Occult B infection in the Brazilian northeastern region: a preliminary report

A sentinel study on viral hepatitis is currently being carried out in the village of Cavunge in a semiarid rural region of the state of Bahia, northeastern Brazil. This study has identified individuals in whom anti-HBc IgG was the only serological marker for hepatitis B virus (HBV). This serological pattern may constitute evidence of occult HBV infection. This study Investigated the possibility of occult hepatitis B virus infection in individuals in a rural community who tested positive for anti-HBc IgG alone. A cross-sectional population-based study. ELISA III was performed on serum samples to test for serological viral markers, and ultrasensitive PCR (US-PCR) was used to assess viremia. Among the 1,536 serum samples, 3.6 percent (n=55) were positive for anti-HBc alone. Four years after this first serological survey, 31 of those 55 individuals (56.3 percent) were retested, and 11 (35.5 percent) remained anti-HBc positive alone. Two of these 31 (6.5 percent) were HBV-DNA positive based on US-PCR, with normal aminotransferase levels in both cases. Cases of occult hepatitis B infection were identified in this semiarid rural community of northeastern Brazil, where endemicity of HBV is moderate.

Liver histological alterations in patients with chronic hepatitis C and normal ALT levels in the city of Salvador, Northeast-Brazil

Patients with chronic hepatitis C can have variable clinical progression. Hepatic histological alterations appear to be milder in asymptomatic subjects who have persistently normal ALT levels. AIMS: To evaluate the severity of histological liver alterations in blood donors with normal and elevated ALT levels. METHODS: We evaluated volunteer blood donors from the main blood bank of the city of Salvador-Brazil. Those who were anti-HCV positive were invited to participate in the study. Serum ALT and AST levels were measured at two time points, two months apart. Donors were divided into two groups: group I, individuals with ALT > 1.5 times the upper limit of normal in at least one time point and group II, individuals with normal or near normal ALT, at both time points RESULTS: We evaluated 30,232 blood donors and 528 (1.7 percent) of them were anti-HCV positive. Eighty-two attended our service and HCV infection was confirmed in 66 individuals. Male gender predominated in both groups; the mean age was 36 for group I, and 33 for group II. Tattoos and intravenous illicit drug use were frequently-encountered risk factors. Liver biopsy was done in 43 subjects. Among donors with elevated ALT, two (10 percent) had minimum alterations, while in group II normal liver or minimum alterations were observed in six (26 percent) subjects. Chronic hepatitis or cirrhosis was encountered in 35 (81 percent) individuals: three (15 percent) and five (21 percent) subjects had chronic hepatitis without inflammatory activity, 10 (50 percent) and 11 (48 percent) had minimum to moderate activity and five (25 percent) and one (4.3 percent) had cirrhosis, in groups I and II, respectively (P was not significant). CONCLUSIONS: The prevalence of anti-HCV among this population of volunteer blood donors was 1.7 percent, and these subjects had few liver histological alterations or chronic hepatitis and cirrhosis. Liver injury severity was significant in patients with elevated ALT, however subjects with normal levels may also present chronic hepatitis and cirrhosis.

Effect of interferon-alpha on experimental septal fibrosis of the liver - study with a new model

Interferon-alpha is used in antiviral therapy in humans, mainly for viral hepatitis B and C. An anti-fibrotic effect of interferon has been postulated even in the absence of anti-viral response, which suggests that interferon directly inhibits fibrogenesis. Rats infected with the helminth Capillaria hepatica regularly develop diffuse septal fibrosis of the liver, which terminates in cirrhosis 40 days after inoculation. The aim of this study was to test the anti-fibrotic effect of interferon in this experimental model. Evaluation of fibrosis was made by three separate methods: semi-quantitative histology, computerized morphometry and hydroxyproline measurements. Treatment with interferon-alpha proved to inhibit the development of fibrosis in this model, especially when doses of 500,000 and 800,000 IU were used for 60 days. Besides confirming the anti-fibrotic potential of interferon-alpha on a non-viral new experimental model of hepatic fibrosis, a clear-cut dose-dependent effect was observed

HCV Infection in Northeastern Brazil: unexpected high prevalence of genotype 3a and absence of African genotypes

The genomic diversity of HCV embraces 6 genoptypes and at least 52 subtypes with clinical and epidemiological correlations. There is a paucity of studiens assessing HCV genotypes and biomolecular epidemiology in Brazil. We studied genotypes distribution and epidemiological aspects in 232 HCV carriers, 133 ( 57,9 per cent) males and 99 (42,1 per cent) females, followed in the liver disease referral unit in Salvador, BA, northeastern Brazil. All of them were anti-HCV positive by 3rd generation ELISA assay, and HCV infection showed that 93 (40 per cent) had past blood transfusion, 14 (6 per cent) intravenous drug use, 19 (8 per cent) inhalation of cocaine, 28 (12 per cent) tattooing, 15 (7 per cent) were health care workers, 5 (2 per cent) had reused disposable syringes, 5 (2 per cent) had multiple risk factors and in 53 (23 per cent) no risk factor was determined.Genotypes 1a was observed in 75 (32 per cent), 1b in 72 (31 per cent), 3a in 61 (26 per cent), 2b in 14 (6 per cent): 5 (2.5 per cent) had mixed genotypes and 5 (2.5 per cent) were undetermined. Patients with genotype 1 had a higher mean age (P<0.05) and no particular risk factors were associated with a specific genotype. Genotype 1 largely predominates in northeast Brazil followed by genotype 3 which, in this population, does not seem to be related to intravenous drug abuse, in contrast to some European studies. Although 80 porcentage of the Salvador population comprise African-Brazilians, no Africa genotype was identified, which way mean that HCV was introduced into this region via European immigration. This study demonstrated some peculiarities of HCV epidemiology in Brazil and strongly suggests that HCV introduction to this region was probably related to European immigration.

Prevalência do vírus da hepatite C em populaçöes urbana e rural no Nordeste do Brasil: estudo piloto / Prevalence of hepatitis C virus in urban and rural populations of Northeast Brazil: pilot study

O vírus da hepatite C é encontrado em todos os continentes, porém com diferenças na sua prevalência. No Brasil, os dados epidemiológicos sao escassos e a maioria baseou-se em doadores de sangue e nao na populaçao geral. Objetivamos mostrar a prevalência do anti-vírus da hepatite C em duas populaçoes, urbana e rural, de características distintas: Salvador, metrópole, e Castro Alves, rural autóctone, com pouco contato com outras populaçoes. Oitocentos indivíduos de Salvador e 800 de Castro Alves, foram aleatoriamente visitados. Procedeu-se à coleta de sangue para sorologia e ALT. Foi dosado anti-vírus da hepatite C por ELISA II e os casos positivos confirmados pelo RIBA III. Estudou-se a prevalência de anti-vírus da hepatite C nas duas populaçoes e a sua distribuiçao em relaçao à faixa etária e sexo, além da correlaçao entre presença de anti-vírus da hepatite C/elevaçao ALT. O teste X(2)exato de Fisher para análise estatística. Dos 800 indivíduos de Castro Alves, nenhum foi anti-vírus da hepatite C positivo. Nao houve correlaçao entre positividade para anti-vírus da hepatite C e as variáveis sexo e nível de ALT. Os resultados do estudo sugerem: maior prevalência do vírus da hepatite C na populaçao urbana de Salvador (1,25 por cento) (P < 0,001) comparada à rural de Castro Alves (0 por cento), provavelmente devido a pouca exposiçao ao vírus; introduçao do vírus da hepatite C no Brasil, possivelmente através de correntes migratórias das populaçoes urbanas; os estudos com doadores nao refletem a verdade epidemiológica do vírus da hepatite C no Brasil, por induzir a vícios de seleçao, superestimando a prevalência.

Fulminant hepatitis with microvesicular steatosis: a histologic comparison of cases occurring in Brazil, Labrea hepatitis, and in Central Africa, Bangui hepatitis

Um quadro histopatológico similar de hepatite fata, associado a mudanças adiposas agudas, muito respalhadas em hepatócitos e necrose unicelular, foi visto em casos epidêmicos ocorrendo em duas diferentes áreas equatoriais, com alta prevalência de infecçöes HBV e HDV. Os casos foram previamente considerados como sendo duas entidades diferentes: hepatite de Labrea no Brasil e hepatite de Bangui na República da Africa Central. Contudo, os achados histopatológicos sugerem que säo patogênica e etiologicamente relacionados a infecçöes HBV e HDV, provavelmente modificados por algum fator ainda desconhecido, presente nas zonas de floresta equatorial

An ELISA method using serum derived HDAg for the sorological detection of HDV antigens and antibodies

Um dos maiores problemas no desenvolvimento de metodologia para detecçäo de antígenos e anticorpos do vírus da hepatite delta (VHD) tem sido a fonte de antígenos uma vez que fígados humanos e de animais infectados pelo VHD säo de difícil obtençäo e baixo rendimento. Ao uso de soro de pacientes na fase aguda da infecçäo pelo VHD, como fonte de antígenos associamos a técnica imunoenzimática, com finalidade de facilitar o manuseio e economizar antígeno. O antígeno delta foi obtido a partir do soro de indivíduo na fase aguda de infecçäo por VHD e o anticorpo a partir de soro deportadores crônicos de VHD. Para a detecçäo do antígeno foi empregado o método "sanduiche" e para a detecçäo do anticorpo um ensaio tipo competiçäo. Visando testar a especificidade e a sensibilidade relativas do novo método de detecçäo de anticorpo, foram feitas comparaçöes do mesmo com radio-imunoensaio comercial (CRIE, Lab. Abbott) e um radio-imunoensaio desenvolvido na Unité 271-INSERM de Lyon, França (NC-RIA). Soros de 42 pacientes foram testados pelos três métodos, sendo observados resultados discrepantes em apenas 2 casos. Os autores concluem que: 1) soros de pacientes na fase aguda e crônica da infecçäo pelo VHD podem ser usados como fonte de antígeno e anticorpos em ensaios imunológicos 2) o EIE e o RIE tem especificidade e sensibilidade relativas comparáveis 3) o EIE é de fácil execuçäo, mais barato, näo poluente, tem vida útil maior, além de proporcionar economia de antígeno