Diagnóstico diferencial de virus hepatótropos y no hepatótropos en pacientes atendidos en el laboratorio regional de referencia virológica: Maracaibo-Venezuela año 2007 / Differential diagnosis of hepatotropic and non-hepatotropic viruses in patients at the regional virological reference laboratory: Maracaibo-Venezuela 2007

La hepatitis viral representa un problema de salud pública a escala mundial, causada por diferentes agentes etiológico como el virus de la hepatitis A, B, C, D, E, F o G. Sin embargo, se han reportado casos relacionados con la enfermedad hepática causados por virus no hepatótropos como el Citomegalovirus (CMV) y el Virus Epstein Barr (VEB). El objetivo del presente estudio fue establecer el diagnóstico diferencial de virus hepatótropos y no hepatótropos en pacientes con síntomas y signos sugestivo de infección hepática, de la ciudad de Maracaibo-Venezuela. Año 2007. Se recolectaron 268 muestras de sangre de pacientes procedente de diferentes centros de salud de la ciudad de Maracaibo, que acudieron al Laboratorio regional de Referencias Virológica. La presencia de anticuerpos de tipo IgM, para el virus de hepatitis A (VHA), B (VHB), C (VHC), CMV y VEB fue detectada mediante la prueba de ELISA. Los resultados obtenidos indican una alta incidencia del VHA 118/268(44,03%), seguido del VHB 5/268(1,86%) y ausencia del VHC. Para virus no hepatótropos, el 4,48% (12/268) fueron positivos para el VEB y el 9,7% (26/268) para CMV. El 39,92% (107/268) son considerados negativos para los virus antes mencionados. En este estudio se señala que los virus CMV y VEB suelen estar comprometidos con daño hepático y deben ser consideradas como posibles agentes etiológicos ante cualquier caso de hepatitis

Viral hepatitis is a public health problem worldwide, caused by different etiologic agents,such as hepatitis A, B, C, D, E, F or G. However, cases have been reported related to liver disease caused by hepatotropic viruses, such as cytomegalovirus (CMV) and Epstein Barr Virus (EBV). The aim of this study was to establish the differential diagnosis of hepatotropic and non-hepatotropic viruses in patients with symptoms and signs suggestive of liver infection in the city of Maracaibo, Venezuela, 2007. 268 blood samples were collected from patients at different health centers in the city of Maracaibo, who recurred to the Regional Viral Reference Laboratory. The presence of IgM antibodies to hepatitis A virus (HAV), B (HBV), C (HCV), CMV and EBV was detected by ELISA. The results indicate a high incidence of HAV 118/268 (44.03%), followed by HBV 5/268 (1.86%) and the absence of HCV. For non-hepatotropic viruses, 4.48% (12/268) were positive for EBV and 9.7% (26/268) for CMV. For the above-mentioned viruses, 39.92% (107/268) are considered negative. This study suggests that CMV and EBV viruses are often involved with liver damage and should be considered as possible etiologic agents for any case of hepatitis

Incidencia de la infección por el virus de la hepatitis A diagnosticadas en la ciudad de Maracaibo estado Zulia Venezuela / Incidence of infection by the hepatitis A virus diagnosed in the city of Maracaibo state Zulia Venezuela

La infección por el virus de la hepatitis A (VHA) sigue siendo un problema de salud pública en los países en vías de desarrollo. El objetivo de la presente investigación fue determinar la incidencia de la infección por el VHA en individuos de la ciudad de Maracaibo, estado Zulia, Venezuela. Durante el periodo comprendido entre enero 2004 a diciembre 2007 se seleccionaron 1056 pacientes en edades de 1 a 60 años de ambos sexos (media ± DS: 27,48 ± 5,24), procedentes de los municipio Maracaibo y San Francisco ubicados en la ciudad de Maracaibo estado Zulia, Venezuela. La presencia de anticuerpos anti-IgM contra el virus de la hepatitis A se determinó mediante métodos convencionales de micro partículas enzimoinmunoanalisis (MEIA). Los resultados encontrados indican una seropositividad en 73 (35,1%), 76 (28%), 66 (24,3%), 35 (20,3%) individuos de las zonas Norte, Sur, Este, Oeste respectivamente, correspondientes al municipio Maracaibo y 31 (23,3%) correspondiente al municipio San Francisco. La mayor prevalencia fue observada en pacientes del sexo femenino menor de 20 años (47,3%), y en pacientes del sexo masculino menor de 10 años (53,7%), siendo el signo clínico más frecuente la ictericia (95,7%). Las deficientes medidas de saneamiento ambiental y sanitario fueron factores aparentemente determinantes en la diseminación del VHA

Hepatitis A virus (HAV) infection continues to be a public health problem in developing countries. The aim of this study was to determine incidence of the hepatitis A virus infection in a population from Maracaibo, Venezuela. From January, 2004 until December, 2007, this study was carried out on 1056 individuals, whose ages were between 1-60 years (average ± DS: 27.48 ± 5.24 years), coming from the Maracaibo and San Francisco municipalities, Venezuela. The IgM antibody against HAV was determined by the ELISA technique. The overall incidence was 26.6%. The North, South, East and West areas of the Maracaibo Municipality and the San Francisco Municipality in the city of Maracaibo showed incidences of 73 (35.1%), 76 (28%), 66 (24.3%), 35 (20.3%) and 31 (23.3%), respectively. The highest incidences were observed in females under 20 years (47.3%) and males under 10 years (53.7%). The most frequent clinical sign was jaundice in 95.7% of patients. Deficient sanitary conditions and hygiene habits seemed to be the main risk factors in spreading HAV infection

Baja prevalencia de la infección por el virus de la hepatitis C en una población de reclusos, Maracaibo, Venezuela / Low prevalence of hepatitis C virus infection in a prisoner population from Maracaibo, Venezuela

Introducción. Las conductas de alto riesgo presentes en los centros de reclusión incrementan la probabilidad de transmisión de la infección por el virus de la hepatitis C. En Venezuela no se han realizado estudios del virus en estos centros, por lo que se desconoce la relevancia de la infección en ellos. Objetivo. Estimar la prevalencia del virus de la hepatitis C y los posibles factores de riesgos involucrados en la transmisión del virus en reclusos de la cárcel de Sabaneta, Maracaibo, Venezuela. Material y métodos. Se seleccionó una población de 200 reclusos de un total de 1.000. Las edades estaban comprendidas entre 18 y 69 años (media ± DE: 31,629,93 a˜os). La detección de anticuerpos contra el virus de la hepatitis C se realizó por duplicado mediante el método inmunoenzimático ELISA de IV generación y por el método de inmunoblot INNO-LIA HCV®, ambos de Innogenetic Lab (Bélgica). El ARN viral se detectó por la técnica de reacción en cadena de la polimerasa, previa transcripción inversa, RT-PCR. Resultados. La frecuencia obtenida con el método ELISA fue de 5% (10/20) y 3/200 (1,5%) individuos fueron positivos, a la vez, con los métodos de INNO-LIA y RT-PCR. Conclusiones. La prevalencia de la infección por el virus de la hepatitis C en esta población fue baja, lo que evidencia la baja circulación del virus en el reclusorio. El principal factor de riesgo para la adquisición de la infección, al parecer, es el uso de drogas intravenosas.

Introduction. The high risk behaviors observed in prison centers have favored the transmission of hepatitis C virus infection. The main risk factor to acquire hepatitis C virus infection seems to be the use of intravenous drugs. In Venezuela, the prevalence of the infection in these centers is unknown since studies of the hepatitis C virus there are lacking. Objective. The aim of this study was to determine the prevalence of hepatitis C virus and the risk factors involved in the transmission in prisoner populations. Material and methods. A sample of 200 prisoners was studied from Sabaneta Jail, Maracaibo, Venezuela. The ages were between 18-69 years (average ± DS: 31.6±9.9 years). Serum samples were tested by a fourth generation enzyme-linked immunosorbent assay ELISA and a confirmatory assay INNO-LIA. Both kits were from Innogenetic Laboratories N.V. (Belgium). Viral RNA was tested by the reverse transcription polymerase chain reaction technique (RT-PCR). Results. The ELISA assay determined a hepatitis C virus prevalence of 5.0% (10/200); 3/200 (1.5%) individuals were positive by both INNO-LIA and RT-PCR tests. Conclusions. The observed prevalence of hepatitis C virus antibodies in this population was very low, suggesting a low circulation of the virus in this environment and a low level of associated risk behaviors.

[Low prevalence of hepatitis C virus infection in a prisoner population from Maracaibo, Venezuela]. / Baja prevalencia de la infección por el virus de la hepatitis C en una población de reclusos, Maracaibo, Venezuela.

INTRODUCTION: The high risk behaviors observed in prison centers have favored the transmission of hepatitis C virus infection. The main risk factor to acquire hepatitis C virus infection seems to be the use of intravenous drugs. In Venezuela, the prevalence of the infection in these centers is unknown since studies of the hepatitis C virus there are lacking. OBJECTIVE: The aim of this study was to determine the prevalence of hepatitis C virus and the risk factors involved in the transmission in prisoner populations. MATERIAL AND METHODS: A sample of 200 prisoners was studied from Sabaneta Jail, Maracaibo, Venezuela. The ages were between 18-69 years (average +/- DS: 31.6+/-9.9 years). Serum samples were tested by a fourth generation enzyme-linked immunosorbent assay ELISA and a confirmatory assay INNO-LIA. Both kits were from Innogenetic Laboratories N.V. (Belgium). Viral RNA was tested by the reverse transcription polymerase chain reaction technique (RT-PCR). RESULTS: The ELISA assay determined a hepatitis C virus prevalence of 5.0% (10/200); 3/200 (1.5%) individuals were positive by both INNO-LIA and RT-PCR tests. CONCLUSIONS: The observed prevalence of hepatitis C virus antibodies in this population was very low, suggesting a low circulation of the virus in this environment and a low level of associated risk behaviors.

[Viral loads in pediatric HIV patients with antiretroviral treatment]. / Carga viral en pacientes pediátricos VIH positivos con terapia antiretroviral.

BACKGROUND: Viral load in pediatric patients with HIV infections can help to make therapeutic decisions to modify the evolution of the disease. AIM: To evaluate viral load in positive HIV children with antiretroviral treatment. MATERIAL AND METHODS: Viral load was measured every six months during three years in fifty pediatric patients chosen randomly in aged 1 to 12 years, using the Test Monitor HIV-1 AMPLICOR, version 1.5. RESULTS: During the three years follow up, there was an increase in CD4 and CD8 lymphocyte count and decrease in the viral load. However, there was no significant relationship between lymphocyte subpopulation counts and viral loads. CONCLUSIONS: Viral load demonstrated to be an appropriate method to quantify plasma HIV-RNA. This tool can help to define the condition of a particular patient to predict clinical course of the disease and to assess the response to the treatment.

Carga viral en pacientes pediátricos VIH positivos con terapia antirretroviral / Viral loads in pediatric HIV patients with antirretroviral treatment

Background: Viral load in pediatric patients with HIV infections can help to make therapeutic decisions to modify the evolution of the disease. Aim: To evaluate viral load in positive HIV children with antiretroviral treatment. Material and methods: Viral load was measured every six months during three years in fifty pediatric patients chosen randomly in aged 1 to 12 years, using the Test Monitor HIV-1 AMPLICOR, versión 1.5. Results: During the three years follow up, there was an increase in CD4 and CD8 lymphocyte count and decrease in the viral load. However, there was no significant relationship between lymphocyte subpopulation counts and viral loads. Conclusions: Viral load demonstrated to be an appropriate method to quantify plasma HIV-RNA. This tool can help to define the condition of a particular patient to predict clinical course of the disease and to assess the response to the treatment.

[Immune evasion mechanisms of hepatitis C virus. Review]. / Mecanismos de evasión inmunitaria del virus de hepatitis C. Revisión.

Hepatitis Virus C (HCV) is a major worldwide health care problem. HCV infection usually tends to become chronic and can generate long-term hepatic cirrhosis and hepatocellular carcinoma. These affections frequently require a liver transplant to prolong the patients life. Maintenance of the chronic infection implies evasion of the host immune responses. Viral mechanisms involved in this evasion are being profusely studied in order to develop new and effective therapies and vaccines against HCV. An important HCV characteristic, its high genetic variability, has been proposed to contribute to immune evasion by means of antigenic change and variation. On the other hand, some studies suggest that genetic variability is not necessary to establish a chronic infection. Other studies related to immune responses in patients with spontaneous virus clearance and patients with chronic infection show a possible immunosuppression caused by some viral proteins, that may be essential to persist in the host. Specifically, it is believed that viral proteins NS5A, E2 and Core modulate some innate and specific immune mechanisms. The analysis of all data related to this topic suggests the existence of synergistic cooperation between viral variation and immunosuppression to overcome the immune defenses of the host.

Mecanismos de evasión inmunitaria del virus de hepatitis C: revisión / Inmune evasion mechanisms of hepatitis C virus: review

El virus de Hepatitis C (VHC) constituye un problema de salud pública mundial. La mayoría de las infecciones se tornan crónicas, ocasionando con frecuencia cirrosis hepática y carcinoma hepatocelular a largo plazo, precisándose no pocas veces de transplantes hepáticos para prolongar la vida del individuo. El mantenimiento de una infección crónica implica la evasión al sistema inmunitario del hospedero. Los mecanismos virales involucrados en dicha evasión están siendo estudiados arduamente con el fin de desarrollar nuevas terapias preventivas y curativas efectivas contra el virus. Una característica importante, la extrema variabilidad genética del virus, se cree que contribuya al escape inmunitario al cambiar continuamente los epítopos expuestos a la detección; sin embargo, algunos trabajos sugieren que no es necesaria para el establecimiento de la cronicidad de la infección. Por otra parte, el estudio comparativo de la respuesta inmunitaria de los pacientes que se recuperan espontáneamente con la de aquellos infectados de manera crónica, señala que algunas proteínas virales podrían inducir cierta inmunosupresión indispensable para la persistencia en el hospedero. Concretamente, se cree que las proteínas NS5A, E2 y core modulan ciertos mecanismos de las respuestas innata y específica. El análisis de los hallazgos relacionados con el tópico permite sugerir la existencia de una sinergia entre la variación genética y la inmunosupresión para evadir de manera continua la detección y destrucción por parte del sistema de defensas del individuo