Rheumatological manifestations associated with viral Hepatitis B or C

Abstract INTRODUCTION Rheumatological findings and rheumatic diseases may be associated with hepatitis virus infection. This study assessed the frequency of these manifestations in a reference unit in Acre, Brazil. METHODS This was a cross-sectional study with a convenience sample of patients having their first consultation at the rheumatology outpatient clinics of a referral unit in Rio Branco, Acre, from March to November 2017. Sociodemographic, clinical, laboratory, and imaging data registereds using a standardized questionnaire form. RESULTS Among the 600 patients with rheumatic complaints, 3.0% were newly diagnosed with hepatitis B virus (HBV) or hepatitis C virus (HCV), and 8.7% were previously diagnosed with hepatitis. Among the 70 patients with hepatitis, 54.3% were carriers of HBV and 45.7% of HCV. For patients infected with HBV and HCV, arthralgia was the most prevalent rheumatic manifestation in 97.4% and 90.6%, followed by myalgia in 81.6% and 65.6%, and arthritis in 26.3% and 40.6% of patients, respectively, according to the descriptive analysis performed using the Statistical Package for the Social Sciences software. In comparative analyses using the chi-squared test, despite the fact that fibromyalgia was the most prevalent rheumatic disease only the Rheumatoid Arthritis there were differences in distribution between the carriers of HCV (18.8%) and HBV (2.6%). According to the Fisher's exact test, hypothyroidism was the most frequent comorbidity in patients with HCV (21.9%). CONCLUSIONS An increased frequency of musculoskeletal manifestations, better than those reported in the medical literature, in patients infected with HBV and HCV was observed.

Prognostic factors of the short-term outcomes of patients with hepatitis B virus-associated acute-on-chronic liver failure

OBJECTIVE: To investigate the impact of the baseline status of patients with hepatitis B virus-associated acute-on-chronic liver failure on short-term outcomes. METHODS: A retrospective study was conducted that included a total of 138 patients with hepatitis B virus-associated acute-on-chronic liver failure admitted to the Department of Infectious Diseases, Taihe Hospital, Hubei University of Medicine, from November 2013 to October 2016. The patients were divided into a poor prognosis group (74 patients) and a good prognosis group (64 patients) based on the disease outcome. General information, clinical indicators and prognostic scores of the patients' baseline status were analyzed, and a prediction model was established accordingly. RESULTS: Elder age, treatment with artificial liver support systems and the frequency of such treatments, high levels of white blood cells, neutrophils, neutrophil count/lymphocyte count ratio, alanine aminotransferase, gamma-glutamyl transferase, total bilirubin, urea, and prognostic scores as well as low levels of albumin and sodium were all significantly associated with the short-term outcomes of hepatitis B virus-associated acute-on-chronic liver failure. The predictive model showed that logit (p) = 3.068 + 1.003 × neutrophil count/lymphocyte count ratio - 0.892 × gamma-glutamyl transferase - 1.138 × albumin - 1.364 × sodium + 1.651 × artificial liver support therapy. CONCLUSION: The neutrophil count/lymphocyte count ratio and serum levels of gamma-glutamyl transferase, albumin and sodium were independent risk factors predicting short-term outcomes of hepatitis B virus-associated acute-on-chronic liver failure, and the administration of multiple treatments with artificial liver support therapy during the early stage is conducive to improved short-term outcomes.

Does infection by the hepatitis C virus decrease the response of immunization against the hepatitis B virus in individuals undergoing dialysis? / Infecção pelo virus da hepatite C diminui a resposta vacinal para o vírus da hepatite B em uma população em diálise?

Abstract Introduction: Vaccination is the most effective tool in preventing transmission of Hepatitis B Virus (HBV). The patient with chronic kidney disease (CKD) on dialysis appear to be at greater risk of becoming infected with this virus and does not show the same vaccine response when compared to patients without uremia. Objectives: To evaluate the results related to the HBV vaccine and identify factors associated with the response in patients with CKD on hemodialysis. Methods: Individuals with HBsAG and negative anti-HBC, under hemodialysis were assessed in two units of São Luis, Maranhão and were undergone full vaccination schedule for HBV. They were divided in groups: anti-HBs10 mUI/mL and compared as to age, gender, presence of diabetes mellitus (DM), time on dialysis and anti-HCV status. Logistic regression analysis was performed to identify factors independently associated with the vaccine response. p10mUI/Ml (or = 5.239 IC: 1.279-21.459, p = 0.021). Conclusion: The rate of vaccine response to HBV in patients with CKD on dialysis was 70% and the lack of anti-HCV infection was associated with seroconversion of anti-HBs suggesting that infection by the hepatitis C virus may be a factor that decreases the response of the HBV vaccine in dialysis CKD patients.

Resumo Introdução: A vacinação é a medida mais efetiva na prevenção da transmissão do vírus da hepatite B (HBV). O portador de doença renal crônica (DRC) em diálise apresenta maior risco de se contaminar com este vírus e não tem a mesma resposta vacinal quando comparada com indivíduos sem uremia. Objetivos: Avaliar os resultados da vacina para o HBV e identificar fatores associados à resposta, em portadores de DRC em hemodiálise. Metodologia: Foram avaliados indivíduos com HBsAg e anti-HBc negativos, que estavam sob hemodiálise em duas unidades de São Luís, Maranhão e que haviam sido submetidos ao esquema completo de vacinação para o HBV. Foram distribuídos em dois grupos: anti-HBs < 10mUI/mL e anti-HBs ≥ 10mUI/mL e comparados quanto à idade, gênero, presença de diabetes mellitus (DM), tempo em diálise e status do anti-HCV. Análise de regressão logística foi realizada para identificar fatores independentemente associados à resposta vacinal. Anti-HBs ≥ 10mUI/mL(OR = 5.239 IC:1.279-21.459, p = 0.021) Conclusões: A taxa de resposta vacinal ao HBV em portadores de DRC em diálise foi de 70% e a ausência do anti-HCV foi associada à soroconversão do anti-HBs, sugerindo que a infecção pelo vírus da hepatite C pode ser um fator que diminui a resposta da vacina para o HBV em indivíduos portadores de DRC em diálise.

Occult HBV infection status among chronic hepatitis C and hemodialysis patients in Northeastern Egypt: regional and national overview

INTRODUCTION: Occult hepatitis B infection (OBI) is considered to be one of the major risks for patients suffering from end-stage renal disease (ESRD) on regular hemodialysis (HD) and patients with chronic hepatitis C virus (HCV) infection. This study compared the prevalence of OBI among these two high-risk groups in the Suez Canal region, Northeastern Egypt, to obtain a better national overview of the magnitude of OBI in this region. METHODS: Serum samples were collected from 165 HD patients and 210 chronic HCV-infected patients. Anti-HCV antibody, hepatitis B surface antigen (HBsAg), total hepatitis B core (anti-HBc) antibody, and hepatitis B surface antibody (anti-HBs) were detected by enzyme-linked immunosorbent assay (ELISA). HCV RNA was detected using a quantitative real-time RT-PCR assay, and HBV was detected using a nested PCR. RESULTS: All patients were negative for HBsAg. A total of 49.1% and 25.2% of the patients in the HD and HCV groups, respectively, were anti-HBc-positive. In addition, more anti-HBs-positive patients were detected in the HD group compared to the HCV group (52.1% and 11.4%, respectively). Three cases were positive for HBV DNA in the HD group, while eighteen positive cases were detected in the HCV group. Both study groups showed significant differences in serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) level as well as anti-HBc, anti-HBs and HBV-DNA positivity. CONCLUSIONS: OBI was more prevalent among chronic HCV patients than HD patients in the Suez Canal region, Egypt, with rates of 8.5% and 1.8%, respectively. However, more precise assessment of this infection requires regular patient follow-up using HBV DNA detection methods. .

Hepatitis virus and hepatocellular carcinoma in Brazil: a report from the State of Espírito Santo

Introduction Few studies have examined hepatocellular carcinoma (HCC) in Brazil, and the incidence and risk factors for this type of malignancy vary greatly geographically. In this paper, we report several risk factors associated with HCC diagnosed at the University Hospital in Vitória, ES, Brazil. Methods We reviewed 274 cases of HCC (January 1993 to December 2011) in which hepatitis B (HBV) and C (HCV) virus infection and chronic alcoholism were investigated. A diagnosis of hepatocellular carcinoma was confirmed by histology or by the presence of a characteristic pattern on imaging. Results HCC with associated liver cirrhosis was noted in 85.4% of cases. The mean ages of men and women were 56.6 years and 57.5 years, respectively. The male-to-female ratio was 5.8:1. Associated risk factors included the following: HBV, 37.6% (alone, 23.4%; associated with chronic alcoholism, 14.2%); HCV, 22.6% (alone, 13.5%; associated with chronic alcoholism, 9.1%), chronic alcoholism, 17.1%, non-alcoholic steatohepatitis, 2.6% and cryptogenic, 19.3%. The male-to-female ratio was higher in cases associated with HBV or chronic alcoholism compared with HCV-associated or cryptogenic cases. In 40 cases without associated cirrhosis, the male-to-female ratio and mean age were lower than those in cirrhosis-associated cases. Conclusions These results demonstrate that the main risk factor associated with HCC in the State of Espírito Santo is HBV. Chronic alcoholism is an important etiological factor, alone or in association with HBV or HCV infection. .

Prevalence, risk factors and genotypes of hepatitis B infection among HIV-infected patients in the State of MS, Central Brazil

Objectives: A cross-sectional study on prevalence of HBV and HDV infection, risk factors and genotype distribution of HBV infection was conducted among 848 HIV-infected patients in Mato Grosso do Sul, Central Brazil. Methods: Serum samples of 848 participants were tested for hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc) and hepatitis surface antibody (anti-HBs). HBsAg positive samples were tested for anti-HBc IgM, HBeAg, anti-HBe, anti-HCV, and total anti-HDV. HBsAg and anti-HBc positive were subjected to DNA extraction. Viral DNA was amplified by semi-nested PCR for the regions pre-S/S and then purified and genotyped/subgenotyped by direct sequencing. Student's t-test, chi-square test and Fisher's exact test were used to compare variables and to evaluate association between HBV positivity (defined as anti-HBc and/or HBsAg positivity) and risk factors. Results: Among the 848 HIV infected patients investigated 222 had serological markers of HBV infection. The prevalence rate of HIV-HBV coinfection was 2.5% (21/848; 95% CI: 1.4–3.5%); 484 (57.1%) patients were susceptible for HBV infection. There were no cases of anti-HDV positive and only one (0.1%) anti-HCV-positive case among the HIV-HBV coinfected patients. Male gender, increasing age, family history of hepatitis, use of illicit drug, and homosexual activity were independent factors associated with HBV exposure. The phylogenetic analysis based on the S gene region revealed the presence of genotypes D (76.9%), F (15.4%) and A (7.7%) in the study sample. Conclusion: This study demonstrates the low prevalence of HIV-HBV infection and also highlights the need for early vaccination against HBV as well as testing for HBV, HCV and HDV in all HIV-infected individuals. .

Hepatitis C and hepatitis B virus infections in the etiopathogenesis of pemphigus

BACKGROUND: Previous studies have shown that some viral infections may be triggers for autoimmune diseases. The role of viral infections in the etiopathogenesis of pemphigus has also been investigated. OBJECTIVES: To investigate the relationship between pemphigus and the hepatitis B and C virus infections. METHODS: This retrospective study included 62 patients with pemphigus and 50 healthy controls of matching ages and genders. The control group included relatives who accompanied the orthopedic patients to the hospital but had no history of systemic and/or autoimmune diseases. RESULTS: The group of patients with pemphigus was composed of 43 (69.3%) females and 19 (29.7%) males, and the mean age was 48.08 ± 15.38. The hepatitis C virus antibody was negative in all of the patients. Hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), or both, were studied in 44 of the 62 patients. Two (4.3%) of these patients were positive for HBsAg and found to have HBV infection. Fourteen of them were HBsAb positive. Two (4%) of the 50 control subjects showed hepatitis C virus antibody positivity, while only 1 (2%) patient with pemphigus displayed HBsAg positivity. There was no statistically significant difference between the two groups for hepatitis B and C virus infections. CONCLUSIONS: This study does not support an association between pemphigus and hepatitis B and/or C virus infections. .

Hepatitis B en Argentina. Situación actual y estrategia de vacunación universal para su control y eliminación / Hepatitis B in argentina. current situation and strategy of universal vaccination for control and elimination

El virus de la hepatitis B es el agente productor de una enfermedad con alta eficacia de transmisión por la vía sexual, vertical y parenteral. Si bien en la mayoría de los casos se trata de una infección aguda con recuperación espontánea y sin secuelas puede evolucionar con una forma fulminante o como hepatitis crónica. Dadas las dificultades para su tratamiento se considera que la mejor estrategia de control es la prevención a través de la inmunización. En Argentina la vacuna está incorporada al calendario nacional para los recién nacidos desde el año 2000 y recomendada para los adultos que integran los grupos de riesgo. Los datos de la vigilancia muestran la persistencia de casos en los mayores de 15 años siendo una de sus causas la dificultad en identificar a la población en riesgo para ser vacunada. Debido a esto el ProNaCEI formuló en 2012 la recomendación de vacunación universal para hepatitis B con el propósito de contribuir a la eliminación y control de la hepatitis B. Este artículo analiza la situación actual de la hepatitis B en Argentina y los fundamentos y de la estrategia de vacunación universal...

The hepatitis B virus is responsible for a disease with high efficiency by sexual transmission, vertical and parenterally. Its complications include fulminant and chronic hepatitis. Vaccination is the most effective prevention strategy. In Argentina the vaccine is incorporated into national schedule for infants and is recommended for adult members of risk groups. Monitoring data show the persistence of cases over 15 years old. One reason for this problem is the difficulty in identifying risk groups. In order to contribute to the elimination and control of hepatitis B ProNaCEI incorporated in July 2013 universal vaccination against hepatitis B. This article describes the current status of hepatitis B in Argentina and technical guidelines recommending universal vaccination is analyzed...

Hepatitis b, c nnd hiv co-infections seroprevalence in a northeast Brazilian center / Soroprevalencia da co-infeccao hepatite B, C e HIV em um centro no Nordeste do Brazil

Context The occurrence of HIV and hepatitis B (HBV) and C (HCV) virus associations is of great concern since co-infected patients respond poorly to antiviral treatment and usually progress to chronic and more complicated hepatic disease. In Brazil, these co-infections prevalence is not well known since published data are few and sometimes demonstrate conflicting results. Also, a significant number of co-infected individuals are HBV/HCV asymptomatic carriers, leading to under notification. Objectives The present study aimed to determine the prevalence of the HBV and HCV infection in a recently diagnosed HIV population in the state of Ceará/Brazil. Methods Retrospective cohort, with >18yo patients diagnosed HIV+ from 2008-2010. First year medical attention information was collected. Results A total of 1.291 HIV+ patients were included. HBV serologies were collected in 52% (23% had previous hepatitis B, 3.7% were co-infected) and HCV in 25.4% (1.5% had previous hepatitis C, 5.4% co-infection). The majority of HBV/HIV patients referred multiple sexual partners/year, 28% homosexualism and 20% bisexualism. In the HCV/HIV group 38.8% individuals had > one sexual partner/year and 22.2% used intravenous drugs. Conclusion The study reinforce the need for better training healthcare workers and providing laboratory support for a prompt hepatitis diagnosis and adequate medical management to avoid complications and decrease viral spread. .

Contexto A ocorrência da associação de HIV com a hepatite por vírus B (HVB) e C (HVC) é preocupante visto que os pacientes coinfectados tendem a ter uma resposta pior à terapia antiviral e uma chance maior de progredirem para a cronificação da doença hepática e suas complicações. No Brasil, os estudos publicados sobre a prevalência dessas coinfecções ainda são escassos e, muitos deles, com resultados conflitantes entre si. Além disso, muitos pacientes coinfectados são portadores assintomáticos dos vírus das hepatites o que causa um atraso no seu diagnóstico, com consequente subnotificação de casos. Objetivos Este estudo objetiva determinar a prevalência da infecção pelo HVB e HVC em pacientes recém-diagnosticados com HIV no Ceará/Brasil. Métodos Coorte retrospectivo com pacientes >18 anos, diagnosticados HIV+ de 2008-2010. Foram coletados dados referentes ao primeiro ano de acompanhamento desses pacientes através de revisão de prontuário: fatores de risco para HIV, HBV e HCV e resultados de provas sorológicas para esses vírus. Resultados Foram acompanhados 1291 pacientes HIV+. Testes sorológicos para HBV foram realizados em 52% dos casos: 23% apresentavam hepatite B prévia e 3,7% eram coinfectados. Apenas 25,4% tinham testes sorológicos para HCV: 1,5% tinham hepatite C prévia e 5,4% eram coinfectados. A maioria dos pacientes HBV/HIV referia ter múltiplos parceiros sexuais em um ano. Homossexualismo e bissexualismo estavam presentes em 28% e 20% respectivamente. No grupo HCV/HIV 38,8% referia múltiplos parceiros sexuais em um ano e o uso de drogas endovenosas ocorreu em 22,2% dos casos. Conclusão O estudo reforça a necessidade de um treinamento dos profissionais de saúde e de facilitação do acesso do paciente ...

Etiology of liver cirrhosis in Brazil: chronic alcoholism and hepatitis viruses in liver cirrhosis diagnosed in the state of Espfrito Santo

OBJECTIVES: To report the etiology of liver cirrhosis cases diagnosed at the University Hospital in Vitoria, Espirito Santo, Brazil. METHODS: The medical charts of patients with liver cirrhosis who presented to the University Hospital in Vitoria were reviewed. Chronic alcoholism and the presence of hepatitis B or C infections (HBV and HCV, respectively) were pursued in all cases. RESULTS: The sample consisted of 1,516 cases (male:female ratio 3.5:1, aged 53.2±12.6 years). The following main etiological factors were observed: chronic alcoholism alone (39.7%), chronic alcoholism in association with HBV or HCV (16.1 %), HCV alone (14.5%) and in association with alcoholism (8.6%) (total, 23.1 %), and HBV alone (13.1%) and in association with alcoholism (7.5%, total 20.6%). The remaining etiologies included cryptogenic cases (9.8%) and other causes (6.0%). The mean patient age was lower and the male-to-female ratio was higher in the cirrhosis cases that were associated with alcoholism or HBV compared with other causes. Intravenous drug abuse and a history of surgery or blood transfusion were significantly associated with HCV infection. Hepatocellular carcinoma was present at the time of diagnosis in 15.4% of cases. Chronic alcoholism associated with HCV infection was significantly associated (p<0.001) with reduced age (at the time of cirrhosis diagnosis) and increased prevalence of hepatocellular carcinoma (p = 0.052). CONCLUSION: Alcoholism, HCV and HBV are the main factors associated with liver cirrhosis in the state of Espirito Santo. Chronic alcoholism associated with HCV infection reduced the age of patients at the time of liver cirrhosis diagnosis.

To study the correlation between carrier status of nasal Staphylococcus aureus in patients on haemodialysis with hepatitis C, hepatitis B and their sociodemographic features / Estudiar la correlación entre el portador del Estafilococo dorado nasal en pacientes de hemodiálisis con hepatitis C, hepatitis B y sus características sociodemográficas

AIM: To study the correlation of nasal Staphylococcus aureus carrier status in patients on haemodialysis, infected by hepatitis C virus (HCV), hepatitis B virus (HBV), and their sociodemographic features. SUBJECTS AND METHODS: A survey, including patients ' sociodemographic features, was applied to patients by physicians in face to face interviews. Medical records regarding their serologic data were recorded from haemodialysis centres. Nasal swab samples of 2 cm depth from both nostrils of patients were obtained for nasal culture. Samples were inoculated in 5% sheep blood agar and incubated in an incubator at a temperature of 37ºCfor 24 hours. The results were studied by the same microbiologist. RESULTS: A total of 185 patients were enrolled in the study. According to culture results, 14.1% of patients (n = 26) had methicillin sensitive Staphylococcus aureus (MSSA) and 1.1% (n = 2) had methicillin resistant Staphylococcus aureus (MRSA). Status of viral hepatitis was 3.8% (n = 8), 10.8% (n = 20) for HBV and HCV, respectively. Forty per cent (n = 8) of patients with HBV (+) had MSSA carrier status. Statistically significant positive correlation between MSSA and HCV carrier was detected (r = 0.325, p = 0.001) but not between HBV carrier and MSSA (p = 0.255). CONCLUSION: In the present study, significant positivity was detected between MSSA carrier status and HCV in patients on haemodialysis and who have lived together with < 2 family members at home. Particularly, statistically significant correlation between HCV (+) and MSSA carrier was observed.

OBJETIVO: Estudiar la correlación entre el portador del Estafilococo dorado (Staphylococcus aureus) nasal en pacientes de hemodiálisis infectados por el virus de la hepatitis C (VHC), el virus de la hepatitis B (VHB), y sus características sociodemográficas. SUJETOS Y MÉTODOS: Una encuesta que incluía características sociodemográficas de los pacientes fue aplicada a pacientes por médicos en entrevistas cara a cara. Historias clínicas contentivas de sus datos serológicos, fueron registradas a partir de los centros de hemodiálisis. Muestras defrotis nasales de 2 cm de profundidad de ambas fosas nasales, fueron obtenidas para un cultivo nasal. Se inocularon muestras en agar de sangre de oveja al 5%, e incubadas en una incubadora a una temperatura de 37ºC por 24 horas. Los resultados fueron examinados por el mismo microbiólogo. RESULTADOS: Un total de 185 pacientes fueron enrolados en el estudio. Según los resultados del cultivo, 14.1% pacientes (n = 26) tenían estafilococo dorado sensible a la meticilina (MSSA) y 1.1% (n = 2) tenían estafilococo dorado resistente a la meticilina (MRSA). El estatus de las hepatitis virales fue 3.8% (n = 8), y 10.8% (n = 20) para HVB y HVC respectivamente. Cuarentapor ciento (n = 8) de los pacientes con HVB (+) eran portadores del MSSA. Estadísticamente, se detectó una correlación positiva significativa (r = 0.325, p = 0.001), entre MSSA y el portador de VHC, no así entre el portador del VHByMSSA (p = 0.255). CONCLUSIÓN: En el estudio presente, se detectó una positividad significativa entre el estatus de; portador de MSSA y los pacientes de VHC en hemodiálisis, que vivían junto con [= dos o menos de dos] miembros de la familia en casa. En particular, se observó una correlación estadísticamente significativa entre HCV (+) y el portador MSSA.

¿Qué sabemos de hepatitis en Venezuela? / What is known about hepatitis in Venezuela?

Cada vez es más reconocido el problema de salud pública que representa la Hepatitis Viral Crónica B y C en todo el mundo, no escapando nuestro país a ésta situación. Ambas pueden conducir a largo plazo a cirrosis hepática y aumentar el riesgo de cáncer de hígado. Dado que las hepatitis virales son patologías de origen infecto contagioso, la Sociedad Venezolana de Gastroenterología, llevó a cabo una encuesta a nivel nacional con el objeto de conocer la información que se maneja en la comunidad sobre éstas enfermedades. Para ello se entrevistaron 1.109 personas, de todos los estratos sociales, 581 de sexo femenino y 528 masculinos, con edades comprendidas entre 18 y 70 años en 8 regiones del país. El 51% de la población encuestada reconoce que tiene poca información sobre la enfermedad. El 57.36% de los encuestados no conocía las diferencias entre los distintos tipos de hepatitis. Más del 80% de las personas desconocían como se adquiere la Hepatitis B y la hepatitis C y casi el 60% de la población no sabe cómo prevenirlas. Al preguntar si tomaban algunas medidas para evitar la hepatitis el 80% de la población NO lo hace. Del 20 % que toma alguna previsión sólo el 36% se vacuna. Cuando se interrogó sobre conocimiento del tratamiento, el 67.09% no sabía que se utiliza para ello. El 24.71% de la población encuestada refirió haberse realizado la prueba diagnóstica. En vista de los resultados recogidos es necesario incrementar la educación de las comunidades en relación a todo lo relacionado con la hepatitis viral...

It is increasingly recognized the worldwide public health problem that represents the Chronic Viral Hepatitis B and C; not escaping our country to this situation. Both can lead, in long-term, to liver cirrhosis and increase the risk of liver cancer. Given that viral hepatitis is an infectiouscontagious disease, the Venezuelan Society of Gastroenterology conducted a nationwide survey in order to know the information that communities have about these diseases. The survey was made to 1109 persons, of all social strata, having 581 female and 528 male, aged between 18 and 70 years in 8 regions of the country. 51% of the population surveyed acknowledged having little information about the disease. 57.36% of respondents did not know the differences between different types of hepatitis. Over 80% of people were unaware of how to get the Hepatitis B and Hepatitis C and nearly 60% of the population does not know how to prevent them. When they were asked if they took some measures to prevent hepatitis, 80% of the population answered they did not. Of the 20% that took some sort of provision only 36% were vaccinated. When they were questioned about knowing any treatment, 67.09% did not know what was used to attack hepatitis. 24.71% of the surveyed population said that they had taken a diagnostic test. In view of the results is necessary to increase the education of communities in everything related to viral hepatitis...

Influência da infecção pregressa pelo vírus da hepatite B na fibrose hepática em portadores de hepatite C crônica: avaliação retrospectiva de uma série de casos / Influence of previous hepatitis B virus infection on liver fibrosis in patients with chronic hepatitis C: a retrospective case series evaluation

INTRODUCÃO: A hepatite C é uma das principais causas de doença hepática em todo mundo. Apresenta um curso evolutivo dinâmico e influenciável por diversos co-fatores. Dentre eles, a infecção pregressa pelo vírus B (anti-HBcAg [+] e HBsAg [-]) tem se associado a pior prognóstico histológico e terapêutico. Este trabalho teve como objetivo analisar a associação entre a infecção pregressa pelo vírus B e fibrose hepática em portadores de hepatite C crônica, de maneira independente. MÉTODOS: Foram revistos retrospectivamente prontuários médicos de pacientes infectados cronicamente pelo vírus C, atendidos consecutivamente durante um ano no ambulatório de Doenças Infecciosas e Parasitárias - HC FMUSP, quanto aos dados epidemiológicos, clínicos, laboratoriais e histológicos. A análise de independência do impacto da infecção pregressa pelo vírus B foi realizada através de modelo estatístico de regressão logística multivariado, considerando a detecção do anti-HBcAg como variável de exposição, sendo o desfecho a alteração estrutural histopatológica graus 3 e 4 (septos com formação de nódulos e cirrose).0 RESULTADOS: 145 indivíduos foram avaliados pelo estudo, 47.2 por cento com anti-HBcAg (+). O fator de risco mais comumente relatado foi transfusão de sangue e hemoderivados (35,9 por cento). Embora necrose em saca-bocado tenha sido encontrada com maior frequência no grupo de infecção pregressa, a sorologia anti-HBcAg (+) não se associou à fibrose hepática avançada. CONCLUSÕES: A infecção pregressa pelo vírus B não parece acentuar a lesão estrutural desencadeada pela hepatite C crônica, após controle estatístico para outros co-fatores sabidamente capazes de influenciar a história natural desta infecção.

INTRODUCTION: Hepatitis C is a major cause of liver disease worldwide. Its evolutionary course is dynamics and may be influenced by several cofactors. Among them, previous hepatitis B virus infection (anti-HBcAg [+] and HBsAg [-]) has been associated with worse histological and therapeutic prognosis. This study had the objective of independently assessing the relationship between previous hepatitis B infection and liver fibrosis in patients with chronic hepatitis C. METHODS: The medical records of patients chronically infected with the hepatitis C virus who had been seen consecutively during a one-year period at the infectious and parasitic diseases outpatient clinic of HC FMUSP were retrospectively reviewed in relation to epidemiological, clinical and histological data. Analysis on the independence of the previous hepatitis B infection was performed using the statistical model of multivariate logistic regression. Detection of anti-HBcAg was taken to be the independent variable. The outcome was taken to be grade 3 and 4 histopathological abnormality (septa with nodule formation and cirrhosis). RESULTS: 145 subjects were evaluated in this study. 47.2 percent of them were anti-HBcAg (+). The main risk factor for infection was blood and blood derivative transfusion (35.9 percent). Findings of anti-HBcAg (+) were not related to advanced liver fibrosis, although piecemeal necrosis has been found frequently in patients with this serological marker. CONCLUSIONS: Previous hepatitis B infection does not seem to increase the structural liver damage triggered by chronic hepatitis C virus infection, after statistical control for other co-factors capable to impact the natural history of this infection.

Prevalence and risk factors for chronic hepatitis B in HIV patients attended at a sexually-transmitted disease clinic in Vitoria, Brazil

This study assessed the prevalence of and correlated factors for chronic hepatitis B infection (HBV) among HIV patients attending the Reference Center for Sexually Transmitted Infections (STI) and AIDS in Vitória, ES, Brazil. HIV patients were studied from 1993 to 2004, using information recorded in a database of the STI Clinic. Demographic data, clinical characteristics, patterns of risk behavior and test results (ELISA-HIV, IFA-HIV, HBsAg, viral load and CD4 counts) were analyzed. We analyzed 851 HIV patients. Median age was 35.0 (interquartile range 30; 42) years and median years of education was 8.0 (IQR 5; 11). The prevalence of chronic HBV was 3.8 percent (95 percent CI 2.5-5.1). Illicit drug use was reported in 185 (21.7 percent) cases, alcohol abuse in 80 (9.4 percent) cases, men who have sex with men in 116 (13.6 percent) cases, and past STI in 320 (37.6 percent) cases. Chronic HBV was associated with intravenous drug use, male gender, STI associated with HIV diagnosis, and death. There is a need for prevention and assistance strategies to control the evolution of this infection in HIV patients.

Occult hepatitis B virus infection in patients with chronic liver disease due to hepatitis C virus and hepatocellular carcinoma in Brazil

BACKGROUND: The prevalence and consequences of occult HBV infection in patients with chronic liver disease by HCV remain unknown. AIMS: To evaluate the prevalence of occult HBV infection in a population of HCV-infected patients with hepatocellular carcinoma. METHODS: The serum samples were tested for HBV DNA by nested PCR and liver tissue analysis was carried out using the immunohistochemical technique of 66 HBsAg-negative patients: 26 patients with chronic hepatitis by HCV (group 1), 20 with hepatocellular carcinoma related to chronic infection by HCV (group 2) and 20 with negative viral markers for hepatitis B and C (control group). RESULTS: Occult HBV infection was diagnosed in the liver tissue of 9/46 (19.5 percent) HCV-infected patients. Prevalence of occult B infection was evaluated in the HCV-infected patients with and without hepatocellular carcinoma, and there were seven (77.7 percent) of whom from group 2, conferring a 35 percent prevalence of this group. No serum sample was positive for HBV DNA in the three groups. CONCLUSION: Occult infection B is frequently detected in liver tissue of HCV-infected patients, especially in cases of hepatocellular carcinoma. However large studies are needed to confirm that co-infection could determine a worse progress of chronic liver disease in this population.

RACIONAL: A prevalência e as conseqüências da infecção oculta pelo VHB em pacientes com infecção crônica pelo VHC permanecem desconhecidas. OBJETIVO: Avaliar a prevalência da infecção oculta pelo VHB em uma população de pacientes infectados com o VHC e carcinoma hepatocelular. MÉTODOS: Amostras de soro foram testadas para o DNA do VHB por "nested" PCR e análise do tecido hepático utilizando imunoistoquímica de 66 pacientes HBsAg negativos: 26 pacientes com hepatite crônica pelo VHC (grupo 1), 20 com carcinoma hepatocelular relacionado ao VHC (grupo 2) e 20 com marcadores negativos para os vírus das hepatites B e C (grupo controle). RESULTADOS: Infecção oculta pelo VHB foi diagnosticada no tecido hepático de 9/46 (19.5 por cento) pacientes com infecção pelo VHC. A prevalência foi avaliada nos pacientes com VHC com e sem carcinoma hepatocelular, estando presente em sete (77.7 por cento) deste último grupo, conferindo 35 por cento de infecção oculta pelo VHB nos pacientes com carcinoma hepatocelular. Nenhuma amostra de soro foi positiva para o DNA-VHB nos três grupos. CONCLUSÃO: A infecção oculta B é freqüentemente detectada no tecido hepático de pacientes infectados com VHC, especialmente nos casos de carcinoma hepatocelular. Entretanto, outros estudos com maior número de pacientes são necessários para confirmar se a co-infecção determina a progressão da doença hepática nesta população.

Low prevalence of hepatitis B virus, hepatitis D virus and hepatitis C virus among patients with human immunodeficiency virus or acquired immunodeficiency syndrome in the Brazilian Amazon basin

Comorbidities in human immunodeficiency virus infection are of great interest due to their association with unfavorable outcomes and failure of antiretroviral therapy. This study evaluated the prevalence of coinfection by human immunodeficiency virus and viral hepatitis in an endemic area for hepatitis B in the Western Amazon basin. Serological markers for hepatitis B virus, hepatitis C virus and hepatitis D virus were tested in a consecutive sample of all patients referred for treatment of human immunodeficiency virus or acquired immunodeficiency syndrome. The variables sex, age, origin and exposure category were obtained from medical records and from the sexually transmitted diseases and acquired immunodeficiency syndrome surveillance database. Among 704 subjects, the prevalence of chronic hepatitis B carriage was 6.4 percent and past infection 40.2 percent. The presence of hepatitis B was associated with birth in hyperendemic areas of the Amazon basin, male sex and illegal drug use. The overall prevalence of hepatitis C was 5 percent and was associated with illegal drug use. The prevalence of hepatitis B and C among human immunodeficiency virus or acquired immunodeficiency syndrome patients in the Western Amazon basin was lower than seen elsewhere and is probably associated with the local epidemiology of these viruses and the degree of overlap of their shared risk factors. An opportunity presents itself to evaluate the prevention of hepatitis C through harm reduction policies and hepatitis B through vaccination programs among human immunodeficiency virus or acquired immunodeficiency syndrome patients.

Co-morbidades na infecção pelo vírus da imunodeficiência humana são de grande interesse devido à associação com desfechos desfavoráveis e falhas na terapia anti-retroviral. Este estudo avalia a prevalência de co-infecção entre o vírus da imunodeficiência humana e hepatites virais, em uma área endêmica de hepatite B, na Amazônia Ocidental. Marcadores sorológicos para o Vírus da hepatite B, Vírus da hepatite C e vírus da hepatite D foram testados em uma amostra de pacientes referenciado para o tratamento em ambulatório para pacientes com infecção pelo vírus da imunodeficiência humana ou síndrome da imunodeficiência adquirida. As variáveis: sexo, idade, origem e categoria de exposição, foram obtidas dos prontuários médicos e do banco de dados da Coordenação Estadual de Doenças sexualmente transmissíveis. Entre os 704 indivíduos incluídos, a prevalência de portador crônico do vírus da hepatite B foi 6,4 por cento e de infecção passada 40,2 por cento. O vírus da hepatite B esteve associado com o local de nascimento em áreas hiperendêmicas da Amazônia, sexo masculino e uso de drogas ilícitas. A prevalência de hepatite C foi 5 por cento, estando associada com uso de drogas ilícitas. A prevalência dos vírus da hepatite B e C, entre indivíduos vivendo com o vírus da imunodeficiência humana e síndrome da imunodeficiência adquirida, na Amazônia ocidental, foi mais baixa que as observadas em estudos com populações de outras regiões. Provavelmente, estes resultados estão associados à epidemiologia local destes vírus, e ao grau de superposição dos fatores de risco associados à infecção na população estudada. O estudo apresenta oportunidade de avaliar a prevenção da hepatite C e B, através de medidas de redução de danos e programa de vacinação em indivíduos vivendo com vírus da imunodeficiência humana e síndrome da imunodeficiência adquirida.

Prevalencia de afección hepática, alcoholismo, hepatitis B, C y HIV en pacientes con antecedentes de consum / Prevalence of hepatic involvement, alcoholism, hepatis B, C and HIV in patients with background history of drug use

Drug addicts frequently have liver diseases for different reasons: alcohol abuse, the drugs themselves, but more often hepatitis B and C infections. AIDS is common in this population as well and could also affect the liver directly or in the form of hepatocellular or biliary damage. We conducted this study to determine the prevalence of liver diseases, alcoholism, hepatitis B and C infections, and HIV positivity in this population. We studied a cohort of 137 persons, all with a history of drug abuse, and investigated the quantity of alcohol intake, the kind of drug used, and he routes of drug administration. RESULTS: We found liver disease in 33.6%. The prevalence of alcoholism was 65.4%, of HCV 67.3%, and of HBV 17.3%. HDV was undetectable, whereas we found HIV at a frequency of 17.3%. HCV RNA was detected in 85.4% of HCV. The drug most often used was cocaine at 90.4%, followed by marihuana at 88.3%; LSD use occurred in 17.5%. We found parenteral drug use in 43.1%. We performed 22 liver biopsies, 21 associated with HCV, and detected histological changes consistent with chronic hepatitis in 17, with cirrhosis in 4, and with hepatocellularcarcinoma in 1.

Efeito a longo prazo da infecção pelos vírus das hepatites B e C na sobrevida de pacientes transplantados renais / Long term effect of hepatitis B and C virus infection on the survival of kidney transplant patients

OBJETIVO: Avaliar o impacto da infecção pelo HBV (vírus da hepatite B) e pelo HCV (vírus da hepatite C) na sobrevida a longo prazo de pacientes transplantados renais e seus enxertos. MÉTODOS: Cento e nove pacientes transplantados renais foram avaliados quanto à presença de anticorpos contra o HCV e presença do antígeno de superfície do HBV. Os pacientes foram divididos em quatro grupos, de acordo com os resultados das sorologias, e seguidos pelo período de 10 anos para avaliação das sobrevidas. As diferenças de idade, sexo, etiologia da insuficiência renal, tempo de diálise, e tempo pós-transplante renal foram avaliados nos grupos. RESULTADOS: Os grupos diferiram apenas nos parâmetros de tempo de diálise prévio ao transplante renal, sendo este significativamente maior nos pacientes anti-HCV positivos. Houve maior número de pacientes re-transplantados nos grupos anti-HCV e HbsAg positivos. Não houve diferença significativa nas sobrevidas de pacientes infectados pelos vírus B ou C (grupo anti-HCV positivo sobrevida de 10 anos: 71,0 por cento; risco relativo: 1,13; IC 95 por cento: 0,86 - 1,47. Grupo HbsAg positivo sobrevida de 10 anos: 77,8 por cento; risco relativo: 1,03; IC 95 por cento: 0,7 - 1,5). O grupo com co-infecção pelos vírus B e C apresentou sobrevida de 10 anos significativamente menor que os demais (37,5 por cento; risco relativo: 2,13; IC 95 por cento: 0,86 - 5,28). Todos os grupos foram comparados à sobrevida de 10 anos com o grupo índice (sem infecção pelo HbsAg ou anti-HCV), que foi de 80,0 por cento. As sobrevidas dos enxertos não apresentaram diferenças com significância estatística. CONCLUSÃO: No presente estudo evidenciou-se diferença significativa na sobrevida de pacientes transplantados renais infectados concomitantemente pelos vírus das hepatites B e C

Marcadores sorológicos da hepatite B em usuários de um Centro de Testagem para o HIV / Serological markers of hepatitis B in users of services at an HIV Testing Center

The objective of this investigation was to study the prevalence of serological markers of hepatitis B and possible risk factors for this disease in a sample of 404 people who attended a Testing and Couseling Center for HIV in the city of Ribeirão Preto, São Paulo State, Brazil. The overall prevalence of serologic hepatitis B markers was 14.6%, equal to that obtained for anti-HBc. HBsAg and anti-HBc IgM showed prevalences of 1%. After adjustment using logistic regression, hepatitis B markers showed association with the following variables: age, place of residence, use of injectable drugs and positivity to anti-HIV. The overall prevalence of human immunodeficiency virus infection was 6.9%. Hepatitis B markers were detected in 55.6% among intravenous drug users and in 42.9% among those who tested positive for HIV, confirming literature findings which indicates high levels of infection in these specific population groups.

Esta investigação objetivou estudar a prevalência de marcadores sorológicos de infecção pelo vírus da hepatite B e analisar possíveis fatores de risco em 404 usuários submetidos à sorologia anti-HIV no Centro de Testagem e Aconselhamento de Ribeirão Preto, SP, Brasil. A prevalência global dos marcadores para o vírus da hepatite B foi de 14,6%, idêntica à encontrada para o anti-HBc, com valores de 1% para o HBsAg e anti-HBc IgM. Após ajuste por regressão logística, os marcadores de infecção do vírus B mostraram associação com as variáveis: idade, local de residência, uso de drogas endovenosas e positividade para o HIV. A prevalência de infecção pelo vírus da imunodeficiência humana foi de 6,9%. Marcadores do vírus B foram detectados em 55,6% dos usuários de drogas endovenosas e em 42,9% dos positivos ao vírus da imunodeficiência humana, confirmando altos índices de infecção nestes grupos específicos.