Análise do tratamento dos pacientes com Hepatite B Crônica no município de Chapecó - SC / Analysis of the treatment of patients with Chronic Hepatitis B in the city of Chapecó - SC

A hepatite B crônica é uma doença causada pelo vírus da hepatite B (VHB), sendo seu diagnóstico confirmado pela persistência por mais de seis meses do antígeno de superfície HBsAg no plasma. Visto que é uma doença sem cura e que pode dar origem a uma série de complicações, o tratamento deve ser instituído de forma precoce e sempre acompanhado. O presente estudo fez uma análise do tratamento de pacientes com hepatite B crônica no município de Chapecó ­ SC. Participaram do estudo 65 pacientes com hepatite B crônica que iniciaram o tratamento entre os anos de 2010 a 2012 no Setor de Hepatites da Secretaria Municipal de Saúde de Chapecó ­ SC. Em relação ao tratamento, logo antes de iniciá-lo, 50,8% dos pacientes apresentavam VHB-DNA entre 2.000 e 100.000 UI/ml. Com a introdução da medicação, após um ano, 76,9% passaram a apresentar índices indetectáveis de VHB-DNA e após dois, esse índice elevou-se para 90,8%. O marcador sorológico HBsAg apresentou soroconversão em 3,1% da amostra após dois anos de tratamento; por outro lado, houve soroconversão do HBeAg em 95,4% dos pacientes após um ano, sendo que essa condição se manteve no ano seguinte. O tratamento para hepatite B crônica se mostrou efetivo em diminuir os níveis virais, o que é um fator imprescindível para um melhor prognóstico na evolução da doença e na qualidade de vida do paciente.

Chronic hepatitis B is a disease caused by the hepatitis B virus (HBV), and its diagnosis is confirmed by persisting for more than six months of the HBsAg surface antigen in plasma. Since this is an incurable disease and may give rise to a number of complications, the treatment should be set early and always accompanied. The present study made an analysis of the clinical profile and treatment of patients with chronic hepatitis B in Chapecó ­ SC. Participated in the study sixty-five patients with chronic hepatitis B who started treatment between the years 2010 to 2012 at the Setor de Hepatites da Secretaria Municipal de Saúde de Chapecó ­ SC. In relation to treatment, just before starting it, 50.8% of patients had HBV-DNA from 2,000 to 100,000 UI / ml. With the introduction of medication after one year, 76.9% showed undetectable levels of HBV-DNA and after two this index increased to 90.8%. The serologic marker HBsAg presented seroconversion in 3.1% of the sample after two years of treatment; on the other hand, there was HBeAg seroconversion in 95.4% of patients after a year, and this condition was maintained in one year later. The treatment for chronic hepatitis B was effective in reducing viral levels, which is an essential factor for a better prognosis in the evolution of the disease and the quality of life of patients.

Perfil clínico de pacientes portadores de hepatite B crônica / Clinical profile of patients with chronic hepatitis B

Objetivo: Conhecer as características e o perfil clínico dos indivíduos em tratamento de hepatite B crônica. Métodos: Participaram do estudo 65 pacientes com hepatite B crônica que iniciaram o tratamento entre os anos de 2010 a 2012. Resultados: Todos os pacientes eram da raça branca. Houve predomínio do sexo masculino (60%), e a maioria tinha entre 41 e 50 anos (32,8%). Grande parte dos pacientes (87,9%) não foi imunizada; 10,3% receberam as três doses da vacina e 43,1% possuíam familiar de primeiro grau ou parceiro com hepatite B crônica. A maioria (70,8%) relatou contato com algum fator de risco, sendo que 61,5% referiram ter realizado tratamento dentário. Conclusão: A implantação da vacina para toda população menor de 1 ano de idade, em 1996, pode ser uma explicação para a alta média de idade encontrada e pela inexistência de indivíduos menores de 23 anos no estudo. A vacinação completa, entretanto, ainda apresenta baixa adesão.(AU)

Objective: To get to know the characteristics and clinical profile of subjects being treated for chronic hepatitis B. Methods: Sixty-five patients with chronic hepatitis B who started treatment between the years 2010 to 2012 participated in the study. Results: All patients were white; there was a predominance of males (60%), and most of them were between 41 and 50 years (32.8%). Most patients (87.9%) were not immunized; 10.3% received all the three doses of the vaccine, and 43.1% had a first-degree relative or a partner with chronic hepatitis B. Most of them (70.8%) reported contact with a risk factor, with 61.5% reporting having had dental treatment. Conclusion: The implantation of the vaccine for all the population lower than 1 year of age, in 1996, can be an explanation for the high average age found, and the nonexistence of individuals younger than 23 years in the study. Complete vaccination, however, still presents low adherence.(AU)

Association between cytokine gene polymorphisms and outcome of hepatitis B virus infection in southern Brazil.

A number of studies have demonstrated associations between cytokine gene polymorphisms and outcome of hepatitis B virus (HBV) infection. However, no general consensus has been reached, possibly due to differences between ethnic groups. In this study, 345 individuals living in southern Brazil, including 196 chronic HBV carriers and 149 subjects who had spontaneously recovered from acute infection, were enrolled to evaluate the influence of cytokine gene polymorphisms on the outcome of HBV infection. Most participants were of European descent. Genotyping of IL2-330 G/T, IL4-589C/T, IL6-174 G/C, IL10-592C/A, IL10-1082 A/G, IL17A-197 G/A, IL17A-692 T/C, TNF-α-238 G/A, and TNF-α-308 G/A single nucleotide polymorphisms was performed by using the minisequencing (single base extension) method. By multivariable analysis, a statistically significant association was found between genotypic profile AA + GA in TNF-α-308 and chronic HBV infection (OR, 1.82; 95%CI, 1.01-3.27; P = 0.046). In southern Brazil, the carriers of the -308A allele in the TNF-α gene promoter have a moderately higher risk of becoming chronic carriers in case of HBV infection. In addition, patients with chronic active hepatitis B (n = 60) exhibited a decreased frequency (3.3%) of the TNF-238A allele when compared to that (14.8%) found among asymptomatic HBV carriers (n = 136), suggesting that this could be a protective factor against liver injury (OR, 0.17; 95%CI, 0.04-0.076; P = 0.023). J. Med. Virol. 88:1759-1766, 2016. © 2016 Wiley Periodicals, Inc.

Hepatitis B Virus Genotype D Isolates Circulating in Chapecó, Southern Brazil, Originate from Italy.

Hepatitis B virus genotype A1 (HBV/A1), of African origin, is the most prevalent genotype in Brazil, while HBV/F predominates in the other South American countries. However, HBV/D is the most common in the three states of southern Brazil, where 'islands' of elevated prevalence, as Chapecó and other cities, have been described. In this study, 202 HBV chronic carriers attending in 2013 the viral hepatitis ambulatory of Chapecó, were investigated. In comparison with previous studies performed in the same ambulatory, a rapid aging of the HBV infected population was observed (mean age of the newly diagnosed patients increasing from 29.9 ± 10.3 years in 1996 to 44.4 ± 13.3 years in 2013), probably due to a singular vaccination schedule at Chapecó that included not only children but also adolescents. Phylogenetic and BLAST analyses (S region) classified 91 HBV isolates into genotypes A (n = 3) and D (n = 88). The majority of HBV/D isolates were closely related to D3 sequences. To understand the reasons for the absence or near absence of genotypes A and F, and how HBV/D was introduced in the south of Brazil, HBV/D infected patients were inquired about their genealogical and geographical origins. Forty-three (52%) patients have their four grandparents of Italian origin, vs. seven (8%) who have their four grandparents of Brazilian origin. At all, 65 out of 83 (78%) patients had at least one grandparent originating from Italy. Taking into consideration the fact that Italy is one of the few countries where subgenotype D3 is predominant, the results strongly suggested that HBV/D was introduced in Brazil through Italian immigration which culminated between 1870 and 1920.