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1.
Braz J Infect Dis ; 20(2): 205-9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26867472

RESUMO

Brazil is one of the 22 countries that concentrates 80% of global tuberculosis cases concomitantly to a large number of hepatitis C carriers and some epidemiological risk scenarios are coincident for both diseases. We analyzed tuberculosis cases that occurred during α-interferon-based therapy for hepatitis C in reference centers in Brazil between 2001 and 2012 and reviewed their medical records. Eighteen tuberculosis cases were observed in patients submitted to hepatitis C α-interferon-based therapy. All patients were human immunodeficiency virus-negative. Nine patients (50%) had extra-pulmonary tuberculosis; 15 (83%) showed significant liver fibrosis. Hepatitis C treatment was discontinued in 12 patients (67%) due to tuberculosis reactivation and six (33%) had sustained virological response. The majority of patients had a favorable outcome but one died. Considering the evidences of α-IFN interference over the containment of Mycobacterium tuberculosis, the immune impairment of cirrhotic patients, the increase of tuberculosis case reports during hepatitis C treatment with atypical and severe presentations and the negative impact on sustained virological response, we think these are strong arguments for latent tuberculosis infection screening before starting α-interferon-based therapy for any indication and even to consider IFN-free regimens against hepatitis C when a patient tests positive for latent tuberculosis infection.


Assuntos
Antivirais/efeitos adversos , Hepatite C Crônica/tratamento farmacológico , Interferon-alfa/efeitos adversos , Tuberculose/epidemiologia , Adulto , Antivirais/uso terapêutico , Brasil/epidemiologia , Coinfecção/epidemiologia , Feminino , Hepatite C Crônica/epidemiologia , Humanos , Incidência , Interferon-alfa/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tuberculose/imunologia
2.
Ann Hepatol ; 14(3): 317-24, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25864211

RESUMO

BACKGROUND: HBV/HCV coinfection is a common finding among hemodialysis patients. However, there is scarce information concerning the impact of HBV coinfection on the response to treatment of HCV-infected patients on hemodialysis. AIM: We aimed to compare the rate of sustained virologic response (SVR) to treatment with interferon-alfa (IFN) between hemodialysis patients with HBV/HCV coinfection and those with HCV-monoinfection. MATERIAL AND METHODS: HCV-infected patients on hemodialysis treated with IFN were included. Patients coinfected by HBV/HCV were compared to HCV-monoinfected patients, regarding clinical and biochemical features and rates of SVR. RESULTS: One hundred and eleven patients were treated. HBV/HCV coinfection was observed in 18/111 patients (16%). Coinfected patients were younger (p = 002), had more time on dialysis (p = 0.05) and showed a tendency to present a higher prevalence of septal fibrosis (p = 0.06). The analysis by intention to treat showed SVR of 56% among coinfected patients and 18% in HCV-monoinfected patients (p = 0.004). CONCLUSION: In conclusion, end-stage renal disease patients with HBV/HCV coinfection exhibit higher rate of SVR to HCV treatment than HCV-monoinfected patients. It is possible that factors related to the host immune response and viral interaction could explain the better response observed among coinfected patients.


Assuntos
Antivirais/uso terapêutico , Coinfecção , Hepatite B Crônica/complicações , Hepatite C Crônica/complicações , Falência Renal Crônica/terapia , Diálise Renal , Feminino , Seguimentos , Hepatite B Crônica/tratamento farmacológico , Hepatite C Crônica/tratamento farmacológico , Humanos , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
3.
Clin Transplant ; 26(6): 842-8, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22594774

RESUMO

BACKGROUND: information regarding histological progression of hepatitis C after renal transplant (RTx) is scarce. AIMS: To analyze clinical and laboratory evolution and histological progression of hepatitis C in patients evaluated before and after RTx. METHODS: Twenty-two HCV-infected patients submitted to liver biopsy pre- and post-RTx were included. A semiquantitative analysis of necroinflammatory activity and fibrosis staging was performed and the two biopsies were compared. RESULTS: Patients were mostly men (73%) with mean age of 36±9 yr. Time post-transplant was 4±2 yr and time between biopsies was 5±2 yr. An elevation of alanine aminotransferase (p=0.041) and aspartate aminotransferase (p=0.004) levels was observed in the post-transplant period. Fibrosis progression after renal transplantation was observed in 11 (50%) of the patients, and necroinflammatory activity worsening was observed in 7 (32%) of the patients. The histological progression occurred even among those without significant histological lesions in pre-transplant biopsy. CONCLUSION: The findings of this study suggest that the practice of indicating treatment in the pre-transplant phase based mainly on histological disease should be revised, because a high proportion of patients present disease progression. Because interferon cannot be used safely after RTx, treatment should be indicated for all ESRD patients with hepatitis C.


Assuntos
Hepacivirus/patogenicidade , Hepatite C Crônica/patologia , Falência Renal Crônica/cirurgia , Transplante de Rim/efeitos adversos , Cirrose Hepática/patologia , Complicações Pós-Operatórias , Adulto , Progressão da Doença , Feminino , Seguimentos , Taxa de Filtração Glomerular , Hepatite C Crônica/etiologia , Hepatite C Crônica/virologia , Humanos , Falência Renal Crônica/complicações , Cirrose Hepática/etiologia , Cirrose Hepática/virologia , Estudos Longitudinais , Masculino , Prognóstico , Fatores de Risco , Taxa de Sobrevida
4.
Rheumatol Int ; 30(11): 1515-8, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19705122

RESUMO

Mixed cryoglobulinemia is one of the most closely related extrahepatic manifestations of hepatitis C virus and requires a challenging therapeutic approach depending on the severity of the symptoms. Here, we describe the long-term follow-up of a patient with important cutaneous, articular and neural manifestations of cryoglobulinemia associated with chronic hepatitis C treated with rituximab. A 42-year-old woman who did not respond to previous interferon-based treatments (standard and pegylated interferon plus ribavirin) and corticosteroids was subjected to treatment with rituximab at a dose of 375 mg/m(2) per week for 4 consecutive weeks. The drug was well tolerated and complete improvement of arthralgia was immediately evident. There was gradual improvement of lower limbs paresthesia and healing of a leg ulcer that had been active for 5 years. The clinical and immunological responses induced by rituximab are sustained over long-term follow-up, and this case illustrates the drug efficacy for non-responder patients to antiviral therapy.


Assuntos
Anticorpos Monoclonais Murinos/uso terapêutico , Crioglobulinemia/tratamento farmacológico , Crioglobulinemia/imunologia , Hepatite C Crônica/complicações , Hepatite C Crônica/imunologia , Adulto , Antirreumáticos/farmacologia , Antirreumáticos/uso terapêutico , Feminino , Humanos , Rituximab , Tempo , Resultado do Tratamento
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