Background In 2017, Brazil integrated Pre-Exposure Prophylaxis (PrEP) into its unified health system. This study aimed to analyze temporal trends in key HIV epidemiological indicators over the past decade to explore the extent to which PrEP expansion has influenced HIV diagnosis rates. We investigated whether disparities in PrEP use across demographic groups were temporally associated with differences in HIV incidence at the populational level. Methods We conducted a retrospective analysis of public surveillance data (2012‒2024) for Rio de Janeiro city, Brazil. We estimated annual trends in the proportion of people living with HIV, HIV identifications rates, ART coverage, viral suppression, and PrEP use, stratified by sex, age, race, and education. We used time-series analysis with 3-year moving averages and segmented regression models to identify significant trend changes and breakpoints. Results Exponential growth in PrEP use was observed from 2017‒2024, with PrEP use surpassing the number of new HIV identifications after 2021. Despite this expansion, HIV identification rates increased among most demographic subgroups since 2020, particularly among young, Black, and Pardo individuals. PrEP expansion disproportionately benefited older individuals rather than those aged 18‒24 years. Black individuals constituted the smallest racial group using PrEP. Males with ≥12-years of education accessed PrEP at rates nine times higher than males with the lowest education level. Conclusions Oral PrEP alone may be insufficient to curb HIV transmission without addressing structural barriers including racism, educational inequities, homophobia, and transphobia. Future prevention efforts should combine different PrEP modalities, community-centered approaches, anti-racism initiatives, LGBTQIAPN+-affirming care, and targeted outreach to younger populations.
Objective The present study therefore aimed to compare and contextualize leprosy indicators in the State of Pernambuco during the pre-pandemic and pandemic periods, to assess the burden of disease using Years Lived with Disability, and to examine its distribution across Pernambuco’s various health regions. Methods This ecological study used secondary data to compare epidemiological indicators and the burden of leprosy-related disease in the State of Pernambuco, Brazil, before (2017‒2019) and during (2020‒2022) the COVID-19 pandemic, and to examine its distribution among health regions. Results The detection rate of new cases decreased from 33.44 to 24.54 per 100,000 inhabitants, although endemicity remained high in most regions and hyperendemic in Petrolina. The detection rate of new cases with grade 2 disability increased from 7.22 to 8.64 per 1000,000 inhabitants, particularly in the regions of Recife, Caruaru, and Petrolina. Years lived with grade 2 disability increased from 352.76 to 463.06 years. Conclusion During the period from 2020 to 2022, the COVID-19 pandemic was associated with significant changes in most leprosy indicators, suggesting an increase in morbidity in the state of Pernambuco, Brazil. Despite the reduction in new leprosy cases due to mobility restrictions, the overburdening of the public health system, and the suspension of active case finding, particularly affecting children and vulnerable populations, there was an increase in hidden prevalence, treatment delays, and disabilities. The behavior of the epidemic in the state of Pernambuco was similar to that observed in Brazil, reinforcing the country's position as the second most affected by leprosy in the world.
Background Gestational and congenital syphilis remain major public health concerns, particularly in low- and middle-income countries, with substantial impacts on neonatal health. This study estimated the prevalence of gestational syphilis and the birth prevalence of congenital syphilis, identified factors associated with gestational syphilis, and evaluated the association between congenital syphilis and adverse neonatal outcomes in Guarujá, São Paulo, Brazil. Methods This cross-sectional study was nested within the population-based Guaru-yá Birth Cohort and included 2,217 hospital births from April 2024 to April 2025. Gestational syphilis was defined by reactive treponemal and non-treponemal tests during pregnancy or delivery, considering diagnosis and treatment during the current pregnancy; adequately treated women were not classified as cases. Congenital syphilis was defined according to clinical, laboratory, or epidemiological criteria compatible with vertical transmission. Adjusted Prevalence Ratios (PR) and 95% Confidence Intervals (95% CI) were estimated using Poisson regression with robust variance. Results Gestational syphilis prevalence was 12.8% (95% CI: 11.4–14.2), and congenital syphilis birth prevalence was 5.8% (95% CI: 4.8–6.8). Higher gestational syphilis prevalence was observed among women with low maternal education (PR = 2.47; 95% CI: 1.43–4.29), living in poorest households (PR = 1.46; 95% CI: 1.07–2.00), who did not cohabit with a partner (PR = 1.83; 95% CI: 1.45–2.31), who smoked during pregnancy (PR = 1.75; 95% CI: 1.35–2.27), and used illicit drug during pregnancy (PR = 1.70; 95% CI: 1.26–2.28). Women aged ≥ 35 years showed lower prevalence of gestational syphilis compared with those aged 20–34 years (PR = 0.67; 95% CI: 0.47–0.97). Congenital syphilis remained independently associated with fetal or neonatal death (PR = 3.25; 95% CI: 1.74–6.07). Conclusions Gestational syphilis was strongly associated with socioeconomic vulnerability and behavioral factors. Congenital syphilis remained independently associated with fetal or neonatal death, reinforcing the need for early prenatal access, repeated screening, timely maternal and partner treatment, and strengthened surveillance to reduce vertical transmission.
Donovanosis is a chronic granulomatous sexually transmitted infection that may clinically mimic malignancy. We report a 64-year-old man with well-controlled HIV infection presenting with a chronic infiltrated vegetative scrotal ulcer showing progressive enlargement, exophytic growth, and hemorrhagic ulceration. Despite prolonged antimicrobial therapy with azithromycin and doxycycline, followed by adjunctive acyclovir because of suspected chronic herpes simplex coinfection, the lesion continued to progress, raising concern for squamous cell carcinoma. Initial histopathological and microbiological investigations, including cytology for Donovan bodies, were inconclusive. Repeat biopsy demonstrated pseudoepitheliomatous hyperplasia with a dense plasma cell-rich inflammatory infiltrate without cytological atypia, while periodic acid-Schiff staining identified intracellular Donovan bodies, confirming donovanosis. Doxycycline was reintroduced and maintained until complete healing after four months. This case highlights the diagnostic challenges of pseudotumoral donovanosis in patients living with HIV.
HIV Cerebrospinal Fluid (CSF) viral escape is a condition characterized by inadequate virological control within the CSF despite systemic antiretroviral therapy, often assessed through discordant CSF and plasma HIV viral loads. The clinical relevance of CSF viral escape remains poorly understood, but it is thought to contribute to a spectrum of neurological and neurocognitive manifestations. The present study details the case of a 51-year-old individual from São Paulo, Brazil, presenting with acute meningoencephalitis and seizures in the context of persistent low-level viremia. Differential diagnoses were considered to rule out other conditions, such as infectious and immune-related diseases, eventually leading to a diagnosis of HIV CSF viral escape, confirmed through clinical presentation and a series of diagnostic evaluations. Antiretroviral therapy was subsequently optimized to improve central nervous system penetration, resulting in clinical improvement, resolution of neurological symptoms and undetectable CSF viral load.
