Lineamientos técnicos para el control de las infecciones de transmisión sexual y hepatitis virales / Technical guidelines for the control of sexually transmitted infections and viral hepatitis

La prevención y el control de las infecciones de transmisión sexual (ITS) y hepatitis virales representan un desafío crucial en la agenda de la salud pública. Con el objetivo de reducir la incidencia y prevalencia de estas enfermedades, se establecen los siguientes lineamientos técnicos, delineando estrategias integrales de promoción, prevención y atención. Estos lineamientos definen las disposiciones técnicas necesarias para el control de las ITS y hepatitis virales, orientando las acciones del personal de salud en la promoción de la salud sexual, la identificación temprana de casos, el diagnóstico oportuno, el tratamiento adecuado y la atención integral de las personas afectadas a través de estrategias innovadoras y la provisión de servicios integrales de atención a la salud. Están diseñados para ser aplicados por el personal multidisciplinario en todos los establecimientos del Sistema Nacional Integrado de Salud (SNIS)

The prevention and control of sexually transmitted infections (STIs) and viral hepatitis represent a crucial challenge on the public health agenda. With the aim of reducing the incidence and prevalence of these diseases, the following technical guidelines are established, outlining comprehensive promotion, prevention and care strategies. These guidelines define the technical provisions necessary for the control of STIs and viral hepatitis, guiding the actions of health personnel in the promotion of sexual health, early identification of cases, timely diagnosis, adequate treatment and comprehensive care of affected people through innovative strategies and the provision of comprehensive health care services. They are designed to be applied by multidisciplinary staff in all establishments of the National Integrated Health System (SNIS)

Antibody persistence 7 years after hepatitis-A vaccine in children with human immunodeficiency virus infection / Persistencia de anticuerpos siete años después de la vacuna de la hepatitis A en niños con infección por el virus de la inmunodeficiencia humana

Abstract Background: HIV-infected children have a higher risk of presenting infections, including the hepatitis A virus (HAV). The inactivated HAV vaccine is immunogenic in immunocompetent hosts; however, there are insufficient studies on the duration of seroprotection in HIV-infected children. Methods: An analytical cohort study was conducted. HIV-1-infected children who received the inactivated HAV vaccine (2 doses) were included. Blood samples were taken for antibody measurement, the first one 28 days after the second dose and another 7 years after the vaccination schedule. Information on viral load, immunological category, weight, height, and response to antiretroviral treatment from diagnosis to the last assessment was obtained. Results: 19 patients were included, with a mean age of 12.6 years (SD ± 2.29). 58% were male. 80% of the patients presented protective immunoglobulin G antibodies against HAV 7-year post-vaccination. The antibody concentration was found to be between 13 and 80 mIU/mL (median of 80 mIU/mL). 52% showed some degree of immunosuppression. There was no statistically significant relationship between the presence of seroprotection and viral load, treatment failure, immunological category, and malnutrition. Twelve patients presented with antiretroviral treatment failure, and in 33% of them, the antibodies did not offer satisfactory seroprotection. Conclusion: 7-year post-vaccination, 80% of HIV-infected children maintain seroprotection titers against HAV.

Resumen Introducción: Los niños infectados por el virus de la inmunodeficiencia humana (VIH) tienen mayor riesgo de presentar infecciones, incluyendo hepatitis por virus A (VHA). La vacuna inactivada contra el VHA es inmunógena en el huésped inmunocompetente. No hay estudios suficientes sobre el tiempo de seroprotección en niños infectados por el VIH. Método: Estudio de cohorte, analítico. Se incluyeron niños con infección por VIH-1 que recibieron la vacuna inactivada contra el VHA (dos dosis). Se les tomaron muestras sanguíneas para medición de anticuerpos, una 28 días después de la segunda dosis y otra 7 años después del esquema de vacunación. Se obtuvo información de carga viral, categoría inmunológica, peso y talla, y respuesta al tratamiento antirretroviral desde el diagnóstico hasta la última valoración. Resultados: Se incluyeron 19 pacientes con una edad media de 12.6 años (± 2.29). El 58% fueron del sexo masculino. El 80% de los pacientes presentaron anticuerpos immunoglobulin G (IgG) contra el VHA protectores a los 7 años de la vacunación. La concentración de anticuerpos se encontró entre 13 y 80 mUI/ml (mediana: 80 mUI/ml). El 52% mostraron algún grado de inmunosupresión. No existe relación estadísticamente significativa entre la presencia de seroprotección y la carga viral, la falla al tratamiento, la categoría inmunológica ni la desnutrición. Doce pacientes presentaron falla al tratamiento antirretroviral; en el 33% de ellos los anticuerpos no ofrecían seroprotección satisfactoria. Conclusiones: A 7 años posvacunación, el 80% de los niños con VIH mantienen títulos de seroprotección frente al VHA.

Epidemiological study of Hepatitis C in people deprived of liberty / Estudo epidemiológico da Hepatite C em pessoas privadas de liberdade

INTRODUCTION: The prevalence of hepatitis C (HCV) is high among prisoners. If untreated, a substantial number of patients progress to cirrhosis, hepatocarcinoma, or liver failure. World Health Organization aims to reduce the incidence of infection by 90% by 2030. OBJECTIVE: To describe the prevalence of anti-HCV and sociodemographic and clinical aspects, related to the presence of the antibody, in the population deprived of liberty. METHODS: Cross-sectional and epidemiological survey, with exploratory, observational, quantitative-analytical components. A simple random sample of 233 participants, with 95% Confidence Interval (CI) and, a 4% margin of error, was calculated for a population of 1,564 prisoners. The relationship between sociodemographic and clinical variables was evaluated, considering as outcome of the rapid test for anti-HCV results, using the associative measure Prevalence Ratio (PR) with a 95% CI. RESULTS: 240 people participated. The prevalence of anti-HCV was 2%, and the use of injectable drugs (PR 14.75; PRIC95% 2.09-104.28), being born in the decades of 1951 to 1980 (PR 9.28; PRIC95% 1.06-81.57) and be co-infected with hepatitis B virus (PR 10.75; PRIC95% 1.66-69.65) were the aspects that presented a relevant prevalence ratio for the presence of the virus, which could be generalized to the population. CONCLUSION: This is a population that is difficult to access, the study is relevant because it contributes to preventive measures of public health in the prison system. Moreover, it shows the need to implement measures to prevent and contain the spread of HCV, aiming at the elimination of hepatitis C in this population.

INTRODUÇÃO: A prevalência da hepatite C (HCV) é elevada entre os prisioneiros. Se não tratada, proporção substancial das infecções progride para cirrose, hepatocarcinoma ou insuficiência hepática. Organização Mundial de Saúde tem a meta de reduzir a incidência da infecção em 90% até 2030. OBJETIVO: Descrever a prevalência do anti-HCV e os aspectos sociodemográficos e clínicos, relacionados à presença do anticorpo, na população privada de liberdade. MÉTODOS: Estudo transversal por inquérito epidemiológico, com componente exploratório, observacional, quantitativo-analítico. Foi calculada amostra aleatória simples de 233 pessoas, Intervalo de Confiança (IC) 95%, margem de erro 4% para população de 1564 prisioneiros. Foi avaliada a relação entre os aspectos sociodemográficos e clínicos com o desfecho obtido pelo teste rápido para anti-HCV por meio da medida associativa Razão de Prevalência (RP) e IC de 95% para essa estimativa. RESULTADOS: Participaram 240 pessoas. A prevalência do anti-HCV foi de 2%, sendo que o uso de drogas injetáveis (RP 14,75; RPIC95% 2,09-104,28), ter nascido nas décadas de 1951 a 1980 (RP 9,28; RPIC95% 1,06-81,57) e ser coinfectado com o vírus da hepatite B (RP 10,75; RPIC95% 1,66-69,65) foram os aspectos que apresentaram razão de prevalência para a presença do vírus, passível de generalização para a população. CONCLUSÃO: Trata-se de população de difícil acesso, o estudo é relevante por contribuir para medidas preventivas de saúde pública no sistema prisional. Outrossim, mostra a necessidade de se implementar medidas para evitar e conter a disseminação de HCV, visando a microeliminação da hepatite C na população carcerária.

Una visión integral del manejo de la hepatitis C y el objetivo de erradicarla / A comprehensive view of hepatitis C management and the goal of eradication

La hepatitis C es una enfermedad viral causada por el virus de la hepatitis C (VHC), que fue identificada por primera vez en 1989 por un equipo de científicos liderado por Michael Houghton en Chiron Corporation. Esta forma de hepatitis era conocida como "hepatitis no-A no-B", ya que no se podía identificar el agente infeccioso responsable. Puede afectar a personas de diferentes géneros y orientaciones sexuales, incluidos los hombres que tienen sexo con hombres (HSH); y su transmisión ocurre a través de situaciones en las que hay un intercambio de sangre, como el uso compartido de agujas o equipo para la inyección de drogas, o durante prácticas sexuales que pueden causar microlesiones en la mucosa anal. Es importante destacar que la hepatitis C también puede transmitirse a través de otras vías, como la transfusión de sangre no segura, la exposición a instrumentos médicos contaminados, o el compartir objetos personales que puedan tener sangre infectada.

Hepatitis C is a viral disease caused by the hepatitis C virus (HCV), which was first identified in 1989 by a team of scientists led by Michael Houghton at Chiron Corporation. This form of hepatitis was known as "non-A non-B hepatitis" as the infectious agent responsible couldn't be identified. It can affect individuals of different genders and sexual orientations, including men who have sex with men (MSM); transmission occurs through situations involving blood exchange, such as needle sharing or equipment for drug injection, or during sexual practices that may cause microlesions in the anal mucosa. It's important to note that hepatitis C can also be transmitted through other routes, such as unsafe blood transfusion, exposure to contaminated medical instruments, or sharing personal items that may have infected blood.

Daño hepático inducido por uso de anticonceptivos orales en una paciente con ictericia prolongada y transaminasas elevadas: reporte de caso / Drug-induced liver injury secondary to the use of oral contraceptives in a patient with prolonged jaundice and elevated transaminases: Case report

La hepatotoxicidad inducida por medicamentos es un diagnóstico de descarte. Típicamente, se presenta en pacientes que desarrollan cambios clínicos y bioquímicos compatibles con hepatitis, pero relacionados con el inicio reciente de agentes farmacológicos, y que se resuelven tras el retiro de la noxa. Su desarrollo se ha descrito con el uso de algunos antibióticos, antituberculosos, estatinas, herbolarios y antiinflamatorios no esteroideos; sin embargo, hay pocos reportes de casos con el uso de anticonceptivos orales, en los cuales el surgimiento de mecanismos idiosincráticos puede llevar a la presentación de características clínicas como ictericia y anormalidades en los exámenes de laboratorio, como la elevación de las transaminasas. Esto requiere de estudios extensos para descartar otras patologías que pueden presentarse de esta forma, lo que representa un reto clínico. En este artículo se muestra el reporte de un caso de una paciente con antecedente de uso crónico de anticonceptivos implantables y que, tras el ajuste de la terapia con el inicio de anticonceptivos orales, desarrolla un episodio de elevación marcada de transaminasas e ictericia.

Drug-induced liver injury is a rule-out diagnosis. Typically, it occurs in patients who develop clinical and biochemical changes compatible with hepatitis, but related to a history of recent onset of pharmacological agents, and resolves after withdrawal of the noxious substances. Its development has been described with the use of some antibiotics, antituberculosis agents, statins, herbal and nonsteroidal anti inflammatory drugs; however, there are few reports of cases with the use of oral contraceptives, in which the appearance of idiosyncratic mechanisms can lead to the presentation of clinical features such as jaundice and laboratory tests abnormalities, like transaminase elevation, requiring extensive studies to rule out other pathologies that may have this clinical presentation, wich represents a clinical challenge. We present a case report of a patient who had chronic use of implantable contraceptives and who, after adjustment of therapy with the start of oral contraceptives, developed an episode of marked elevation of transaminases and jaundice.

Lesión hepática inducida por Phyllanthus niruri (chancapiedra), un remedio natural para urolitiasis / Liver injury induced by Phyllanthus niruri (chancapiedra), a natural remedy for urolithiasis

Tanto la lesión hepática inducida por drogas (DILI), así como la lesión hepática inducida por hierbas (HILI), son una preocupación creciente en la atención sanitaria contemporánea que plantea importantes desafíos clínicos debido a sus variadas etiologías, presentaciones clínicas y posibles resultados potencialmente mortales. Presentamos el caso de un paciente masculino de 38 años con antecedentes de cálculos renales que consultó por dolor lumbar y hematuria. Al ingreso presentó ictericia, hepatomegalia, dolor a la palpación en fosa ilíaca derecha y no tenía signos de hepatopatía crónica, con pruebas de función hepática anormales, que mostraron un patrón hepatocelular asociado con hiperbilirrubinemia. Se descartó obstrucción biliar, trombosis portal, hepatitis autoinmune y viral, con panel autoinmune negativo. El paciente refirió haber consumido un remedio herbario para los cálculos renales llamado "vino rompe cálculos (chancapiedra)", que se supone contiene Phyllanthus niruri, cinco días antes del inicio de los síntomas. Una biopsia hepática reveló hepatitis aguda con infiltrado inflamatorio mixto. Debido al empeoramiento de las pruebas de función hepática y la sospecha de DILI idiosincrásico, se inició un ensayo terapéutico con corticosteroides, que resultó en una mejoría clínica y del perfil hepático. La gravedad de este caso nos recuerda la necesidad de incrementar el seguimiento por parte de las autoridades reguladoras de medicamentos, implementar campañas educativas para los pacientes e informar a la comunidad sobre productos con alertas activas.

Both drug-induced liver injury (DILI) and herb-induced liver injury (HILI) are a growing concern in contemporary healthcare that poses significant clinical challenges due to their varied etiology, clinical presentations, and potential life-threatening outcomes. We present the case of a 38-year-old male patient with a history of kidney stones who consulted for low back pain and hematuria. On admission he presented with jaundice, hepatomegaly, pain on palpation in the right iliac fossa and no signs of chronic liver disease, with abnormal liver function tests, which showed a hepatocellular pattern associated with hyperbilirubinemia. Biliary obstruction, portal thrombosis, autoimmune and viral hepatitis were ruled out, with negative autoimmune panel. The patient reported consuming an herbal remedy for kidney stones called "stone-breaking wine (chancapiedra)", presumed to contain Phyllanthus niruri, five days before the onset of symptoms. A liver biopsy revealedacute hepatitis with mixed inflammatory infiltrate. Due to worsening liver function tests and suspicion of idiosyncratic DILI, a therapeutic trial with corticosteroids was initiated, which resulted in clinical and liver profile improvement. The severity of this case reminds us of the need to increase follow-up by drug regulatory authorities, implement educational campaigns for patients, and inform the community about products with active alerts.

Fatores associados à adesão à vacina contra hepatite b em gestantes expostas à sífilis / Factors associated with adherence to hepatitis b vaccine in pregnant women exposed to syphilis / Factores asociados a la adherencia a la vacuna contra la hepatitis b en mujeres embarazadas expuestas a sífilis

Objetivo: Avaliar os fatores associados à adesão à vacina contra hepatite B em gestantes expostas à sífilis. Métodos: Trata-se de uma pesquisa analítica, com abordagem quantitativa, realizada em uma capital do nordeste brasileiro. Participaram gestantes com diagnóstico de sífilis. Utilizou-se um instrumento previamente validado para coleta de dados. A pesquisa atendeu os aspectos éticos. Resultados: Do total de 73 participantes, 43,8% estavam no primeiro trimestre, 53,4% com faixa etária de 26 a 38 anos, 80,8% casadas ou em união estável, 57,5% com menos de 12 anos de estudos, 94,5% não brancas, 61,7% sem renda. À adesão à vacina contra hepatite B foi verificada em 57 gestantes (78%). E teve associação com escolaridade (p= 0,057) e ter um trabalho remunerado (p= 0,028). Conclusão: À adesão à vacinação contra Hepatite B foi elevada quando comparada com populações chaves, contudo abaixo da meta proposta pelo ministério da saúde. Gestantes mais esclarecidas e que tinha alguma remuneração iniciaram o prénatal no primeiro trimestre e tiveram maior adesão a vacina. Recomenda-se aproveitar oportunidades para atualização do cartão vacinal. (AU)

Objective: To evaluate the factors associated with adherence to the hepatitis B vaccine in pregnant women exposed to syphilis. Methods: This is analytical research, with a quantitative approach, carried out in a capital city in northeastern Brazil. Pregnant women diagnosed with syphilis participated. A previously validated instrument was used for data collection. The research met the ethical aspects. Results: Of the total of 73 participants, 43.8% were in the first trimester, 53.4% were aged between 26 and 38 years, 80.8% were married or in a stable relationship, 57.5% had less than 12 years of schooling, 94.5% non-white, 61.7% without income. Adherence to the hepatitis B vaccine was verified in 57 pregnant women (78%). And it was associated with schooling (p=0.057) and having a paid job (p=0.028). Conclusion: Hepatitis B vaccination adherence was high when compared to key populations, but below the target proposed by the Ministry of Health. More informed pregnant women who had some remuneration started prenatal care in the first trimester and had greater adherence to the vaccine. It is recommended to take advantage of opportunities to update the vaccination card. (AU)

Objetivo: Evaluar los factores asociados a la adherencia a la vacuna contra la hepatitis B en gestantes expuestas a sífilis. Métodos: Se trata de una investigación analítica, con enfoque cuantitativo, realizada en una ciudad capital del noreste de Brasil. Participaron mujeres embarazadas con diagnóstico de sífilis. Para la recolección de datos se utilizó un instrumento previamente validado. La investigación cumplió con los aspectos éticos. Resultados: Del total de 73 participantes, el 43,8 % se encontraba en el primer trimestre, el 53,4 % tenía entre 26 y 38 años, el 80,8 % estaba casado o en relación estable, el 57,5 % tenía menos de 12 años de escolaridad, el 94,5 % no -blanco, 61,7% sin ingresos. Se verificó la adherencia a la vacuna contra la hepatitis B en 57 gestantes (78%). Y se asoció con la escolaridad (p=0,057) y tener trabajo remunerado (p=0,028). Conclusión: La adherencia a la vacunación contra la Hepatitis B fue alta en comparación con las poblaciones clave, pero por debajo de la meta propuesta por el Ministerio de Salud. Las gestantes más informadas y con algún ingreso económico iniciaron el control prenatal en el primer trimestre y tuvieron mayor adherencia a la vacuna. Se recomienda aprovechar las oportunidades para actualizar el carné de vacunación. (AU)

Antivirales de acción directa contra la hepatitis C: revisión narrativa / Direct acting antivirals against hepatitis C: Literature review

Desde los años ochenta se ha explorado el tratamiento para el virus de la hepatitis C, aunque en ese entonces los medicamentos disponibles eran poco toleradas y poco eficaces. En el 2011, la introducción de antivirales de acción directa transformó significativamente el curso de la enfermedad, logrando tasas de curación superiores al 90 % en los pacientes. Este avance ha permitido prevenir complicaciones futuras con efectos adversos mínimos. La presente revisión aborda la línea de tiempo del descubrimiento de los antivirales, su mecanismo de acción, sus indicaciones y potencial impacto en la salud pública.

Since the 1980s, the treatment of hepatitis C has been explored, although at that time, the available medications were poorly tolerated and ineffective. In 2011, the introduction of direct-acting antivirals significantly transformed the course of the disease, achieving cure rates of over 90% in patients. This advance has made it possible to prevent future complications with minimal adverse effects. This review addresses the timeline of the discovery of antivirals, their mechanism of action, and their impact on medicine.

Características clínicas, epidemiológicas y de laboratorio en hepatitis autoinmune / Clinical, epidemiological and laboratory characteristics in autoimmune hepatitis / Características clínicas, epidemiológicas e laboratoriais em hepatite autoimune

Resumen La hepatitis autoinmune (HAI) es una inflamación hepatocelular progresiva. En la Unidad de Hepatología y Alcoholismo del hospital se atienden aproximadamente 550 pacientes anualmente, muchos de ellos con diagnóstico de HAI. El objetivo de este trabajo fue evaluar las características clínicas, epidemiológicas y los parámetros de laboratorio de pacientes con HAI desde 2012 hasta 2018. Se incluyeron 44 pacientes: 40 con HAI tipo I y 4 seronegativos. El 91% fueron mujeres con edades entre 13 y 68 años; la forma de presentación más frecuente fue la hepatitis aguda. Se realizó biopsia en 32 pacientes; 50% mostraban características de HAI (hepatitis de interfase) y 35% presentaban cirrosis en la histología. El estudio ofrece una imagen aproximada de las particularidades de la HAI de la población atendida en este hospital. Respecto a otras poblaciones, esta comunicación muestra un mayor porcentaje de pacientes de sexo femenino, con alta preponderancia de presentación aguda y de las enfermedades autoinmunes asociadas.

Abstract Autoimmune hepatitis (AIH) is a progressive hepatocellular inflammation. Approximately 550 patients are treated per year in the Hepatology and Alcoholism Unit of the hospital, many of them with a diagnosis of AIH. The objective was to evaluate clinical and epidemiological characteristics and laboratory parameters of patients with AIH from 2012 to 2018; 44 patients were included, 40 with type I AIH and four seronegative patients. Ninety- one per cent were women aged between 13 and 68 years old. The most frequent form of presentation (54.5%) was acute hepatitis. Thirty-two patients required biopsy; 50% showed features of AIH (interphase hepatitis) and 35% had histologic cirrhosis. The study offers an approximate image of the particularities of AIH in the population treated in this hospital. Compared to other populations, this communication shows a higher percentage of female patients, with a high preponderance of acute presentation and associated autoimmune diseases.

Resumo A hepatite autoimune (HAI) é uma inflamação hepatocelular progressiva. Na Unidade de Hepatologia e Alcoolismo do hospital, aproximadamente 550 pacientes são atendidos por ano, muitos deles com diagnóstico de HAI. O objetivo deste trabalho foi avaliar as características clínicas, epidemiológicas e parâmetros laboratoriais de pacientes com HAI de 2012 a 2018. Foram incluídos 44 pacientes, 40 com HAI tipo I e quatro soronegativos. Noventa e um por cento foram mulheres com idades entre 13 e 68 anos; a forma de apresentação mais comum foi a hepatite aguda. Biópsias foram realizadas em 32 pacientes, 50% apresentando características de HAI (hepatite de interface) e 35% com cirrose na histologia. O estudo fornece uma visão aproximada das características da HAI na população atendida neste hospital. Em comparação com outras populações, esta comunicação mostra uma maior proporção de pacientes do sexo feminino, com alta incidência de apresentação aguda e das doenças autoimunes associadas.

Respuesta al tratamiento inmunosupresor de pacientes con hepatitis autoinmune

Introducción: La respuesta al tratamiento inmunosupresor en la hepatitis autoinmune influye en el curso clínico de la enfermedad y se asocia a mayor sobrevida. Objetivo: Describir la respuesta al tratamiento inmunosupresor en pacientes con hepatitis autoinmune. Método: Se realizó un estudio descriptivo, longitudinal, ambispectivo, en 32 enfermos con hepatitis autoinmune, los cuales recibieron tratamiento inmunosupresor con evaluación de la respuesta a los 6 meses. Las variables incluidas fueron: tipo de hepatitis autoinmune, forma de presentación, forma de debut y respuesta al tratamiento. Se utilizaron medidas descriptivas de resumen: media y desviación estándar para variables cuantitativas y porcentaje para las variables cualitativas. Para estimar la función de supervivencia se utilizó la curva de Kaplan-Meier y Log-rank para la comparación de medias. Resultados: El 71,9 % de los enfermos estaban con cirrosis en el momento del diagnóstico. Los 13 pacientes con remisión bioquímica permanecieron sin progresión en la evaluación actual. La supervivencia en los pacientes respondedores fue del 100 % y en los no respondedores de 47,5 % a los 10 años de seguimiento. Conclusiones: La respuesta al tratamiento inmunosupresor tiene un impacto positivo en la no progresión de la hepatitis autoinmune y se asoció a mayor supervivencia.

Introduction: The response to immunosuppressive treatment in autoimmune hepatitis influences the clinical course of the disease and is associated with a longer survival. Objective: Describe the response to immunosuppressive treatment in patients with autoimmune hepatitis. Method: A descriptive, longitudinal, ambispective study was carried out in 32 patients with autoimmune hepatitis, who received immunosuppressive treatment with response evaluation at 6 months. The variables included were: type of autoimmune hepatitis, form of presentation, form of onset, and response to treatment. Descriptive summary measures were used: mean and standard deviation for quantitative variables and percentage for qualitative variables. To estimate the survival function, the Kaplan-Meier curve and Log-rank were used to compare means. Results: 71.9 % of the patients were already cirrhotic at the time of diagnosis. The 13 patients with biochemical remission, remained without progression in the current evaluation. Survival in responding patients was 100 %, while in non-responders it was 47.5% at 10-year follow-up. Conclusions: The response to immunosuppressive treatment has a positive impact on the non-progression of autoimmune hepatitis and was associated with greater survival.

Manifestaciones cutáneas comunes de las principales enfermedades hepáticas / Common cutaneous manifestations of major liver diseases

Las enfermedades hepáticas presentan múltiples manifestaciones sistémicas, entre las cuales se destacan los hallazgos en piel, siendo los más comunes el prurito y la ictericia; así mismo, se pueden encontrar angiomas en araña, eritema palmar, xantomas, vasculitis y cambios en anexos. Este artículo tiene como objetivo describir los principales signos y síntomas cutáneos en las enfermedades hepáticas para brindar herramientas semiológicas al clínico en su práctica diaria

Liver disease present multiple systemic manifestations, among which skin findings stand out, being the most common pruritus and jaundice. Other findings can also be manifested like spider angiomas, palmar erythema, xanthomas, vasculitis and changes in skin appendages. The objective of this article is to describe the main skin signs and symptoms of liver diseases to provide semiological tools to the physician in his daily practice.

The infusion of Baccharis spicata (Lam. ) Baill (Asteraceae) has antiviral activity against hepatitis B virus without cytotoxic effects against several cell lines / La infusión de Baccharis spicata (Lam. ) Baill (Asteraceae) posee actividad antiviral contra el virus de la hepatitis B sin efectos citotóxicos contra varias líneas celulares

Medicinal plants are used to cure diseases, and their replacement is frequent and affects public health. The genus Baccharis has representatives within the medicinal flora of Argentina, although the replacement of the species of this genus known under the vulgar name of "carqueja" by Baccharis spicata has been detected i n herbalists or markets of herbal products. The genotoxic safety of this species has been established in previous work of our group. The aim of this study was to evaluate the antiviral activity of an infusion made from B. spicata leaves against hepatitis B virus with the HepG2.2.15 cellular system and to determine cytotoxicity in HepG2.2,15, A549 and Vero cell lines. Infusion of B. spicata was active to inhibit HBV replication with an EC 50 of 22.54 µg/mL and a CC 50 of 190 µg/mL.

Las plantas medicinales son empleadas para la cura de enfermedades, y su sustituc ión es frecuente y afecta a la salud pública. El género Baccharis posee representantes dentro de la flora medicinal de Argentina, aunque se ha detectado la sustitución de las especies de dicho género conocidas bajo el nombre vulgar de "carqueja" por Baccha ris spicata en herboristerías o mercados de productos herb arios . Se ha establecido la seguridad genotóxica de esta especie en trabajos previos de nuestro grupo. Este estudio buscó evaluar la actividad antiviral de una infusión elaborada a partir de hojas de B. spicata frente al virus de la hepatitis B con el sistema celular HepG2.2.15 y determinar la citotoxicidad en las líneas celulares HepG2.2.15, A549 y Vero. La infusión de B. spicata fue activa para inhibir la replicación del virus con un EC 50 de 22.54 µg/mL y un CC 50 de 190 µg/mL.

Infections in the era of immunobiologicals

Abstract Immunobiologicals represent an innovative therapeutic option in dermatology. They are indicated in severe and refractory cases of different diseases when there is contraindication, intolerance, or failure of conventional systemic therapy and in cases with significant impairment of patient quality of life. The main immunobiologicals used in dermatology basically include inhibitors of tumor necrosis factor-alpha (anti-TNF), inhibitors of interleukin-12 and -23 (anti-IL12/23), inhibitors of interleukin-17 and its receptor (anti-IL17), inhibitors of interleukin-23 (anti-IL23), rituximab (anti-CD20 antibody), dupilumab (anti-IL4/IL13) and intravenous immunoglobulin. Their immunomodulatory action may be associated with an increase in the risk of infections in the short and long term, and each case must be assessed individually, according to the risk inherent to the drug, the patient general condition, and the need for precautions. This article will discuss the main risks of infection associated with the use of immunobiologicals, addressing the risk in immunocompetent and immunosuppressed patients, vaccination, fungal infections, tuberculosis, leprosy, and viral hepatitis, and how to manage the patient in the most diverse scenarios.

Impact of sustained virologic response on glucose parameters among patients with chronic hepatitis C treated with direct-acting antivirals

ABSTRACT Objective: The aim of this study was to evaluate the glycated hemoglobin (HbA1c) levels before and after sustained virologic response (SVR) and investigate the baseline characteristics associated with improved glycemic control in patients with chronic hepatitis C (CHC) achieving SVR after direct-acting antivirals (DAA) therapy. Materials and methods: Consecutive adult patients with CHC who achieved SVR after DAA treatment between January 2016 and December 2017 at Hospital de Clínicas de Porto Alegre (RS, Brazil) were prospectively included. Levels of HbA1c were measured up to 24 weeks before DAA therapy and 12 weeks after SVR. Exclusion criteria were decompensated cirrhosis, HIV and/or hepatitis B virus, liver disease of other etiologies, and/or modification of prediabetes/type 2 diabetes mellitus (PDM/T2DM) management. The primary outcome was a comparison of HbA1c levels before and after SVR. Secondary outcomes were the baseline variables associated with improved glycemic control. Results: The study included 207 patients with a mean age of 60.6±10.7 years, of whom 51.7% were women, 56% had cirrhosis, 37.7% had HCV genotype 3, and 54.5% had baseline T2DM or PDM. The median HbA1c level reduced significantly after SVR (5.5%, interquartile range [IQR] 4.9%-6.3%) compared with baseline (5.7%, IQR 5.3­%-6.7%; p = 0.01). The baseline characteristics associated with improved HbA1c after SVR were cirrhosis, genotype 3, and age ≤ 60 years. Conclusion: Among patients with CHC, SVR after DAA was associated with HbA1c reduction, particularly in those with cirrhosis, genotype 3, and age ≤ 60 years.

Regressão espontânea do carcinoma hepatocelular: foco nos fatores de risco associados / Spontaneous regression of hepatocellular carcinoma: focusing in the associated risk factors

ABSTRACT Background: Spontaneous regression (SR) is defined as the partial or complete disappearance of a tumor, in the absence of a specific treatment. Evidence of the SR in hepatocellular carcinoma (HCC) is rare. Objective: The authors aimed to review all the cases of SR of HCC in two reference centers of Southern Brazil, highlighting the main characteristics. Methods: Data of all patients with HCC were retrospectively reviewed looking for the occurrence of SR in patients from two tertiary centers in Southern Brazil, in the last five years. The diagnosis of cirrhosis was established according to clinical, laboratory and imaging data, as well as upper endoscopy or histopathological examination when necessary. The diagnosis of HCC was based on typical findings according to radiologic criteria (LIRADS) or histopathological examination. Spontaneous regression was defined as a partial or complete involution of a HCC in the absence of a specific therapy. Results: From all cases of HCC in the last 5 years (n=433), there were five cases of SR. Three (60%) were men, the mean age was 62.6 (50.0-76.0) years, and the etiology was HCV in 3 (60%). Complete regression was observed in three patients (60%), one patient (20%) presented partial regression, and one (20%) relapesed and died. The time of follow-up varied between 12 and 21 months. In this presentation, it was highlighted one case of SR observed after COVID-19 infection in a patient with cirrhosis. The possible mechanisms involved in this situation were reviewed, emphasizing the most common like hypoxia and immunological. There were also one patient submitted to a surgical procedure as a possible fator involved and three patients without obvious risk factors. Conclusion: This phenomenon will possibly contribute to a better understanding of the pathophysiological mechanisms of HCC.

RESUMO Contexto: A evidência da regressão espontânea (RE) no carcinoma hepatocelular (CHC) é rara. Objetivo: Revisar todos os casos de RE de CHC em dois centros de referência do Sul do Brasil, destacando as principais características. Métodos: Os dados de todos os pacientes com CHC foram revisados retrospectivamente buscando a ocorrência de RE em pacientes de dois centros terciários do Sul do Brasil, nos últimos 5 anos. O diagnóstico de cirrose foi estabelecido de acordo com dados clínicos, laboratoriais e de imagem, além de endoscopia digestiva alta ou exame histopatológico quando necessário. O diagnóstico de CHC foi baseado em achados típicos de acordo com critérios radiológicos (LIRADS) ou exame histopatológico. A RE foi definida como uma involução parcial ou completa de um CHC na ausência de terapia específica. Resultados: Do total de casos de CHC nos últimos 5 anos (n=433), houve cinco casos de RE. Três (60%) eram homens, a média de idade foi de 62,6 (50,0-76,0) anos, a etiologia foi virus da hepatite C em 3 (60%). A regressão completa foi observada em três pacientes (60%), um paciente (20%) apresentou regressão parcial e um (20%) apresentou recidiva e evoluiu a óbito. O tempo de seguimento variou entre 12 e 21 meses. Nesta apresentação foi destacado um caso (20%) de RE observado após infecção por COVID-19 em paciente com cirrose. Foram revisados os possíveis mecanismos envolvidos nesta situação, enfatizando os mais comuns como hipóxia e imunológicos. Houve também um paciente submetido a procedimento cirúrgico como possível fator envolvido e três pacientes sem fatores de risco evidentes. Conclusão: Este fenômeno possivelmente contribuirá para uma melhor compreensão dos mecanismos fisiopatológicos do CHC.

Hospital admissions for chronic liver diseases: a temporal study in the South Region of Brazil

SUMMARY OBJECTIVE: The aim of the study was to compare the epidemiology and clinical profiles of hospital admissions in a single Brazilian Hepatology Unit from the period 2014-2017 to 2019-2022. METHODS: A retrospective analysis of hospital database from the abovementioned periods was done. The study included patients over the age of 18 years who were hospitalized due to complications of diseases such as viral hepatitis, alcoholic disease, nonalcoholic fatty liver disease, and autoimmune liver and drug-induced hepatitis. RESULTS: In both study periods, middle-aged males were predominant and were younger than females. In the first period (2014-2017), hepatitis C (33.5%) was the most prevalent cause of admission, followed by alcoholic liver disease (31.7%). In the second period (2019-2022), nonalcoholic fatty liver disease (38%) and alcoholic liver disease (27.6%) were the most frequent causes of admission. No changes were observed in the proportion of alcoholic liver disease or drug-induced hepatitis in both study periods. The prevalence of viral hepatitis decreased in both genders, with hepatitis C decreasing from 32.4 to 9.7% for males and 35.4 to 10.8% for females, and OR=0.2; 95%CI 0.1-0.3 for both males and females. Similarly, the prevalence of hepatitis B decreased from 19.1 to 8.1% and OR=0.3; 95%CI 0.2-0.5 for males and 8.2 to 3.7% and OR=0.4; 95%CI 0.1-0.9 for females. The prevalence of autoimmune liver diseases increased only in males, from 2.1 to 5.9% and OR=2.9; 95%CI 1.2-6.6. CONCLUSION: Over the past 4 years, there has been a shift in hospital admission profile at a Brazilian Hepatology Unit, with a decrease in viral hepatitis and an increase in autoimmune diseases and nonalcoholic fatty liver disease. Males were more affected at younger ages than females. Furthermore, ascites was the most prevalent cause of complications in both periods analyzed.

Trends and spatial distribution of hepatitis B in pregnant women in Brazil / Tendência e distribuição espacial da hepatite B em gestantes no Brasil

Abstract Objectives: to analyze the trend and spatial distribution of hepatitis B in pregnant women in Brazil. Methods: ecological study based on all notified cases of hepatitis B in pregnant women through the Information System for Notifiable Diseases - Sinan between 2009 and 2018. Hepatitis B virus (HBV) detection rates were calculated in all municipalities. Spatial analysis was performed using the Global Moran Index for global data and local indicators of spatial association (Lisa) for the 5,570 municipalities. For trend analysis by State, the Prais-Winsten generalized linear regression model was used. Results: 15,253 pregnant women with HBV were reported. High detection rates were observed in the municipalities of São Miguel da Boa Vista-SC (68.96/1000 live births (LB)), Araguaiana-MT (68.18/1000 LB), Reserva do Cabaçal-MT (80, 00/1,000 LB), São Geraldo da Piedade-MG (75/1000 LB), Porto Mauá-RS (111, 11/1000 LB), in the respective bienniums. Moran (I) (I=0.056) showed a positive spatial association. In Lisa, 78 municipalities were included in the high-high cluster, 51.28% in the South region and 48 in the low-low cluster with 72.91% in the Southeast. There was an increasing trend in Maranhão (p=0.004) and Pernambuco (p=0.007) and a decrease in Mato Grosso (p=0.012), Paraná (p=0.031) and Santa Catarina (p=0.008). Conclusion: the detection of hepatitis B in pregnant women was observed in most Brazilian municipalities, with an increasing trend in two states and a decrease in three others.

Resumo Objetivos: analisar a tendência e distribuição espacial da hepatite B em gestantes no Brasil. Métodos: estudo ecológico a partir de todos os casos notificados de hepatite B em gestantes pelo Sistema de Informação de Agravos de Notificação - Sinan entre 2009 e 2018. Foram calculadas as taxas de detecção do vírus da hepatite B (HBV) em todos os municípios. A análise espacial foi realizada por meio do Índice Global de Moran para os dados globais e os indicadores locais de associação espacial (Lisa) para os 5.570 municípios. Para análise de tendências por Estado, utilizou-se o modelo de regressão linear generalizada de Prais-Winsten. Resultados: foram notificadas 15.253 gestantes com HBV. Observou-se altas taxas de detecção nos municípios de São Miguel da Boa Vista-SC (68,96/1000 Nascidos vivos (NV)), Araguaiana-MT (68,18/1000 NV), Reserva do Cabaçal-MT(80,00/1.000 NV), São Geraldo da Piedade-MG (75/1000 NV), Porto Mauá-RS (111,11/1000 NV), nos respectivos biênios. Moran (I) (I=0,056) apresentou associação espacial positiva. No Lisa observou-se 78 municípios inserido no cluster alto-alto, sendo 51,28%na região Sul e 48 no cluster baixo-baixo com 72,91% no Sudeste. Verificou-se tendência crescente no Maranhão (p=0,004) e Pernambuco (p=0,007) e diminuição no Mato Grosso (p=0,012), Paraná (p=0,031) e Santa Catarina (p=0,008). Conclusão: Observou-se a detecção de hepatite B em gestantes na maioria dos municípios brasileiros, com tendência crescente em dois estados e diminuição em outros três.

Lack of evidence of acute HEV infections as a sexually transmitted disease: Data from a German cohort of PrEP users

Abstract Background While the sexual transmissibility of HAV in MSM has been extensively described, the potential for sexual transmission of HEV has not been definitively established. Although HEV has been detected in the ejaculate of chronically infected men, studies among MSM PrEP users in France did not observe an elevated anti-HEV seroprevalence as an indicator of increased exposure risk by sexual intercourse. Patients and methods A total of 111 unselected PrEP users and 111 age- and sex-matched blood donors were tested for anti-HEV IgG, IgM and HEV (PCR). Of the participants 79/111 (71 %) responded to a questionnaire covering topics as sexual preferences, previous sexually transmitted diseases, profession, food consumption, and pet ownership. Results The anti-HEV IgG seroprevalence in PrEP users (22 %) did not differ significantly from the rate in controls (17 %). While one PrEP user and three controls tested positive for anti-HEV IgM, all PrEP users and controls tested PCR negative. Conclusion In immunocompetent individuals with frequent changes of sexual partners, the epidemiology of Hepatitis E Virus does not significantly involve the sexual transmission route.

Independent predictors for non-alcoholic fatty liver disease in patients with treatment-naïve chronic hepatitis B

SUMMARY OBJECTIVE: There are limited data on non-alcoholic fatty liver disease in chronic hepatitis B virus infection. We aimed to determine the predictors for non-alcoholic fatty liver disease in patients with treatment-naïve chronic hepatitis B virus infection. METHODS: All consecutive treatment-naïve patients with chronic hepatitis B virus infection at the Haseki Training and Research Hospital between October 1, 2021, and September 31, 2022, were retrospectively enrolled. Chronic hepatitis B virus infection is defined by positive serum hepatitis B surface antigen for 6 months or more. Patients with significant alcohol consumption, prolonged steatogenic drug use, malignancy, monogenic hereditary disorders, patients co-infected with hepatitis D virus, hepatitis C virus infection, or human immunodeficiency virus were excluded. Demographic characteristics, anthropometric determinants, laboratory findings, and virological parameters were retrospectively collected from patients' charts and electronic medical records. RESULTS: A total of 457 patients with treatment-naïve chronic hepatitis B virus infection were included in the study. The three multivariate regression models revealed that age (p<0.028), body mass index (p=0.046), diabetes mellitus (p=0.030), hemoglobin (p=0.008), platelet (p=0.012), and triglyceride (p=0.002) in Model 1; body mass index (p=0.033), diabetes mellitus (p<0.001), hemoglobin (p=0.008), platelet (p=0.004), LDL (p=0.023), and HDL (p=0.020) in Model 2; and age (p<0.001), body mass index (p=0.033), hemoglobin (p=0.004), platelet (p=0.004), and HDL (p=0.007) in Model 3 were independent predictors. CONCLUSION: Non-alcoholic fatty liver disease was observed in about one-third of patients with chronic hepatitis B virus infection and was positively associated with older age, higher body mass index, presence of comorbid conditions including diabetes mellitus, increased levels of metabolic laboratory parameters, especially serum triglyceride and LDL, and decreased HDL.

Prevención de las hepatitis virales crónicas como contenido de la superación del Equipo Básico de Salud

Introducción: Entre las causas más frecuentes de mortalidad se encuentran las enfermedades infecciosas, en particular en el tercer mundo. Y entre estas, están las hepatitis virales crónicas, las cuales aumentan su incidencia en Cuba. Objetivo: Exponer elementos de un sistema de superación dirigido al desarrollo de los conocimientos en los miembros del Equipo Básico de Salud del Policlínico Docente José Martí de la provincia de Camagüey, Cuba, sobre la prevención de las hepatitis virales crónicas en la Atención Primaria de Salud. Método: Se desarrolló una investigación participativa cuanticualitativa de carácter explicativo causal, mediante la ejecución del proyecto de investigación no asociado a programa Sistema de estrategias para la prevención de las hepatitis virales crónicas, desde la consulta provincial, ejecutado entre 2017 y 2022. El universo involucró 137 profesionales para una muestra de 68. Resultados: Los profesionales adquirieron nuevas experiencias, reconocieron la necesidad de capacitación, así como la comprensión de su vínculo con los pacientes que padecen estas enfermedades para advertir el riesgo que corren al no acudir a los servicios de salud para ser diagnosticados y tener un seguimiento con los servicios de la Atención Primaria de Salud. Predominó el índice alto como calificación de las preguntas del instrumento de salida para todos los participantes. Conclusiones: El sistema favorece el desarrollo de los conocimientos sobre la prevención de las hepatitis virales crónicas del Equipo Básico de Salud objeto de estudio. Las acciones potencian la participación de los actores de la comunidad y sus sesiones de intercambio se distinguen por su carácter activo, dinámico y funcional, en pos de una mejor práctica asistencial, preventiva de las hepatitis virales crónicas en el nivel primario.

Introduction: Among the most frequent causes of mortality are infectious diseases, particularly in the third world. And among these are chronic viral hepatitis, which increases its incidence in Cuba. Objective: To present elements of an improvement system aimed at developing knowledge in the members of the Basic Health Team of the José Martí Teaching Polyclinic in the province of Camagüey, Cuba, on the prevention of chronic viral hepatitis in Primary Health Care. Method: A quantitative participatory research of a causal explanatory nature was developed, through the execution of the research project not associated with the System of Strategies for the Prevention of Chronic Viral Hepatitis program, from the provincial consultation, executed between 2017 and 2022. The universe involved 137 professionals for a sample of 68. Results: Professionals acquired new experiences, recognized the need for training, as well as understanding their relationship with patients who suffer from these diseases to warn of the risk they run by not going to health services, to be diagnosed and have follow-up with Primary Health Care services. The high index predominated as the rating of the output instrument questions for all participants. Conclusions: The system favors the development of knowledge on the prevention of chronic viral hepatitis of the Basic Health Team under study. The actions enhance the participation of community actors and their exchange sessions are distinguished by their active, dynamic and functional nature, in pursuit of better care practice, preventive of chronic viral hepatitis at the primary level.

Introdução: Entre as causas mais frequentes de mortalidade estão as doenças infecciosas, principalmente no terceiro mundo. E entre estas estão as hepatites virais crónicas, que aumentam a sua incidência em Cuba. Objetivo: Apresentar elementos de um sistema de melhoria que visa desenvolver conhecimentos nos membros da Equipe Básica de Saúde da Policlínica Escolar José Martí, na província de Camagüey, Cuba, sobre a prevenção das hepatites virais crônicas na Atenção Primária à Saúde. Método: Desenvolveu-se uma pesquisa quantitativa participativa de natureza causal explicativa, através da execução do projeto de pesquisa não vinculado ao programa Sistema de Estratégias de Prevenção das Hepatites Virais Crônicas, a partir da consulta provincial, executada entre 2017 e 2022. O universo envolveu 137 profissionais para uma amostra de 68. Resultados: Os profissionais adquiriram novas experiências, reconheceram a necessidade de capacitação, bem como compreenderam sua relação com os pacientes que sofrem dessas doenças para alertar sobre o risco que correm ao não procurarem os serviços de saúde. ser diagnosticado e ter acompanhamento nos serviços de Atenção Primária à Saúde. O índice alto predominou na classificação das questões do instrumento de saída para todos os participantes. Conclusões: O sistema favorece o desenvolvimento do conhecimento sobre a prevenção das hepatites virais crônicas da Equipe Básica de Saúde em estudo. As ações potenciam a participação dos atores comunitários e as suas sessões de intercâmbio distinguem-se pelo seu caráter ativo, dinâmico e funcional, na procura de melhores práticas assistenciais, preventivas das hepatites virais crónicas no nível primário.