RESUMEN
Hepatitis C virus (HCV) and human T-lymphotropic virus type 1 (HTLV-1) coinfection occurs in many regions. However, few studies have focused on the natural history of HCV-induced liver disease in coinfected patients. To describe the clinical, epidemiological, and histopathological aspects of HTLV-1/HCV coinfection in Brazil. A cross-sectional study with 23 patients coinfected with HCV/HTLV. The control groups consisted of 21 patients monoinfected with HCV and 20 patients monoinfected with HTLV-1. The cytokine profiles (Th1 and Th2 cell responses), clinical, laboratory features, and histopathological aspects were examined. The control group for cytokine analysis validation consisted of patients monoinfected with HTLV, and a fourth group consisted of healthy blood donors. No anthropometric differences present between the three infected groups. We observed higher serum concentrations of IFN-γ in patients coinfected with HCV/HTLV-1 than those in HCV monoinfected patients. The HCV/HTLV-1 coinfected group also exhibited a higher degree of liver steatosis than the HCV monoinfected patients. Results suggest that HCV/HTLV-1 coinfection may result in a different pattern of HCV infection due to the immunologic disorders likely associated with HTLV-1, but there is no clear evidence of the HTLV role in the natural history of HCV infection. J. Med. Virol. 88:1967-1972, 2016. © 2016 Wiley Periodicals, Inc.
Asunto(s)
Coinfección/epidemiología , Coinfección/fisiopatología , Hígado Graso/virología , Infecciones por HTLV-I/complicaciones , Hepacivirus/aislamiento & purificación , Hepatitis C/complicaciones , Virus Linfotrópico T Tipo 1 Humano/aislamiento & purificación , Adulto , Brasil/epidemiología , Coinfección/complicaciones , Coinfección/virología , Estudios Transversales , Citocinas/inmunología , Hígado Graso/etiología , Femenino , Infecciones por HTLV-I/inmunología , Infecciones por HTLV-I/virología , Hepacivirus/inmunología , Hepatitis C/epidemiología , Hepatitis C/inmunología , Hepatitis C/virología , Virus Linfotrópico T Tipo 1 Humano/inmunología , Humanos , Interferón gamma/sangre , Masculino , Persona de Mediana Edad , Células TH1/inmunología , Células Th2/inmunologíaRESUMEN
CONTEXT: Intestinal parasites induce detectable histopathological changes, which have been studied in groups with known diagnosis of parasitic disease. There is no available study with a larger base without previous diagnosis. OBJECTIVE: To describe clinical and histopathological findings of parasitosis diagnosed by endoscopic biopsy in patients submitted to upper digestive endoscopy. METHODS: Recorded biopsies archive at "Complexo Hospitalar Professor Edgar Santos" , a general teaching Hospital in the state of Bahia, Northeast Brazil, from January 1995 to January 2009, were reviewed. One thousand ten duodenal biopsy reports were found. Reports positive for parasites had their specimens reviewed and photographed. All blocks of biopsy selected as case were retrieved and reviewed by an experienced pathologist. Clinical, laboratorial and endoscopic data were collected. RESULTS: Eleven biopsies showed parasites, including cases of Cryptosporidium sp. and Strongyloides stercoralis. Vomiting (91%), abdominal pain (78%), diarrhea (78%) and weight loss (78%) were usual symptoms. Seventy-five percent had duodenal mucosa changes on endoscopy, while 25% have no changes. Anemia and low serum albumin were important laboratorial data. HIV infection association was observed. Villus atrophy and reactive epithelium were usual in Strongyloides cases. CONCLUSIONS: No endoscopic or histopathologic finding was pathognomonic. One percent of duodenal endoscopic biopsies showed parasites.
Asunto(s)
Duodenitis/parasitología , Parasitosis Intestinales/parasitología , Adulto , Animales , Biopsia , Duodenitis/patología , Duodeno/patología , Endoscopía Gastrointestinal , Femenino , Humanos , Parasitosis Intestinales/patología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
CONTEXT: Intestinal parasites induce detectable histopathological changes, which have been studied in groups with known diagnosis of parasitic disease. There is no available study with a larger base without previous diagnosis. OBJECTIVE: To describe clinical and histopathological findings of parasitosis diagnosed by endoscopic biopsy in patients submitted to upper digestive endoscopy. METHODS: Recorded biopsies archive at "Complexo Hospitalar Professor Edgar Santos" , a general teaching Hospital in the state of Bahia, Northeast Brazil, from January 1995 to January 2009, were reviewed. One thousand ten duodenal biopsy reports were found. Reports positive for parasites had their specimens reviewed and photographed. All blocks of biopsy selected as case were retrieved and reviewed by an experienced pathologist. Clinical, laboratorial and endoscopic data were collected. RESULTS: Eleven biopsies showed parasites, including cases of Cryptosporidium sp. and Strongyloides stercoralis. Vomiting (91 percent), abdominal pain (78 percent), diarrhea (78 percent) and weight loss (78 percent) were usual symptoms. Seventy-five percent had duodenal mucosa changes on endoscopy, while 25 percent have no changes. Anemia and low serum albumin were important laboratorial data. HIV infection association was observed. Villus atrophy and reactive epithelium were usual in Strongyloides cases. CONCLUSIONS: No endoscopic or histopathologic finding was pathognomonic. One percent of duodenal endoscopic biopsies showed parasites.
CONTEXTO: Parasitas intestinais podem induzir alterações histopatológicas, que têm sido estudadas em subgrupos com diagnóstico firmado de parasitose. Não há estudo disponível com base mais ampla, sem diagnóstico prévio. OBJETIVO: Descrever os achados clínicos e histopatológicos de parasitoses diagnosticadas por biopsia em pacientes submetidos a endoscopia digestiva alta. MÉTODO: Laudos de biopsias realizadas de janeiro de 1995 a janeiro de 2009, no Complexo Hospitalar Professor Edgar Santos, hospital geral universitário localizado no nordeste brasileiro, foram revisados. Mil e dez laudos de biopsia duodenal foram revistos. Biopsias positivas para parasitas tiveram suas lâminas revisadas e fotografadas. Todos os blocos de biopsia selecionados como casos foram recuperados e revisados por experiente patologista. Dados clínicos, laboratoriais e endoscópicos foram coletados. RESULTADOS: Onze biopsias mostraram parasitas, incluindo casos de Cryptosporidium sp. e Strongyloides stercoralis. Vômitos (91 por cento), dor abdominal (78 por cento), diarreia (78 por cento) e perda ponderal (78 por cento) foram sintomas comuns. Setenta e cinco por cento apresentaram alterações na mucosa duodenal à endoscopia, enquanto 25 por cento não apresentaram modificações. Anemia e hipoalbuminemia foram importantes dados laboratoriais. Foi observada associação com infecção pelo HIV. Atrofia de vilosidades e epitélio reativo foram comuns nos casos de S. stercoralis. CONCLUSÕES: Nenhum achado endoscópico ou histopatológico foi patognomônico. Um por cento das biopsias duodenais por via endoscópica mostraram parasitas.
Asunto(s)
Adulto , Animales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Duodenitis/parasitología , Parasitosis Intestinales/parasitología , Biopsia , Duodenitis/patología , Duodeno/patología , Endoscopía Gastrointestinal , Parasitosis Intestinales/patología , Estudios RetrospectivosRESUMEN
OBJECTIVE: In order to analyze the effect on autoimmune thyroiditis (AT) of current anti-hepatitis C virus (HCV) treatment in HCV-infected patients, we performed a systematic review with meta-analysis of the available literature. The present meta-analysis was conducted to evaluate the strength and the consistency of the association between treatments with interferon-alpha (IFN-alpha) for HCV infection and AT. MATERIAL AND METHODS: A search in Medline, PubMed, and EMBASE was conducted with a systematic review of clinical studies in English and other languages. Only studies in HCV subjects compared to a control group with hepatitis B (positive HBsAg) were considered. The relative risk (RR) of AT was regarded as the most reliable outcome end-point. The pooled odds ratio (OR) and 95% confidence intervals (95% CI) were calculated from the raw study data using the Mantel-Haenszel methods. We used a statistical evaluation of heterogeneity by the chi2-test to assess whether the variation in treatment effect within trials of the same group was greater than it might be expected. RESULTS: We identified 35 clinical trials with a total of 6.403 patients. Five trials were selected for analysis involving a total of 625 patients with hepatitis C treatment with IFN-alpha and 456 HBsAg-positive controls. These studies yielded a combined adjusted OR of 4.98 (95% IC 1.56-15.91). The test for heterogeneity was significant (P = 0.0008), and the test for overall effect was Z statistic 2.71 (P = 0.007). CONCLUSION: Our meta-analysis indicates that treatment with IFN-alpha for HCV infection has an increased risk of AT.
Asunto(s)
Antivirales/efectos adversos , Hepatitis C Crónica/tratamiento farmacológico , Interferón-alfa/efectos adversos , Tiroiditis Autoinmune/inducido químicamente , Adulto , Anciano , Antivirales/uso terapéutico , Estudios de Casos y Controles , Femenino , Humanos , Interferón-alfa/uso terapéutico , Masculino , Persona de Mediana Edad , Factores de RiesgoRESUMEN
Cryoglobulinemia and non-organ-specific-autoantibody are biomarkers of autoimmunity of the chronic infection caused by hepatitis C virus (HCV). In this work, we report the association between the presence of smooth muscle antibodies (SMA) and cryoglobulinemia and chronic liver disease in HCV carriers. Sixty-five untreated HCV patients, 38 women and 27 men were included in this study. Cryoglobulinemia was tested by cryoprecipitation, SMA by indirect fluorescent antibody test, and liver fibrosis and hepatocellular inflammation activity was investigated by histology of liver biopsy using the METAVIR score. The prevalence of SMA in the patients was 33.8% and cryoglobulinemia was demonstrated in 36.9% patients. Cryoglobulinemia and SMA seropositivity was associated with advanced fibrosis (p < 0.05). The presence of SMA and cryoglobulinemia was not associated with hepatocellular inflammation activity, age, carrier gender or HCV genotype. We concluded that liver biopsy should be recommended for HCV carriers that are seropositive for SMA or cryoglobulinemia.
Asunto(s)
Autoanticuerpos/análisis , Autoinmunidad/inmunología , Crioglobulinemia/inmunología , Hepatitis C Crónica/inmunología , Cirrosis Hepática/virología , Músculo Liso/inmunología , Adulto , Anciano , Autoanticuerpos/inmunología , Biomarcadores/análisis , Biopsia , Portador Sano/inmunología , Crioglobulinemia/complicaciones , Femenino , Técnica del Anticuerpo Fluorescente Indirecta , Hepatitis C Crónica/complicaciones , Humanos , Cirrosis Hepática/inmunología , Cirrosis Hepática/patología , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
Cryoglobulinemia and non-organ-specific-autoantibody are biomarkers of autoimmunity of the chronic infection caused by hepatitis C virus (HCV). In this work, we report the association between the presence of smooth muscle antibodies (SMA) and cryoglobulinemia and chronic liver disease in HCV carriers. Sixty-five untreated HCV patients, 38 women and 27 men were included in this study. Cryoglobulinemia was tested by cryoprecipitation, SMA by indirect fluorescent antibody test, and liver fibrosis and hepatocellular inflammation activity was investigated by histology of liver biopsy using the METAVIR score. The prevalence of SMA in the patients was 33.8 percent and cryoglobulinemia was demonstrated in 36.9 percent patients. Cryoglobulinemia and SMA seropositivity was associated with advanced fibrosis (p < 0.05). The presence of SMA and cryoglobulinemia was not associated with hepatocellular inflammation activity, age, carrier gender or HCV genotype. We concluded that liver biopsy should be recommended for HCV carriers that are seropositive for SMA or cryoglobulinemia.