Mortality trend due to Hepatitis B and C in the city of São Paulo, 2002-2016 / Tendência de mortalidade por hepatites B e C no município de São Paulo, 2002-2016

ABSTRACT OBJECTIVE: To describe mortality due to hepatitis B and C as underlying cause in the municipality of São Paulo, verifying the trend of these rates, and to assess the association of these diseases with others, from 2002 to 2016. METHODS: This is a time series study on mortality due to hepatitis B and C according to sex, with data from the Sistema de Informação de Mortalidade (SIM - Mortality Information Sistem). Prais Winsten regression was used in rate trend analysis. RESULTS: The findings of this study showed a trend of decline of mortality from hepatitis B and C in recent years, particularly among males. These infections were important associated causes of liver cell carcinoma and HIV. The proportion of deaths under 70 years of age stands out. CONCLUSIONS: The study provides a baseline for research on mortality trend and the impact of interventions, given the history of expanded detection and supply of treatments, including the most recent antivirals in Brazil, since 2015.

RESUMO OBJETIVO: Descrever a mortalidade por hepatites B e C como causa básica no município de São Paulo, verificando a tendência dessas taxas, e avaliar a associação dessas doenças a outras no período de 2002 a 2016. MÉTODOS: Trata-se de um estudo de série temporal sobre mortalidade por hepatites B e C segundo sexo, com dados do Sistema de Informação de Mortalidade. A regressão de Prais Winsten foi usada na análise de tendência das taxas. RESULTADOS: Os achados do presente estudo mostraram tendência de declínio da mortalidade por hepatites B e C nos últimos anos, particularmente entre pessoas do sexo masculino. Essas infecções foram causas associadas importantes ao carcinoma de células hepáticas e ao HIV. Destaca-se a proporção de óbitos com menos de 70 anos de idade. CONCLUSÕES: O estudo fornece uma linha de base para pesquisas de tendência de mortalidade e de impacto de intervenções, visto o histórico de ampliação da detecção e oferta de tratamentos, incluindo os mais recentes antivirais no Brasil, desde 2015.

Acciones prioritarias para un programa nacional de detección, tratamiento y seguimiento de pacientes con hepatitis C / Priority actions towards a national program for detection, treatment, and monitoring of patients with hepatitis C

Resumen: En el escenario de la salud mexicana, la epidemia por virus de la hepatitis C se encuentra presente junto con sus comorbilidades y mortalidad prematura. Actuar de manera inmediata permitirá una contención de la misma en el corto plazo dada la existencia de herramientas de prevención, diagnóstico y terapias farmacológicas altamente eficaces. La Coalición para el estudio de la hepatitis C en México ha desarrollado una postura donde aprovecha esas medidas de contención y presenta el desarrollo de un programa nacional para la detección, tratamiento oportuno y seguimiento de pacientes con hepatitis C.

Abstract: In the Mexican health scenario, the hepatitis C virus epidemic is present, along with its comorbidities and premature mortality. Acting immediately will allow its containment in short term with the proper implementation of the current available tools for prevention, diagnosis and highly effective pharmacological therapies. The Coalition for the study of hepatitis C in Mexico has developed a position paper that takes advantage of these containment measures and presents the development of a National program for the detection, timely treatment and follow-up of patients with hepatitis C.

Determining seroprevalence of Hepatitis B and C virus infections and associated risk factors among apparently healthy mothers in Addis Ababa, Ethiopia

Introduction: Viral hepatitis is a global public health problem affecting millions of people every year, causing disability and death. Hepatitis B (HBV) and hepatitis C (HCV) viruses spread horizontally, mainly through sexual contact and contaminated needles, and vertically. Both cause considerable morbidity and mortality worldwide. Maternal infection is a risk factor for vertical transmission. Objective: To determine the sero-prevalence of HBsAg and anti-HCV antibody among non-pregnant, apparently healthy mothers and to identify potential risk factors associated with HBV or HCV infection. Methods: A community based cross sectional study was conducted on 454 apparently healthy women, in Addis Ababa, Ethiopia from May 2016 to June 2017. A systematic random sampling method was used to recruit participants. Result: A total of 454 mothers were enrolled. Sero-prevalence of HBsAg and HCV was found to be 3.7% and 2.0%, respectively. HBc antibody was detected in 36.3% of the mothers. None of the participants were co-infected with both viruses. Previous history of liver disease, history of jaundice, HIV infection, and family history of liver disease were significantly associated with HBV infection. Marital status, caring for hepatitis patients, and a history of liver disease were factors significantly associated with HCV infection. Conclusion: Apparently healthy mothers in Addis Ababa had intermediate level of endemicity for hepatitis B and C infections Routine screening and vaccination of high risk reproductive mothers against HBV is advisable. Emphasis should be given to health education and promotion of infection control practices. Population based studies are strongly recommended to help monitor disease transmission patterns and to design evidence-based interventions against the spread of hepatitis infections in Ethiopia

Survival analysis of acquired immune deficiency syndrome patients with and without hepatitis C virus infection at a reference center for sexually transmitted diseases/acquired immune deficiency syndrome in São Paulo, Brazil

INTRODUCTION: Survival of patients with acquired immune deficiency syndrome has improved with combination antiretroviral therapy; mortality due to liver diseases, however, has also increased in these patients. OBJECTIVES: To estimate the accumulated probability of survival in human immunodeficiency virus-hepatitis C virus coinfected and non-coinfected patients and to investigate factors related to acquired immune deficiency syndrome patients' survival. METHODS: Non-concurrent cohort study using data from surveillance information systems of acquired immune deficiency syndrome patients over 13 years of age. Hepatitis C and B, human immunodeficiency virus exposure category, CD4+ T cell count, age group, schooling, race, sex, and four acquired immune deficiency syndrome diagnosis periods were studied. Kaplan-Meier survival analysis and Cox model with estimates of the hazard ratio and 95% confidence interval were used. RESULTS: Of the total 2864 individuals included, with median age was 35 years, 219 died (7.5%), and 358 (12.5%) were human immunodeficiency virus-hepatitis C virus coinfected. The accumulated probability of survival in human immunodeficiency virus-hepatitis C virus coinfected patients, after acquired immune deficiency syndrome diagnosis, at 120 months, was 0%, 38.9%, 83.8% in 1986-1993, 1994-1996, 1997-2002, respectively, and 92.8% at 96 months in 2003-2010; survival in non-coinfected patients at 120 months was 80%, 90.2%, 94% in 1986-1993, 1994-1996, 1997-2002, respectively, and 94.1% at 96 months in 2003-2010. In the multivariate model the following variables were predictive of death: hepatitis C virus coinfection (hazard ratio=2.7; confidence interval 2.0-3.6); Hepatitis B virus coinfection (hazard ratio=2.4; confidence interval 1.7-3.6); being >50 years old (hazard ratio=2.3; confidence interval 1.3-3.8); having 8-11 years of schooling (hazard ratio=1.6; confidence interval 1.1-2.3), having 4-7 years of schooling ...

Influencia de la infección por el virus de la hepatitis C en la mortalidad de los pacientes en hemodiálisis / Influence of infection by the hepatitis C virus on mortality in hemodialysis patients

Introducción: la hepatitis C se mantiene como un problema de salud en los centros de hemodiálisis. Métodos: se realizó un estudio de cohorte histórico donde se incluyeron 215 pacientes que ingresaron al centro de hemodiálisis del Hospital Militar Dr. Luis Díaz Soto, entre 1995 y 2008. Se tomaron como períodos de exposición los criterios de aislamiento de pacientes con hepatitis C. Resultados: se halló mortalidad general de 30,2 por ciento, la letalidad y la mortalidad por hepatitis C fueron mayores en el período de exposición con 53,8 por ciento y 16,6 por ciento, respectivamente. En el análisis multivariado por regresión de Cox se observó que constituyeron factores de riesgo de morir, en un menor tiempo de observación, la presencia de hepatitis C y recibir tratamiento con hemodiálisis en los períodos de mayor incidencia (p=0,014), independientemente de la carga de comorbilidades. Conclusiones: la infección por el VHC contribuye a aumentar la mortalidad de los pacientes en tratamiento con hemodiálisis, cuando se tiene en cuenta la carga de comorbilidades

Introduction: hepatitis C remains a health problem in hemodialysis centers. Methods: a historical cohort study was conducted. 215 patients who entered Dr. Luis Díaz Soto Military Hospital hemodialysis center from 1995 to 2008 were included. Isolation criteria of patients with hepatitis C were considered as exposure periods. Results: overall mortality was 30.2 percent, lethality and mortality from hepatitis C were higher in the exposure period (53.8 percent and 16.6 percent respectively). In multivariate analysis by Cox regression, the presence of hepatitis C and treatment with hemodialysis were observed to be death risk factors in a shorter time of observation, during periods of increased incidence (p = 0.014), regardless of the burden of comorbidities. Conclusions: HCV infection in patients on hemodialysis contributes to increased mortality even when taking into account the burden of comorbidities

Impacto da hepatite C na mortalidade de pacientes em hemodiálise / Impact of hepatitis C in mortality in patients on hemodialysis

OBJETIVO: As causas mais importantes de mortalidade em pacientes com Doença Renal Crônica Terminal (DRCT) são as doenças cardiovasculares. No entanto, existem doenças infecciosas virais (hepatite B e C) que se tornaram uma questão de grande importância para pacientes em hemodiálise, pois afetam a sua sobrevida aumentando a morbidade e a mortalidade. Nosso objetivo foi estudar a influência da hepatite C na mortalidade em pacientes em hemodiálise. MÉTODOS: Realizamos um estudo de coorte não concorrente durante 10 anos. RESULTADOS: Foram estudados 74 pacientes em cada coorte. A hepatite C não aumentou o risco de morte nos pacientes e a sobrevida dos pacientes com essa infecção foi melhor do que no grupo sem hepatite C. A sobrevida em pacientes não infectados no primeiro e quinto anos foi de 93,9 por cento e 52,3 por cento; e para os não infectados foi de 95,5 por cento e 73,1 por cento, respectivamente (Log Rank Mantel Cox, p = 0,02). CONCLUSÃO: Não encontramos aumento no risco de mortalidade. A hepatite C não se correlaciona com aumento de mortalidade em pacientes com DRCT em programa de hemodiálise.

OBJECTIVE: Cardiovascular diseases are the most important causes of mortality in patients with end-stage renal disease. However, viral infections (hepatitis B and C) have acquired great importance for patients undergoing hemodialysis, because they affect patients' survival and increase morbidity and mortality. This study aimed at assessing the influence of hepatitis C on the mortality of patients undergoing hemodialysis. METHODS: This is a non-concurrent cohort study during a period of ten years. RESULTS: Each cohort comprised 74 patients. Hepatitis C did not increase the risk of death, and the survival of infected patients was better than that of patients without hepatitis C. The one-year and five-year survivals of non-infected patients were 93.9 percent and 52.3 percent, respectively, while those of noninfected patients were 95.5 percent and 73.1 percent, respectively (Cox-Mantel log-rank, p = 0.02). CONCLUSION: No increase in mortality risk was observed. Hepatitis C did not correlate with an increase in mortality in patients with end-stage renal disease undergoing hemodialysis.

Análise dos escores de gravidade como preditores na mortalidade em cirróticos hospitalizados / Evaluation of the prognostic scores to predict mortality in hospitalized cirrhotic patient

Introdução: Diversos índices têm sido propostos na avaliação da gravidade da doença hepática. Objetivo: Analisar os escores de Child-Turcote- Pugh (CTP), APACHE II, MELD e SOFA como índices prognósticos de mortalidade hospitalar em pacientes cirróticos. Metodologia: Foram avaliados prospectivamente todos os cirróticos que se internaram em enfermaria provenientes da emergência de um Hosputal Geral de Porto Alegre, em um período de 6 meses. Os escores CTP, MELD, APACHE II e SOFA foram registrados, bem como o desfecho (alta ou óbito). O nível de significância adotado foi de 5%. Resultados: Foram avaliados 61 cirróticos. Quarenta e três eram homens (70%). A média de idade foi de 54,7±11,7 anos. Álcool e/ou o vírus da hepatite C (HCV) foram responsáveis pela etiologia de 50 (82%) casos. Quanto ao CTP, houve 7 (32%) mortes naqueles CTP A ou B, e 11 (38%) naqueles C (p=0,27). A mediana do escore MELD foi de 15, sendo que houve 3 (11%) mortes naqueles com MELD < 15 e 15 (45%) naqueles com MELD ≥15 (p=0,02). A mediana do escore APACHE II foi de 9, sendo que houve 0 morte naqueles com índice < 9 e 18 (41%) naqueles com índice ≥9 (p<00,1). Em relação ao SOFA, a média foi de 3,6±1,8 naqueles vivos versus 5,6±2,6 naqueles que foram a óbito durante a internação (p=0,005). A mortalidade hospitalar foi de 29% (18 casos). Conclusões: Os escores MELD, APACHE II e SOFA se mostraram bons preditores de mortalidade em cirróticos hospitalizados, mas não a classificação de CTP.

Introduction: A number of indexes have historically been proposed to assess the severity of liver disease. Aim: To evaluate the Child-Turcote-Pugh (CTP), APACHE II, MELD and SOFA scores as prognostic indexes of in-hospital mortality among cirrhotic patients. Methods: This is a prospective analysis of all cirrhotic patients who were admitted to a general hospital of Porto Alegre in a period of 6 months. CTP, MELD, APACHE II and SOFA scores were analyzed, as well as the outcome (discharge or death). The level of significance was 5%. Results: A total of 61 cirrhotic patients were evaluated. Forty-three patients were males (70%) and the mean age was 54.7±11.7 years. Alcohol and/or hepatitis C virus (HCV) were the ethiological agents in 50 (82%) cases. Concerning CTP scores, there were 7 (32%) deaths among CTP A or B and 11 (38%) deaths among CTP C (p=0.27). The median for the MELD scores was 15, and there were 3 (11%) deaths among those with MELD < 15 and 15 (45%) deaths among those with MELD ≥15 (p=0.02). The median for the APACHE II scores was 9, and there were no deaths (0) among patients with indexes ≥9 (p<00.1). Concerning the SOFA, the mean was 3.6±1.8 among living patients versus 5.6±2.6 among those who progressed to death during the hospitalization (p=0.005). The overall in-hospital mortality rate was 29% (18 cases). Conclusions: MELD, APACHE II, and SOFA scores proved to be good predictors of mortality of hospitalized cirrhotic patients, but the CTP did not.

Prevalencia de la co-infección con hepatitis B y C en pacientes HIV positivos y factores de riesgo asociados / Prevalence of co-infection with hepatitis B and C in HIV-positive patients and associated risk factors

Los virus de la hepatitis B (HBV) y C (HCV) son, frecuentemente, causa de enfermedad hepática crónica en pacientes infectados por el HIV (HIV +), ya que tienen las mismas rutas de transmisión. Se ha informado de prevalencias variables de co-infección, dependiendo de la población bajo estudio. El objetivo de este estudio fue determinar la prevalencia y los factores de riesgo asociados a la infección por HBV y HCV en pacientes HIV+ en el Hospital Universitario Oswaldo Cruz (HUOC) de Recife, Brasil, entre julio y spetiembre de 2004.

Hepatitis B and C are highly prevalent among HIV infected patients, resulting of shared transmission routes. Prevalences of HIV and hepatitis co-infections vary depending on the population studied. The main goal was to assess the prevalence and associated risk factors for HBV and HCV among HIV-infected patients. HIV infected patients at the Hospital Universitário Oswaldo Cruz (HUOC), Recife, Brazil, were studiend from July through September 2004.

Hepatitis C: a leading cause of cirrhosis at DHQ hospital D.I.Khan

Heptatic cirrhosis is a common condition in our country and because of its morbidity and mortality the financial implications of this disease are enormous for our health care system. Diagnosis of cirrhosis, especially in the advanced stage, means ultimate progression to death due to the complications occurring in due course of the disease. It is therefore important to know about the main factors responsible for this condition so as to avoid or remove them before establishment of this deadly disease. Alcohol is an important cause of cirrhosis in the western world but in developing countries hepatotropic viruses namely Hepatitis B virus and Hepatitis C virus are mainly responsible for this condition. The aim of this study was to know about the recent situation regarding causation of this disease in our area and to make comparison with similar studies carried out elsewhere. This study was conducted in department of medicine at DHQ Teaching Hospital D.I. Khan from 1st January 2003 to April 2006. All cirrhotic patients attending this hospital were admitted to the Medical Unit. Serum was tested for Hepatitis B surface antigen and for Hepatitis C virus antibodies by ELISA. A total of 336 patients were studied. Their variables were recorded and analyzed. Out of 336 patients, 190 [56.54%] were HCV positive, 102 [30.35%] were positive for Hepatitis B Surface antigen. Sixteen [4.76%] were having markers of both Hepatitis B and Hepatitis C virus indicating dual infection. In 28 [8.33%] patients there was no evidence of infection with either Hepatitis B or Hepatitis C virus. Two hundred and twenty eight [67.85%] patients were males and 108 [32.15%] were females. As a conclusion cases of cirrhosis due to Hepatitis C virus outnumber all other causes and the condition is more common in males

Anticuerpos contra el virus de la hepatitis C - anti HCV. Prevalencia e influencia sobre la morbimortalidad en los pacientes sometidos a trasplante renal, en los dos ultimos anos del programa de trasplante renal de la ciudad de la Plata / Hepatitis C viruses antibodies - anti HCV. Prevalence and their influence on the morbi-mortality in transplantation patients, in the last two years of the kidney transplantation program of the La Plata city

Se estudiaron 34 pacientes con trasplante renal (TxR), 18 varones y 16 mujeres, con el objetivo de conocer la prevalencia de Anti HCV, en este tipo de pacientes y su influencia sobre la morbimortalidad temprana. La media de segmiento fue 8.44 DS 6.7 meses y la de edad 38.32 años DS 13.97. Todos recibieron el mismo esquema inmuno-supresor y los episodios de rechazo se trataron con pulsos de metilprednisolona. Resultaron Anti HCV r (por EIA II) de Abbott e Inmunoblotting de Péptidos Sintéticos LIA TEK Organon Teknika); 7 (20.6 por ciento) pacientes y (NR) 27 (79.4 por ciento). Recibieron injerto de donante cadavérico 4 (57.1 por ciento), Anti HCV R y 10 (37.0 por ciento) Anti HCV NR; de donante vivo relacionado 3 (42.9 por ciento) Anti HCV R y 17 (63.0 por ciento) Anti HCV NR. Tenían antecedentes de haber pedacido hepatitis 6 (85.7 por ciento) de lso 7 Anti HCV R: 2 hepatitis crónicas y 4 agudas (2 HBV y 2 no B (NABV) y 6 (22.2 por ciento) de los 27 Anti HCV NR. El tiempo medio de tratamiento hemodialítico antes del trasplante en el grupo Anti HCV r fue 63.0 DS 27.0 meses y resultó significativamente superior (P<0.05) al del grupo Anti HCV (NR) (27.3 DS 20.7). Episodios de rechazos, hepatopatías post-trasplante y sobrevida del injerto y del paciente no fueron significativamente diferentes entre los pacientes Anti HCV R y los NR.