A real-life study on the impact of direct-acting antivirals in the treatment of chronic hepatitis C in liver transplant recipients at two university centers in Northeastern Brazil.

The efficacy of direct-acting antivirals (DAAs) in the treatment of chronic hepatitis C (CHC) in liver transplant recipients is poorly understood, and several factors, including immunosuppression, drug interactions, elevated viraemia, and intolerance to ribavirin (RBV), can reduce cure rates. We conducted a real-life study on liver transplant recipients with CHC treated with a combination of sofosbuvir (SOF) and daclatasvir (DCV) or simeprevir (SIM), with or without RBV, followed-up for 12 to 24 weeks. The treatment effectiveness was assessed by determining the sustained virological response (SVR) rates at 12 or 24 weeks after the treatment cessation. Eighty-four patients were evaluated, with a mean age of 63.4 ± 7.4 years, HCV genotype 1 being the most prevalent (63.1%). Nineteen patients (22.7%) had mild fibrosis (METAVIR < F2) and 41 (48.8%) significant fibrosis (METAVIR ≥ F2). The average time between liver transplantation and the start of treatment was 4 years (2.1-6.6 years). The SOF + DCV regimen was used in 58 patients (69%). RBV in combination with DAAs was used in seven patients (8.3%). SVR was achieved in 82 patients (97.6%), and few relevant adverse events could be attributed to DAA therapy, including a patient who stopped treatment due to a headache. There was a significant reduction in ALT, AST, GGT and FA levels, or the APRI index after 4 weeks of treatment, which remained until 12/24 weeks post-treatment. DAA treatment of CHC in liver-transplanted patients achieved a high SVR rate and resulted in the normalization of serum levels of liver enzymes.

New index for the diagnosis of liver fibrosis in Schistosomiasis mansoni / Novo índice biológico para o diagnóstico da fibrose hepática na Esquistossomose mansoni

ABSTRACT BACKGROUND Periportal fibrosis is the major pathological consequence of the Schistosoma mansoni infection. OBJECTIVE To evaluate the accuracy of serum markers and to construct an index to assess fibrosis. METHODS Patients (n=116) with schistosomiasis were evaluated by ultrasound scan and measurements of serum levels of aminotransferases, γ-glutamyl transferase, alkaline phosphatase, hyaluronic acid, cytokines and platelets. Ultrasound images were used to evaluate the fibrosis using Niamey's classification and identified 19 patients without periportal fibrosis (patterns A and B), 48 with mild to moderate fibrosis (C and D) and 49 with advanced fibrosis (E and F). RESULTS Using multivariate analysis, a model was created, which involved alkaline phosphatase and platelets and could separate patients with different patterns of fibrosis. This index showed a better performance in separating patients without fibrosis from with advanced periportal fibrosis. The biological index showed an area under the ROC curve of 1.000. Using values below the lowest or above the highest cut-off point, the presence or absence of advanced fibrosis could be predicted in all patients. CONCLUSION The index constructed can be used to separate patients with different patterns of periportal fibrosis, specially to predict advanced fibrosis in schistosomiasis patients.

RESUMO CONTEXTO A fibrose periportal é a maior consequência patológica da infecção pelo Schistosoma mansoni. OBJETIVO Avaliar a acurácia de marcadores séricos e construir um índice para avaliar a fibrose. MÉTODOS Pacientes (n=116) com esquistossomose foram avaliados pela ultrassonografia e dosados os níveis de aminotransferases, γ-glutamil transferase, fosfatase alcalina, ácido hialurônico, citocinas e plaquetas. Imagens de ultrasom foram utilizadas para avaliar a fibrose através de classificação de Niamey e identificados 19 pacientes sem fibrose periportal (padrão A e B), 48 com fibrose média a moderada (C e D) e 49 com fibrose avançada (E e F). RESULTADOS Através de análise multivariada, um modelo foi criado, que envolveu a fosfatase alcalina e plaquetas e conseguiu separar pacientes com diferentes padrões de fibrose periportal. Este índice mostrou um melhor desempenho em separar pacientes sem fibrose dos pacientes com fibrose avançada. O índice biológico mostrou uma área sob a curva ROC de 1,000. Usando valores infereiores e acima do ponto de corte, a presença ou ausência de fibrose avançada pode ser prevista em todos os pacientes. CONCLUSÃO O índice construído pode ser usado para separar os pacientes com diferentes padrões de fibrose periportal, especialmente para prever fibrose avançada em pacientes com esquistossomose.

New index for the diagnosis of liver fibrosis in Schistosomiasis mansoni.

BACKGROUND: - Periportal fibrosis is the major pathological consequence of the Schistosoma mansoni infection. OBJECTIVE: - To evaluate the accuracy of serum markers and to construct an index to assess fibrosis. METHODS: - Patients (n=116) with schistosomiasis were evaluated by ultrasound scan and measurements of serum levels of aminotransferases, γ-glutamyl transferase, alkaline phosphatase, hyaluronic acid, cytokines and platelets. Ultrasound images were used to evaluate the fibrosis using Niamey's classification and identified 19 patients without periportal fibrosis (patterns A and B), 48 with mild to moderate fibrosis (C and D) and 49 with advanced fibrosis (E and F). RESULTS: - Using multivariate analysis, a model was created, which involved alkaline phosphatase and platelets and could separate patients with different patterns of fibrosis. This index showed a better performance in separating patients without fibrosis from with advanced periportal fibrosis. The biological index showed an area under the ROC curve of 1.000. Using values below the lowest or above the highest cut-off point, the presence or absence of advanced fibrosis could be predicted in all patients. CONCLUSION: - The index constructed can be used to separate patients with different patterns of periportal fibrosis, specially to predict advanced fibrosis in schistosomiasis patients.

Hepatitis E virus seroprevalence among schistosomiasis patients in Northeastern Brazil

Abstract Background Hepatitis E virus (HEV) can cause chronic infection with rapid progression to liver cirrhosis in immunocompromised patients. HEV seroprevalence in patients with Schistosoma mansoni in Brazil is unknown. We evaluated the prevalence of past or present HEV infection in schistosomiasis patients in Recife, Pernambuco, Brazil. A total of 80 patients with Schistosoma mansoni were consecutively enrolled in a cross-sectional study. Serum samples were tested for the presence of anti-HEV IgG antibodies by enzyme immunoassay (Wantai anti-HEV IgG, Beijing, China) and for the presence of HEV RNA using real time reverse transcriptase-polymerase chain reaction with primers targeting the HEV ORF2 and ORF3. Clinical and laboratory tests as well as abdominal ultrasound were performed at the same day of blood collection. Results Anti-HEV IgG was positive in 18.8% (15/80) of patients with SM. None of the samples tested positive for anti-HEV IgM or HEV-RNA. Patients with anti-HEV IgG positive presented higher levels of alanine aminotranferase (p = 0.048) and gama-glutamil transferase (p = 0.022) when compared to patients without anti-HEV IgG antibodies. Conclusion This study demonstrates that the seroprevalence of HEV is high in patients with Schistosoma mansoni in Northeastern of Brazil. Past HEV infection is associated with higher frequency of liver enzymes abnormalities. HEV infection and its role on the severity of liver disease should be further investigated among patients with Schistosoma mansoni.

Hepatitis E virus seroprevalence among schistosomiasis patients in Northeastern Brazil.

BACKGROUND: Hepatitis E virus (HEV) can cause chronic infection with rapid progression to liver cirrhosis in immunocompromised patients. HEV seroprevalence in patients with Schistosoma mansoni in Brazil is unknown. We evaluated the prevalence of past or present HEV infection in schistosomiasis patients in Recife, Pernambuco, Brazil. A total of 80 patients with Schistosoma mansoni were consecutively enrolled in a cross-sectional study. Serum samples were tested for the presence of anti-HEV IgG antibodies by enzyme immunoassay (Wantai anti-HEV IgG, Beijing, China) and for the presence of HEV RNA using real time reverse transcriptase-polymerase chain reaction with primers targeting the HEV ORF2 and ORF3. Clinical and laboratory tests as well as abdominal ultrasound were performed at the same day of blood collection. RESULTS: Anti-HEV IgG was positive in 18.8% (15/80) of patients with SM. None of the samples tested positive for anti-HEV IgM or HEV-RNA. Patients with anti-HEV IgG positive presented higher levels of alanine aminotranferase (p=0.048) and gama-glutamil transferase (p=0.022) when compared to patients without anti-HEV IgG antibodies. CONCLUSION: This study demonstrates that the seroprevalence of HEV is high in patients with Schistosoma mansoni in Northeastern of Brazil. Past HEV infection is associated with higher frequency of liver enzymes abnormalities. HEV infection and its role on the severity of liver disease should be further investigated among patients with Schistosoma mansoni.

Estado nutricional de pacientes alcoolistas de uma Instituição hospitalar do Nordeste Brasileiro / Nutritional Status of alcoholic patients of a hospital institution of the Brazilian Northeast

Introdução: O alcoolismo é caracterizado pela ingestão repetitiva do álcool, constituindo atualmente um problema de saúde pública. O aproveitamento orgânico da energia fornecida pelas bebidas alcoólicas dependerá do estado nutricional do indivíduo, da frequência e do padrão de consumo, podendo levar ao sobrepeso e a obesidade, em consumidores moderados, e a desnutrição entre os usuários crônicos. Objetivo: avaliar o estado nutricional e associá-lo aos fatores sociodemográficos de pacientes alcoolistas internos. Metodologia: estudo do tipo transversal realizado em uma Instituição hospitalar do nordeste brasileiro. Foram incluídos na pesquisa todos os pacientes com diagnóstico de Síndrome de Dependência do Álcool (SDA), internos e que preenchiam os critérios de elegibilidade. A coleta de dados foi realizada por meio de questionário próprio estruturado, abordando informações sociodemográficas, antropométricas e de comorbidades. Resultados: foram avaliados 121 alcoolistas adultos, com média de idade de 43,59±9,53 anos, do sexo masculino. A prevalência foi de indivíduos divorciados (38%), desempregados (54,5%), com baixa escolaridade (44,6%) e com renda familiar entre um e dois salários mínimos (41,3%). Verificou-se, ainda, que 75,2% eram eutróficos, segundo o Índice de Massa Corporal (IMC), no entanto, 66,1%, 83,5% e 88,4% eram desnutridos, de acordo com a Prega Cutânea Tricipital (PCT), a Circunferência do Braço (CB) e a Circunferência Muscular do Braço (CMB), respectivamente. Em relação à obesidade abdominal, 92,6% e 72,7% dos indivíduos, foram classificados sem obesidade abdominal, segundo a Circunferência da Cintura (CC) e a Razão cintura/estatura (RCEst), respectivamente, e 91,7% sem risco para doença cardiovascular de acordo com a Razão cintura/quadril (RCQ). Conclusão: além de prejuízos sociais e econômicos causados pelo uso abusivo do álcool, evidenciou-se, também, os efeitos deletérios à saúde, principalmente ao estado nutricional, observando-se comprometimento tanto de massa magra quanto de massa gorda (AU)

Introduction: Alcoholism is characterized by repetitive intake of alcohol, currently constituting a public health problem. Organic use of the energy provided by alcohol depends on the nutritional status of the individual, the frequency and pattern of consumption, which can lead to overweight and obesity in moderate drinkers, and malnutrition among chronic users. Aim: To assess the nutritional status and associate it to socio-demographic factors of alcoholic inpatients. Methodology: Study of a cross-sectional type made in a hospital institution of the Brazilian Northeast. All patients with diagnoses for Alcohol Dependence Syndrome (ADS) were included in the research, inpatients and those who fulfilled the eligibility criterion. The data collection was done through a proper structured questionnaire, approaching socio-demographic information, anthropometrical and of comorbidities. Results: 121 alcoholic adults were assessed, with an age range of 43,59±9,53 years old, of the masculine gender. The prevalence was of divorced individuals (38%), unemployed (54,5%), with low school level (44,6%) and with family income between one and two minimum wages (41,3%). It was also verified that 75,2% of them were eutrophic, according to the Body Mass Index (BMI), however 66,1%, 83,5% and 88,4% were malnourished, according to the Triceps Skinfold Thickness (TSF), the Arm Circumference (AC) and the Arm Muscle Circumference (AMC), respectively. As for the abdominal obesity, 92,6% and 72,7% of the individuals were classified as with no abdominal obesity, according to the Waist Circumference (WC) and the waist-to-height (WHtR), respectively, and 91,7% with no risk to cardiovascular disease in accordance to waist hip ratio (WHR). Conclusion: Besides the social and economic damages caused by the excessive alcohol consumption, It also became clear the detrimental health effects, mainly to the nutritional status, with the impairment of either the lean mass or the fat mass being observed (AU)

Ultrasound versus biological markers in the evaluation of periportal fibrosis in human Schistosoma mansoni.

In this paper, the authors review the literature and share their experience of the principal biological markers of fibrosis for the evaluation of periportal fibrosis (PPF) caused by mansoni schistosomiasis. These biological markers are compared to diagnostic ultrasound (US) scans as means of grading PPF. We also review procollagen type I and III, collagen type IV, laminin, hyaluronic acid (HA), immunoglobulin G, platelets, aspartate aminotransferase to platelet ratio index (APRI) and gamma-glutamyl transpeptidase as markers of the disease. Although there are several good markers for evaluating PPF and portal hypertension, such as HA, platelets or APRI, none can yet replace US. These markers may, however, be used to identify patients at greater risk of developing advanced disease in endemic areas and determine who will need further care and US studies.

Ultrasound versus biological markers in the evaluation of periportal fibrosis in human Schistosoma mansoni

In this paper, the authors review the literature and share their experience of the principal biological markers of fibrosis for the evaluation of periportal fibrosis (PPF) caused by mansoni schistosomiasis. These biological markers are compared to diagnostic ultrasound (US) scans as means of grading PPF. We also review procollagen type I and III, collagen type IV, laminin, hyaluronic acid (HA), immunoglobulin G, platelets, aspartate aminotransferase to platelet ratio index (APRI) and gamma-glutamyl transpeptidase as markers of the disease. Although there are several good markers for evaluating PPF and portal hypertension, such as HA, platelets or APRI, none can yet replace US. These markers may, however, be used to identify patients at greater risk of developing advanced disease in endemic areas and determine who will need further care and US studies.