Sobre la hepatitis aguda grave de etiología desconocida: la situación en México / About severe acute hepatitis of unknown etiology: the situation in Mexico

Introducción: en México, las hepatitis virales son de notificación epidemiológica obligatoria, pero no existe un sistema especial de vigilancia. La información disponible se limita a la distribución por edad y sexo. Ante la alerta de casos de hepatitis aguda grave de etiología desconocida, en la Unión Europea el Consejo Nacional de Vigilancia Epidemiológica (CONAVE) alertó al Sistema Nacional de Salud (SNS) para la atención y vigilancia de estos casos. Desarrollo: la hipótesis más convincente sobre la etiología está relacionada con una respuesta inmunitaria exacerbada que es mediada por superantígenos relacionados con la proteína espiga del SARS-CoV-2, activados por una infección por adenovirus que desencadena una respuesta de linfocitos T que provoca apoptosis de hepatocitos. Con base en la presentación clínica (niños menores de 16 años, con diarrea, dolor abdominal, ictericia, vómito e hipertransaminasemia) se han diseñado definiciones operacionales para su identificación y notificación al Sistema Nacional de Vigilancia Epidemiológica (SINAVE). Hasta junio del 2022, se han identificado 56 casos en México. Conclusiones: este brote de hepatitis representa un reto para el SINAVE. Es necesario incluir la identificación de adenovirus en el algoritmo diagnóstico de enfermedad respiratoria viral, implementar un sistema especial de vigilancia epidemiológica de hepatitis virales y sensibilizar a los profesionales sanitarios en el tema.

Introduction: In Mexico viral hepatitis requires mandatory epidemiological notification, but there is no special surveillance system. Available information is limited to distribution of cases by age and sex. Given the alert of cases of severe acute hepatitis of unknown etiology in the European Union, the National Council for Epidemiological Surveillance (Consejo Nacional de Vigilancia Epidemiológica) alerted the entire National Health System to care for and monitor these cases in Mexico. Development: The most convincing hypothesis is an exacerbated immune response mediated by superantigens related to the spike protein of SARS-CoV-2, activated by adenovirus infection that ends in a response of T lymphocytes that causes apoptosis of hepatocytes. Based on clinical presentation (children under 16 years of age, with diarrhoea, abdominal pain, jaundice, vomiting and increase in transaminases) the operational case definitions have been designed for their timely identification and notification to the National System of Epidemiological Surveillance (Sistema Nacional de Vigilancia Epidemiológica). Until June 2022, 56 cases have been identified in Mexico. Conclusions: This hepatitis outbreak represents a challenge for the National System of Epidemiological Surveillance. It is necessary to include the identification of adenovirus in the diagnostic algorithm for viral respiratory disease, to implement a special epidemiological surveillance system for viral hepatitis, and to sensitize health professionals on this subject.

Prevalence, risk factors and hepatitis B immunization: helping fill the gap on hepatitis B epidemiology among homeless people, Goiânia, Central Brazil / Prevalência, fatores de risco e imunização contra a hepatite B: ajudando a preencher as lacunas na epidemiologia da hepatite B entre pessoas em situação de rua em Goiânia, Goiás, Brasil / Prevalencia, factores de riesgo e inmunización contra la hepatitis B: ayudando a completar las lagunas en la epidemiología de la hepatitis B entre personas sin techo en Goiânia, Goiás, Brasil

Data are limited in Brazil on hepatitis B infection among homeless individuals, a marginalized population with high risk of sexually transmissible infections (STI), including hepatitis B. The aim of this study was to investigate hepatitis B epidemiology in homeless persons lodged in a public shelter in Goiânia, Central Brazil. From August 2014 to June 2015, 353 individuals were interviewed and tested for markers of HBV infection. Overall HBV prevalence was 21.8% (95%CI: 17,82-26,41), and 19,5% (95%CI: 15,75-24,0) showed a serological profile of previous HBV vaccination. Older individuals (> 50 years), blacks, and homosexuals or bisexuals showed increased exposure to HBV. The low frequency of individuals immunized against HBV, high social vulnerability, and risk behaviors emphasize the need for health services administrators to provide more opportunities for HBV vaccination in this target population.

No Brasil, existem poucos dados sobre a infecção por hepatite B entre pessoas em situação de rua, uma população marginalizada com alto risco para infecções sexualmente transmissíveis (IST), incluindo a hepatite B. O objetivo deste estudo foi investigar a epidemiologia da hepatite B em pessoas alojadas em um abrigo público da cidade de Goiânia, Brasil Central. De agosto de 2014 a junho de 2015, 353 indivíduos foram entrevistados e testados para os marcadores da infecção pelo HBV. Uma prevalência global de 21,8% (IC95%: 17,82-26,41) para HBV foi estimado, e 19,5% (IC95%: 15,75-24,0) apresentaram perfil sorológico de vacinação prévia contra o HBV. Ser mais velho (acima de 50 anos de idade), preto e homossexual ou bissexual foram preditores de exposição ao HBV. A baixa frequência de indivíduos imunizados contra o HBV, bem como de alta vulnerabilidade social e ocorrência de comportamentos de risco reforçam a necessidade dos gestores de saúde proporcionar mais oportunidades de vacinação para esta população-alvo.

En Brasil, existen pocos datos sobre la infección por hepatitis B entre personas sin techo, una población marginalizada con un alto riesgo de infecciones sexualmente transmisibles (IST), incluyendo la hepatitis B. El objetivo de este estudio fue investigar la epidemiología de la hepatitis B en personas alojadas en un albergue público de la ciudad de Goiânia, Brasil Central. De agosto de 2014 a junio de 2015, se entrevistó a 353 individuos y se probaron los marcadores de la infección por HBV. Se estimó una prevalencia global de un 21,8% (IC95%: 17,82-26,41) para HBV, y 19,5% (IC95%: 15,75-24,0) presentaron un perfil serológico de vacunación previa contra el HBV. Ser más viejo (por encima de 50 años de edad), negro y homosexual o bisexual fueron predictores de exposición al HBV. La baja frecuencia de individuos inmunizados contra el HBV, así como la alta vulnerabilidad social y ocurrencia de comportamientos de riesgo refuerzan la necesidad de los gestores de salud de proporcionar más oportunidades de vacunación para esta población-objetivo.

Infección por virus de Hepatitis B y C en pacientes hemodializados / Hepatitis B and C virus' infection in hemodialysed patients

Introducción: Los pacientes en tratamiento con hemodiálisis constituyen un grupo de alto riesgo para la infección por virus de hepatitis B y C. Objetivo: Identificar marcadores serológicos y moleculares de infección viral de hepatitis B y C en pacientes hemodializados. Material y métodos: Se realizó un estudio observacional, descriptivo, transversal que incluyó a 103 pacientes con IRC sometidos a régimen de hemodiálisis de las regiones occidental y central de Cuba. Las muestras fueron recibidas entre enero y abril del 2016 para estudio de marcadores serológicos y moleculares de hepatitis B y C a realizar en el Instituto de Gastroenterología. Se estimó la seroprevalencia de anti HCV, HBsAg y Anti S, además se realizaron determinaciones de carga viral mediante prueba de amplificación de ácidos nucleicos para la cuantificación de ADN y ARN para virus de hepatitis B y C respectivamente. Las asociaciones fueron evaluadas mediante el estadígrafo x2. Resultados: EL 7.8 por ciento de los hemodializados fueron portadores inactivos de hepatitis B. El 70.8 por ciento de los pacientes poseían marcadores de infección por virus de hepatitis C con viremia oculta en 18.4 por ciento de los mismos. Conclusiones: Elevada prevalencia de infección y viremia oculta por virus de hepatitis C en los pacientes hemodializados(AU)

Introduction: Patients subjected to hemodialysis treatment are a high risk group for hepatitis B and C infection. Objective: To identify molecular and serologic markers of hepatitis B and C viral infection in hemodialysis patients. Materials and Methods: Was performed an observational, descriptive, cross-sectional study including 103 patients with chronic kidney disease undergoing hemodialysis regime from Cuba's Western and Central regions. The samples were received between January and April 2016 to study serologic and molecular markers of hepatitis B and C to be performed at the Gastroenterology's Institute. Seroprevalence of anti HCV, HBsAg and Anti S was estimated, plus viral load determinations using amplification test to measuring nucleic acids DNA and RNA for hepatitis B and C respectively. Associations were evaluated using the x2 statistician. Results: 7.8 por ciento of hemodialysis patients were inactive carriers of hepatitis B. The 70.8 por ciento of patients had infection markers of hepatitis C virus; being hepatitis C hidden viremia in 18.4 por ciento of them. Conclusions: High prevalence of infection and hepatitis C hidden viremia in hemodialysis patients(AU)

Exposición a aflatoxina: un problema de salud pública / Exposition to aflatoxin: A public health problem

La aflatoxina, una micotoxina producida por hongos contaminantes, es un potente tóxico hepático y un agente carcinógeno. La exposición a ella en la dieta es de particular importancia en ciertas regiones del Sureste de Asia y de África subsahariana, cuyas poblaciones presentan alta frecuencia de carcinoma hepatocelular y de la mutación en el codón 249 del gen p53; además, tienen alta prevalencia de la infección por el virus de la hepatitis B. Este factor de riesgo es muy importante si se tiene en cuenta que se ha demostrado sinergia entre la infección por dicho virus y la exposición a aflatoxina en la patogénesis del carcinoma hepatocelular. Pocos estudios han explorado la exposición a aflatoxinas en la dieta de la población latinoamericana y se desconoce el papel en ella de esta micotoxina como factor de riesgo para dicho carcinoma. En este artículo se presenta una revisión sobre diversos aspectos de las aflatoxinas, con énfasis en su relación con la infección por el virus de la hepatitis B y con el carcinoma hepatocelular.

Aflatoxin, a mycotoxin produced by pollutant molds, is a potent hepatotoxic and carcinogenic agent. Dietary exposition to it is of particular importance in certain regions of Southeast Asia and sub-Saharan Africa. Populations in these regions suffer from high incidence of hepatocellular carcinoma, and have high frequency of the mutation in the codon 249 of p53 gene; besides, prevalence of Hepatitis B virus (HBV) infection is high in those populations. Synergism between infection with HBV and the exposition to this mycotoxin in the pathogenesis of hepatocellular carcinoma has been demonstrated. Few studies have explored the exposition to aflatoxin in the diet of populations in Latin America, and the role in them of this mycotoxin as a risk factor for hepatocellular carcinoma is unknown. In this article different aspects of aflatoxin are reviewed with emphasis on its relationship with HBV infection and with such neoplasia.

A study of hepatitis B virus reactivation associated with rituximab therapy in real-world clinical practice: a single-center experience

BACKGROUND/AIMS: The widespread use of cytotoxic chemotherapy and immunosuppressants has resulted in reactivation of hepatitis B virus (HBV) recently becoming an issue. Although rituximab (an anti-CD20 monoclonal antibody) has revolutionized the treatment of lymphoma, recent reports have suggested that rituximab therapy increases the risk of viral-mediated complications, and particularly HBV reactivation. This study analyzed real clinical practice data for rituximab-related HBV reactivation. METHODS: Between January 2005 and December 2011, 169 patients received treatment with rituximab. Screening status of the HBV infection and frequency of preemptive therapy were determined in these patients, and the clinical features of HBV reactivation were analyzed. RESULTS: Seventy-nine of the 169 patients with chronic or past HBV infection were selected for evaluation of HBV reactivation. Of the 90 patients who were excluded, 22 (13.0%) were not assessed for HBsAg and anti-HBc, and 14 (8.3%) were not assessed for anti-HBc due to seronegativity for HBsAg. The selected patients were divided into those with chronic HBV infection (n=12) and those with past HBV infection (n=67); six patients (7.6%) experienced HBV reactivation. Eight patients received preemptive therapy, but three patients (37.5%) underwent HBV reactivation. Although HBsAg seropositivity was an independent risk factor for HBV reactivation (P=0.038), of the six patients with HBV reactivation, two (33.3%) had past HBV infection and three (50%) died of liver failure. CONCLUSIONS: The findings of this study demonstrate that adherence to guidelines for screening and preemptive therapy for HBV reactivation was negligent among the included cohort. Attention should be paid to HBV reactivation in patients with past as well as chronic HBV infection during and after rituximab therapy.

Seropositivity of HIV and HBV Co-infection.

The rise of HIV as well as HBV infections in rural population is alarming. Different studies suggest, approximately one third of HIV infected individuals also harbour Hepatitis B virus simultaneously. Co-infection of HIV and HBV leads to complex immuno-pathological disease heralding poor prognosis. The present study was undertaken to ascertain sero-positivity of HIV and Hepatitis B virus co-infection in and around the rural area of Loni. The rate of sero-positivity for HIV infection was 2.61%; however, that of Hepatitis B was 1.26 %. The incidence of Hepatitis B in HIV infected individuals was found to be 2.5 %.

Hepatites virais: B, C e D: atualização / Viral hepatitis: B, C and D: an update

JUSTIFICATIVA E OBJETIVOS: As hepatites causadas pelos vírus da hepatite B (VHB), vírus da hepatite C (VHC) e vírus da hepatite (VHD) têm como aspecto comum a transmissão por via parenteral e a possibilidade de cronificação. Revisar os aspectos clínico-epidemiológicos, diagnósticos, terapêuticos e profiláticos das infecções virais por tais agentes é o escopo do presente artigo. Realizou-se pesquisa bibliográfica nas bases de dados Scielo e Pubmed empregando-se os descritores hepatite B (hepatitis B); hepatite C (hepatitis C); hepatite D (hepatitis D) e hepatite G (hepatitis G), assim como livros texto, consensos e diretrizes relacionadas ao tema.CONTEÚDO: As formas agudas das hepatites B, C e D são usualmente benignas, podendo, sem embargo, ocorrerem quadros de hepatite fulminante. Em situações nas quais o sistema imunológico não é capaz de depurar o VHB e/ou VHC, há cronificação da infecção, com risco de desenvolvimento de cirrose e consequente insuficiência hepática crônica, bem como carcinoma hepatocelular. As hepatites B e D são imunopreveníveis, graças à vacina parao vírus B, mas, até o momento, não há imunoprofilaxia disponível para o vírus C.CONCLUSÃO: As hepatites pelos VHB e VHC constituem importantes desafios para a medicina atual, especialmente pela prevalência das infecções no planeta e pelo risco de desenvolvimento das complicações crônicas. Neste contexto, destaque-se a importância da avaliação diagnóstica, da instituição da terapêutica adequada e do emprego das medidas preventivas para tais infecções, elementos que devem ser solidamente conhecidas pelo clínico.

BACKGROUND AND OBJECTIVES: Hepatitis caused by hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis D virus (HDV) have in common the transmission by parenteral route and the possibility of chronification. Reviewing the clinic, epidemiology, diagnose, therapeutics and prophylaxis of viral infections by these agents is the scope of this work. Bibliographic research was conducted both at databases Scielo and Pubmed through the chosen descriptors: hepatitis B, hepatitis C, hepatitis D and hepatitis G, and text books, consensus and guidelines related to the subject.CONTENTS: The acute viral B, C and D hepatitis are usually benign, though acute liver failure, fulminant hepatitis, may occur. In the cases when the immune system is unable to debug HBV and HCV the infection becomes chronic, cirrhosis with consequent chronic liver insufficiency and hepatocellular carcinomamay develop. HBV and HDV are immunopreventable, thanks to the hepatitis B virus vaccine, but at this point there's no immunoprophylaxis available for hepatitis C virus. CONCLUSION: HBV and HCV hepatitis are great challenges for medicine, particularly due to the prevalence of infections worldwide and the risk of chronic complications. In this context, diagnostic evaluation, adequate therapeutic care, and preventive measures must be soundly known by the physician.

Elevada circulación del genotipo F del virus de la hepatitis B en población infectada urbana no migratoria y migratoria de Venezuela / High circulation of genotype F hepatitis B non-migratory and migratory urban population infected virus Venezuela

Introducción: Se ha demostrado ampliamente que el genotipo F del virus de la hepatitis B (VHB) es dominante en nuestra población Amerindia. Recientemente, nosotros identificamos que en los pacientes infectados por VHB habitantes no migratorios de áreas urbanas venezolanas prevalece también el genotipo F. Objetivo: Determinar los genotipos del VHB en portadores crónicos urbanos migratorios y compararlos con el grupo no migratorio. Material y Métodos: Se investigaron 136 portadores crónicos del VHB, 110 no inmigrantes y 26 inmigrantes de origen asiático. Se evaluaron antígeno eHB y anti-eHB y los genotipos del VHB, este último mediante PCR. Resultados: En los 110 pacientes urbanos venezolanos persistió la elevada frecuencia del genotipo F (95%) con 3 casos coinfectados, 2 por genotipos A+F y 1 caso con genotipos E+F. Interesantemente, 2 casos demostraron genotipo D del VHB. Hepatitis crónica B (HCB) antígeno-e positivo fue diagnosticada en 83 pacientes (80,6%) mientras 20 casos (19,4%) presentaron HCB antígeno-e negativo. En los pacientes asiáticos infectados con un solo genotipo se identificó el C en 11 casos, el B en 4 pacientes, el F en 3 y, en 1 caso, genotipo D. Se demostró coinfección entre estos diferentes genotipos, incluyendo un caso coinfectado con genotipo E. El genotipo F se encontró coinfectando a 4 pacientes, 2 de ellos con genotipo C. Doce casos presentaron HCB antígeno e positivo y 14 pacientes HCB antígeno e negativo. De los pacientes infectados con genotipo C, 7 de ellos (54%), incluyendo los 2 coinfectados con genotipo F, presentaron HCB antígeno-e negativo. Conclusión: Es notoria la elevada circulación del genotipo F del VHB en nuestras áreas urbanas...

Introduction: It has been widely demonstrated that the genotype F of hepatitis B virus (HBV) is dominant in our Amerindian population. Recently, we identified that genotype F is prevalent in HBV non-migratory infected patients living in urban areas. Objective: To determine the genotypes of HBV in migratory chronic carriers compared to non-migratory population. Material and Methods: We investigated 136 chronic HBV carriers, 110 non-immigrants and 26 immigrants of Asian origin. We assessed hepatitis B e-antigen and antibody and HBV genotypes, the latter using PCR. Results: High prevalence (95%) of genotype F persisted among 110 Venezuelan urban patients, with 3 co-infected patients, 2 with genotypes A+F and 1 case with E+F. Interestingly, 2 cases showed HBV genotype D. Chronic hepatitis B (CHB) e-antigen positive was diagnosed in 83 patients (80.6%) while 20 cases (19.4%) showed CHB e-antigen negative. In Asian patients infected with one sole genotype, C was identified in 11 cases, B in 4 patients, F in 3, and in 1 case, genotype D. Co-infection was demonstrated among these different genotypes, including one case co-infected with genotype E. Genotype F was found in 4 co-infected patients, 2 with genotype C. Twelve cases had CHB e-antigen positive and 14 CHB e-antigen negative. From patients infected with genotype C, 7 of them (54%), including 2 co-infected with genotype F, demonstrated CHB e-antigen negative. Conclusion: It is remarkable the high circulation of HBV genotype F in our urban areas. However, given the distinct outcome described in CHB genotype F and the identification of other genotypes rather than F in urban areas, suggests that inclusion of HBV genotypes in Venezuela, should be considered standard in the management of CHB regardless the patient’s geographical origin.

Risk factors of hepatitis B virus infection in Turkey: a population-based, case-control study

Although the World Health Organization [WHO] classifies Turkey as a country with a moderate-high prevalence of hepatitis B virus [HBV] infection, there is little data on HBV transmission in this country. To identify risk factors for HBV infection, we performed a retrospective case-control study between January 2007 and December 2009. Acute HBV patients and population controls were selected, and data from these groups were analyzed by logistic regression method. The study included 129 patients with acute HBV infection and 219 controls. Hemodialysis [OR:8.2, 95% CI: 4.17-16.61, p< 0.05], having an HBsAg [+] spouse [OR: 4.3, 95%CI:2.17-8.53, p <0.05], living with an HBsAg [+] parent[s] [OR:3.25, 95% CI:1.73-6.12, p<0.05], and being male [OR:1.34, 95% CI:0.82-2.21, p < 0.05] were independent risk factors that were potentially associated with HBV infection. More than one-third of female patients had a significantly higher risk [34.5% vs 13.5%, p < 0.05] of acquiring HBV from their sexual partners. Hemodialysis was the most frequent risk factor [46.9% vs.20%, x[2] =10.45, p<0.05] for patients aged over 31 years, and living with HBsAg [+] parents was a significantly higher risk factor [28.8% vs. 10.2%, x[2] =6.15, p< 0.05] that is more likely to lead to HBVin patients aged under 30 years. This study suggests that persons in Turkey who undergo hemodialysis are at high risk for acquiring HBV. Having an HBsAg [+] spouse [sexual transmission] or living with HBsAg [+] parents [household transmission] are significant risk factors for HBV transmission. Vaccination appears to be better preventive method against the spread of HBV

Actualización sobre hepatitis B / Upgrade in hepatitis B

El virus de la hepatitis B (VHB), es un virus DNA, el cual tiene varios antígenos, como el antígeno de superficie, y antígeno core. Colombia, es un país de baja endemicidad, sin embargo, en la Sierra Nevada de Santa Marta, está endemicidad es alta. El VHB tiene como una de sus complicaciones la hipertensión porta. En general, el VHB no atraviesa la placenta, por lo que la infección es rara in utero. Son pocos los pacientes que se presentan con HB y falla hepática fulminante y por lo tanto, son pocos los antivirales que han sido utilizados, con muy poca experiencia.

The hepatitis B virus (HBV) is a DNA virus, which has several antigens such as surface antigen and core antigen. Colombia is a country of low endemicity, however, in the Sierra Nevada of Santa Marta, is endemic is high. HBVis one of the complications of portal hypertension. In general, HBV does not cross the placenta, so the infection is rare in utero. Few patients who present with HB and fulminant hepatic failure and therefore, few antiviral drugs that have been u s e d , wi t h v e r y l i t t l e e x p e r i e n c e.

HBV markers in haemodialysis Brazilian patients: a prospective 12-month follow-up

The aim of this study was to determine the prevalence and the incidence of hepatitis B virus (HBV) among haemodialysis (HD) subjects and to evaluate whether testing for serological markers at the time of admission is suitable for HBV screening in this population. One hundred twenty-three patients belonging to two HD centres from São Paulo, Brazil, were tested prospectively. HBV DNA was detected by polymerase chain reaction (PCR) in each of the prospective subjects (n = 123) during one year. Additionally, all samples (n = 1,476) were analysed for HBV serological markers. The prevalence of hepatitis B core antibody (anti-HBc), hepatitis B surface antigen (HBsAg) and HBV DNA were 34.1 percent, 15.4 percent and 8.1 percent, respectively, while the incidence was null. Fluctuation in HBV serology was observed in one patient. Only 37.8 percent (17/45) of cases responded to the HBV vaccine. Our results suggest that employing more than one HBV marker and repeated follow-up evaluations may improve HBV screening in HD units.

Pro-apoptotic function of hepatitis B virus X protein / 대한간학회지

Infection of hepatitis B virus (HBV) is a main cause of liver diseases including hepatitis, cirrhosis and hepatocellular carcinoma (HCC). Among the HBV-encoded proteins, the HBV X protein (HBx) has been suspected to be strongly involved in HBV-associated liver pathogenesis. HBx, a virally encoded multifunctional regulator, has been shown to induce apoptosis, anti-apoptosis, proliferation, and transformation of cells depending on the cell lines, model systems used, assay protocols, and research groups. Among the several activities of HBx, the pro-apoptotic function of HBx will be discussed in this review. Given that the disruption of apoptosis pathway by HBx contributes to the liver pathogenesis, a better understanding of the molecular interference in the cellular pro-apoptotic networks by HBx will provide useful clues for the intervention in HBV-mediated liver diseases.

Importancia de las vacunas contra los virus de las hepatitis A y B en Chile / Vaccines against hepatitis A and B in Chile

The mode of transmission and epidemiological approach for hepatitis A and B are different. However, both are preventable with vaccines whose efficacy and long lasting protection has been demonstrated. This review describes the secular tendency of both infections in Chile, their risk factors that have contributed to their persistence in the country and the interventions that have been carried out to reduce the disease burden. Although the vaccine for hepatitis B was incorporated to the immunization program in 2005, the vaccine for hepatitis A persists in the list of interventions that must be assumed with priority by the Ministry of Health. If Chilean health authorities pretend to reach the enteric disease indicators of developed countries, they must accelerate the epidemiological transition towards the elimination of hepatitis A.

[Paraclinical disorders and prevalence of viral infections in injection drug users]

It is reported that 24-40% of hospital admissions in the world are related to addiction and its complications. Considering hepatitis, AIDS, cirrhosis and various malignancies following these complications, addiction is one of the most important problems in treatment centers worldwide. To determine Para clinical disorders and prevalence of viral infections in injection drug users This was a cross-sectional study in which Para clinical derangements including lab results, chest radiography, and abdominal and pelvic sonography of all patients admitted to infectious diseases ward at Al-Zahra hospital in Isfahan were evaluated during 2005. Also, the presence of HIV, HCV, and HBV infections in these patients during two consecutive years of 2004 and 2005 was taken into consideration. The total number of patients during 2 years was 92 among those 53 hospitalized during 2005 and 39 in 2004. The mean age was 31.7 years with an age range between 20 and 53. The mean length of injection was 3.9 years with a minimum of 2 months and a maximum of 21 years. Among patients hospitalized in 2005, 47% were abnormal for chest radiographs and 17% found to have splenomegaly based on sonography. Among these patients, leucocytosis [85.5%], anemia 86%], higher levels of ESR [74%], derangement in liver tests [60%] and coagulation disorders [55%] were also observed. Viral infections in patients admitted during 2004 were HCV [71%], HBV [12.8%], and HIV [7.6%] while 25.6% were negative for viral infection. In patients hospitalized through 2005, the viral infections were due to HCV [74.3%], HBV [14.3%], and HIV [17%] whereas 17% of patients found to be without viral infection. Based on data found in our study, the high prevalence of viral infection and Para clinical disorders in these patients highlights the importance and the urgency of such laboratory measurements at the very beginning following hospitalization

Influência dos genótipos no tratamento da hepatite B: [revisão] / Influence on its genotypes of the treatment for type B hepatitis: [review]

A hepatite B pode ser classificada em oito diferentes genótipos (A-H). Esses genótipos diferem na sua distribuição geográfica mundial. No Brasil, os genótipos mais freqüentemente encontrados são o A, D e F. Algumas alterações na estrutura genética desses genótipos podem resultar em diferentes níveis de patogenicidade, sendo relacionadas com maior ou menor risco de desenvolvimento de hepatocarcinoma ou cirrose no fígado. Além das diferenças citadas, a heterogeneidade dos genótipos da hepatite B parece estar relacionada com diferenças na evolução clínica da infecção e na resposta ao tratamento antiviral. Alguns genótipos demonstraram responder melhor ao tratamento com interferon ou nucleotídeos análogos do que outros. O objetivo desta revisão foi demonstrar a importância do tratamento da hepatite B baseado nos seus diferentes genótipos. Foram revisados artigos da literatura, selecionando aqueles que abordavam questões relacionadas aos genótipos da hepatite B e sua relação com o tratamento desta infecção. Nos artigos revisados, o tratamento da hepatite B baseada em genótipos apresentou diferenças significativas. Os genótipos A e B parecem ter uma melhor resposta ao tratamento antiviral com interferon alfa e/ou lamivudina; porém, mais estudos são necessários para a consistência dessa afirmação. No entanto, através dos presentes dados, já é possível demonstrar forte associação entre genótipos e resposta antiviral. Deste modo, adaptar o tratamento aos genótipos pode promover uma melhor resposta do interferon e dos nucleotídeos na terapêutica da infecção pelo vírus da hepatite B.

Type B hepatitis can be classified according to eight different genotypes (A-H). These genotypes are different in terms of worldwide geographical distribution. In Brazil the most frequent genotypes are A, D and F. Some changes in the genetic structure of these genotypes can cause different levels of pathogenesis, being related to lower or higher risk of developing hepatocellular carcinoma or liver cirrhosis. In addition to the above mentioned differences, heterogeneity of hepatitis B genotypes seems to be related to the differences in clinical evolution of the infection and response to antiviral treatment. Some genotypes proved to have a better response to the treatment using interferon or similar nucleotides than others. This review aimed at showing the importance of treatment of type B hepatitis based on its different genotypes. Different articles from the specific medical literature were reviewed and those including genotypes for type B hepatitis and their association with the treatment of this infection were selected. In the reviewed articles genotypebased treatment of hepatitis B showed significant differences. Genotypes A and B seem to have a better response to the antiviral treatment with alpha interferon and/or lamivudine; however, more studies are necessary to confirm this assertion. Nevertheless, using the present data it is already possible to prove a strong connection between genotypes and antiviral response. Therefore, adjusting treatment to genotypes can cause a better therapeutic response from interferon and nucleotides in type B hepatitis therapy.

Hepatitis B virus infection profile in hemodialysis patients in Central Brazil: prevalence, risk factors, and genotypes

Hemodialysis patients are at high risk for hepatitis B virus (HBV) infection. A survey was conducted in the hemodialysis population of the state of Goiás, Central Brazil, aiming to assess the prevalence of HBV infection, to analyse associated risk factors, and also to investigate HBV genotypes distribution. A total of 1095 patients were interviewed in 15 dialysis units. Serum samples were screened for HBV serological markers by enzyme-linked immunosorbent assay. Hepatitis B surface antigen (HBsAg) positive samples were tested for HBV DNA by polymerase chain reaction and genotyped by restriction fragment length polymorphism. Global HBV infection prevalence was 29.8 percent (95 percent CI: 27.1-32.5). Multivariate analysis of risk factors showed that male gender, length of time on hemodialysis, and blood transfusion before 1993 were associated with HBV positivity. HBV DNA was detected in 65.4 percent (17/26) of the HBsAg-positive samples. Thirteen of 17 HBV DNA positive samples were genotyped. Genotype D (61.5 percent) was predominant, followed by A (30.8 percent), while genotype F was detected in only one (7.7 percent) sample.