RESUMO
INTRODUCTION: The aim of this study was to evaluate the therapeutic response of hepatitis C in patients coinfected with human immunodeficiency virus (HIV-1). METHODS: A retrospective study of 20 patients coinfected with HIV-1/HCV who were treated in the outpatient liver clinic at the Sacred House of Mercy Foundation Hospital of Pará (Fundação Santa Casa de Misericórdia do Pará - FSCMPA) from April 2004 to June 2009. Patients were treated with 180 µg PEG interferon-α2a in combination with ribavirin (1,000 to 1,250 mg/day) for 48 weeks. The end point was the sustained virological response (SVR) rate (HCV RNA negative 24 weeks after completing treatment). RESULTS: The mean age of the patients was 40 ± 9.5 years, of which 89% (n = 17) were male, and the HCV genotypes were genotype 1 (55%, n = 11/20), genotype 2 (10%, n = 2/20) and genotype 3 (35%, n = 7/20). The mean CD4+ lymphocyte count was 507.8, and the liver fibrosis stages were (METAVIR) F1 (25%), F2 (55%), F3 (10%) and F4 (10%). The early virological response (EVR) was 60%, the end-of-treatment virological response (EOTVR) was 45% and the SVR was 45%. CONCLUSIONS: The median HCV viral load was high, and in 85% of cases in which highly active antiretroviral therapy (HAART) was used, none of the patients with F3-F4 fibrosis responded to treatment. Of the twenty patients treated, 45% achieved SVR and 45% achieved EOTVR. Studies that include cases from a wider region are needed to better evaluate these findings.
Assuntos
Antivirais/uso terapêutico , Coinfecção/virologia , Infecções por HIV/tratamento farmacológico , Hepatite C/tratamento farmacológico , Interferon-alfa/uso terapêutico , Polietilenoglicóis/uso terapêutico , Ribavirina/uso terapêutico , Adulto , Terapia Antirretroviral de Alta Atividade , Contagem de Linfócito CD4 , Quimioterapia Combinada , Feminino , Genótipo , Infecções por HIV/complicações , Hepatite C/complicações , Humanos , Masculino , RNA Viral , Proteínas Recombinantes/uso terapêutico , Estudos Retrospectivos , Resultado do TratamentoRESUMO
INTRODUCTION: The aim of this study was to evaluate the therapeutic response of hepatitis C in patients coinfected with human immunodeficiency virus (HIV-1). METHODS: A retrospective study of 20 patients coinfected with HIV-1/HCV who were treated in the outpatient liver clinic at the Sacred House of Mercy Foundation Hospital of Pará (Fundação Santa Casa de Misericórdia do Pará - FSCMPA) from April 2004 to June 2009. Patients were treated with 180µg PEG interferon-α2a in combination with ribavirin (1,000 to 1,250mg/day) for 48 weeks. The end point was the sustained virological response (SVR) rate (HCV RNA negative 24 weeks after completing treatment). RESULTS: The mean age of the patients was 40±9.5 years, of which 89% (n=17) were male, and the HCV genotypes were genotype 1 (55%, n=11/20), genotype 2 (10%, n=2/20) and genotype 3 (35%, n=7/20). The mean CD4+ lymphocyte count was 507.8, and the liver fibrosis stages were (METAVIR) F1 (25%), F2 (55%), F3 (10%) and F4 (10%). The early virological response (EVR) was 60%, the end-of-treatment virological response (EOTVR) was 45% and the SVR was 45%. CONCLUSIONS: The median HCV viral load was high, and in 85% of cases in which highly active antiretroviral therapy (HAART) was used, none of the patients with F3-F4 fibrosis responded to treatment. Of the twenty patients treated, 45% achieved SVR and 45% achieved EOTVR. Studies that include cases from a wider region are needed to better evaluate these findings.
Assuntos
Adulto , Feminino , Humanos , Masculino , Antivirais/uso terapêutico , Coinfecção/virologia , Infecções por HIV/tratamento farmacológico , Hepatite C/tratamento farmacológico , Interferon-alfa/uso terapêutico , Polietilenoglicóis/uso terapêutico , Ribavirina/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Quimioterapia Combinada , Genótipo , Infecções por HIV/complicações , Hepatite C/complicações , Estudos Retrospectivos , RNA Viral , Proteínas Recombinantes/uso terapêutico , Resultado do TratamentoRESUMO
INTRODUÇÃO: Com o advento da terapia antirretroviral de alta atividade em 1996, a doença hepática tornou-se causa importante de morbidade e mortalidade em pessoas infectadas pelo vírus da imunodeficiência humana-1 (HIV-1). OBJETIVO: Descrever os aspectos demográficos e laboratoriais de 62 pacientes coinfectados com o vírus da imunodeficiência humana e da hepatite C (HIV-1/HCV). MÉTODO: Estudo transversal, incluindo pacientes portadores do HIV, confirmados sorologicamente (ELISA + Imunofluorescência indireta ou Western Blot), com anti-HCV positivos pelo teste de ELISA confirmados por RT-PCR, atendidos no ambulatório de fígado da Fundação Santa Casa de Misericórdia do Pará no período de agosto de 2004 até abril de 2008. RESULTADOS: Foram atendidos 49 (79 por cento) indivíduos do gênero masculino e 13 indivíduos do gênero feminino, com mediana de idade de 42,6 anos, solteiros (66, por cento. n = 41), heterossexuais (59,7 por cento, n = 37), bissexuais (27,4 por cento, n = 17), homem que faz sexo com homem HSH (12,9 por cento. n = 8); contagem de linfócitos T CD4+ com mediana de 327 células/mm3, carga viral plasmática do HIV com mediana de 2,54 log10 HIV-RNA cópias/mL, carga viral do HCV (HCV-RNA) de 5,90 log10 UI/mL. O genótipo 1 do HCV foi encontrado em 60,87 por cento. A biópsia hepática foi realizada em 41 (66,12 por cento) pacientes, tendo sido observada a seguinte classificação METAVIR: F0 (12 por cento), F1 (24,4 por cento), F2 (32 por cento), F3 (17 por cento) e F4 (14,6 por cento). CONCLUSÃO: Os pacientes eram predominantemente solteiros,com carga viral do HCV elevada, apresentavam fibrose de moderada a severa em mais de 50 por cento dos casos sem alterações laboratoriais significativas...
INTRODUCTION: Since highly active antiretroviral therapy was developed in 1996, liver injury has become an important cause of morbidity and mortality in individuals infected by the human immunodeficiency virus-1 (HIV-1). OBJECTIVE: To report the demographic and laboratory findings of 62 patients coinfected with HIV-1/HCV. METHODS: This cross-sectional study analyzed HIV patients, confirmed serologically by ELISA and indirect immunofluorescence or Western Blot, with positive anti-HCV by ELISA and confirmed by RT-PCR. These patiens were treated at the Liver Department of the Fundação Santa Casa de Misericórdia do Pará from August 2004 to April 2008. RESULTS: A total of 49 (79 per cent) male and 13 female patients were analyzed. Their age median was 42.6 years and they were single (66.1 per cent n=41), heterosexual (59.7 per cent, n = 37), bisexual (27.4 per cent, n = 17), man who have sex with man MSM (12.9 per cent, n = 8); the lymphocytes T CD4+ count median was 327 cells/mm3, HIV serum viral load median was 2.54 log10 HIV RNA copies/mL, HCV viral load (RNA-HCV) was 5.9 log10 UI/mL. The HCV genotype 1 was found in 60.87 per cent of the patients. Forty-one (66.12 per cent) patients were submitted to liver biopsies and the histopathology results according to METAVIR were F0 (12 per cent), F1 (24.4 per cent), F3 (17 per cent), F4 (14.6 per cent). CONCLUSION: Patients were predominantly single, with high viral load. They presented with moderate to severe fibrosis in more than 50 per cet of cases without significant changes in their laboratory findings...
Assuntos
Masculino , Feminino , Humanos , HIV , Estudos Transversais , Ensaio de Imunoadsorção Enzimática/métodos , Hepacivirus/patogenicidade , Hepatite C CrônicaRESUMO
The present study compares the genotype frequencies between two population groups composed by 73 hepatitis C virus (HCV)-infected patients and 92 seronegative controls and investigates the role of allele variants as a possible factor in the susceptibility to HCV infection and the influence on disease progression. The identification of MBL*B and MBL*C alleles was performed by restriction fragment length polymorphism analysis of the 349-bp product using BanI and MboII restriction enzymes, respectively, and a polymerase chain reaction-sequence-specific polymorphism for discrimination of MBL*D. The analysis of allele and genotype frequencies between an HCV-infected group and seronegative controls did not indicate significant differences. The comparison of chronically infected subjects with and without liver cirrhosis was also not statistically significant. The odds ratio estimations were not significant, and the values obtained cannot suggest that the presence of allele variant MBL*B could have some influence in the risk of HCV infection progression to liver cirrhosis and that the presence of allele MBL*D could confer some protection against disease progression, but a larger sample size is necessary to confirm the present results.
Assuntos
Hepacivirus/imunologia , Hepatite C Crônica/genética , Lectina de Ligação a Manose/genética , Adolescente , Adulto , Idoso , Alelos , Brasil , Análise Mutacional de DNA , Progressão da Doença , Feminino , Frequência do Gene , Predisposição Genética para Doença , Genótipo , Hepacivirus/patogenicidade , Hepatite C Crônica/imunologia , Hepatite C Crônica/fisiopatologia , Humanos , Masculino , Lectina de Ligação a Manose/imunologia , Lectina de Ligação a Manose/metabolismo , Pessoa de Meia-Idade , Polimorfismo Genético , Fatores de Risco , VirulênciaRESUMO
In order to contribute to a better understanding of the possible role of hepatits B and C in the etiopathogenis of HCC in the East Amazon, there were studied 36 patients in Belém/PA. Serological hepatitis markers were evaluated and polymerase chain reaction assays were used to detect HBV-DNA and HCV-RNA. Alcohol abuse was observed in 33.3% and cirrhosis in 83.3%. In 88.9% of the sample, one or more hepatitis B markers were positive. Also, 8.3% those patients had anti-HCV simultaneously positive. The HBsAg serological test was positive in 58.3%; anti-HBc in 86%; anti-HBe in 85.7%; anti-HBe in 9.5%; IgM anti-HBc in 57.1%. The HBV DNA was found in 37.7% and in 65% of the HBsAg positive. The HCV RNA was detected in 8.5% and in 100% of the patients positive to anti-HCV. The AFP was above the normal value in 88.9% of patients, with levels up to 400ng/ml in 75% of them. In conclusion, hepatitis B virus infection seems to be important in the etiology of HCC and improving measures such immunization and screening in the risk population should be emphasyzed.
Assuntos
Carcinoma Hepatocelular/virologia , Hepatite B/complicações , Hepatite C/complicações , Neoplasias Hepáticas/virologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Brasil , Criança , DNA Viral/análise , Feminino , Anticorpos Anti-Hepatite B/sangue , Antígenos de Superfície da Hepatite B/sangue , Anticorpos Anti-Hepatite C/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , RNA Viral/análiseRESUMO
Com o objetivo de contribuir para um melhor conhecimento do envolvimento das infecções pelos vírus das hepatites B e C, na etioepidemiologia do CHC na Amazônia Oriental, estudou-se 36 pacientes em Belém-PA. Foram avaliados marcadores sorológicos e a pesquisa do HBV-DNA e HCV-RNA pela reação em cadeia da polimerase. Observou-se etilismo em 33,3% e cirrose em 83,3%. Marcadores sorológicos das infecções pelo HBV e HCV foram encontrados respectivamente em 88,9% e 8,3%. O HBsAg foi encontrado em 58,3%; anti-HBc em 86%; anti-HBe em 85,7; HBeAg em 9,5%; anti-HBc IgM em 57,1%. O HBV-DNA foi detectado em 37,7% e em 65% dos HBsAg positivos; o HCV-RNA em 8,5% e em 100% dos anti-HCV positivos. AFP esteve alterada em 88,9% e acima de 400ng/ml em 75% dos casos. Conclui-se que a infecção pelo HBV parece ter importância na etiologia do CHC e ressalta-se a importância de implementar programas de vacinação e detecção precoce do tumor.
In order to contribute to a better understanding of the possible role of hepatits B and C in the etiopathogenis of HCC in the East Amazon, there were studied 36 patients in Belém/PA. Serological hepatitis markers were evaluated and polymerase chain reaction assays were used to detect HBV-DNA and HCV-RNA. Alcohol abuse was observed in 33.3% and cirrhosis in 83.3%. In 88.9% of the sample, one or more hepatitis B markers were positive. Also, 8.3% those patients had anti-HCV simultaneously positive. The HBsAg serological test was positive in 58.3%; anti-HBc in 86%; anti-HBe in 85.7%; anti-HBe in 9.5%; IgM anti-HBc in 57.1%. The HBV DNA was found in 37.7% and in 65% of the HBsAg positive. The HCV RNA was detected in 8.5% and in 100% of' the patients positive to anti-HCV. The AFP was above the normal value in 88.9% of patients, with levels up to 400ng/ml in 75% of them. In conclusion, hepatitis B virus infection seems to be important in the etiology of HCC and improving measures such immunization and screening in the risk population should be emphasyzed.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Hepatocelular/virologia , Hepatite B/complicações , Hepatite C/complicações , Neoplasias Hepáticas/virologia , Brasil , Biomarcadores/sangue , DNA Viral/análise , Anticorpos Anti-Hepatite B/sangue , Antígenos de Superfície da Hepatite B/sangue , Anticorpos Anti-Hepatite C/sangue , Reação em Cadeia da Polimerase , RNA Viral/análiseRESUMO
A hepatite Autoimune (HAI) é uma doença hepática infreqüente, porém seu diagnóstico preciso e precoce permite uma melhora substancial no prognóstico dos pacientes acometidos desta enfermidade. Objetivando encontrar a taxa de incidência de HAI entre os hapatopatas crônicos atendidos no programa de hepatopatias do Hospital da FSCMP, foram avaliados 459 pacientes no período de janeiro de 1993 a julho de 1998, sendo diagnosticados 12 (2,6 por cento) como portadores de HAI, sendo 11 do sexo feminino. A idade média era de 20,7 anos, em duas pacientes havia o antecedente de hepatite viral aguda A precedendo o quadro. A icterícia foi vista em 91 por cento (11/12) dos casos e a hepatomegalia esteve presente em 50 por cento (6/12) pacientes. Cinco já possuiam varizes esofagianas. Em 50 por cento (4/8), os auto-anticorpos encontrados foram a ANA e/ou AML. O histopalógico demonstrava hepatite crônica com atividade severa, sendo em seis com evoluçäo cirrogênica. Em 9/12 (75 por cento) o sistema de "score" era superior ou igual a 15 pontos, portanto com diagnóstico definitivo antes do tratamento. Conclui-se que neste estudo, a HAI corresponte a uma pequena parcela das etiologias de doença hepática em nosso meio, mais relacionada a mulheres jovens, do tipo 1, forma clássica, e em 51 por cento (6/11) observou-se uma atividade histológica grave com evoluçäo para cirrose hepática