Lizomar de Jesus Maués Pereira Moia

Hepatitis D and B virus genotypes in chronically infected patients from the Eastern Amazon Basin

Hepatitis D virus (HDV) is a defective hepatotropic virus whose infectivity is dependent on hepatitis B virus (HBV). HDV super- or co-infection leads to an increased risk of fulminant hepatitis or progression to severe chronic liver disease in HBV infected patients. The Brazilian Amazon Basin has been reported to be endemic for HBV and HDV, especially in the Western Amazon Basin. In this region, HDV infection is frequently associated with acute fulminant hepatitis with characteristic histologic features. HDV is classified into seven major clades (HDV-1 to HDV-7) and HBV is subdivided into eight genotypes (A-H). HDV and HBV genotypes have been shown to have a distinct geographic distribution. The aim of this study was to determine the HBV and HDV genotypes harbored by chronically infected patients from the Eastern Amazon Basin, Brazil. We studied 17 serum samples from HBV and HDV chronically infected patients admitted to a large public hospital (Santa Casa de Misericórdia) at Belém, state of Pará, Brazil, between 1994 and 2002. HDV-3 and HBV genotype A (subtype adw2) have been identified in all cases, in contrast to previous studies from other regions of the Amazon, where HBV genotype F has been found co-infecting patients that harbored HDV-3. The HDV-3/HBV-A co-infection suggests that there is not a specific interaction between HBV and HDV genotypes, and co-infection might merely reflect the most frequent genotypes found in a particular geographic area. The analysis of the carboxy-terminal region of the large hepatitis D antigen (L-HDAg), which interacts with the hepatitis B surface antigen (HBsAg) and is essential for HDV assembly, showed some diversity between the different isolates from the Eastern Amazon. This diversity is not observed among HDV-3 sequences from other South American regions.

Prevalência de genótipos e de mutantes pré-core A-1896 do vírus da hepatite B e suas implicações na hepatite crônica, em uma população da Amazônia oriental

A infeccao pelo virus da hepatite B apresenta amplo espectro de manifestacoes clinicas. Objetivando conhecer os genotipos do HBV mais prevalentes e determinar a ocorrencia da mutacao pre-core A-1896, em uma populacao da Amazonia oriental, correlacionando com o diagnostico clinico, foram selecionados 51 pacientes portadores cronicos de HBsAg e HBV-DNA positivos e divididos em tres grupos: grupo A (n=14, pacientes assintomaticos); grupo B (n=20, sintomaticos HBeAg positivos) e grupo C (n=17, sintomaticos HBeAg negativos), sendo usado o sequenciador automatico ABI modelo 377 para identificacao de genotipos e mutantes pre-core. Os resultados evidenciaram o genotipo A como o mais prevalente, 81,8%, 89,5% e 93,7%, nos grupos A, B e C, respectivamente. A mutacao pre-core A-1896 foi encontrada em 11,5% (3/26), sendo todos assintomaticos. Concluiu-se que na populacao estudada o genotipo A foi o mais prevalente e houve baixa ocorrencia do mutante pre-core A-1896, ambos nao se constituindo fatores agravantes da doenca hepatica.

Mannose-binding lectin gene polymorphisms are not associated with susceptibility to hepatitis C virus infection in the Brazilian Amazon region

The present study compares the genotype frequencies between two population groups composed by 73 hepatitis C virus (HCV)-infected patients and 92 seronegative controls and investigates the role of allele variants as a possible factor in the susceptibility to HCV infection and the influence on disease progression. The identification of MBL*B and MBL*C alleles was performed by restriction fragment length polymorphism analysis of the 349-bp product using BanI and MboII restriction enzymes, respectively, and a polymerase chain reaction-sequence-specific polymorphism for discrimination of MBL*D. The analysis of allele and genotype frequencies between an HCV-infected group and seronegative controls did not indicate significant differences. The comparison of chronically infected subjects with and without liver cirrhosis was also not statistically significant. The odds ratio estimations were not significant, and the values obtained cannot suggest that the presence of allele variant MBL*B could have some influence in the risk of HCV infection progression to liver cirrhosis and that the presence of allele MBL*D could confer some protection against disease progression, but a larger sample size is necessary to confirm the present results.

Equinococose policística na Amazônia oriental brasileira: atualização da casuística

Mediante criterios epidemiologicos, clinicos e laboratoriais, foi levantada a casuistica de equinococose policistica no periodo de 1962 a 2003, no âmbito da Amazonia oriental brasileira, incluindo casos ineditos e aqueles ja publicados. Dessa forma, foram identificados 40 casos da doenca no referido periodo, compreendendo casos procedentes dos estados do Para e Amapa, Brasil. A amplitude das idades foi de 10 a 72 anos. Do total 47,5% pertenciam ao sexo masculino. O figado foi o orgao mais acometido (82,5% dos casos). O Echinococcus vogeli (Rausch e Bernstein, 1972), apresentou-se como o principal agente etiologico envolvido. A partir do reconhecimento da importância e das implicacoes do manejo da equinococose para a regiao tropical, acredita-se que devera ocorrer uma implementacao do diagnostico precoce, tratamento adequado e de um melhor registro da doenca.

Infecções pelos vírus das hepatites B e C e o carcinoma hepatocelular na Amazônia oriental

Com o objetivo de contribuir para um melhor conhecimento do envolvimento das infeccoes pelos virus das hepatites B e C, na etioepidemiologia do CHC na Amazonia Oriental, estudou-se 36 pacientes em Belem-PA. Foram avaliados marcadores sorologicos e a pesquisa do HBV-DNA e HCV-RNA pela reacao em cadeia da polimerase. Observou-se etilismo em 33,3% e cirrose em 83,3%. Marcadores sorologicos das infeccoes pelo HBV e HCV foram encontrados respectivamente em 88,9% e 8,3%. O HBsAg foi encontrado em 58,3%; anti-HBc em 86%; anti-HBe em 85,7; HBeAg em 9,5%; anti-HBc IgM em 57,1%. O HBV-DNA foi detectado em 37,7% e em 65% dos HBsAg positivos; o HCV-RNA em 8,5% e em 100% dos anti-HCV positivos. AFP esteve alterada em 88,9% e acima de 400ng/ml em 75% dos casos. Conclui-se que a infeccao pelo HBV parece ter importância na etiologia do CHC e ressalta-se a importância de implementar programas de vacinacao e deteccao precoce do tumor.

Epidemiologia de pacientes co-infectados HIV/HCV atendidos na Fundação Santa Casa de Misericórdia do Pará

Objetivo: descrever os aspectos epidemiologicos de pacientes co-infectados atendidos em um servico de referencia para hepatopatias, na cidade de Belem-PA. Metodo: realizou-se um estudo transversal de prevalencia, utilizandose um protocolo de pesquisa contendo informacoes referentes a identificacao e fatores de risco de 31 pacientes com sorologias positivas para o HIV e o HCV. Resultados: dez individuos (32,3%) receberam transfusao sanguinea; 20 (64,5%) eram heterossexuais; 18 (58,1%) referiram dois a cinco parceiros sexuais; 29 (93,6%) referiram uso eventual ou nao-uso de preservativos; 14 (45,2%) referiram uso de drogas ilicitas injetaveis e todos os pacientes relataram dois ou mais diferentes fatores de risco. Conclusao: encontrado associacao de fatores de risco, nao sendo possivel identificar um unico fator responsavel pela co-infeccao. Objective: to describe the epidemiological aspects in a group of co-infected patients who was attended at public health service of reference to liver diseases in Belem-Brazil. Methodology: a Transversal study of prevalence was performed using a research protocol with had information about identiJication and the risk factors of 31 patients seropositives for HIV and HCV. Results: ten patients (32,3%) had received blood transfusion; 20 (64,5%) were heterosexuals; 18 (58,1%) had 2 to 5 sexual partners; 29 (93,6%) related eventual use or no use of condom; 14 (45,2%) had use of injected illicit drugs and ali the patients referred two or more different risk factors. Conclusion: in this study we found association of risk factors, and it was not possible to identify an isolate factor responsible for the co-infection.

Coinfection caused by the human immunodeficiency virus and hepatitis C virus (HIV-1/HCV): a case study in the Brazilian Amazon

INTRODUCTION: Since highly active antiretroviral therapy was developed in 1996, liver injury has become an important cause of morbidity and mortality in individuals infected by the human immunodeficiency virus-1 (HIV-1). OBJECTIVE: To report the demographic and laboratory findings of 62 patients coinfected with HIV-1/HCV. METHODS: This cross-sectional study analyzed HIV patients , confirmed serologically by ELISA and indirect immunofluorescence or Western Blot, with positive anti-HCV by ELISA and confirmed by RT-PCR. These patiens were treated at the Liver Department of the Fundação Santa Casa de Misericórdia do Pará from August 2004 to April 2008. RESULTS: A total of 49 (79%) male and 13 female patients were analyzed. Their age median was 42.6 years and they were single (66.1%, n=41), heterosexual (59.7%, n = 37), bisexual (27.4%, n = 17), man who have sex with man MSM (12.9%, n = 8); the lymphocytes T CD4+ count median 3 was 327 cells/mm , HIV serum viral load median was 2.54 log HIV RNA copies/mL, HCV viral load (RNA-HCV) was 5.9 10 log UI/mL. The HCV genotype 1 was found in 60.87% of the patients. Forty-one (66.12%) patients were submitted to liver 10 biopsies and the histopathology results according to METAVIR were F0 (12%), F1 (24.4%), F3 (17%), F4 (14.6%). CONCLUSION: Patients were predominantly single, with high viral load. They presented with moderate to severe fibrosis in more than 50% of cases without significant changes in their laboratory findings.

Coinfecção provocada pelos vírus da imunodeficiência humana e hepatite C (HIV-1/HCV): uma casuística da Amazônia brasileira

INTRODUCTION: Since highly active antiretroviral therapy was developed in 1996, liver injury has become an important cause of morbidity and mortality in individuals infected by the human immunodeficiency virus-1 (HIV-1). OBJECTIVE: To report the demographic and laboratory findings of 62 patients coinfected with HIV-1/HCV. METHODS: This cross-sectional study analyzed HIV patients , confirmed serologically by ELISA and indirect immunofluorescence or Western Blot, with positive anti-HCV by ELISA and confirmed by RT-PCR. These patiens were treated at the Liver Department of the Fundação Santa Casa de Misericórdia do Pará from August 2004 to April 2008. RESULTS: A total of 49 (79%) male and 13 female patients were analyzed. Their age median was 42.6 years and they were single (66.1%, n=41), heterosexual (59.7%, n = 37), bisexual (27.4%, n = 17), man who have sex with man MSM (12.9%, n = 8); the lymphocytes T CD4+ count median 3 was 327 cells/mm , HIV serum viral load median was 2.54 log HIV RNA copies/mL, HCV viral load (RNA-HCV) was 5.9 10 log UI/mL. The HCV genotype 1 was found in 60.87% of the patients. Forty-one (66.12%) patients were submitted to liver 10 biopsies and the histopathology results according to METAVIR were F0 (12%), F1 (24.4%), F3 (17%), F4 (14.6%). CONCLUSION: Patients were predominantly single, with high viral load. They presented with moderate to severe fibrosis in more than 50% of cases without significant changes in their laboratory findings.

Programa de hepatopatias do Hospital da Fundação Santa Casa de Misericórdia do Pará: infra-estrutura e epidemiologia clínica em 10 anos de atendimento

O Programa de Hepatopatias do Hospital da Fundacao Santa Casa de Misericordia do Para surgiu pela necessidade de prestar assistencia a hepatopatas na regiao amazonica priorizando assistencia qualificada, identificacao das etiologias, seguimento clinico, e tratamento direcionado. Este trabalho visa descrever dados relativos a epidemiologia clinica, fatores etiologicos e analise histopatologica. Dos 1469 pacientes avaliados, atraves de exames clinicos, laboratoriais, endoscopicos e de imagem e/ou histopatologico, foram considerados hepatopatas cronicos 935 (63,6%). Nesta casuistica, a media de idade foi 50 anos, 666 (71,2%) do sexo masculino e maior procedencia de Belem. Os agentes etiologicos mais prevalentes foram alcoolismo (53,7%) e hepatites virais (39,1%). Biopsia hepatica realizada em 403/935 (43,1%), demonstrou hepatite cronica (34%) e cirrose (34%) na maioria das amostras. Conclui-se, portanto, que a doenca hepatica cronica na regiao e mais prevalente no sexo masculino, sendo o alcoolismo a principal etiologia e mais da metade dos casos se encontravam em fase avancada no momento do diagnostico.

Case report: Niemann-Pick disease with liver failure manifestations

OBJECTIVE: To report the case of a patient with Niemann-Pick disease who developed chronic liver failure, and to thus draw attention to this nosological entity. CASE REPORT: A female patient, 34 years of age, presented with splenomegaly and was referred to the Fundação Santa Casa de Misericórdia do Pará hospital, in the City of Belém, Pará State, Brazil, with a diagnosis of Niemann-Pick disease confirmed by enzymatic dosages for investigation of her liver disease. The patient developed cirrhosis after five years with decompensated chronic liver failure and was referred for liver transplantation. FINAL CONSIDERATIONS: It is noted that this disease, although rare, can be a cause of chronic liver disease and should be diagnosed early, as the patients life expectancy depends on the magnitude and impact of the symptoms.