ABSTRACT
ABSTRACT Worldwide, transplant programs have suffered a setback during the coronavirus disease 2019 (COVID-19) pandemic and most have temporarily suspended their transplant activities. . We identified 36 liver transplant patients who tested positive for COVID-19. The cases were confirmed by the nucleic acid test (RT-PCR). Epidemiological, demographic, clinical, laboratory, management and outcome data were obtained from the patients' medical records. Fourteen patients (38.9%) required admission to the Intensive Care Unit and/or invasive ventilatory support (severe cases). The mean age of these severe cases was 63.8 years. Regarding the time since the transplant, 71.4% (10/14 patients) had undergone the procedure less than one year before. The immunosuppressive therapy was reduced in patients who required Intensive Care Unit. A total of 12 cases (12/14, 85.7%) required invasive ventilatory support. Eight cases (8/14, 57.1%) required renal replacement therapy. In this group of patients, nine died (64.3 %). In turn, 22 patients had mild to moderate symptoms of COVID-19, not requiring invasive ventilatory support or admission to the Intensive Care Unit. The mean age in these patients was 56.5 years and comorbidities were present in 15 (68.2%) of the cases. In this group, only five patients (5/22, 22.7%) required hospitalization due to complications and there were no deaths This report describes the results of COVID-19 infection in a very specific population, suggesting that liver transplant patients have a significant higher risk of progressing to severeCOVID-19 , with a mortality rate among critically-ill patients above that of the general population.
ABSTRACT
Context The occurrence of HIV and hepatitis B (HBV) and C (HCV) virus associations is of great concern since co-infected patients respond poorly to antiviral treatment and usually progress to chronic and more complicated hepatic disease. In Brazil, these co-infections prevalence is not well known since published data are few and sometimes demonstrate conflicting results. Also, a significant number of co-infected individuals are HBV/HCV asymptomatic carriers, leading to under notification. Objectives The present study aimed to determine the prevalence of the HBV and HCV infection in a recently diagnosed HIV population in the state of Ceará/Brazil. Methods Retrospective cohort, with >18yo patients diagnosed HIV+ from 2008-2010. First year medical attention information was collected. Results A total of 1.291 HIV+ patients were included. HBV serologies were collected in 52% (23% had previous hepatitis B, 3.7% were co-infected) and HCV in 25.4% (1.5% had previous hepatitis C, 5.4% co-infection). The majority of HBV/HIV patients referred multiple sexual partners/year, 28% homosexualism and 20% bisexualism. In the HCV/HIV group 38.8% individuals had > one sexual partner/year and 22.2% used intravenous drugs. Conclusion The study reinforce the need for better training healthcare workers and providing laboratory support for a prompt hepatitis diagnosis and adequate medical management to avoid complications and decrease viral spread. .
Contexto A ocorrência da associação de HIV com a hepatite por vírus B (HVB) e C (HVC) é preocupante visto que os pacientes coinfectados tendem a ter uma resposta pior à terapia antiviral e uma chance maior de progredirem para a cronificação da doença hepática e suas complicações. No Brasil, os estudos publicados sobre a prevalência dessas coinfecções ainda são escassos e, muitos deles, com resultados conflitantes entre si. Além disso, muitos pacientes coinfectados são portadores assintomáticos dos vírus das hepatites o que causa um atraso no seu diagnóstico, com consequente subnotificação de casos. Objetivos Este estudo objetiva determinar a prevalência da infecção pelo HVB e HVC em pacientes recém-diagnosticados com HIV no Ceará/Brasil. Métodos Coorte retrospectivo com pacientes >18 anos, diagnosticados HIV+ de 2008-2010. Foram coletados dados referentes ao primeiro ano de acompanhamento desses pacientes através de revisão de prontuário: fatores de risco para HIV, HBV e HCV e resultados de provas sorológicas para esses vírus. Resultados Foram acompanhados 1291 pacientes HIV+. Testes sorológicos para HBV foram realizados em 52% dos casos: 23% apresentavam hepatite B prévia e 3,7% eram coinfectados. Apenas 25,4% tinham testes sorológicos para HCV: 1,5% tinham hepatite C prévia e 5,4% eram coinfectados. A maioria dos pacientes HBV/HIV referia ter múltiplos parceiros sexuais em um ano. Homossexualismo e bissexualismo estavam presentes em 28% e 20% respectivamente. No grupo HCV/HIV 38,8% referia múltiplos parceiros sexuais em um ano e o uso de drogas endovenosas ocorreu em 22,2% dos casos. Conclusão O estudo reforça a necessidade de um treinamento dos profissionais de saúde e de facilitação do acesso do paciente ...