Incidência de hepatite viral C em pacientes em hemodiálise no Brasil entre 2000 e 2003 / Hepatitis C incidence in hemodialysis patients in Brazil from 2000 to 2003 / Incidencia de hepatitis viral C en pacientes en hemodiálisis en Brasil entre 2000 y 2003

Resumo: O estudo visou estimar a incidência dos fatores associados à soroconversão para o anti-HCV em pacientes em hemodiálise no Sistema Único de Saúde (SUS). Trata-se de um estudo prospectivo, não concorrente, utilizando dados de pacientes identificados por relacionamento determinístico-probabilístico nos registros dos sistemas de informação do SUS. Foram incluídos 47.079 pacientes que iniciaram em hemodiálise no período de 1º de janeiro de 2000 a 31 de dezembro de 2003, acompanhados até a soroconversão ou o término do estudo em 2004. Nesta pesquisa, 3% dos pacientes em hemodiálise apresentaram soroconversão para anti-HCV (incidência de 1,7 soroconversão por 100 pacientes/ano). Maior risco de soroconversão para o anti-HCV foi associado com idade, glomerulonefrites, região de residência, anti-HIV positivo e efeito da unidade de diálise. A incidência observada de soroconversão para anti-HCV foi semelhante à registrada em alguns países desenvolvidos, destacando-se a evidência de transmissão entre os pacientes em hemodiálise.

Abstract: The study aimed to estimate the incidence of HCV seroconversion in hemodialysis patients in the Brazilian Unified National Health System (SUS). This was a prospective, non-concurrent study using patients' data identified by deterministic and probabilistic record linkage in the SUS information system. The study included 47,079 patients started on hemodialysis between January 1, 2000, and December 31, 2003, followed until seroconversion or conclusion of the study in 2004. Three percent of hemodialysis patients HCV-seroconverted (1.7 per 100 patient-years). Increased risk of HCV seroconversion was associated with age, glomerulonephritis, geographic region, HIV-positivity, and dialysis service. The observed HCV seroconversion rate was similar to that in developed countries, highlighting evidence of transmission among hemodialysis patients.

Resumen: El estudio tuvo como objetivo estimar la incidencia de los factores asociados a la seroconversión para el anti-VHC en pacientes en hemodiálisis dentro del Sistema Único de Salud (SUS). Se trata de un estudio prospectivo, no concurrente, utilizando datos de pacientes identificados por relación determinístico-probabilística en los registros de los sistemas de información del SUS. Se incluyeron a 47.079 pacientes que comenzaron la hemodiálisis durante el período del 1º de enero de 2000 a 31 de diciembre de 2003, seguidos hasta la seroconversión al final del estudio en 2004. En este estudio, un 3% de los pacientes en hemodiálisis presentaron seroconversión para anti-VHC (incidencia de 1,7 seroconversiones por 100 pacientes/año). El mayor riesgo de seroconversión para el anti-VHC fue asociado a la edad, glomerulonefritis; región de residencia, presentar anti-VIH positivo y a los efectos de la unidad de diálisis. En ese estudio, la incidencia observada de seroconversión para anti-VHC fue semejante a la registrada en algunos países desarrollados, destacándose la evidencia de transmisión entre los pacientes en hemodiálisis.

Sexual dysfunction and dissatisfaction in chronic hepatitis C patients

Introduction The prevalence of sexual dysfunction (SD) and dissatisfaction with sexual life (DSL) in patients with chronic hepatitis C virus infection (CHC) was jointly investigated via a thorough psychopathological analysis, which included dimensions such as fatigue, impulsiveness, psychiatric comorbidity, health-related quality of life (HRQL) and sociodemographic and clinical characteristics. Methods Male and female CHC patients from an outpatient referral center were assessed using the Brief Fatigue Inventory, the Barrat Impulsiveness Scale, the Beck Depression Inventory (BDI), the Hospital Anxiety and Depression Scale, the Hamilton Anxiety Scale (HAM-A), and the World Health Organization Quality of Life Scale-Brief Version (WHOQOL-BREF). Structured psychiatric interviews were performed according to the Mini-International Neuropsychiatric Interview. SD was assessed based on specific items in the BDI (item 21) and the HAM-A (item 12). DSL was assessed based on a specific question in the WHOQOL-BREF (item 21). Multivariate analysis was performed according to an ordinal linear regression model in which SD and DSL were considered as outcome variables. Results SD was reported by 60 (57.1%) of the patients according to the results of the BDI and by 54 (51.4%) of the patients according to the results of the HAM-A. SD was associated with older age, female gender, viral genotype 2 or 3, interferon-α use, impulsiveness, depressive symptoms, antidepressant and benzodiazepine use, and lower HRQL. DSL was reported by 34 (32.4%) of the patients and was associated with depressive symptoms, anxiety symptoms, antidepressant use, and lower HRQL. Conclusions The prevalence of SD and DSL in CHC patients was high and was associated with factors, such as depressive symptoms and antidepressant use. Screening and managing these conditions represent significant steps toward improving medical assistance and the HRQL of CHC patients. .

Health related quality of life among patients with chronic hepatitis C: a cross-sectional study of sociodemographic, psychopathological and psychiatric determinants

INTRODUCTION: Chronic hepatitis C virus infection patients have higher rates of psychiatric disorders than the general population. Chronic hepatitis C virus infection is known to be associated with impaired health related quality of life. To our knowledge, there is no previous research of health related quality of life in chronic hepatitis C patients that combined structured psychiatric interview and careful psychopathological evaluation, including depression, anxiety and fatigue instruments. The aim of this study was to evaluate health related quality of life of chronic hepatitis C patients and to investigate the association with sociodemographic, psychopathological and psychiatric factors. MATERIALS AND METHODS: Eighty-one individuals with chronic hepatitis C virus infection receiving care at a Brazilian public university-based outpatient service for infectious diseases were enrolled in the study. The World Health Organization Quality of Life Scale Brief Version was used to assess health related quality of life. Standard psychiatric interview (Mini International Neuropsychiatric Interview-Plus) was conducted to establish Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I psychiatric diagnosis. Further instruments completed psychopathological investigation: Beck Depression Inventory, Hospital Anxiety and Depression Scale, Brief Fatigue Inventory, Hamilton Depression Scale and Hamilton Anxiety Scale. Pearson Chi-Square and Kruskal-Wallis were performed for categorical and continuous univariate analysis, respectively. Correlation between psychopathological and health related quality of life scores was performed according to Spearman's correlation. Multivariate analysis was performed according to stepwise forward ordinal logistic regression. The significance threshold was fixed at α = 0.05. RESULTS: Depressive disorders were associated with worse scores in overall health related quality of life and in all domains. Fatigue was associated with lower scores in physical and psychological domains, and married status with higher scores in psychological health related quality of life. We found strong correlation among scores of depression, fatigue and health related quality of life. CONCLUSION: Depression and fatigue must be properly investigated and managed in HCV patients in order to improve HRQL. WHOQOL-BREF proved to be a useful instrument to assess HRQL in HCV patients.

Vulnerabilidade e fatores associados a HIV e sífilis em homens que fazem sexo com homens, Belo Horizonte, MG / Vulnerability and factors associated with HIV and syphilis among men who have sex with men, Belo Horizonte, MG

Introdução: a epidemia do HIV no Brasil caracteriza-se como concentrada em populações-chave, incluindo homens que fazem sexo com homens (HSH). No entanto, são pouco conhecidos os indicadores de monitoramento e avaliação da epidemia em nível estadual ou municipal destas populações. Objetivo: descrever comportamentos de risco e prevalências de HIV e sífilis em população de HSH em Belo Horizonte, MG.Métodos: estudo de corte transversal parte de estudo multicêntrico nacional entre HSH adultos. A amostra foi recrutada pela técnica Respondent Driven Sampling (RDS). Foram realizadas entrevistas semiestruturadas e exames para HIV e sífilis. Resultados: foram recrutados 274 HSH em Belo Horizonte. Os participantes eram principalmente indivíduos jovens, com alta escolaridade, de classes sociais A/B, que se autorreferiram gay ou homossexual e tinham alta proporção do uso irregular de preservativos. As prevalências ponderadas da infecção pelo HIV e de sífilis foram, respectivamente, 10,3 e 13,9%. Idade, cor, contar para a mãe ou pai sobre a orientação sexual, testagem prévia para o HIV ou sífilis, diagnóstico prévio de sífilis ou de outras DSTs foram estatisticamente associados a ambas as infecções (p<0,05). Estado civil, família ser indiferente ou desaprovar a opção sexual, ter melhor conhecimento sobre HIV/Aids, mas não saber avaliar sua percepção de risco estiveram estatisticamente associados somente ao HIV e classe social somente com sífilis. Conclusão: os resultados revelam a gravidade da epidemia do HIV na população de HSH residentes em Belo Horizonte. Políticas públicas no nível municipal e estadual devem ser implementadas e/ou revistas com urgência...

Introduction: The HIV epidemic in Brazil is characterized as concentrated on key populations, incluiding men Who have sex with men (MSM). However, monitoring and evaluation indicators are not well known at Municipal or State levels. Objective: To describe risk behaviors and HIV and syphilis prevalences among MSM in Belo Horizonte, MG. Methods: Crosssectional study part of a national multicenter study among adult MSM in Brazil. The sample was recruited using Respondent Driven Sampling (RDS) technique. Semistructure interviews and serological exams for HIV and syphilis were conducted. Resultads: A total of 274 MSM were recruited in Belo Horizonte. Participants were mostly young, with high education, social classes A/B, self-reported as gay or homosexual and with high proportion of irregular use of condoms. Weighted prevalence of HIV infection and syphilis were, respectively, 10.3% and 13.9%. Age, color, sharing with their mother or father their sexual orientation, prior HIV and syphilis testing, and previous diagnosis of syphilis or other STDs were statistically associated with both infections (p<0.05). Marital status, family disapproval or indifference of their sexual orientation, better HIV/Aids knowledge, not knowing their chances of acquiring HIV were statistically associated only with HIV and social class only with syphilis. Conclusion: These results indicate the severity of the HIV epidemic amongthe MSM population in Belo Horizonte. Public policies at the municipal and state levels must be implemented and/or revised urgently...

Soluble inflammatory markers as predictors of virological response in patients with chronic hepatitis C virus infection treated with interferon-α plus ribavirin

The host immune response plays an important role in viral clearance in patients who are chronically infected with hepatitis C virus (HCV) and are treated with interferon and ribavirin. Activation of the immune system involves the release of pro and anti-inflammatory molecules that can be measured in plasma samples. The present study aimed to evaluate the association between pretreatment plasma levels of chemokines and soluble tumor necrosis factor receptors (sTNF-R) and the virological response in treated patients with chronic hepatitis C infection. Forty-one chronically-infected HCV patients that were being treated with interferon-α (IFN-α) plus ribavirin were included in the study. Socio-demographic, clinical and laboratory data were collected and pretreatment plasma levels of chemokine CCL2, CCL3, CCL11, CCL24, chemokine CXCL9, CXCL10, sTNF-R1 and sTNF-R2 were measured. The virological response was assessed at treatment week 12, at the end of treatment and 24 weeks after treatment. Pretreatment CXCL10 levels were significantly higher in patients without an early virological response (EVR) or sustained virological response (SVR) compared to responders [512.9 pg/mL vs. 179.1 pg/mL (p = 0.011) and 289.9 pg/mL vs. 142.7 pg/mL (p = 0.045), respectively]. The accuracy of CXCL10 as a predictor of the absence of EVR and SVR was 0.79 [confidence interval (CI) 95 percent: 0.59-0.99] and 0.69 (CI 95 percent: 0.51-0.87), respectively. Pretreatment plasma levels of the other soluble inflammatory markers evaluated were not associated with a treatment response. Pretreatment CXCL10 levels were predictive of both EVR and SVR to IFN-α and ribavirin and may be useful in the evaluation of candidates for therapy.

Hyaluronic acid in the evaluation of liver fibrosis in patients with hepatitis C on haemodialysis

BACKGROUND: This study evaluated the role of HA as a marker of liver fibrosis in patients with hepatitis C on haemodialysis. METHODS: This is a cross-sectional study in which 52 patients were divided into two groups: Group 1: patients with hepatitis C and end-stage renal disease (ESRD) undergoing haemodialysis (n = 23); and Group 2: patients with hepatitis C without ESRD (n = 29). Plasma levels of HA were associated with histological data of the samples obtained by liver biopsy and classified by METAVIR group scoring system. RESULTS: Higher plasma levels were significantly correlated to significant liver fibrosis (METAVIR > F2). In Group 1, the HA cutoff to discriminate significant fibrosis was 984.8 ng/mL, with accuracy, sensitivity and specificity of 80.8 percent, 83.0 percent, and 70.0 percent, respectively. In Group 2, the HA cutoff was 222.3 ng/mL, with accuracy, sensitivity and specificity of 74.5 percent, 70.0 percent, and 94.0 percent, respectively. CONCLUSION: HA was an accurate noninvasive marker in predicting significant fibrosis in patients with hepatitis C on haemodialysis.

Soluble inflammatory markers as predictors of hepatocellular damage and therapeutic response in chronic hepatitis C

Hepatitis C is an important burden worldwide being an important cause of cirrhosis and liver cancer in different parts of the world. Host immune response, especially T helper type 1 (Th1) cell-mediated, seems to play an important role in disease progression but is also crucial for viral elimination following specific therapy. Immune activation can be evaluated using peripheral levels of different cytokines, such as different chemokines (e.g. CCL5, CXCL10) and tumor necrosis factor alpha (TNF-á), and their soluble receptors (e.g. soluble TNF-á receptors 1 (sTNF-R1) and 2 (sTNF-R2). This review article focuses on the potential use of peripheral inflammatory markers as predictors of liver histological changes and therapeutic response among patients with chronic hepatitis C.

HIV, syphilis, and hepatitis B and C prevalence among patients with mental illness: a review of the literature / Prevalência de infecção por HIV, sífilis e hepatite B e C entre portadores de doenças mentais crônicas

A limited number of studies worldwide have investigated the prevalence of HIV, syphilis, and hepatitis B and C infection among psychiatric patients. However, prevalence of these infections in the population with chronic mental illness has not been clearly established. Most of the published papers are from developed countries and have derived from relatively small and non-representative samples. We performed a systematic review of the published literature to identify studies on these infectious diseases within psychiatric populations in Brazil and other developing countries. Overall, prevalence rates varied from 0 percent to 29 percent for HIV; 1.6 percent to 66 percent for HBV; 0.4 percent to 38 percent for HCV; and 1.1 percent to 7.6 percent for syphilis. Several risk factors were identified and discussed, although sampling limitations restrict the generalization of study findings. This review highlights the lack of information on the prevalence of sexually transmitted diseases and their associated factors among persons with chronic mental illness and identifies gaps in the knowledge base in both developing and developed countries.

Os portadores de doenças mentais crônicas encontram-se em risco para a infecção pelo HIV e outras infecções sexualmente transmissíveis. Entretanto, a prevalência dessas infecções entre portadores de doença mental crônica ainda não está claramente estabelecida nesta população. A maioria dos trabalhos sobre o tema foi conduzida em países desenvolvidos, com amostras relativamente pequenas e não representativas. Foi realizada uma revisão sistemática da literatura para identificar estudos sobre a prevalência do HIV, sífilis, hepatite B e C entre pacientes com doença mental crônica no Brasil e no mundo. De um modo geral, as prevalências variaram de 0 por cento a 29 por cento, 3 a 66 por cento, 0,4 a 38 por cento e 3,3 por cento a 7,6 por cento para HIV, hepatite B, hepatite C e sífilis, respectivamente. Vários fatores de risco foram identificados e discutidos, embora a literatura atual não demonstre achados significativos gerados por estudos representativos. Tal revisão destaca a escassez de informação sobre a prevalência de infecções sexualmente transmitidas e seus fatores associados entre portadores de doenças mentais crônicas e identifica lacunas no conhecimento atual em países desenvolvidos bem como nos em desenvolvimento.