Vaccination coverage and immunity against hepatitis B among HIV-infected patients in South Brazil

Evidence-based strategies to improve the hepatitis B virus (HBV) vaccination coverage rates might help to reduce the burden caused by co-infection with HBV and human immuno-deficiency virus (HIV). In this study, the aim was to evaluate the vaccination coverage and immunity against HBV among HIV-infected individuals in South Brazil, and identify factors that are associated with compliance patterns and antibody reactivity. Three hundred HIV-infected men and women were included in this survey. The patients answered a standardized questionnaire, and vaccination cards were checked in order to assess hepatitis B vaccine status. A blood sample was collected for quantitative determination of antibody to hepatitis B virus surface antigen (anti-HBs). Participants were also evaluated for their CD4 cell count and HIV viral load. The overall vaccination coverage of HBV vaccination found in this study (57.4%) was lower than that was previously reported in South Brazil. Anti-HBs levels >10 IU/L were observed in 47.0% of the studied population. A significant inequality in the coverage rates and antibody reactivity was found in favor of patients with better economic status. In conclusion, the results indicate the need for improvement in the HBV vaccination coverage among HIV carriers, in particular focusing on low-income individuals.

The prevalence of hepatitis B virus infection markers and socio-demographic risk factors in HIV-infected patients in Southern Brazil

Introduction Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) infections are two of the world's most important infectious diseases. Our objective was to determine the hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (anti-HBc) prevalences among adult HIV-infected patients and identify the associations between socio-demographic variables and these HBV infection markers. Methods This study was performed from October 2012 to March 2013. Three hundred HIV-seropositive patients were monitored by the Clinical Analysis Laboratory of Professor Polydoro Ernani de São Thiago University Hospital, Santa Catarina, Brazil. The blood tests included HBsAg, anti-HBc immunoglobulin M (IgM) and total anti-HBc. Patients reported their HIV viral loads and CD4+ T-cell counts using a questionnaire designed to collect sociodemographic data. Results The mean patient age was 44.6 years, the mean CD4 T-cell count was 525/mm3, the mean time since beginning antiretroviral therapy was 7.6 years, and the mean time since HIV diagnosis was 9.6 years. The overall prevalences of HBsAg and total anti-HBc were 2.3% and 29.3%, respectively. Among the individuals analyzed, 0.3% were positive for HBsAg, 27.3% were positive for total anti-HBc, and 2.0% were positive either for HBsAg or total anti-HBc and were classified as chronically HBV-infected. Furthermore, 70.3% of the patients were classified as never having been infected. Male gender, age >40 years and Caucasian ethnicity were associated with an anti-HBc positive test. Conclusions The results showed an intermediate prevalence of HBsAg among the studied patients. Moreover, the associations between the anti-HBc marker and socio-demographic factors suggest a need for HBV immunization among these HIV-positive individuals, who are likely to have HIV/HBV coinfection. .

Seroprevalence of HBV and HCV markers among young adult males in the Air Force in Florianópolis, South Brazil

We investigated the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) serological markers of infection in young adults from the metropolitan region of Florianópolis who were conscripts of the Air Base of Florianópolis in the state of Santa Catarina, Brazil. A population-based cross-sectional seroprevalence study was conducted with 371 young males during a one year period starting in June 2009. Demographic characteristics, socio-economic characteristics and possible risk factors to HBV and HCV were assessed. Blood samples were analyzed for HBsAg, anti-HBc, anti-HCV and anti-HBs through automated microparticle enzymatic immunoassays (Abbott®, AxSYM System, Wiesbaden, Germany). None of the participants showed positivity to HBsAg or anti-HCV. The prevalence of anti-HBc was 1.6% (95% CI 0.6 - 3.5), and the prevalence of anti-HBs was 40.7% (95% CI 35.7 - 45.9). Unsafe sex was associated with positive anti-HBc in a bivariate analysis. There was a very low prevalence of past HBV infection and no cases of past HCV infection in a young adult population in the metropolitan region of Florianópolis. The very low prevalence of markers of infection and risk factors indicates a very optimistic future with respect to HBV and HCV infection in this population.

Este estudo teve como objetivo investigar a prevalência dos marcadores sorológicos de infecção pelo HBV e HCV em adultos jovens na Região Metropolitana de Florianópolis, conscritos da Base Aérea de Florianópolis, Santa Catarina, Brasil. Trata-se de um estudo soroepidemiológico transversal de base populacional com 371 adultos jovens, no período de um ano a partir de junho de 2009. Foram pesquisadas características sócio-econômicas e possíveis fatores de risco para HBV e HCV. As amostras de sangue foram analisadas quanto à presença de HBsAg, anti-HBc, anti-HCV e anti-HBs pelo método imunoensaio enzimático automatizado de micropartículas (Abbott®, Sistema AxSYM, Wiesbaden, Alemanha). Nenhum dos participantes demonstrou positividade para HBsAg ou anti-HCV. A prevalência do anti-HBc foi de 1,6% (IC 95% 0,6 - 3,5) e do anti-HBs foi 40,7% (IC 95% 35,7 - 45,9). Relação sexual desprotegida associou-se com a positividade do anti-HBc na análise bivariada. Demonstrou-se prevalência muito baixa de infecção passada pelo HBV e ausência de HCV nesta população de adultos jovens na Região Metropolitana de Florianópolis. A particularidade desta prevalência muito baixa de marcadores de infecção e fatores de risco aponta para um quadro otimista em relação ao HBV e HCV no futuro para esta população.

Hepatitis B marker seroprevalence and vaccination coverage in adolescents in the City of Itajaí, State of Santa Catarina, Southern Brazil, in 2008 / Soroprevalência de marcadores da hepatite B e cobertura de vacinação em adolescentes no município de Itajaí, Estado de Santa Catarina Sul do Brasil, em 2008

INTRODUCTION: Hepatitis B infection constitutes an important cause of morbidity and mortality worldwide. In Brazil, however, the current epidemiological situation is not clear. Considering the importance of establishing this prevalence, the aim of this study was to determine the prevalence of HBV markers in voluntary adolescents, junior high (secondary school) students, in the City of Itajaí, State of Santa Catarina, Brazil. METHODS: A seroepidemiological, transverse study was conducted with 353 randomly chosen adolescents from elementary school in 2008. Blood samples were analyzed for HBsAg, anti-HBc and anti-HBs. All analyses were conducted by automated microparticle enzyme immunosorbent assay (Abbott®, AxSYM system, Deerfield, IL, USA), according to the manufacturer's instructions. RESULTS: The prevalence of HBsAg was 0.6% (CI 95% 0.1 - 2.0), that of anti-HBc was 1.1% (CI 95% 0.3 - 2.9) and that of detectable anti-HBs was 83.6% (CI 95% 79.3 - 87.3). Hepatitis B vaccination coverage was 97.5% (CI 95% 95.2 - 98.8). CONCLUSIONS: These results demonstrate the success of the vaccination program against hepatitis B in the region studied and indicate that prevention strategies must be maintained and, if possible, expanded to contribute to the establishment of positive prevalence rates in all age groups.

INTRODUÇÃO: A hepatite B constitui uma causa relevante de morbidade e mortalidade em todo o mundo. No Brasil, entretanto, a situação epidemiológica atual não é claramente conhecida. Considerando-se a importância do estabelecimento de tal prevalência, o objetivo deste estudo foi determinar a prevalência dos marcadores de HBV em adolescentes voluntários, estudantes do ensino fundamental na Cidade de Itajaí, Santa Catarina, Brasil. MÉTODOS: Trata-se de um estudo soroepidemiológico, transversal, conduzido com 353 adolescentes do ensino fundamental, randomicamente selecionados, em 2008. As amostras de sangue foram analisadas quanto à presença dos marcadores HBsAg, anti-HBc e anti-HBs. Todas as análises foram conduzidas em ensaio imunoenzimático de micropartículas automatizado (Abbott®, AxSYM system, Deerfield, IL, EUA), de acordo com as instruções do fabricante. RESULTADOS: A prevalência do HBsAg foi de 0,6% (CI 95% 0,1 - 2,0), do anti-HBc foi de 1,1% (CI 95% 0,3 - 2,9) e de títulos detectáveis de anti-HBs foi de 83,6% (CI 95% 79,3 - 87,3). A cobertura vacinal nos adolescentes estudados foi de 97,5% (CI 95% 95,2 - 98,8). CONCLUSÕES: Estes resultados demonstram o sucesso do programa de vacinação contra a hepatite B na região estudada e indicam que as estratégias de prevenção devem ser mantidas e, se possível, expandidas para que contribuam no estabelecimento de taxas de prevalência positivas em todas as faixas etárias.

Anti-HBs levels among children and adolescents with complete immunization schedule against hepatitis B virus. A cross-sectional study in Blumenau, State of Santa Catarina, Brazil, 2007-2008 / Níveis de anti-HBs entre crianças e adolescentes com o esquema completo de imunização contra o vírus da hepatite B. Um estudo transversal em Blumenau, Estado de Santa Catarina, 2007-2008

INTRODUCTION: Vaccination is the main tool for preventing hepatitis B virus (HBV) infection; however, following the completion of the vaccination series, the concentrations of anti-HBs can decline over the years and reach levels less than 10mIU/mL. The persistence of protection in these individuals is still unknown. The present study aimed to determine the anti-HBs antibody levels among children and adolescents who had received a complete vaccination course for hepatitis B. METHODS: Antibodies against HBV surface antigen (anti-HBs) were tested in 371 individuals aged 10 to 15 years-old. RESULTS: Volunteers who showed undetectable quantities of anti-HBs accounted for 10.2% of the population studied and 39.9% presented antibody titers of less than 10mIU/mL. Anti-HBs ≥ 10mIU/mL were verified in 49.9%. CONCLUSIONS: These results corroborate other studies indicating levels of anti-HBs below 10mIU/mL in vaccinated individuals. Additional studies are required to assess whether this indicates susceptibility to HBV infection and the need and age for booster doses.

INTRODUÇÃO: A vacinação é o principal instrumento para prevenir a infecção pelo vírus da hepatite B. Todavia, após a conclusão da série de vacinação, as concentrações de anti-HBs podem diminuir ao longo dos anos e atingir níveis inferiores a 10mUI/mL. A persistência da proteção nestes indivíduos ainda é desconhecida. O presente estudo objetivou determinar os níveis do anticorpo anti-HBs em crianças e adolescentes que receberam o esquema completo de vacinação para a hepatite B. MÉTODOS: O anticorpo para o antígeno de superfície do vírus da hepatite B (anti-HBs) foi testado em 371 indivíduos com idade entre 10-15 anos. RESULTADOS: Os voluntários que apresentaram quantidades indetectáveis de anti-HBs corresponderam a 10,2% da população estudada, e 39,9% apresentaram títulos do anticorpo inferiores a 10mUI/mL. Anti-HBs ≥ 10mUI/mL foi verificado em 49,9%. CONCLUSÕES: Nossos resultados corroboram com outros estudos que indicam níveis de anti-HBs inferiores a 10mUI/mL em indivíduos vacinados. Estudos adicionais são necessários para avaliar se isso indica suscetibilidade à infecção pelo HBV e necessidade e idade para a dose reforço.

Seroprevalence of hepatitis B and hepatitis C markers in adolescents in Southern Brazil / Soroprevalência de marcadores de hepatite B e hepatite C em adolescentes no Sul do Brasil

Este estudo teve como objetivo determinar a prevalência de marcadores do vírus da hepatite B (HBV) e do vírus da hepatite C (HCV) entre adolescentes com idade entre 10 e 16 anos, alunos do Ensino Fundamental da cidade de Chapecó, Santa Catarina, Brasil. Trata-se de um estudo transversal incluindo 418 voluntários, realizado entre março e julho de 2008. As análises sorológicas incluíram: HBsAg, anti-HBc, anti-HBs e anti-HCV. Os testes foram realizados em Ensaio Enzimático de Micropartículas (Abbott, AxSYM System, Wiesbaden, Alemanha). A prevalência de HBsAg foi de 0,2 por cento (IC95 por cento: 0,0-1,3), e a prevalência de anti-HBc foi de 1,4 por cento (IC95 por cento: 0,5-3,1). Quanto ao anti-HBs, 48,6 por cento dos voluntários apresentaram títulos maiores que 10UI/L. Nenhum dos voluntários apresentou resultados reativos para anti-HCV. Este estudo demonstrou uma baixa prevalência de marcadores de infecção HBV e HCV e um grande número de voluntários imunizados contra o HBV. Finalmente, demonstrou-se a importância de campanhas e políticas adequadas de saúde na redução dessas prevalências.

This study was carried out to determine the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) markers among adolescents aged between 10 and 16 years old, who are elementary school students in the city of Chapecó, Santa Catarina State, Brazil. The study involved a cross-sectional survey that included 418 volunteers, from March to July, 2008. Serology comprised HBsAg, anti-HBc, anti-HBs and anti-HCV. Tests were performed using automated Microparticle Enzyme Immunosorbant Assay (Abbott, AxSYM System, Wiesbaden, Germany). The prevalence of HBsAg was found to be 0.2 percent (95 percentCI: 0.0-1.3), and the prevalence of anti-HBc was found to be 1.4 percent (95 percentCI: 0.5-3.1). Regarding anti-HBs, 48.6 percent had titers greater than 10UI/L. None of the volunteers presented reactive results for anti-HCV. This study showed a low prevalence of HBV and HCV markers of infection and a great number of volunteers immunized against HBV. Finally this study shows the importance of proper health campaigns and policies in reducing those prevalences.

Seroprevalence of hepatitis B and C infection markers among children and adolescents in the southern Brazilian region / Soroprevalência dos marcadores de infecção das hepatites B e C em crianças e adolescentes da região sul do Brasil

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections account for a substantial proportion of liver diseases worldwide. The aim of this study was to determine the prevalence of HBV and HCV serological markers among children and adolescents and verify the epidemiology of the HBV infection over than a decade of the introduction of vaccination program. Serologic markers to HBsAg, total anti-HBc and anti-HCV had been tested in 393 samples. The seropositivity for HBsAg was 0.76 percent and for total anti-HBc was 1.02 percent. Copositivity between HBsAg and total anti-HBc was verified in 0.76 percent of the analyzed samples. There was no seropositivity for anti-HCV marker. The seroprevalence of HBV infection markers among children and adolescents in the southern Brazilian region is high compared to that reported in other countries. Preventive measures, such as educational activities in addition to the universal childhood HBV vaccination, should be initiated in order to reduce the morbimortality and the economic burden associated with the disease.

As infecções pelo vírus da hepatite B (HBV) e pelo vírus da hepatite C (HCV) representam a causa de uma substancial proporção das doenças hepáticas em todo o mundo. O objetivo deste estudo foi determinar a prevalência dos marcadores sorológicos do HBV e do HCV em crianças e adolescentes, e verificar a epidemiologia da infecção pelo HBV passada uma década desde a introdução do programa de vacinação. Os marcadores sorológicos HBsAg, anti-HBc total e anti-HCV foram avaliados em 393 amostras. A soropositividade para o HBsAg foi de 0,76 por cento e para o anti-HBc total foi de 1,02 por cento. Co-positividade entre HBsAg e anti-HBc total foi verificada em 0,76 por cento das amostras analisadas. Não houve soropositividade para o marcador anti-HCV. A soroprevalência dos marcadores de infecção pelo HBV em crianças e adolescentes da região sul do Brasil é elevada em relação à reportada em outros países. Medidas preventivas, tais como atividades educativas além da vacinação infantil universal contra o HBV, devem ser iniciadas a fim de reduzir a morbimortalidade e o impacto econômico associados a doença.

Seroprevalence of cytomegalovirus antibodies in blood donors in southern, Brazil / Soroprevalência de anticorpos contra citomegalovírus em doadores de sangue do Sul do Brasil

INTRODUCTION: Cytomegalovirus (CMV) infection is a matter of concern for blood bank professionals and blood transfusion recipients, especially in cases of transfusions to neonates and immunocompromised patients. Thus, the present study aimed to determine the seroprevalence of CMV IgG and IgM antibodies among blood donors in the city of Lages, in the mountain region of Santa Catarina, southern Brazil, and to investigate possible associations between the socioeconomic characteristics of donors and CMV serological status. METHODS: A seroepidemiological cross-sectional study was conducted on 1,045 blood samples from donors that were used in serological screening over a one-year investigation. All the analyses were conducted using the microparticle enzyme immunoassay with Biokit® reagents (Barcelona, Spain), in accordance with the manufacturer's instructions. RESULTS: Anti-CMV IgG seroprevalence in the sample studied was 96.4 percent (95 percent CI: 95.23 - 97.50) and that of anti-CMV IgM was 2.3 percent (95 percent CI: 1.39 - 3.20). There were no statistically significant associations between the presence of antibodies and the socioeconomic characteristics of donors. CONCLUSIONS: The blood donors in the study region had high seroprevalence of anti-CMV IgG. Thus, blood component screening strategies and careful indication for blood transfusions require special attention among healthcare professionals as part of the actions for prevention and reduction of primary infections caused by CMV.

INTRODUÇÃO: A infecção pelo citomegalovírus representa uma preocupação para os profissionais de bancos de sangue e para receptores de transfusões sanguíneas, especialmente em casos de transfusões para neonatos e pacientes imunocomprometidos. Assim, o presente estudo teve como objetivo determinar a soroprevalência de anticorpos IgG e IgM contra CMV em doadores de sangue da Cidade de Lages, Região Serrana de Santa Catarina, Sul do Brazil e investigar possíveis associações entre as características socioeconômicas dos doadores e a sorologia para CMV. MÉTODOS: Trata-se de um estudo soroepidemiológico, transversal, conduzido com 1.045 amostras de sangue de doadores utilizadas na triagem sorológica durante um ano de investigação. Todas as análises foram conduzidas em ensaio imunoenzimático de micropartículas com reagentes Biokit® (Barcelona, Espanha), de acordo com as instruções do fabricante. RESULTADOS: A soroprevalência de IgG antiCMV na amostra estudada foi de 96,4 por cento (IC 95 por cento 95,23 - 97,50) e de IgM antiCMV foi de 2,3 por cento (IC 95 por cento 1,39 - 3,20). Não houve associação significativa entre a presença de anticorpos e as características socioeconômicas dos doadores. CONCLUSÕES: Os doadores de sangue da região estudada apresentaram uma alta soroprevalência de IgG antiCMV, e assim, estratégias de triagem de hemocomponentes e a indicação criteriosa de transfusões sanguíneas requerem atenção especial dos profissionais da saúde como parte das ações de prevenção e redução da infecção primária pelo CMV.

Seroprevalence of hepatitis B and hepatitis C markers among children and adolescents in the south brazilian region: metropolitan area of Florianópolis, Santa Catarina

Hepatitis B and C are important causes of morbidity and mortality worldwide. In Brazil, according to the Ministry of Health, about 15 percent of population is infected by hepatitis B virus (HBV) and less than 1 percent by hepatitis C virus (HCV). Nevertheless, the age-specific prevalence of HBV and HCV markers remains unknown. This study aimed to determine the seroprevalence of HBV and HCV markers of infection and immunity in children and adolescents between 10 to 16 years old who live in the metropolitan area of Florianópolis, state of Santa Catarina, South of Brazil. Three hundred and eighty four individuals were enrolled in this study. Serological markers for HBV and HCV (HBsAg, total anti-HBc, anti-HBc IgM, anti-HBs and anti-HCV) were determined through Microparticle Enzyme Immunosorbant Assay (MEIA) - AxSYM System® - by using commercial diagnostic kits (Abbott Laboratories, Abbott Park, Illinois, USA). All 384 adolescents (100 percent) were negative for HBsAg and anti-HBc IgM. Only two (0.52 percent) were positive for total anti-HBc. Among the studied individuals, 226 (58.85 percent) presented titers of anti-HBs > 10.0mIU/mL, 121 (31.51 percent) presented anti HBs < 10.0mIU/mL, and 37 (9.64 percent) did not present titers of anti-HBs. Regarding to anti-HCV, all 384 adolescents (100 percent) presented negative results for this marker. In conclusion, this study showed a low prevalence of HBV and HCV infections. In addition, it was verified a great number of children and adolescents (89.84 percent) who were positive for the immunity marker anti-HBs, implying that the National Immunization Program Protocol for hepatitis B has been effective in the studied region.

Avaliação do nível de conhecimento de adolescentes a respeito da transmissão e prevenção das hepatites B e C / Evaluation of the knowledge of adolescents on transmission and prevention of hepatitis B and C

O objetivo deste estudo foi avaliar o conhecimento de adolescentes do município de Blumenau, Santa Catarina, sobre os meios de transmissão e prevenção das hepatites B e C. Foi realizado um estudo transversal com 393 adolescentes entre 10 e 15 anos atendidos em postos de saúde do município, que responderam a um questionário relativo às hepatites B e C. Dos 393 participantes, 210 (53,4 por cento) eram do sexo feminino. A maioria dos adolescentes (83,2 por cento) demonstrou ter conhecimento da vacina preventiva contra a hepatite B. Pouco mais da metade dos participantes (55,5 por cento) acreditam que a contaminação pelo HBV e HCV ocorra pelo contato com sangue ou secreções de uma pessoa infectada e 23,5 por cento desconhecem as formas de transmissão. Dentre os participantes, 29,0 por cento relataram conhecimento de um ou mais casos de hepatite na família. Quase 40 por cento dos adolescentes informaram antecedente de internação hospitalar, dos quais 5 (1,3 por cento do total de participantes) já haviam recebido sangue por transfusão e 13 (3,3 por cento do total) possuem body piercing e/ou tatuagem. O nível de conhecimento na população estudada mostra a necessidade de intensificação das atividades educativas e a importância de uma política de educação em saúde voltada para os adolescentes.

Variabilidade interensaios de dislipidemias em pacientes hipertensos / Inter-assays variability of dislipidemias in hypertensive patients

INTRODUÇÃO E OBJETIVOS: Ensaios de diferentes procedências para avaliação das dislipidemia podem resultar em variações significativas nos resultados obtidos e consequente conduta inadequada pelo clínico. O estudo objetivou comparar resultados laboratoriais de colesterol total (CT), triglicérides (TG), colesterol da lipoproteína de alta densidade (HDL-C), colesterol da lipoproteína de baixa densidade (LDL-C), apolipoproteína A-1 (Apo A-1), apolipoproteína B (Apo B) e lipoproteína (a) (Lp[a]) e índices lipídicos (não-HDL-C, CT/HDL-C, LDL-C/HDL-C, TG/HDL-C e Apo B/HDL-C) de pacientes hipertensos e/ou diabéticos diagnosticados. MÉTODOS: Foram utilizados conjuntos reativos, e os respectivos analisadores Gold Analisa, Dia Sys (CCX - Abbott), Dade Behring (Nefelômetro BN 100) e Roche (COBAS Integra 400), para verificar a reprodutibilidade dos resultados obtidos. Participaram 99 pacientes (36 do sexo masculino e 63 do feminino). Comparando os resultados, verificamos que: todas as médias obtidas dos constituintes lipídicos apresentaram diferença significativa; número semelhante de pacientes apresentou níveis séricos elevados de CT, TG, Lp(a) e Apo A-1. O HDL-C, o LDL-C e a Apo B apresentaram discordância, assim como os índices de CT/LDL-C, LDL-C/HDL-C e TG/HDL-C. Para não-HDL-C e ApoB/HDL, houve semelhança no número de pacientes com valores não recomendados. Em consequência da diferença, em relação ao LDL-C, a decisão da conduta terapêutica poderá ser inadequada, enquanto o não-HDL-C, além de evidenciar partículas aterogênicas, apresentou número de hipertensos com valores séricos não referendados semelhantes, independente da metodologia e do equipamento utilizado. CONCLUSÃO: No grupo de hipertensos analisados, o não-HDL-C se caracterizou um importante fator de correção interensaios de parâmetros lipídicos. E sua associação à relação Apo B/HDL-C pode ser um fator adicional em relação às condutas hipolipemiantes a serem adotadas.

INTRODUCTION AND OBJECTIVES: Different assays to evaluate dyslipidemia may show significant variations in the obtained results and a consequent inappropriate clinical approach may be adopted. This study aimed to compare the results of total cholesterol (CT), triglycerides (TG), HDL-C, Apo A1, Apo B, lipoprotein (a) and lipidic indexes (not-HDL-C, CT/HDL-C, LDL-C/HDL-C, TG/HDL-C and Apo B/HDL-C) of hypertensive and/or diabetic patients. METHODS: The following reactive kits and respective analyzers were applied to verify the reproducibility of results: Gold Analisa, DiaSys (CCX-ABBOTT), Dade Behring (Nephelometer BN 100) and Roche (COBAS Integra 400). Ninety nine patients (36 male and 63 female gender) were investigated. Comparing the results, we observed that all mean numbers of lipid constituents showed a significant difference. A similar number of patients had high CT, TG, Lp (a) and Apo A-1 serum levels. There was also disagreement in HDL-C, LDL-C, ApoB, CT/LDL-C, LDL-C/HDL-C and TG/HDL-C indexes. For not-HDL-C and ApoB/HDL, there was similarity in the number of patients with not recommended values. As a consequence of this difference, the choice of therapeutic approach may be inappropriate as to LDL-C levels, whereas Not-HDL-C not only showed atherogenic particles but also a number of hypertensive patients with similar not recommended serum values, regardless of the methodology and the equipment used. CONCLUSION: In the analyzed group of hypertensive patients, not-HDL-C was an important inter assay correction factor of lipidic parameters. The association with Apo B/HDL-C relation may be an additional factor as to the choice of hypolipemiant treatments.

Alterations in lipid transfer to High-Density Lipoprotein (HDL) and activity of paraoxonase-1 in HIV+ patients / Alterações na transferência de lípides para a lipoproteína de alta densidade (HDL) e atividade da paroxonase 1 em pacientes HIV+

HIV+ patients often develop alterations of the plasma lipids that may implicate in development of premature coronary artery disease. High-density lipoprotein (HDL) has an important role in preventing atherogenesis and the aim of this study was to investigate aspects of HDL function in HIV+ patients. HIV+ patients (n = 48) and healthy control subjects (n = 45) of both sexes with similar age were studied. Twenty-five were not being treated with antiretroviral agents, 13 were under reverse transcriptase inhibitor nucleosidic and non-nucleosidic (NRTI+NNRTI) and 10 were under NRTI + protease inhibitors (NRTI+PI) treatment. Paraoxonase 1 (PON1) activity and the transfer of free and esterified cholesterol, tryglicerides and phospholipids from a lipidic nanoemulsion to HDL were analyzed. In comparison with healthy controls, HIV+ patients presented low PON-1 activity and diminished transfer of free cholesterol and tryglicerides. In contrast, phospholipid transfer was increased in those patients, whereas the transfer of cholesteryl esters was unchanged. NRTI+NNRTI increases the transfer of cholesteryl esters and triglycerides but in NRTI+PI there was no difference in respect to non-treated HIV+ patients. HDL from HIV+ patients has smaller antioxidant properties, as shown by lower PON-1 activity, and the transfer of lipids to this lipoprotein fraction is also altered, suggesting that HDL function is defective in those patients.

Pacientes HIV+ freqüentemente desenvolvem alterações no metabolismo de lípides que podem influir no desenvolvimento de doença arterial coronária. A lipoproteína de alta densidade (HDL) tem papel importante na prevenção da aterogênese. Para investigar aspectos funcionais da HDL na doença, foram estudados 48 pacientes HIV+ e 45 indivíduos-controle saudáveis de ambos os sexos, com idade semelhantes. Vinte e cinco pacientes HIV+ não recebiam terapia antirretroviral, 13 estavam sob tratamento com inibidores nucleosídicos de transcriptase reversa e não-nucleosídicos (NRTI+NNRTI) e 10 sob tratamento com NRTI e inibidor de protease (NRTI+PI). Analisou-se a atividade da paroxonase 1 e a transferência de colesterol livre e esterificado, triglicérides e fosfolipídios de uma nanoemulsão lipídica para a HDL. Pacientes HIV+ apresentaram menor atividade da paroxonase 1 e menor transferência de colesterol livre e triglicérides em relação aos indivíduos saudáveis. A transferência de fosfolipídios foi maior nesses pacientes, mas a transferência de éster de colesterol foi similar. NRTI+NNRTI aumenta a transferência de éster de colesterol e triglicérides, mas em NRTI+PI não houve diferença comparando com os pacientes HIV+ não tratados. A HDL de pacientes HIV+ tem propriedades antioxidantes reduzidas, evidenciada pela menor atividade da paraxonase 1, e transferência de lipídios alterada, sugerindo que a HDL apresente função defeituosa nestes pacientes.

Evaluation of annexin V and Calcein-AM as markers of mononuclear cell apoptosis during human immunodeficiency virus infection

Evaluation of apoptosis by flow cytometry is generally accomplished by methods that use annexin V-FITC as vital dye, which access phosphatidylserine exposed on the external membrane at the beginning of this process. In addition, the concomitant use of propidium iodide makes possible to verify the characteristic nuclear alterations in the late stages of apoptosis, as a consequence of the increase in membrane permeability. On the other hand, the use of calcein-AM in association with ethidium homodimer (EthD-1) allows the evaluation of cell apoptosis through detection of esterase activity and cellular membrane physical and chemical alterations. The aim of this study was to compare the sensibility of calcein-AM and EthD-1 with annexin V-FITC and propidium iodide for early apoptosis evaluation in peripheral blood mononuclear cell culture, obtained from HIV-infected patients. Apoptosis and cellular viability were detected and quantified by flow cytometry after 24 and 48 hours incubation times. Our results showed that calcein-AM/EthD-1 was more sensitive for apoptotic cell quantification in both incubation times than annexin V-FITC/propidium iodide (mean of 46.95 percent ± 3.56, p < 0.0001, for 24 hours and mean of 37.67 percent ± 2.47, p < 0.0014 for 48 hours), besides allowing to clearly define viable, apoptotic and dead cell populations.

Prevalência do tabagismo em doadores de sangue da região serrana de Santa Catarina - Brasil / Smoking prevalence in donors from the mountain region of Santa Catarina — Brazil

O tabagismo é um problema de saúde pouco explorado nos bancos de sangue, um dos motivos que objetivou este estudo, para tornar os dados disponíveis a outros pesquisadores, de forma a garantir a realização de novos estudos interdisciplinares sobre a situação transfusional e a qualidade do sangue doado pelo fumante, melhorando a qualidade de vida do doador. O estudo foi realizado mediante uma pesquisa de 3 mil candidatos aptos à doação de sangue no Hemocentro Regional de Lages. Para abordar o tabagismo foi elaborado um questionário que foi inserido na triagem clínica realizada rotineiramente com os candidatos à doação de sangue. Dos 3 mil doadores avaliados na pesquisa, 373 (12,4 por cento) eram fumantes, sendo 66,5 por cento do sexo masculino, 77,2 por cento da cor branca, 57,5 por cento com idade entre 18 a 35 anos. O grau de escolaridade foi o ensino fundamental com 42,1 por cento. Em relação ao número de doações anteriores, 43,1 por cento doaram pela 1ª vez, 56,9 por cento dos doadores eram de repetição. O número de cigarros fumados entre um e cinco por dia foi 30,8 por cento e de seis a dez/dia, 33,2 por cento. Os valores de hematócrito e hemoglobina, comparando grupos não fumantes e fumantes, diferiram significativamente uns dos outros. A prevalência de doadores fumantes verificada neste estudo foi considerada pequena, possivelmente não interferindo na qualidade do sangue, pois o percentual que traz problemas em relação a carboxi-hemoglobina está relacionado aos grandes fumantes, sendo a minoria dos doadores estudados. Faz-se necessário conhecer o perfil do doador fumante nos bancos de sangue do País para poder levar o conhecimento e informações através de campanhas educativas e preventivas.

Exposure to smoking is a public health problem not very often explored in blood banks. This study was carried out for the purpose of making these data available to other researchers in order to develop new interdisciplinary studies concerning the blood quality donated by smokers. Exposure to smoking was measured by a questionnaire applied to 3.000 individuals who donated blood in the Hemocentro Regional of Lages through a clinical selection regularly done with the candidates. Among the 3.000 individuals 373 (12.4 percent) were cigarette smokers, males (66.5 percent), white people (77.2 percent), and between 18 and 35 years of age (57.5 percent). The educational degree was elementary school (42.1 percent). Considering the previous donations, 43.1 percent were donors for the first time, 56.9 percent were used to donate blood frequently. The number of cigarettes smoked daily from 1 to 5 was 30.8 percent and from 6 to 10, 33.2 percent. Haematocrit and hemoglobin values comparing smokers and non-smokers differ meaningfully. Smoking prevalence in these selected donators was considered small and did not affect the blood quality since the percentage due to problems about carboxihemoglobin is related to tobacco users who were the minority group. The profile of smoking addicted donators should be regarded in order to obtain some information through educational and preventive campaigns.

Estimation of the residual risk for the transmission of HIV in blood donors from the mountain region of Santa Catarina

The HIV, in hemotheraphy, may be transmitted by erythrocyte, platelets, crioprecipitated, frozen fresh plasma and possibly, by other blood components. Appropriate legislations for this new reality were elaborated normatizing the hemotheraphy practices in Brazil, creating a set of procedures and actions aiming at guaranteeing the quality of the blood, during, during the whole process. However, the residual risk remains, and it can be calculated as a product of the incidence and period of the immunological window. The objetive of the present study was to determine the rate of residual risk of the HIV blood transmission, in the blood donors from the Mountain Region of Santa Catarina. In order to calculate the residual risk of the HIV markers, 4,857 donors of repetition from the 24,969 individuals who donated blood from 2000 to 2003 were evaluated, and the results showed a serumconversion, in one case. The method used to calculate the residual risk followed the model of the immunological incidence window used by Schreiber (1996), in the USA. A estimate risk of 1:50,000 was verified. The case was considered as confirmed when one of the HIV, in the Hemocenter, is considered one of the HIV markers, in 1:50.000, which confirms the hypothesis that the new legislation related to the Blood National Politics, with the introduction of more sensible tests is decreasing the immunological window, diminishing the residual and, consequently, intensifying the transfusion security.

Effect of N-acetyl-L-cysteine on lymphocyte apoptosis, lymphocyte viability, TNF-alpha and IL-8 in HIV-infected patients undergoing anti-retroviral treatment

N-acetyl-L-cysteine (NAC) has been proposed as an additional therapeutic agent for AIDS patients because it reduces human immunodeficiency virus type 1 (HIV-1) replication in stimulated CD4+ lymphocytes, and it ameliorates immunological reactivity. In a randomized, 180-day, double-blind, placebo-controlled trial performed with HIV-infected patients classified as A2 and A3 according to the criteria of the Center for Disease Control and Prevention, we investigated the effects of oral administration of NAC on HIV-infected patients undergoing their first anti-retroviral therapy; viral load, CD4+ lymphocyte, lymphocyte viability and apoptosis, and TNF-alpha and IL-8 levels were determined. Sixteen patients who received anti-retroviral therapy plus a placebo formed the control group and the study group consisted of 14 patients who received anti-retroviral therapy and NAC supplementation. A significant decrease was seen in viral load, TNF-alpha and IL-8 levels, and lymphocyte apoptosis, and a significant increase was found in levels of CD4+ lymphocytes and lymphocyte viability in both groups after anti-retroviral treatment, but no measurable benefits of anti-retroviral therapy plus NAC oral supplementation (600 mg/day) were found in relation to anti-retroviral therapy alone, and the baseline levels of cysteine and glutathione in plasma were not recovered by this treatment. In conclusion, the daily doses of NAC necessary for the total recuperation of plasma cysteine and glutathione levels in HIV-infected patients and the additional benefits following the supplementation of NAC in patients submitted to anti-retroviral therapy, need to be studied further.

Seroprevalence of HbsAg, anti-HBc and anti-HCV in Southern Brazil, 1999-2001

The prevalence of infection by the hepatitis B (HBV) and C (HCV) viruses varies among geographical regions. We evaluated 263,795 blood donor samples collected from 1999-2001 in various cities in the state of Santa Catarina to determine the prevalence of HbsAg, anti-HBc and anti-HCV markers. The markers were analyzed by immunoenzymatic tests, as determined by the Ministry of Health, and the data were obtained from blood banks and from ANVISA (the Brazilian National Agency for Sanitary Vigilance). There was a significant reduction in the mean frequency of HbsAg and anti-HBc during the study period, from 0.98 percent to 0.64 percent and from 8.83 percent to 5.35 percent, respectively, though they varied considerably among the different regions. There was also a decrease in the mean frequency of anti-HCV, although it was not significant, decreasing from 0.38 percent to 0.34 percent. Even with this reduction, the frequency of these markers was still high compared with that found in other countries, indicating high rates of infection by hepatitis B and C viruses. This emphasizes the urgency of vaccination programs against HBV, especially in some regions of Santa Catarina state, in order to reduce the prevalence of this infection and consequently reduce the risk of transmission through sexual relations or from the donation of blood and/or hemocomponents

Suplementaçäo de N-acetilcisteína em pacientes infectados pelo HIV submetidos ao primeiro tratamento anti-retroviral: avaliaçäo do efeito sobre a carga viral, TNF-"alfa", IL-6, IL-8, "beta"2-microglobulina, IgA, IgG e IgM, haptoglobina e "alfa"1-glicoproteína ácida / N-acetylcysteine supplementation of HIV-infected patients under the first anti-retroviral treatment: evaluation of the effect on viral load, TNF-

Indivíduos infectados pelo vírus da imunodeficiência humana (HIV-I) apresentam aumento progressivo da carga viral, da destruiçäo do sistema de defesa imune celular e alterações imunológicas e inflamatórias, incluindo a elevaçäo dos níveis séricos do fator de necrose tumoral alfa (TNF-"alfa"), interleucina 8 (IL-8), "beta"2-microglobulina, IgA, IgG e IgM, haptoglobina e "alfa"1-glicoproteína ácida. O objetivo deste estudo foi avaliar os níveis séricos destes marcadores em indivíduos submetidos ao primeiro tratamento antiretroviral, suplementados ou näo com N-acetilcisteína. Participaram deste estudo, duplo cego controlado por placebo, que teve a duraçäo de 180 dias, 24 indivíduos que iniciaram a terapia...

Os efeitos da suplementaçäo de N-acetilcisteína em pacientes soropositivos para o HIV / N-acetylcysteine supplementation effects in HIV seropositives patients

Na infecçäo pelo HIV o equilíbrio entre antioxidantes e pró-oxidantes e a produçäo de citocinas encontram-se alterados, causando estresse oxidativo crônico. Presume-se que o estresse oxidativo crônico e a ativaçäo do sistema imunológico favorecem a replicaçäo do vírus através da ativaçäo da NF-"capa"B e a apoptose de células mononucleares do sangue periférico. O objetivo deste estudo foi avaliar o efeito da suplementaçäo, durante 180 dias, com 600mg/dia de N-acetilcisteína (NAC), sobre a carga viral, os níveis de sub-populações de linfócitos, a viabilidade de linfócitos e sobre os níveis séricos de citocinas, proteínas, lipídeos, "beta"2 microglobulina e outros marcadores da ativaçäo do sistema imunológico...

Lipid and acute-phase protein alterations in HIV-1 infected patients in the early stages of infection: correlation with CD4+ lymphocytes

Lipid and acute-phase protein alterations have been described in various infection diseases, and they have been recorded during the early stages of HIV infection. Lipid and acute-phase protein profiles also have been correlated with cellular immunological abnormalities. To document these correlations during HIV infection, we studied 75 HIV-infected patients and 26 HIV-negative controls. Patients were classified according to the criteria proposed by the Walter Reed army Institute: as WR-1 (CD4lymphocytes, 1154+268/mm3), WR-2 (CD4,793+348/mm3) and WR3/4(CD4287+75mm3). Triglycerides, total cholesterol and HDL-cholesterol concentrations were measurede by enzymatic methods. Immunoglobulins (IgA and IgG) and acute-phase proteins (haptoglobin, &,-acid glycoprotein, C-reactive protein and transferrin) were determined by immunonephelometry. Haptoglobin levels were significantly increased in HIV-positive patients and correlated with the progression of HIV-infection (control