Hepatitis B genotype G and high frequency of lamivudine-resistance mutations among human immunodeficiencyvirus/hepatitis B virus co-infected patients in Brazil

In this study, we evaluated the hepatitis B virus (HBV) genotype distribution and HBV genomic mutations among a group of human immunodeficiency virus-HBV co-infected patients from an AIDS outpatient clinic in São Paulo. HBV serological markers were detected by commercially available enzyme immunoassay kits. HBV DNA was detected using in-house nested polymerase chain reaction and quantified by Cobas Amplicor. HBV genotypes and mutations in the basal core promoter (BCP)/pre-core/core regions and surface/polymerase genes were determined by sequencing. Among the 59 patients included in this study, 55 reported prior use of lamivudine (LAM) or tenofovir. HBV DNA was detected in 16/22 patients, with a genotype distribution of A (n = 12,75 percent), G (n = 2,13 percent), D (n = 1,6 percent) and F (n = 1,6 percent). The sequence data of the two patients infected with genotype G strongly suggested co-infection with genotype A. In 10 patients with viremia, LAM-resistance mutations in the polymerase gene (rtL180M + rtM204V and rtV173L + rtL180M + rtM204V) were found, accompanied by changes in the envelope gene (sI195M, sW196L and sI195M/sE164D). Mutations in the BCP and pre-core regions were identified in four patients. In conclusion, genotype G, which is rarely seen in Brazil, was observed in the group of patients included in our study. A high prevalence of mutations associated with LAM-resistance and mutations associated with anti-HBs resistance were also found among these patients.

Clinical and histological characteristics of HIV and hepatitis C virus-co-infected patients in Brazil: a case series study / Características clínicas e histológicas de pacientes co-infectados pelo HIV e vírus da hepatite C no Brasil: estudo de uma série de casos

Hepatitis C virus (HCV) is an important factor contributing to morbidity and mortality in patients co-infected with HIV and HCV. In addition, liver biopsy is an important tool in the clinical management of these patients. Although liver biopsy is controversial, it is recommended for all patients. Data regarding the clinical and histological characteristics of these patients are scarce not only in Brazil but in Latin America as a whole. With the goal of better understanding these characteristics and the benefit of liver biopsy indications in this disease setting, data collected from 234 patients followed from 1996 to 2004 at Casa da AIDS, São Paulo, were analyzed. The following variables were extracted from the patients' medical files at the time of liver biopsy: sex, age, hepatitis C infection risk factors, hepatitis C infection duration, ALT levels, CD4+ T cell counts, history of alcohol abuse, history of antiretroviral therapy, HCV genotype, and liver histological alterations. CONCLUSIONS: 1 - Hepatitis C virus 1 and 3 were the most frequently identified genotypes and were diagnosed in 72 percent and 25.5 percent of cases respectively; 2 - Structural liver alterations were found to be mild or absent in 48.2 percent (113/234) of the analyzed patients; 3 - Fifty-three patients (23 percent) had normal ALT levels and 4 - Significant liver architectural changes (F2-F3) were evident in 22.5 percent of the patients with normal ALT levels.

A infecção causada pelo vírus da hepatite C (VHC) constitui importante causa de morbidade e mortalidade entre pacientes co-infectados pelo HIV e VHC. A indicação da realização de biópsia hepática nesses pacientes é controversa, podendo constituir importante ferramenta no manejo clínico desses pacientes. São escassos os dados relativos às características clínicas e histopatológicas dos pacientes co-infectados no Brasil e em toda a América Latina. Com o objetivo de analisar as características clínicas e histopatológicas em co-infectados e avaliar os benefícios da realização de biópsia hepática nesse grupo de pacientes, analisamos dados relativos a 234 pacientes acompanhados na Casa da AIDS, São Paulo, de 1996 a 2004. A partir de informações obtidas em prontuários, foram analisadas as seguintes variáveis relativas aos pacientes, coletadas à época da realização da biópsia hepática: gênero, idade, fatores de risco para a transmissão da hepatite C, tempo estimado de infecção pelo VHC, níveis séricos de ALT, contagem de células CD4, antecedentes relativos ao uso de álcool, antecedente de uso de terapia antiretroviral, genótipo de VHC e alterações histológicas obtidas através da biópsia hepática. CONCLUSÕES: 1- Os genótipos 1 e 3 foram os mais freqüentes nessa população, representando cerca de 72 por cento e 25,5 por cento dos casos analisados respectivamente; 2- Alterações estruturais hepáticas leves ou ausentes foram observadas em 48,2 por cento dos pacientes (113/234); 3- Cinqüenta e três pacientes (23 por cento) apresentaram níveis de ALT persistentemente normais; 4- Alterações estruturais significativas (F2-F3) foram observadas em 22,5 por cento entre pacientes com níveis de ALT persistentemente dentro da normalidade.

Acute pancreatitis associated with lamivudine therapy for chronic B hepatitis

Hyperamylasemia is a common complication during lamivudine use. We report a case of a pancreatitis following lamivudine therapy. A careful monitoring of amylase levels during treatment with lamivudine is discussed, mainly in the first weeks, considering the cost of this exam and further complication.

Hepatitis C virus seroprevalence and risk factors among patients with HIV infection

The objective of this study was to evaluate the prevalence and risk factors associated with HCV infection in a group of HIV seropositive patients. We analyzed the medical records of 1,457 patients. All patients were tested for HCV infection by third generation ELISA. Whenever possible, a sample of the positive patients was also tested for HCV by PCR. HCV positive patients were analyzed according to their risk factors for both infections. The prevalence of anti-HCV positive patients was 17.7 percent (258 patients). Eighty-two (82) of these patients were also tested by PCR and 81 were positive for HCV virus (98 percent). One hundred fifty-one (58.5 percent) were intravenous drug users (IDU); 42 (16.3 percent) were sexual partners of HIV patients; 23 (8.9 percent) were homosexual males; 12 (4.7 percent) had received blood transfusion; 61 (17.5 percent) had promiscuous sexual habits; 14 (5.4 percent) denied any risk factor; 12 (4.7 percent) were sexual partners of IDU. Two hundred four patients mentioned only one risk factor. Among them, 28 (10.9 percent) were sexual partners of HIV-positive patients. Although intravenous drug use was the most important risk factor for co-infection, sexual transmission seemed to contribute to the high HCV seroprevalence in this group of patients

Prevalence of hepatitis B and C in the sera of patients with HIV infection in São Paulo, Brazil

The objective of this study was to evaluate the prevalence of hepatitis B and C viruses in a group of HIV infected patients, followed at a single institution since 1996. 1,693 HIV positive patients (1,162 male, 531 female) were tested for HBV infection. Virological markers for HBV included HBsAg and total anti-HBc by ELISA. 1,457 patients (1,009 male, 448 female) were tested for HCV infection. Detection of HCV antibodies was carried out by ELISA. A sample of HCV antibody positive patients was tested for HCV by PCR to confirm infection. Of 1,693 patients tested for HBV, 654 (38.6 per cent) and 96 (5.7 per cent) were anti-HBc and HBsAg positive, respectively. Of 1,457 patients tested for HCV, 258 (17.7 per cent) were anti-HCV positive. 82 of these patients were also tested by PCR and 81 were positive (98 per cent). Of 1,411 patients tested for HBV and HCV 26 (1.8 per cent) were positive for both viruses.

Novas caracteristicas das endemias em centros urbanos / New features of the endemic diseases in urban centers

A invasao desordenada de ecotopos naturais, a falta de controle de vetores biologicos de doencas infecciosas, as mudancas nas interacoes hospedeiro-parasita em condicao de imunodepressao e as alteracoes dos agentes infecciosos sao alguns dos fatores relacionados a emergencia de varias doencas infecto-parasitarias, entre as quais a dengue, a infeccao por hantavirus, a leishmaniose, a tuberculose, a infeccao por Trypanosoma cruzi. A migracao de grandes contingentes populacionais do campo para as metropoles propiciou a endemizacao de algumas doencas tipicamente de ambientes rurais como a...