Kashmiri refugees at the verge of hepatitis B and C epidemic in the State of Azad Jammu and Kashmir, Pakistan

ABSTRACT OBJECTIVE To determine the seroprevalence of hepatitis B and C among immigrants residing refugee camps in Muzaffarabad, Azad Kashmir, Pakistan, and to identify possible risk factors for hepatitis B virus (HBV) and hepatitis C virus (HCV) transmission. METHODS Around 1,225 individuals inhabiting Muzaffarabad refugee camps, participated in the study. A qualitative Immuno-Chromatographic Technique was used for initial screening and PCR test was used for detection of HBV and HCV in participants. The major risk factors for HBV and HCV transmission were assessed using a questionnaire approach. RESULTS Around 86 (7.0%) individuals were observed for hepatitis B surface antigen (HBsAg) presence, and 215 (17.5%) individuals were found positive for Anti-HCV. Only 32 (2.6%) individuals were confirmed for HBV DNA and 126 (10.3%) individuals were positive for HCV RNA after PCR. Demographically, both HBsAg and Anti-HCV were found more prevalent in female (4.4% HBsAg and 10.8% Anti-HCV) population as compared to male (2.6% HBsAg and 6.7% Anti-HCV) population. Surprisingly, the HBsAg (23.5%) and Anti-HCV (41.1%) appeared to be more frequent in the age group 62-75 years. Previous history of hepatitis in the family (p < 0.0001), blood transfusion (p = 0.0197) dental treatment (p < 0.0001) and tattooing or piercing on any part of the body (p = 0.0028) were assessed as significant risk factors in HBV and HCV transmission. CONCLUSIONS Presence of 7.0% HBsAg and 17.5% Anti-HCV in a small fragment of the migrant population cannot be overlooked. Lack of awareness among people and negligence of health department could escalate the situation.

Comparison of samples found positive by anti-HCV screening test with line immunoassay and determination of threshold value

SUMMARY OBJECTIVE: This study aimed to compare the serum samples found reactive (≥1-≤20 signal-to-cutoff ratio) with Elecsys antibodies to hepatitis C virus screening test with innogenetics-line immunassay hepatitis C Virus Score test and to determine the most appropriate threshold value for our country, since positive results close to the cutoff value cause serious problems in routine diagnostic laboratories. METHODS: Antibodies to hepatitis C virus-positive samples from 687 different patients were included in the study. Antibodies to hepatitis C virus antibody detection was performed using Elecsys antibodies to hepatitis C virus II kits (Roche Diagnostics, Germany), an electrochemiluminescence method based on the double-antigen sandwich principle, on the Cobas e601 analyzer (Roche Diagnostics) in accordance with the recommendations of the manufacturer. Samples that were initially identified as reactive were studied again. Samples with ≥1-≤20 signal-to-cutoff ratio reagents as a result of retest were included in the study to be validated with the third-Generation Line immunassay kit (innogenetics-line immunassay hepatitis C Virus, Belgium). RESULTS: A total of 687 samples with antibodies to hepatitis C virus positive and levels between 1-20 S/Co were found to be 56.1% negative, 14.8% indeterminate, and 29.1% positive by innogenetics-line immunassay hepatitis C Virus confirmation test. When the cases with indeterminate innogenetics-line immunassay hepatitis C Virus test results were accepted as positive, the signal-to-cutoff ratio value for antibodies to hepatitis C virus was determined as 5.8 (95% confidence interval) in distinguishing the innogenetics-line immunassay hepatitis C Virus negative and positive groups. CONCLUSION: It was concluded that with further studies on this subject, each country should determine the most appropriate S/Co value for its population, and thus it would be beneficial to reduce the problems such as test repetition and cost increase.

The impact of hepatitis E infection on hepatic fibrosis in liver transplanted patients for hepatitis C infection

ABSTRACT Hepatitis E Virus (HEV) is an infection known worldwide for its asymptomatic and self-limited course in most cases. Some cases progressing to chronicity have been described in immunosuppressed patients, especially in recipients of solid organ transplants. We evaluated laboratory parameters of HEV infection (HEV RNA, anti-HEV IgM and anti-HEV IgG) through enzyme-linked immunosorbent assay (Elisa), confirmed by immunoblotting, in a cohort of 294 patients who received liver transplants at the HCFMUSP (Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo). Laboratory and demographic data were collected from the entirety of the transplanted population. Hepatic biopsies of 122 patients transplanted due liver failure secondary to hepatitis C (HCV), with or without serological or molecular markers of HEV, were analyzed according to METAVIR score. Out of 24 (8.2%) patients tested positive for anti-HEV IgG, six (2%) were positive for anti-HEV IgM and 17 (5.8%) for HEV RNA. Of the patients transplanted because of HCV infection, 95 (77.8%) had received treatment including ribavirin for at least six months before blood sample collection. Among patients transplanted due to HCV cirrhosis who tested positive for anti-HEV IgG, only three (37.5%) showed fibrosis beyond stage 2, while five (41.7%) of the HEV RNA-positive patients had liver fibrosis beyond stage 2. Overall, the prevalence of HEV in the post-hepatic transplant scenario appears to be low, and, at least histologically, seemingly not harmful. We conclude that, although some studies reported a risk of HEV chronification, patients who had their livers transplanted due to HCV and showed serological or molecular markers of HEV did not have higher levels of fibrosis compared to patients who showed no indications of HEV infection at the time of the analysis.

Evaluation of a strategy for identification of hepatitis C virus carriers in outpatient and emergency units: contribution to the microelimination of hepatitis C in Brazil

ABSTRACT Introduction: Hepatitis C virus (HCV) infection continues to be an important public health problem worldwide. Despite the availability of drugs that promote the cure of infection in more than 95% of cases, the identification of HCV carriers remains a major challenge. Objective: To evaluate a strategy for identifying HCV carriers based on combined criteria: screening in emergency units and specialty outpatient clinics of a tertiary hospital and among older adults (≥45 years), both suggested as efficient in epidemiological studies. Methods: A cross-sectional, analytical and descriptive study was conducted on individuals of both sexes, aged 45 years and older, attending the emergency department and specialty outpatient clinics of a University Hospital in São Paulo, Brazil, from January 2016 to June 2018. After giving formal consent, the patients were submitted to a standardized interview and rapid testing for the identification of HCV antibodies (SD BIOLINE® anti-HCV). Results: A total of 606 adult patients (62% women and 37% men) were evaluated. The mean age was 62 ± 10 years. Four positive tests were identified, with confirmation by conventional serology and HCV-RNA determination. Thus, the prevalence of HCV identified in the sample was 0.66%. All patients had a history of risk factors for infection. Conclusion: The strategies of birth-cohort testing and screening in emergency medical services for the identification of HCV carries, both suggested in the literature as efficient for the diagnosis of hepatitis C, resulted in a low rate of HCV infection. These findings highlight the magnitude of the challenge of identifying asymptomatic HCV carriers in Brazil.

Improving Diagnosis of Hepatitis C Virus Infection Using Hepatitis C Core Antigen Testing in a Resource-Poor Setting

Abstract INTRODUCTION: We compared the hepatitis C virus (HCV) core antigen test with the HCV RNA assay to confirm anti-HCV results to determine whether the HCV core antigen test could be used as an alternative confirmatory test to the HCV RNA test. METHODS: Sera from 156 patients were analyzed for anti-HCV and HCV core antigen using a chemiluminescent microparticle immunoassay (Architect i2000SR) and for HCV RNA using the artus HCV RG RT-PCR Kit (QIAGEN) in a Rotor-Gene Q instrument. RESULTS: The diagnostic sensitivity, specificity, and positive and negative predictive values of the HCV core antigen assay compared to the HCV RNA test were 77.35%, 100%, 100%, and 89.38%, respectively. HCV core antigen levels showed a good correlation with those from HCV RNA quantification (r =0.872). However, 13 samples with a viral load of less than 4000 IU/mL were negative in the HCV core antigen assay. All gray-zone reactive samples were also RNA positive and were positive on repeat testing. CONCLUSIONS: The Architect HCV core antigen assay is highly specific and has an excellent positive predictive value. At the present level of sensitivity (77%), the study is still relevant in a low-income setting in which most of the HCV-positive patients would go undiagnosed, since HCV RNA testing is not available and/or not affordable. HCV core antigen testing can also help determine the true burden of infection in a population, considering the fact that almost 50% of the anti-HCV positive cases are negative for HCV RNA.

Caracterización clínica, humoral, laparoscópica e histológica de pacientes con anticuerpos contra el virus de la hepatitis C / Clinical, humoral, laparoscopic and histologic characterization of patients with antibodies against the hepatitis C virus

Introducción: La hepatitis C es una infección viral que puede presentarse como una afección leve, de pocas semanas de duración, o evolucionar hasta una enfermedad hepática crónica. Objetivo: Caracterizar a pacientes con anticuerpos contra el virus de la hepatitis C según variables clínicas, humorales, laparoscópicas e histológicas. Métodos: Se realizó un estudio observacional, descriptivo, de serie de casos, de 150 pacientes con anticuerpos contra el virus de la hepatitis C, atendidos en la consulta de Hepatología del Hospital General Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba desde diciembre de 2017 hasta igual mes de 2019, a los cuales se les realizó una biopsia hepática por laparoscopia. Como medida de resumen se utilizó el porcentaje. Resultados: Predominaron el grupo etario de 61-70 años y el sexo femenino. La vía sanguínea resultó ser la de mayor riesgo para la transmisión del virus de la hepatitis C. A pesar de estar infectados, 45,3 % de los pacientes evolucionaron en algunos momentos de la enfermedad con valores de alanina aminotransferasa normales. Conclusiones: En los estudios laparoscópicos fueron más frecuentes el hígado normal y la hepatitis crónica, a la vez que primaron estas últimas con lesiones leves y moderadas. Se constató la presencia de lesiones hísticas tanto en los pacientes sintomáticos como asintomáticos.

Introduction: Hepatitis C is a viral infection that can be presented as a light disorder, during few weeks, or become into a chronic hepatic disease. Objective: To characterize patients with antibodies against the hepatitis C virus according to clinical, humoral, laparoscopic and histological variables. Methods: An observational, descriptive, serial cases study, of 150 patients with antibodies against the hepatitis C virus was carried out, they were assisted in the hepatology service of Dr. Juan Bruno Zayas Alfonso General Hospital in Santiago de Cuba from December, 2017 to the same month in 2019, to whom a hepatic biopsy by laparoscopy was carried out. The percentage was used as summary measure. Results: There was a prevalence of the 61-70 age group and the female sex. The higher risk for the transmission of hepatitis C virus was by blood. In spite of being infected, the 45.3 % of patients had a clinical course in some moments of the disease with normal alanine aminotransferase values. Conclusions: In the laparoscopic studies the normal liver and chronic hepatitis were more frequent, at the same time that these last ones prevailed with light and moderate lesions. The presence of tissue lesions was verified either in the symptomatic or asymptomatic patients.

Characteristics associated with anti-HCV serological markers in prisoners in the state of Paraná, Brazil: a case-control study

ABSTRACT Background: The prison system in Paraná, Brazil, is experiencing serious problems related to the increasing number of prisoners. Control of hepatitis C virus (HCV) has become more intense because the incarcerated population is considered a high-risk group for contagious diseases due to the favorable conditions found in prisons for the spread of these morbidities. The objective of this study was to identify features associated with hepatitis C infection among male prisoners in correctional institutions of Paraná state, Brazil. Methods: This was a case-control study (27 cases and 54 controls) of men incarcerated in 11 penitentiaries in Paraná, Brazil. Information was obtained through a questionnaire in a cross-sectional epidemiological survey on HCV infection during the period from May 2015 to December 2016. Eligible men were recruited after testing positive for anti-HCV antibodies. Cases and controls were selected based on serological results of enzyme-linked immunosorbent assays and were matched by age, location of the penitentiary, and time in prison. Logistic regression analysis was used to identify risk factors for HCV seropositivity. Results: The main significant independent risk factor for the acquisition of HCV infection was the use of injectable drugs (OR = 4.00; 95%CI:1.41-11.35; p < 0.001). Conclusions: This study provides evidence that HCV infection is associated with drug use by this population. This information is pivotal for tailoring prevention programs and guiding specific socioeducational measures that aim to reduce or prevent HCV transmission within the prison setting.

Epidemiological survey of hepatitis C in a region considered to have high prevalence: the state of Minas Gerais, Brazil

Abstract INTRODUCTION: The prevalence of hepatitis C virus (HCV) infection is affected by demographic, virological, clinical, and lifestyle-related factors and varies in different regions in Brazil or worldwide. The present study aimed to clarify the epidemiological patterns of HCV infection in the interior region of Brazil. METHODS: This study was conducted in the Southern Triangle Macro-region of the state of Minas Gerais, Brazil, according to the guidelines of the National Program for the Prevention and Control of Viral Hepatitis. The participants answered a structured questionnaire on social and epidemiological factors. Immunochromatographic rapid tests were used for the qualitative detection of antibodies against HCV in whole blood (Alere HCV® Code 02FK10) in adult subjects by a free-standing method. RESULTS: Of 24,085 tested individuals, 184 (0.76%) were anti-HCV positive. The majority of anti-HCV-positive individuals were born between 1951 and 1980 (n=146 [79.3%]), with 68 women and 116 men. Identified risk factors included syringe and/or needle sharing (p = 0.003), being in prison (p = 0.004), and having tattoos or piercings (p = 0.005) and were significantly associated with the decade of birth. CONCLUSIONS: The study shows the importance of testing populations at risk for HCV infection, including incarcerated individuals, those with tattoos or piercings, those who share or have shared syringes or needles, and those in high-risk birth cohorts (1950s, 1960s, and 1970s) in the Southern Triangle Macro-region.

Prevalence of HCV infection in a prison population of the greater Florianópolis area

Abstract INTRODUCTION The present study aimed to estimate the prevalence of Hepatitis C virus (HCV) infection in a prison population. METHODS: A total of 147 individuals were interviewed and subjected to venipuncture for collection of blood sample. The study population consisted of male individuals who attended the health unit of the state penitentiary of Florianópolis. RESULTS: The prevalence of HCV infection was 5.4%. Regarding behavioral variables, 95 (64.6%, p<0.0507) subjects reported consuming alcohol and 7 (4.8%, p<0.0476) reported having already used injectable drugs. CONCLUSIONS: The prevalence of HCV infection in the studied population was higher than that in the general populations.

IgG1 and IgG4 antibodies against core and NS3 antigens of hepatitis C virus

Abstract INTRODUCTION: IgG subclasses involved in the immune response to hepatitis C virus (HCV) antigens have been rarely studied. We investigated the immune response mediated by IgG1 and IgG4 antibodies against the recombinant core and NS3 antigens in patients with chronic hepatitis C. METHODS: Sixty patients infected with HCV genotype 1 without antiviral treatment and 60 healthy subjects participated in the study. Serum levels of alanine aminotransferase, HCV viremia, and the presence of cryoglobulinemia and liver fibrosis were determined. We investigated the serum IgG1 and IgG4 antibodies against recombinant HCV core and NS3 non-structural protein antigens using amplified indirect ELISA. RESULTS: Anti-core and anti-NS3 IgG1 antibodies were detected in 33/60 (55%) and 46/60 (77%) patients, respectively, whereas only two healthy control samples reacted with an antigen (NS3). Anti-core IgG4 antibodies were not detected in either group, while 30/60 (50%) patients had anti-NS3 IgG4 antibodies. Even though there were higher levels of anti-NS3 IgG4 antibodies in patients with low viremia (< 8 × 105 IU/mL), IgG1 and IgG4 antibody levels did not correlate with ALT levels, the presence of cryoglobulinemia, or degree of hepatic fibrosis. High production of anti-core and anti-NS3 IgG1 antibodies was observed in chronic hepatitis C patients. In contrast, IgG4 antibodies seemed to only be produced against the NS3 non-structural antigen and appeared to be involved in viremia control. CONCLUSIONS: IgG1 antibodies against structural and non-structural antigens can be detected in chronic hepatitis C, while IgG4 antibodies seem to be selectively stimulated by non-structural HCV proteins, such as the NS3 antigen.

Fluctuations in serological hepatitis C virus levels in HIV patients

Abstract INTRODUCTION: Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) have identical transmission routes, explaining the high prevalence of coinfections. The main aim of this study was to detect fluctuations in serological HCV levels in HIV patients. METHODS: We analyzed samples of 147 patients who attended an outpatient service that supports HIV/AIDS patients in São Paulo city. We also recruited 22 HCV-monoinfected patients who attended the Instituto Adolfo Lutz Laboratory in São Paulo city, to compare the test results. Serological testing of the blood samples was performed for the detection of HCV antibodies. The samples were then analyzed using real-time PCR for RNA viral quantification and sequencing. RESULTS We found that 13.6% of the study population was coinfected with HIV and HCV. In 20% of coinfected patients, fluctuations in serology results were detected in samples collected during the follow-up. No changes in anti-HCV serological markers were observed in HCV-monoinfected patients. An HCV viral load was detected in 9,5% of the samples collected from HIV patients. CONCLUSIONS: Our findings provide important clinical data to public health professionals and highlight the importance of periodic monitoring of HCV/HIV coinfected patients.

Hepatite B e C em gestantes atendidas em um programa de pré-natal em um hospital universitário no Rio de Janeiro, Brasil: estudo retrospectivo de rastreamento da soroprevalência / Hepatitis b and c in pregnant women attended by a prenatal program in an universitary hospital in rio de janeiro, brazil: retrospective study of seroprevalence screening

ABSTRACT BACKGROUND: Hepatitis B and C are diseases with high morbimortality and constitute a global public health problem. In Brazil, the prevalence is not homogeneous, oscillating among different regions, but it is estimated that currently about 1% of the population present chronic disease related to the B virus and that there are 1.5 million infected with the C virus. Despite the development of hepatitis B vaccine, improvement in diagnostic methods and therapeutic advances in the field of viral hepatitis, there is still a large number of people who continues to be infected by these viruses, especially in populations at risk and also due to several factors, including vaccination and migration policies. Vertical and perinatal transmissions are of great importance in the epidemiology of viral hepatitis and the blood tests performed during prenatal care constitute a great opportunity for screening and identifying these viruses. OBJECTIVE: To evaluate the seroprevalence of markers for B and C viruses in women who underwent prenatal care at the Hospital Universitário Antônio Pedro (Antonio Pedro University Hospital) from 2006 to 2013 and to compare the results found with regional data and those described in the specific literature. METHODS: A descriptive, cross-sectional, quantitative study with retrospective data collected from 635 records of pregnant women attended at the Prenatal Service of the Hospital Universitário Antônio Pedro, Niterói, state of Rio de Janeiro, from March 2006 until December 2013. The database was built in the Microsoft Office Access program and was later exported to Microsoft Office Excel. For the processing and analysis of the data, it was used the SPSS (Statistical Package for Social Science, IBM) version 22.0, for Windows. RESULTS: Twelve cases with positive HBsAg (1.9%), 189 cases with positive anti-HBs (35.9%) and seven positive anti-HCV patients (1.3%) were observed. There was no significant association between age and positivity for HBsAg, anti-HBs and anti-HCV (P =0.205, 0.872 and 0.676, respectively). There was a direct relationship between the anti-HBs positivity and the last four years of the study (P<0.0001). CONCLUSION: A high prevalence of HBsAg was observed, higher than the expected for the evaluated region; there was a prevalence of anti-HCV, consistent with the current Brazilian reality; and a likely low rate of hepatitis B immunization, with a relatively high rate of susceptibility to this infection and no case of co-infection between B and C viruses and HIV. It is emphasized not only the need to trace hepatitis B and C, without exceptions, during prenatal care, since even though the current advances in therapy may not cure, at least they may allow a better quality of life for patients with chronic disease and the mandatory completion of immunoprophylaxis in all newborns. Special attention should be given to those patients susceptible to HBV, with prompt diagnosis and referral for specific vaccination.

RESUMO CONTEXTO: As hepatites pelo vírus B e C são doenças com elevada morbimortalidade e um problema de saúde pública global. No Brasil a prevalência não é homogênea, variando entre as diferentes regiões, mas estima-se que atualmente cerca de 1% da população apresente doença crônica relacionada ao vírus B e que haja 1,5 milhões de infectados pelo vírus C. Apesar do desenvolvimento da vacina contra a hepatite B, da melhoria nos métodos diagnósticos e dos avanços terapêuticos no campo das hepatites virais, ainda é grande o número de pessoas que continuam sendo infectadas por esses vírus, principalmente nas populações sob algum tipo de risco e devido a vários fatores incluindo políticas de vacinação e migração. A transmissão vertical e também a perinatal têm grande importância na epidemiologia das hepatites virais e os exames realizados durante o pré-natal constituem uma oportunidade única de rastreio e identificação destes vírus. OBJETIVO: Avaliar a soroprevalência de marcadores para os vírus B e C em mulheres que realizaram a assistência pré-natal no Hospital Universitário Antônio Pedro no período de 2006 a 2013 e comparar os resultados encontrados com os dados regionais e os descritos na literatura específica. MÉTODOS: Estudo transversal, descritivo, do tipo quantitativo, com coleta retrospectiva de dados em 635 prontuários de gestantes atendidas no Serviço de pré-natal do Hospital Universitário Antônio Pedro, Niterói, estado do Rio de Janeiro no período de março de 2006 a dezembro de 2013. O banco de dados foi construído no programa Microsoft Office Access, sendo posteriormente exportado para Microsoft Office Excel. Para o processamento e análise dos dados, foi utilizado o pacote estatístico SPSS (Statistical Package for Social Science, IBM) versão 22.0, para Windows. RESULTADOS: Foram observados 12 casos com HBsAg positivo (1,9%), 189 casos com anti-HBs positivo (35,9%) e sete pacientes positivas para o anti-HCV (1,3%). Não foi observada associação significativa entre a faixa etária e a positividade do HBsAg, anti-HBs e anti-HCV (P=0, 205, 0,872 e 0,676 respectivamente). Houve relação direta entre a positividade do anti-HBs e os últimos quatro anos da pesquisa (P<0,0001). CONCLUSÃO: Foi observada uma prevalência alta do HBsAg, acima daquela esperada para a região avaliada; uma prevalência para o anti-HCV concordante com a realidade brasileira atual; um índice provavelmente baixo de imunização contra a hepatite B, com índice relativamente alto de susceptibilidade para esta infecção e nenhum caso de coinfecção entre o vírus B, C e o HIV. Enfatiza-se não só a necessidade da triagem das hepatites B e C, sem exceções, durante o pré-natal, já que os avanços atuais na terapêutica poderão se não curar, pelo menos possibilitar uma melhor qualidade de vida para as pacientes com doença crônica e da realização mandatória da imunoprofilaxia em todos os recém-natos. Atenção especial deverá ser dada àquelas pacientes susceptíveis ao HBV, com pronto diagnóstico e encaminhamento para a realização da vacinação específica.

Detección de anticuerpos contra el virus de la hepatitis C en donantes de sangre voluntarios / Detection of antibodies against hepatitis C virus in volunteer blood donors

Introducción: las pruebas de detección de anticuerpos contra el virus de la hepatitis C en donantes de sangre han servido para la identificación de enfermos y son un elemento importante para interrumpir la transmisión por esta vía. Objetivo: describir el comportamiento de la detección de anti-HVC en el municipio de Artemisa entre los años 2006-2010 e identificar las principales alteraciones clínicas en los pacientes con prueba de detección de ARN positiva. Métodos: se realizó un estudio ecológico de series temporales. El universo estuvo conformado por los 162 pacientes pertenecientes al municipio Artemisa a los cuales, en las donaciones de sangre, se les detectó positividad para en anti-VHC según método de ELISA (UMELISA). La información se obtuvo a través de la base de datos del Banco de Sangre Territorial de San Antonio de los Baños entre el 1º de enero de 2006 y el 31 de diciembre de 2010. Resultados: de las 8 057 donaciones de sangre realizadas en el período; el 2,01 por ciento resultaron positivas. Se demostró el comportamiento estacional, la variación cíclica de la serie cronológica y una tendencia creciente. Se identificaron los meses de septiembre, junio y noviembre como los de mayor incidencia. La relación hombre/mujer fue de 13:1, predominando el sexo masculino entre los donantes anti-HVC positivos con el 94,7 por ciento. Se detectó el ácido nucleico del virus C por biopsia hepática en 41 casos comprendidos entre los 41 y 45 años predominantemente. El 95,1 por ciento de los enfermos presentaron transaminasas normales, antecedentes de instrumentaciones percutáneas y cambios histológicos compatibles con una hepatitis crónica en el momento del diagnóstico. Conclusiones: se confirma la utilidad del pesquisaje del anti-HVC para la planificación de los recursos de salud en el territorio y para la identificación de enfermos con distintos grados de lesión hepática, a pesar de estar asintomáticos y con transaminasas normales(AU)

Introduction: Tests for antibodies to the hepatitis C virus in blood donors have been used to identify patients and it is an important element in disrupting transmission by this route. Objective: The objective of the present investigation was to describe the behavior of the detection of anti-HVC in Artemisa municipality between 2006-2010 years and to identify the main clinical alterations in the patients with positive RNA detection test. Methods: An ecological study of time series was carried out. The universe was 162 patients resident in Artemisa municipality, to whom, in blood donations, they were detected positivity for anti-HCV according to the ELISA method (UMELISA). The information was obtained through the database of the Territorial Blood Bank of San Antonio de los Baños between January 1, 2006 and December 31, 2010. Results: In this period 8057 blood donations were made; 2.01 percent were positive. The seasonal behavior, the cyclical variation of the chronological series and an increasing tendency were demonstrated. The months of September, June and November were identified as months with highest incidence. The male-to-female ratio was 13: 1, with male sex predominating among anti-HVC positive donors with 94.7 percent. Nucleic acid of C virus was detected by liver biopsy in 41 cases between 41 and 45 years old predominantly. The 95.1 percent of the patients presented normal transaminases, a history of percutaneous instrumentation and histological changes compatible with chronic hepatitis at the time of diagnosis. Conclusions: The usefulness of anti-HVC screening for the planning of health resources in the territory and for the identification of patients with different degrees of liver injury, despite being asymptomatic and with normal transaminases, is confirmed(AU)

Prevalencia de hepatitis B y C en el banco de sangre de un hospital en Callao, Perú / Hepatitis B and C prevalence in a blood bank at general hospital in Callao, Peru

Objetivo: El objetivo del presente estudio fue determinar la prevalencia de seropositividad para HBsAg, Anti-HBcAg y Anti- HVC del Banco de Sangre del Hospital Nacional Daniel Alcides Carrión (HNDAC) durante el periodo 2010 al 2012. Materiales y métodos: Estudio transversal retrospectivo. Se incluyó a los potenciales donadores. Se recolectaron las características tales como edad, sexo y conductas de riesgo. Se realizó el análisis descriptivo con el programa STATA 14. Resultados: Se incluyó 13 887 potenciales donantes del HNDAC entre enero 2010 y diciembre 2012. Se identificaron 897 potenciales donantes positivos. La prevalencia de HBsAg fue 0,55%; Anti-HBcAg, 5,15%; y Anti-HVC, 1,25%. De ellos se encontró edad promedio de 37,4 años para los pacientes infectados por virus de hepatitis B y de 36,9 para los pacientes infectados por virus de hepatitis C, 31,2% fueron mujeres del total de infectados. Conclusión: La prevalencia de serología positiva para virus de hepatitis B fue similar a reportes anteriores, por otro lado la serología positiva para virus de hepatitis C fue mayor a lo reportado en nuestro país

ABSTRACT Objective: The aim of the present study was to determine the prevalence of sero positivity for HBsAg, Anti-HBcAg and Anti- HVC in the blood bank of Hospital Daniel Carrion during the period 2010 - 2012. Materials and methods: Retrospective cross-sectional study. Potential donors who met the inclusion criteria were included. Sociodemographic factors, risk behaviors were gathered. A descriptive analysis was performed with STATA 14. Results: 13,887 potential blood donors of the HNDAC between January 2010 and December 2012 were identified. The population's mean was 37 years, 32% were women. 897 potential positive blood donors were identified. The prevalence of HBsAg was 0.55%; Anti-HBcAg, 5.15%; and Anti-HVC, 1.25%. Conclusion: The prevalence of positive serology for HBsAg was similar to the previous reports and Anti-HVC was higher than the prevalence reported in our country

Marcadores de infección para hepatitis viral en donantes de sangre de un hospital nacional de lima metropolitana / Viral Hepatitis Infection Markers Among Blood Donor in a National Hospital of Metropolitan Lima

RESUMEN El objetivo del estudio fue determinar la frecuencia de marcadores de infección para hepatitis B, hepatitis C y conocer los factores asociados en los donantes de sangre. El estudio se realizó con datos del registro de donantes de un hospital público de Lima. De 28 263 sujetos analizados entre 2012 y 2015, el 0,6% (n=156) fue reactivo para HBsAg; 5,2% (n=1465) para anti-HBc, y 0,8% (n=232) para Anti-HVC. Los resultados positivos para HBsAg (p=0,319) y anti-HVC (p=0,037) fueron en mayor proporción en los donantes voluntarios. Los resultados positivos para HBsAg y anti-HBc fueron en mayor proporción en las personas de 50 a más años de edad. Los donantes voluntarios fueron en mayor proporción en los sujetos menores de 20 años (p<0,001). En conclusión, la reactividad a los marcadores de infección para hepatitis está asociado a la donación voluntaria y al grupo de edad de los donantes.

ABSTRACT The aim of the study was to determine the frequency of infection markers for hepatitis B and hepatitis C and to identify associated factors in blood donors. The study was carried out using data obtained from blood donor medical records collected in a public hospital in Lima. Of 28,263 individuals analyzed between 2012 and 2015, 0.6% (n=156) were reactive for HBsAg; 5.2% (n=1,465), for anti-HBc; and 0.8% (n=232), for anti-HVC. Positive results for HBsAg (p=0.319) and anti-HVC (p=0.037) were more common in voluntary donors. For HBsAg and anti-HBc, positive results were more common in individuals aged 50 years or older. The number of voluntary donors was higher among individuals younger than 20 years (p<0.001). The study indicates that reactivity to hepatitis infection markers is associated with voluntary donation and the age group of blood donors.

Viral Outcome in Patients with Occult HBV Infection or HCV-Ab Positivity Treated for Lymphoma

ABSTRACT HBV and HCV reactivation has been widely reported in patients undergoing immunosuppressive therapy for oncohaematological diseases. We aimed to evaluate the HBV and HCV reactivation events in patients with non-Hodgkin lymphoma (NHL) or Hodgkin lymphoma (HL) underwent cytotoxic chemotherapy containing or not rituximab. This is a retrospective observational study, including all patients with NHL and HL attending an Italian tertiary referral hospital, the University of Naples "Federico II". A total of 322 patients were enrolled. We evaluated serum HBV and HCV markers. A total of 47 (38%) patients with occult HBV infection were enrolled. Seven/47 were treated with therapeutic cytotoxic schedule containing rituximab. Of them, 6/7 received prophylaxis with lamivudine. HBV reactivation was observed in two patients treated with rituximab. A reactivation was observed in the only patient (HBcAb+/HBsAb+) not receiving lamivudine prophylaxis, and the other one was observed in 1 patient with isolated HBcAb positivity during lamivudine prophylaxis. Moreover, 8 patients with HCV-Ab positivity were enrolled. No viral reactivation was observed in these patients. In conclusion, patients with occult HBV infection receiving chemotherapy containing rituximab for lymphoma without antiviral prophylaxis are at risk of viral reactivation. On the contrary, there is no risk of reactivation in patients undergoing rituximab-free schedule. Our findings suggest that there is also very low risk of HCV reactivation. This preliminary report underlines the concept that HBV reactivation is strongly related to the type of immunosuppressive therapy administered and that antiviral prophylaxis needs to be tailored.

Hepatitis C among blood donors: cascade of care and predictors of loss to follow-up

ABSTRACT OBJECTIVE To investigate the HCV cascade of care and to identify the factors associated with loss or absence to follow-up of patients identified as infected with hepatitis C through blood donation. METHODS Blood donors from 1994 to 2012, identified with positive anti- HCV by enzyme immunoassay and immunoblot tests were invited to participate in the study, through letters or phone calls. Patients who agreed to participate were interviewed and their blood samples were collected for further testing. The following variables were investigated: demographic data, data on comorbidities and history concerning monitoring of hepatitis C. Multiple regression analysis by Poisson regression model was used to investigate the factors associated with non-referral for consultation or loss of follow-up. RESULTS Of the 2,952 HCV-infected blood donors, 22.8% agreed to participate: 394 (58.2%) male, median age 48 years old and 364 (53.8%) Caucasian. Of the 676 participants, 39.7% did not receive proper follow-up or treatment after diagnosis: 45 patients referred not to be aware they were infected, 61 did not seek medical attention and 163 started a follow-up program, but were non-adherent. The main reasons for inadequate follow-up were not understanding the need for medical care (71%) and health care access difficulties (14%). The variables showing a significant association with inadequate follow-up after multiple regression analysis were male gender (PR = 1.40; 95%CI 1.15–1.71), age under or equal to 50 years (PR = 1.36; 95%CI 1.12–1.65) and non-Caucasians (PR = 1.53; 95%CI 1.27–1.84). CONCLUSIONS About 40.0% of patients did not receive appropriate follow-up. These data reinforce the need to establish strong links between primary care and reference centers and the need to improve access to specialists and treatments.