* * * : 1) F ( 2 , 2 3 4 ) = 2 . 2 5 ; 2 ) x 2 ( 3 d f ) = 8 . 2 1 ; 3 ) x 2 ( 4 d f ) = 1 0 . 7 3 ; 4) X 2(4df)= 2 1 . 8 5
Recebido para publicação em 12/7/87
C a r t a a o E d i t o r . R e v i s t a d a S o c i e d a d e B r a s i l e i r a d e M e d i c i n a T r o p i c a l 2 0 : 2 2 5 - 2 2 6 , O u t - D e z , 1 9 8 7
87% of the patients had received a t least one blood transfusion during their lives and 74% had received at least one transfusion during the previous year; c) the mean number of hemodialysis varied from 117 to 119 in the investigated centers; d) only one individual had antibody against HIV by Elisa examination, but this serum was negative when retested by means of W es tern blot analysis. These results demonstrate that the problem of HIV infection in the studied patients does not exist at the present stage of the A ID S epidemic in
Belo Horizonte.
R E F E R E N C E S
1. Brazil. Secretaria do Estado da Saúde de Minas Gerais. Informe Epidemiológico sobre A ID S /S ID A , M arch, 1987 (unpublished data).
2. Peterman TA , Lang G R, Mikos N J, Solomon SL, Schable CA, Feorino PM , Britz JA , Allen JR. HTLV -III/ LAV Infection in Hemodialysis Patients Journal of the American M edical Association 255:2324-2326, 1986.
M a r i a F e r n a n d a F d e Li m a e C o st a 1 , F e r n a n d o A Pr oi e t t i 1 , U r q u i z a H M P a u l i n o 2 , Ef i ge n i a A O Si l v a 3 , Eu l e r P L a sm a r 4 , C a r l o s M F A n t u n e s1 ,
M a r k D C G u i m a r ã e s1, Di r ce u B G r e c o 2
1. G rupo Interdepartamental de Pesquisas em Epidemiologia, Universidade Federal de Minas Gerais. 2. Laboratório de Pós-Graduação em M edicina Tropical, Universidade Federal de M inas Gerais. 3. Instituto Mineiro de Nefrologia, Belo Horizonte.
4. Hospital Felício Rocho, Belo Horizonte.
