Model for End-Stage Liver Disease: Is Sex-Based Creatinine Correction a Viable Strategy for Black Females?

BACKGROUND: The model for end-stage liver disease (MELD) is based on objective variables, including serum creatinine (SCr). This study assesses the influence of skin color on MELD scores calculated using SCr or corrected creatinine (CrC) in female candidates for liver transplantation (LTx). METHODS: White and black women were eligible. The glomerular filtration rate (GFR) was calculated by means of the Modification of Diet in Renal Disease formula, using SCr. The GFR was then used for reverse calculation of CrC considering each female as male. The MELD scores were calculated using both creatinine values and compared between white and black candidates. RESULTS: SCr-based and CrC-based scores were similar between groups. Calculated GFR was significantly higher in black women than in white women (P < 0.001). Use of CrC yielded 1-point, 2-point, and 3-point increases in the MELD score in 20.2%, 25.7%, and 17.5% of white patients, respectively. None of the black patients had a MELD score increase greater than 1 point. The CrC-based MELD calculation would benefit 63.4% of white females and only 26.1% of black females. CONCLUSIONS: Use of CrC for MELD calculation would prioritize white females for liver allocation, but does not seem feasible, as it would not ensure equitable allocation across different ethnicities.

Comparison between potential risk factors for cardiovascular disease in people living with HIV/AIDS in areas of Brazil.

INTRODUCTION: Coronary heart disease and its risk factors depend on genetic characteristics, behaviors, and habits, all of which vary in different regions. The use of antiretroviral therapy (ARV) has increased the survival of people living with HIV/AIDS (PLWHA), who begin to present mortality indicators similar to the general population. This study aimed to compare the prevalence of factors potentially associated with coronary heart disease in three cohorts of PLWHA from three different regions of Brazil. METHODOLOGY: The study population was composed of participants of the cohorts of Pernambuco, Goiás, and Rio Grande do Sul states. In these sites, adult patients attending reference centers for treatment of HIV/AIDS were consecutively enrolled. RESULTS: Pernambuco and Goiás had a higher proportion of males and of individuals with high-risk high-density lipoprotein (HDL). Pernambuco also had a greater proportion of individuals with hypertension, elevated triglycerides, and CD4 counts below 200 cells/mm(3). Lower education was more frequent in Rio Grande do Sul, and the use of cocaine was higher in this state. CONCLUSIONS: The results confirm the importance of risk factors for coronary heart disease in PLHIV and highlight differences in the three cohorts. Specific measures against smoking and sedentary lifestyle, avoidance of advanced stages of immunosuppression, and appropriate treatment of dyslipidemia and dysglicemia are urgently needed to cope with the disease in Brazil.

Absence of occult hepatitis B among blood donors in southern Brazil

BACKGROUND: Occult hepatitis B virus (HBV) infection is characterized by the detection of HBV DNA in serum and/or in liver in the absence of detectable hepatitis B surface antigen (HBsAg). The reported prevalence of occult hepatitis B varies markedly among populations and according to the sensitivity of the HBV DNA assay. The aim of the present study was to describe the prevalence of occult hepatitis B among HCV-infected and non-infected blood donors in Porto Alegre, Southern Brazil, using a highly sensitive real time polymerase chain reaction (PCR) method. METHODOLOGY: Between 1995 and 1997 a sample of 178 blood donors with two positive anti-HCV ELISA tests were consecutively selected as cases, and 356 anti-HCV negative donors were selected as controls. Blood donors were randomly selected from eight blood centers in Porto Alegre, Southern Brazil, representative of the whole blood donor population. Blood samples were kept at 70ºC and defrosted for the first time for the analysis of this report. Tests previously performed in the laboratory using the same real time PCR for HBV DNA had sensitivity for detecting as low as 9 copies/mL. Among 158 blood samples from HBsAg-negative blood donors, five were anti-HBc positive, 53 tested positive for anti-HCV and 105 had anti-HCV negative. The samples analysis was performed in duplicate and all blood samples tested negative for HBV DNA. CONCLUSION: The result reflects a very low prevalence of occult hepatitis B in our setting.