Maria Silvia de Brito Barbosa

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.

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.

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.

Evaluation of the therapeutic response of hepatitis C in coinfected patients (HIV/HCV): a study of cases from a hospital for chronic liver diseases in the Eastern Brazilian Amazon

INTRODUCTION The aim of this study was to evaluate the therapeutic response of hepatitis C in patients coinfected with human immunodeficiency virus (HIV-1). METHODS A retrospective study of 20 patients coinfected with HIV-1/HCV who were treated in the outpatient liver clinic at the Sacred House of Mercy Foundation Hospital of Pará (Fundação Santa Casa de Misericórdia do Pará - FSCMPA) from April 2004 to June 2009. Patients were treated with 180 µg PEG interferon-α2a in combination with ribavirin (1,000 to 1,250 mg/day) for 48 weeks. The end point was the sustained virological response (SVR) rate (HCV RNA negative 24 weeks after completing treatment). RESULTS The mean age of the patients was 40 ± 9.5 years, of which 89% (n = 17) were male, and the HCV genotypes were genotype 1 (55%, n = 11/20), genotype 2 (10%, n = 2/20) and genotype 3 (35%, n = 7/20). The mean CD4+ lymphocyte count was 507.8, and the liver fibrosis stages were (METAVIR) F1 (25%), F2 (55%), F3 (10%) and F4 (10%). The early virological response (EVR) was 60%, the end-of-treatment virological response (EOTVR) was 45% and the SVR was 45%. CONCLUSIONS The median HCV viral load was high, and in 85% of cases in which highly active antiretroviral therapy (HAART) was used, none of the patients with F3-F4 fibrosis responded to treatment. Of the twenty patients treated, 45% achieved SVR and 45% achieved EOTVR. Studies that include cases from a wider region are needed to better evaluate these findings.

Coinfección provocada por los virus de inmunodeficiencia humana y hepatitis C (VIH-1/VHC): una casuística de la Amazonía brasileña

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.

Alaterações hepáticas em gestantes internadas em um hospital de referência de Belém-Pará

Metodo: estudo transversal; no periodo de marco de 2005 a fevereiro de 2006, foram avaliadas gravidas internadas na enfermaria de alto risco do Hospital Fundacao Santa Casa de Misericordia do Para (HFSCMPA), sendo em todas realizados exames de aspartato-aminotransferase (AST), alanino-aminotransferase (ALT), gama-glutamil transpeptidase (GGT) e bilirrubinas. Naquelas que apresentavam qualquer alteracao, sua investigacao era ampliada com exames bioquimicos, sorologicos, culturas de material biologico e metodos de imagens necessarios para elucidacao diagnostica e acompanhamento de sua evolucao. Apos esta fase, as pacientes foram divididas no grupo I (doencas relacionadas a gestacao) ou no grupo II (doencas nao relacionadas a gestacao).