Hepatitis B virus genotype E detected in Brazil in an African patient who is a frequent traveler

Genotype E of hepatitis B virus (HBV) has not been described in Brazil and is found mainly in Africa. Genotype A is the most prevalent in Brazil, and genotypes B, C, D, and F have already been reported. We report here an HBV genotype E-infected patient and some characterization of surface (S) protein, DNA polymerase (P) and precore/core (preC/C) coding regions based on the viral genome. The patient is a 31-year-old black man with chronic hepatitis B who was born and raised in Angola. He has been followed by a hepatologist in São Paulo, Brazil, since November 2003, and he is a frequent traveler to Latin America, Africa, and Europe. In 2003, he was diagnosed with HBV infection and started treatment with lamivudine with the later addition of adefovir dipivoxil. No known risk factor was identified. Serologically, he is HBsAg and anti-HBe positive, but HBeAg and anti-HBs negative. DNA sequence analysis of the S/P region confirmed that this patient is infected with genotype E, subtype ayw4. The preC/C region showed G1896A and G1899A mutations but no mutations in the basal core promoter. Nucleotide substitutions common in genotype E were also observed (C1772, T1858 and A1757). Although this is not an autochthonous case and there is no evidence of further spread, the description of this case in Brazil highlights the current risk of viral genotypes spreading with unprecedented speed due to constant travel around the world.

Autoantibodies before, during and after administration of recombinant interferon-alpha for chronic viral hepatitis.

This study was undertaken to investigate the presence of autoantibodies in patients with chronic viral hepatitis B and C, before, during and after interferon-alpha (IFN-alpha) therapy and to study their relation to dose and type of IFN-alpha and response to treatment. Fifty patients with chronic hepatitis were divided in two groups, a control-group of 21 patients (10 type B and 11 type C) who were followed for 6 months without treatment and an IFN-group consisting of 29 patients (8 type B and 21 type C) who received IFN therapy for 6 months. Serum samples were tested for a range of antibodies at the start of the study, during therapy and at the end of the 6 month period. Antibodies tested for included: antinuclear, smooth muscle, antimitochondrial, parietal cell and thyroid microsomal. Four (8%) of the total patient group had autoantibodies at the beginning of the study (two in each group). During the follow-up period no patient in the control group developed antibodies compared with 3 (11%) patients in the treatment group. Autoantibodies developed in patients treated with higher doses of IFN and were found in those patients who tended to show a poor response to IFN-therapy. Further studies are needed to establish the relationship between poor response to IFN-alpha and development of autoantibodies.

Phyllanthus amarus no tratamento da infecçäo crônica pelo vírus da hepatite B: crença ou realidade? / Phyllantus amarus in the treatment of chronic infection caused by the hepatitis B virus: belief or reality?

Estudos recentes têm demostrado eficácia do extrato de um vegetal, o Phyllanthus amarus, no tratamento dos portadores crônicos do vírus da hepatite B. Por tratar-se de substância facilmente encontrada em nosso meio e pela ausência de publicaçöes sobre seu uso para esta virose, na literatura nacional, revisäo do assunto foi realizada. Entretanto, os bons resultados referidos nao têm sido repetidos por alguns pesquisadores e, até o momento, a análise dos dados disponíveis revela controvérsias. Falhas metodológicas nesses protocolos, seja com respeito aos critérios de inclusäo, seja na discussäo dos resultados, poderiam explicar a situaçäo do problema. Conclui-se que novos estudos deveräo ser conduzidos, até que se possa estabelecer o real papel do Phyllanthus amarus no tratamento dos portadores crônicos do vírus de hepatite B.