Acute exacerbation of chronic hepatitis B virus infection in renal transplant patients

Introduction: There is scarce information regarding clinical evolution of HBV infection in renal transplant patients. Aims: To evaluate the prevalence of acute exacerbation in HBV-infected renal transplant patients and its association with the time after transplantation, presence of viral replication, clinical evolution, and use of antiviral prophylaxis. Materials and methods: HBV infected renal transplant patients who underwent regular follow-up visits at 6-month intervals were included in the study. The criteria adopted to characterize exacerbation were: ALT >5 × ULN and/or >3 × baseline level. Predictive factors of exacerbation evaluated were age, gender, time on dialysis, type of donor, post-transplant time, ALT, HBeAg, HBV-DNA, HCV-RNA, immunosuppressive therapy, and use of antiviral prophylaxis. Results: 140 HBV-infected renal transplant patients were included (71% males; age 46 ±10 years; post-renal transplant time 8 ±5 years). During follow-up, 25% (35/140) of the patients presented exacerbation within 3.4 ±3 years after renal transplant. Viral replication was observed in all patients with exacerbation. Clinical and/or laboratory signs of hepatic insufficiency were present in 17% (6/35) of the patients. Three patients died as a consequence of liver failure. In univariate analysis variables associated with exacerbation were less frequent use of prophylactic/preemptive lamivudine and of mycophenolate mofetil. Lamivudine use was the only variable independently associated with exacerbation, with a protective effect. Conclusions: Acute exacerbation was a frequent and severe event in HBV-infected renal transplant patients. Prophylactic/preemptive therapy with antiviral drugs should be indicated for all HBsAg-positive renal transplant patients. .

Aspectos epidemiológicos de pacientes com doença renal crônica e hepatite C submetidos a hemodiálise em Belém (PA) / Epidemiological aspects of patients with chronic kidney disease and hepatitis C infection on hemodialysis in Belém (PA)

Objetivo: Avaliar o perfil epidemiológico de pacientes com doença renal crônica e hepatite C submetidos a hemodiálise em Belém (PA). Método: estudo transversal realizado através de protocolos auto-aplicáveis em 46 pacientes matricu-lados em 5 unidades de Hemodiálise de Belém (PA), nos meses de agosto e setembro de 2010. Resultados: a maioria dos pacientes era do sexo masculino, sendo a nefropatia diabética a principal doença de base (43,5%). A incidência de Hepatite C após início de tratamento dialítico foi de 67,4%, a idade média de infecção foi menor nos pacientes que tiveram diagnóstico durante a hemodiálise, o tempo de hemodiálise maior que 5 anos e realizar diálise em diferentes serviços demonstraram maior risco de infecção, além disso, houve alteração dos níveis de alanina aminotrasferase (ALT) de 11 pacientes antes, durante e após a soroconversão. Conclusão: pacientes submetidos a hemodiálise tem risco maior de infecção pelo Vírus da Hepatite C (VHC) do que na população em geral, sendo necessária permanente vigilância e controle nos fatores de risco associados.

Revista Paraense de Medicina - V.28 (1) janeiro-março 2014 19Objective: The purpose of this study was to evaluate epidemiological aspects of patients with chronic kidney disease and hepatitis C infection on hemodialysis in Belem (PA). Methods: transversal, retrospective and prospective study was conducted through analysis of self-applicable protocols of 46 patients during August and September of 2010. Re-sults: the prevalence of male witch diabetic nephropathy was the first cause of chronic kidney disease (43,5%), 67,4% were anti-HCV positive after starting dialysis treatment, the average age was lower in patients diagnosed during hemodialysis,time of dialysis longer than 5 years and hemodialysis in different services have an increased risk for HCV infection, ALT average of 11 patients were significant a month before seroconversion, in month with anti-HCV positive and a month after seroconversion. Final Considerations: Patients in hemodialysis have important risk factors for Hepatitis C infection requiring permanent surveillance.

Hepatitis B virus genotypes in Southeast Brazil and its relationship with histological features

Data concerning the relationship between hepatitis B virus (HBV) genotypes and liver histology are scarce. The aim of this study was to compare HBV non-B and non-C genotypes according to demographic features, clinical status, HBV-DNA levels and liver histology in Rio de Janeiro. One hundred twenty one consecutive chronic HBV-infected patients were enrolled during two-year period and data were prospectively collected. Sera were tested for HBV genotyping using restriction fragment length polymorphism. Liver biopsy was obtained from patients with either increased alanine aminotransferase (ALT) or HBV-DNA levels. Genotype A was the most common, found in 82 (68%) patients, followed by F in 19 (15%), D in 17 (14%), B in one (1%) and C in two (2%). There was no association between HBV genotypes A, D and F and gender (p = 0.37), age (p = 0.78), race (p = 0.22), mode of infection (p = 0.94), HB "e" antigen status (p = 0.37) and HBV-DNA levels (p = 0.47). The ALT levels were lower in genotype D (75%) compared with A (47%) and F (55%) (p = 0.05). Liver biopsy showed lower inflammation [histological activity index (HAI) = 4] and fibrosis (F) (= 0) scores in genotype D than in genotypes A (HAI = 5, p < 0.001; F = 2, p = 0.008) or F (HAI = 5, p = 0.009; F = 2, p = 0.01). Genotype A was the most prevalent in chronic HBV-infected patients and genotype D patients presented with less intense liver disease.

Avaliação da atividade enzimática de gama-glutamiltransferase em ex-dependentes do álcool / Evaluation of gamma-glutamyltransferase enzimatic activity in former-alcoholics

O alcoolismo é uma doença crônico-degenerativa originada pela dependência química do álcool que leva a degeneração hepática, sendo uma das principais causas de cirrose hepática. As lesões hepatocelulares cursam com icterícia e aumento na atividade de enzimas hepáticas como a alanina-aminotransferase (ALT), Aspartato-aminotransferase (AST) e gama-glutamil-transferase (GGT). A GGT aumenta em indivíduos alcoolistas mesmo quando não há lesão hepática evidente. Para verificar a atividade plasmática de GGT em ex-dependentes do álcool foi realizada a dosagem de GGT, AST e ALT em 35 voluntários da Associação dos Alcoólicos Anônimos do Pará. Não foiobservada variação significativa (p>0,05) nos valores médios das dosagens de ALT (20,8UI/L +- 7,2) e AST (24,7 UI/L +- 5,2). Entretanto, os valores médios das dosagens (30,9 UI/L +- 31,2)apresentaam variação significativa (p<0,001) devido a indivíduos com tempo de abstinência menor que dois meses que tiveram um aumento de três vezes na atividade de GGT é um indicador de alcoolismo recente permanecendo aumentada por até dois meses de abstinência, retornando aos níveis de referência com o aumento do tempo de abstinência.

Epidemiological aspects of hepatitis C virus infection among renal transplant recipients in Central Brazil

An investigation was conducted involving 255 renal transplant recipients in the state of Goiás, Central Brazil, to determine the prevalence of hepatitis C virus (HCV), its risk factors, the genotypes involved, and the level of alanine aminotransferase (ALT) present in the patients. All serum samples were tested for anti-HCV antibodies and HCV RNA. Forty-one patients were anti-HCV and/or HCV RNA positive, resulting in an overall HCV infection prevalence of 16.1 percent (95 percent CI: 11.9-21.3). A multivariate analysis of risk factors showed that a history of blood transfusions without anti-HCV screening, the length of time spent on hemodialysis, and renal transplantation before 1994 are all associated with HCV positivity. In HCV-positive patients, only 12.2 percent had ALT levels above normal. Twenty-eight samples were genotyped as genotype 1, subtypes 1a (62.5 percent) and 1b (31.3 percent), and two samples (6.2 percent) were genotype 3, subtype 3a. These data show a high prevalence of HCV infection and low ALT levels in the studied population. The risk factor analysis findings emphasize the importance of public health strategies such as anti-HCV screening of candidate blood and organ donors, in addition to the stricter adoption of hemodialysis-specific infection control measures. The present study also demonstrates that HCV genotype 1 (subtype 1a) is predominant in this population.