Cytokines profile in patients with acute and chronic hepatitis B infection.

Hepatitis B virus (HBV) is one of the leading causes of acute and chronic hepatitis and represents a serious public health threat. Cytokines are important chemical mediators that regulate the differentiation, proliferation, and function of immune cells, with accumulating evidence indicating that the inadequate immune responses are responsible for the elimination or persistence of HBV. This study aimed to determine the cytokine profiles (IFN-γ, TNF-α, IL-2, IL-4, IL-6, IL-10, and IL-17A) during HBV infection and investigate their association with genotypes. A total of 66 plasma samples, 19 from patients with acute and 47 with chronic hepatitis B infection, were subjected to biochemical tests, nested-PCR, and real-time PCR, with cytokines evaluated using a commercial BD Cytometric Bead Array Human Th1/Th2/Th17 Cytokine Kit. Healthy controls (10 individuals) were selected from blood donors with no history of liver diseases. No correlation was found between genotypes, viral load, and cytokines analyzed. All cytokines showed higher levels of production among infected individuals when compared with the control group. A positive correlation classified as moderate to strong was found between cytokines IFN-γ, TNF, IL-10, IL-6, IL-4, and IL-2 through the Spearman correlation coefficient. TNF (P = 0.009), IL-10 (P < 0.001), and IL-6 (P < 0.001) levels were higher in acute individuals compared with chronic and control groups. Theses cytokines could be involved in the elimination of virus and protection against chronicity.

Clinical Profile and Risk Factors for Severe COVID-19 in Hospitalized Patients from Rio de Janeiro, Brazil: Comparison between the First and Second Pandemic Waves.

Since COVID-19 was declared a pandemic, Brazil has become one of the countries most affected by this disease. A year into the pandemic, a second wave of COVID-19 emerged, with a rapid spread of a new SARS-CoV-2 lineage of concern. Several vaccines have been granted emergency-use authorization, leading to a decrease in mortality and severe cases in many countries. However, the emergence of SARS-CoV-2 variants raises the alert for potential new waves of transmission and an increase in pathogenicity. We compared the demographic and clinical data of critically ill patients infected with COVID-19 hospitalized in Rio de Janeiro during the first and second waves between July 2020 and October 2021. In total, 106 participants were included in this study; among them, 88% had at least one comorbidity, and 37% developed severe disease. Disease severity was associated with older age, pre-existing neurological comorbidities, higher viral load, and dyspnea. Laboratory biomarkers related to white blood cells, coagulation, cellular injury, inflammation, renal, and liver injuries were significantly associated with severe COVID-19. During the second wave of the pandemic, the necessity of invasive respiratory support was higher, and more individuals with COVID-19 developed acute hepatitis, suggesting that the progression of the second wave resulted in an increase in severe cases. These results can contribute to understanding the behavior of the COVID-19 pandemic in Brazil and may be helpful in predicting disease severity, which is a pivotal for guiding clinical care, improving patient outcomes, and defining public policies.

Prevalence of hepatitis E virus RNA and antibodies in a cohort of kidney transplant recipients in Central Brazil.

OBJECTIVE: To assess the prevalence of hepatitis E virus (HEV) RNA and antibodies among kidney transplant recipients (KTR) in Central Brazil. The presence of chronic HEV infection was also investigated. METHODS: A cohort study was conducted among 316 KTR treated at a referral center for kidney transplantation in Goiânia, Brazil. All serum samples were tested for the presence of HEV RNA (real-time PCR) and anti-HEV IgG/IgM (ELISA). Anti-HEV-positive samples were confirmed using an immunoblot test. HEV chronicity was investigated in a subgroup of patients with elevated alanine aminotransferase (ALT >40IU/l) through HEV RNA detection in additional serum samples collected 3 and 6 months apart. RESULTS: A seroprevalence of 2.5% (95% confidence interval 1.2-5.1%) was found for anti-HEV IgG. There was no difference in characteristics between the anti-HEV IgG seropositive and seronegative KTR groups. Anti-HEV IgM was detected in only one patient (0.3%). All KTR were negative for HEV RNA. CONCLUSIONS: These results show that HEV infection is infrequent in KTR in Central Brazil, with low seroprevalence rates of past and recent infection, and also an absence of active and chronic HEV infections.

Hepatite E em pacientes imunocomprometidos e imunossuprimidos / Hepatitis E in immunocompromised and immunosuppressed patients

O vírus da hepatite E (HEV) é o agente etiológico de hepatite humana mais recentemente descrito no Brasil, sendo responsável por hepatite crônica e cirrose em indivíduos imunocomprometidos. Como grupos imunossuprimidos relevantes, temos os doentes renais crônicos dependentes de hemodiálise (HD), um grupo cada vez maior e mais exposto a infecções por HEV. Além destes pacientes HD, temos os transplantados renais, um grupo também crescente no Brasil, para o qual o tacrolimo é incluído como protocolo imunossupressor e conhecido por estimular a replicação do HEV em receptores de órgãos. Assim, entender a influência da terapia com tacrolimo na prevalência de infecção por HEV em pacientes transplantados renais é fundamental para a adoção de medidas preventivas específicas. No entanto, dados consistentes não estão disponíveis sobre estas prevalências de HEV em populações imunocomprometidas no Brasil. Assim, a prevalência de HEV foi investigada em amostras de soro de 280 pacientes HIV positivos do Rio de Janeiro e em amostras de plasma de 286 pacientes HD do sudeste e nordeste do Brasil, 316 transplantados renais do Centro-Oeste em colaboração com a Universidade Federal de Goiás e em 50 doadores de sangue do HEMORIO. Além disso, 50 pacientes transplantados renais foram acompanhados durante 01 ano (t= 0, 3, 6, 9, 12 meses) após o transplante e início da imunossupressão, totalizando em 250 amostras de plasma. Todas as amostras foram analisadas quanto a presença de anticorpos anti-HEV IgG e à detecção de RNA genômico do HEV (HEV-RNA). A soroprevalência encontrada entre os pacientes em hemodiálise foi de 24,48%, considerada média em relação a pacientes HD descritos na literatura e alta em relação à população geral

Fatores como baixa renda familiar e longos períodos em hemodiálise representaram tendências em relação à presença de anticorpos anti-HEV IgG. Além disso, níveis mais baixos de fosfato foram associados como fatores de risco para positividade para anti-HEV IgG. No grupo de transplantados do Centro-Oeste, a soroprevalência encontrada foi de 2,5% sem diferenças epidemiológicas relevantes entre os grupos anti-HEV positivo e negativo e sem fatores de risco associados. No grupo de transplantados renais acompanhados por um ano, foi encontrada prevalência de 16% (8/50) no primeiro momento da coleta (t = 1 mês) e prevalência de 20% (10/50) no último momento do estudo (t = 12 meses), sugerindo a conversão de dois pacientes no intervalo de 1 ano após o transplante. Finalmente, entre os doadores de sangue a prevalência foi de 6% (3/50). Entre pacientes HIV positivos, a prevalência encontrada foi de 0%, neste grupo o HEV-RNA foi detectado em 3,6% dos pacientes, enquanto esta detecção não ocorreu nos outros grupos estudados. Esses resultados mostram como a prevalência do HEV pode variar de acordo com a região estudada e com o grupo estudado, sendo especialmente importante entre pacientes dependentes de hemodiálise e transplantados. Além disso, nossos resultados justificam e reforçam o monitoramento constante e a aplicação de medidas preventivas destes grupos e de doadores de sangue, cujas bolsas poderão ser aplicadas em pacientes de risco para o desenvolvimento de hepatite E crônica. (AU)