Impact du traitement par les antiviraux à action directe sur la qualité de vie des patients atteints d'hépatite C à Cotonou / Impact of treatment with direct-acting antivirals on quality of life in hepatitis C patients in Cotonou

Introduction: L'altération de la qualité de vie est l'une des conséquences de l'infection chronique au virus de l'hépatite C. L'objectif de cette étude était d'évaluer l'impact du traitement par les antiviraux à action directe (AAD) sur la qualité de vie des patients atteints d'hépatite C à Cotonou. Méthodes : Il s'agissait d'une étude transversale descriptive et analytique, avec un recueil de données à la fois rétrospectif et prospectif sur une période de 5 ans allant du 1er décembre 2015 au 1er septembre 2020. Etaient inclus tous les patients atteints d'hépatite C traités par les AAD dans la Clinique Universitaire d'hépato-gastroentérologie du Centre National Hospitalier et Universitaire Hubert Koutoukou Maga (CNHU-HKM) de Cotonou. L'efficacité était évaluée par la réponse virologique soutenue (RVS) à 12 semaines après la fin du traitement. Le questionnaire SF-36 était utilisé pour évaluer la qualité de vie des patients atteints d'hépatite C, avant et après traitement. Résultats : Pendant la période d'étude, 206 patients ont été colligés. Ils étaient constitués de 33,5% d'hommes et 66,5 % de femmes, soit une sex-ratio de 0,5. La moyenne d'âge des patients était de 62,0 ± 1,7 ans (extrêmes de 18 et 87 ans). La charge virale moyenne en UI/ml était de 3.507.336,9 ± 1.156.443,98 (extrêmes de 3422 et 75.674.348 UI/ml). Le score SF-36 était statistiquement plus élevé pour tous les items après le traitement par AAD (p˂0,05). Conclusion: Les antiviraux à action directe constitue un traitement qui améliore significativement la qualité de vie des patients atteints d'hépatite C à Cotonou.

Background: Impaired quality of life is one of the consequences of chronic infection with the hepatitis C virus. The aim of this study was to assess the impact of treatment with direct-acting antivirals (DAAs) on quality of life in patients with hepatitis C in Cotonou. Methods: This was a descriptive and analytical cross-sectional study, with both retrospective and prospective data collection over a 5-year period from 1 December 2015 to 1 September 2020. All patients with hepatitis C treated with DAAs at the University Hepato-Gastroenterology Clinic of the National and University Hospital Hubert Koutoukou Maga (CNHU-HKM) in Cotonou were included. Efficacy was assessed by the sustained virological response (SVR) at 12 weeks after the end of treatment. The SF-36 questionnaire, the reference measurement instrument, was used to assess the quality of life of hepatitis C patients before and after treatment. Results: A total of 206 patients were enrolled during the study period. They comprised 33.5% men and 66.5% women, giving a sex ratio of 0.5. The mean age of the patients was 62.0 ± 1.7 years, (extremes 18 and 87 years). The mean viral load in IU/ml was 3,507,336.9 ± 1,156,443.98 (extremes 3,422 and 75,674,348 IU/ml). The SF-36 score was statistically significantly higher for all items after DAA treatment (p˂0.05). Conclusion: Direct-acting antivirals are a treatment that significantly improves the quality of life of hepatitis C patients in Cotonou.

Epidemiología de infección por hepatitis B y C en personas con VIH/SIDA. Villa Clara 1986-2021 / Epidemiology of hepatitis B and C infection in people with HIV/AIDS. Villa Clara 1986-2021

Se realizó un estudio observacional descriptivo retrospectivo con el objetivo de caracterizar la infección por hepatitis B y C en pacientes seropositivos al VIH de la provincia Villa Clara, durante el período del 1 de enero de 1986 al 31 de diciembre de 2021. Esta coinfección se presentó con mayor frecuencia en pacientes adultos del sexo masculino de 60 años en adelante (22 casos, 18,48 %), seguido de pacientes con las edades 50-54 años (21, 17,64 %). Santa Clara fue el municipio de mayor prevalencia (25, 21%). Los factores de riesgo asociados fueron: la conducta sexual de riesgo (81 casos, 68,06%) y estado civil soltero (65, 54,62 %); predominó el nivel de escolaridad secundaria básica (53, 44,53 %); en la ocupación, amas de casa (42, 35,29 %) y desocupados (34, 28,57 %). En el 70,58 % de los casos, les fue diagnosticada la coinfección en el mismo año.

A retrospective, descriptive and observational study was carried out with the aim of characterizing hepatitis B and C infection in HIV seropositive patients in Villa Clara province from January 1, 1986 to December 31, 2021. This coinfection occurred more frequently in adult male patients, between 60 years and older (22 cases, 18.48%), followed by patients aged 50-54 years (21, 17.64%). Santa Clara was the municipality with the highest prevalence (25 cases, 21%). The associated risk factors were risky sexual behaviour (81 cases, 68.06%) and single marital status (65, 54.62%); secondary school level predominated (53, 44.53%); as well as, housewives (42, 35.29%) and unemployed people (34, 28.57%). The coinfection was diagnosed in 70.58% of the cases in the same year.

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.

Distribuição e autocorrelação espacial das hepatites virais B e C no Paraná: estudo ecológico, 2011-2019 / Distribution and spatial autocorrelation of viral hepatitis B and C in Paraná, Brazil: an ecological study, 2011-2019 / Distribución y autocorrelación espacial de las hepatitis virales B y C en Paraná, Brasil: estudio ecológico, 2011-2019

Objetivo: analisar a distribuição e a autocorrelação espacial das taxas de detecção das hepatites B e C no estado do Paraná, Brasil. Métodos: estudo ecológico das notificações de hepatites B e C no Sistema de Informação de Agravos de Notificação, 2011-2019; estimou-se a variação percentual das taxas de detecção entre o primeiro e o último triênios do período; analisou-se a autocorrelação espacial pelo índice de Moran. Resultados: houve 16.699 notificações de hepatite B, com maior diminuição da detecção nas macrorregionais de saúde Norte (-30,0%) e Noroeste (-25,9%) paranaenses; foram observados clusters de alta ocorrência nas regionais de saúde de Foz do Iguaçu, Francisco Beltrão e Cascavel (2011-2019); para hepatite C, houve 10.920 notificações, com maior redução da detecção na macrorregional Noroeste (-18,9%) e aumento na Oeste (+51,1%); a regional de Paranaguá registrou cluster de alta detecção (2011-2016). Conclusão: as hepatites B e C apresentaram distribuição heterogênea entre regionais de saúde.

Objective: to analyze the distribution and spatial autocorrelation of hepatitis B and C detection rates in the state of Paraná, Brazil. Methods: this was an ecological study of hepatitis B and C notifications held on the Notifiable Health Conditions Information System, between 2011 and 2019. Percentage change in detection rates between the first and last three-year periods was estimated. Spatial autocorrelation was analyzed using Moran's index. Results: there were 16,699 notifications of hepatitis B, with a greater reduction in detection in the North (-30.0%) and Northwest (-25.9%) macro-regions. There were clusters of high occurrence in the Foz do Iguaçu, Francisco Beltrão and Cascavel regions between 2011 and 2019. There were 10,920 notifications of hepatitis C, with a greater reduction in detection in the Northwest macro-region (-18.9%) and an increase in the West (51.1%). The Paranaguá region recorded a high detection cluster between 2011 and 2016. Conclusion: hepatitis B and C showed heterogeneous distribution between health regions.

Objetivo: analizar la distribución y autocorrelación espacial de tasas de detección de hepatitis B y C en el estado de Paraná, Brasil. Métodos: estudio ecológico de notificaciones de hepatitis B y C en el Sistema de Información de Enfermedades de Declaración Obligatoria, entre 2011 y 2019. Se estimó la variación porcentual de las tasas de detección entre el primer y el último trienio del período. La autocorrelación espacial se analizó por el índice de Moran. Resultados: hubo 16.699 notificaciones de hepatitis B, con mayor reducción de detección en las macrorregiones Norte (-30,0%) y Noroeste (-25,9%). Hubo conglomerados de alta ocurrencia en regiones de Foz do Iguaçu, Francisco Beltrão y Cascavel entre 2011 y 2019. Para la hepatitis C, hubo 10.920 notificaciones, con una mayor reducción en la detección de la macrorregional Noroeste (-18,9%) y aumento en la Oeste (51,1%). La regional de Paranaguá registró un conglomerado de detección alto entre 2011 y 2016. Conclusión: la Hepatitis B y C mostraron distribución heterogénea entre regionales de salud.

Interpretation of the important update of the Guideline for the prevention and treatment of hepatitis C (2022 edition) / 中华肝脏病杂志

In the past 20 years, Chinese Medical Association had issued several versions of hepatitis C prevention and treatment guidelines. In the latest guidelines published in 2022, the Chinese Society of Hepatology and the Society of Infectious Diseases for the Chinese Medical Association organized experts to update their recommendations for hepatitis C screening and treatment. The updated key points on prevention, diagnosis, and treatment proposed in the guidelines are now interpreted, aiming to provide reference for more effective clinical application of the guidelines.

Survey of prevalence of hepatitis C in people aged 1-69 years in Henan Province, 2020 / 中华流行病学杂志

Objective: To understand the infection status and epidemiological characteristics of hepatitis C in people aged 1-69 years in Henan Province in 2020. Methods: The estimated sample size was 5 827. From August to December 2020, multistage sampling was used to select 8 counties (districts) in Henan, and two survey sites were selected in each county (district), and a questionnaire survey was conducted in local people aged 1-69 years, blood samples were collected from them for anti-HCV, HCV RNA and genotype detections. Results: A total of 5 165 people aged 1-69 years completed the questionnaire survey. Men accounted for 44.76% (2 312/5 165), women accounted for 55.24% (2 853/5 165). In the people aged 1-69 years, the overall prevalence rates of anti-HCV and HCV RNA were 0.69% (95%CI: 0.68%-0.70%) and 0.20% (95%CI: 0.19%-0.21%) respectively. The prevalence rates of anti-HCV and HCV RNA were 0.48% (95%CI: 0.46%-0.50%), 0.09% (95%CI: 0.08%-0.10%) in men and 0.86% (95%CI: 0.85%-0.87%), 0.30% (95%CI: 0.28%-0.32%) in women. The prevalence rates of anti-HCV and HCV RNA increased with age. The prevalence rates of anti-HCV and HCV RNA were 0.87% (95%CI: 0.86%-0.88%), 0.28% (95%CI: 0.26%-0.30%) in urban residents and 0.53% (95%CI: 0.51%-0.55%), 0.14% (95%CI: 0.13%-0.15%) in rural residents. The genotyping results of 10 HCV RNA positive samples ware genotype 1b (4/10), genotype 2 (3/10), genotype 1b/3 (1/10), genotype 1b/3/6 (1/10) and genotype 2/6 (1/10). Conclusions: The prevalence of hepatitis C was low in Henan in 2020. It is necessary to strengthen hepatitis C surveillance in people aged 40 years and above. The major HCV genotypes were 1b and 2, and mixed genotype infection existed.

Prevalence of HCV Antibody and its Associated Factors: A Study from Sentinel Hospitals in China / 生物医学与环境科学（英文）

OBJECTIVE@#The prevalence and related factors of serum anti-HCV in different regions and hospitals have not been studied extensively in China. We used routine screening data to determine the prevalence of HCV antibody in hospital patients, evaluate the epidemic trend of hepatitis C and formulate screening strategies.@*METHODS@#Patient information and HCV antibody testing results were collected from January 2017 to December 2019 in 77 HCV sentinel hospitals in China. Univariate and multivariate logistic regression was used to determine the characteristics and associations.@*RESULTS@#HCV antibody prevalence rates were distinct among patients in different departments, with a range of 0.33%-6.93%. Patients who were admitted to the liver disease-related departments (a OR = 10.76; 95% CI, 10.27-11.28), Internal Medicine (a OR = 2.87; 95% CI, 2.75-3.00), and Department of Surgery (a OR = 1.95; 95% CI, 1.87-2.04), were more likely to be tested for HCV antibody positive. HCV antibody prevalence was associated with patients aged 45 years and older (a OR = 2.74; 95% CI, 2.69-2.80), testing in infetious disease hospitals (a OR = 2.33; 95% CI, 2.26-2.40) and secondary hospitals (a OR = 1.72; 95% CI, 1.69-1.75). Patients in sentinel hospitals of the Northeast (a OR = 12.75; 95% CI, 12.40-13.11), the Central (a OR = 1.65; 95% CI, 1.61-1.70), and the West (a OR = 1.78; 95% CI, 1.73-1.83) China had higher HCV prevalence than those who were in the Eastern coastal area.@*CONCLUSION@#Those who were over 45 years old and saw doctors for liver diseases, and invasive diagnosis and treatment should be referred to HCV antibody testing.

Global trajectories of liver cancer burden from 1990 to 2019 and projection to 2035 / 中华医学杂志(英文版)

BACKGROUND@#Large disparities exist in liver cancer burden trends across countries but are poorly understood. We aimed to investigate the global trajectories of liver cancer burden, explore the driving forces, and predict future trends.@*METHODS@#Data on the liver cancer burden in 204 countries and territories from 1990 to 2019 were extracted from the Global Burden of Disease Study. The age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) trajectories were defined using growth mixture models. Five major risk factors contributing to changes in the ASIR or ASMR and socioeconomic determinants were explored using the identified trajectories. A Bayesian age-period-cohort model was used to predict future trends through 2035.@*RESULTS@#Three trajectories of liver cancer burden were identified: increasing, stable, and decreasing groups. Almost half of the American countries were classified in the decreasing group (48.6% for ASIR and ASMR), and the increasing group was the most common in the European region (ASIR, 49.1%; ASMR, 37.7%). In the decreasing group, the decrease of liver cancer due to hepatitis B contributed 63.4% and 60.4% of the total decreases in ASIR and ASMR, respectively. The increase of liver cancer due to alcohol use, hepatitis C, and hepatitis B contributed the most to the increase in the increasing group (30.8%, 31.1%, and 24.2% for ASIR; 33.7%, 30.2%, and 22.2% for ASMR, respectively). The increasing group was associated with a higher sociodemographic index, gross domestic product per capita, health expenditure per capita, and universal health coverage (all P <0.05). Significant variations in disease burden are predicted to continue through 2035, with a disproportionate burden in the decreasing group.@*CONCLUSION@#Global disparities were observed in liver cancer burden trajectories. Hepatitis B, alcohol use, and hepatitis C were identified as driving forces in different regions.

Study on the related factors of antiviral treatment in previously reported hepatitis C patients based on the Andersen model / 中华肝脏病杂志

Objective: To understand the basic characteristics of previously reported patients with hepatitis C and analyze the related factors affecting their antiviral treatment. Methods: A convenient sampling method was adopted. Patients who had been previously diagnosed with hepatitis C in the Wenshan Prefecture of Yunnan Province and Xuzhou City of Jiangsu Province were contacted by telephone for an interview study. The Andersen health service utilization behavior model and related literature were used to design the research framework for antiviral treatment in previously reported hepatitis C patients. A step-by-step multivariate regression analysis was used in previously reported hepatitis C patients treated with antiviral therapy. Results: A total of 483 hepatitis C patients, aged 51.73 ± 12.06 years, were investigated. The proportion of male, agricultural occupants who were registered permanent residents, farmers and migrant workers was 65.24%, 67.49%, and 58.18%, respectively. Han ethnicity (70.81%), married (77.02%), and junior high school and below educational level (82.61%) were the main ones. Multivariate logistic regression analysis results showed that married patients with hepatitis C (OR = 3.19, 95% CI: 1.93-5.25, compared with unmarried, divorced, and widowed patients) with high school education or above (OR = 2.54, 95% CI: 1.54-4.20, compared with patients with junior high school education or below) were more likely to receive antiviral treatment in the predisposition module. Patients with severe self-perceived hepatitis C in the need factor module (compared with patients with mild self-perceived disease, OR = 3.36, 95% CI: 2.09-5.40) were more likely to receive treatment. In the competency module, the family's per capita monthly income was more than 1,000 yuan (compared with patients with per capita monthly income below 1,000 yuan, OR = 1.59, 95% CI: 1.02-2.47), and the patients had a high level of awareness of hepatitis C knowledge (compared with patients with a low level of knowledge, OR = 1.54, 95% CI: 1.01-2.35), and the family members who knew the patient's infection status (compared with patients with an unknown infection status, OR = 4.59, 95% CI: 2.24-9.39) were more likely to receive antiviral treatment. Conclusion: Different income, educational, and marital statuses are related to antiviral treatment behavior in hepatitis C patients. Family support of hepatitis C patients receiving hepatitis C-related knowledge and their families knowing the infection status is more important in promoting the antiviral treatment of patients, suggesting that in the future, we should further strengthen the hepatitis C knowledge of hepatitis C patients, especially the family support of hepatitis C patients' families in treatment.

Recurrence of hepatitis C virus after treatment with pegylated interferon and direct acting antivirals in Punjab Pakistan / Recorrência do vírus da hepatite C após tratamento com interferon peguilado e antivirais de ação direta em Punjab, Paquistão

Although increased response rates concomitant in hepatitis C virus but relapse after treatment is threatened. Therefore, it is terrible requirement to evaluate the response of Pegylated interferon and direct acting antivirals in Punjab Pakistan. The study was conducted to find the rate of recurrence of HCV infection after treatment with Pegylated Interferon and Direct Acting Antivirals in Punjab Pakistan. This study was conducted at Department of Pathology, Nawaz Sharif Medical College Gujrat, while treatment effects monitored in different Government and Private Hospitals of Punjab, Pakistan. Total 973 patients who administered the recommended dose and divided in two groups (i) Interferon based therapy (ii) direct acting antivirals (DAAs).Other parameters like ALT and viral load studied. The rate of recurrence was higher in female infected with genotype 2b and in male with mixed genotype 3a/2b after six month of antiviral therapy. Genotype 3a showed significant response to therapy after three month. 32 among 374 (8.5%) were positive after 24 weeks of treatment with interferon, 29 (7.7%) patients have same genotype while 3 patients were re-infected with different HCV strains. With DAAs, only 27 (4.8%) patients were positive among 558 after 2 weeks and one patient re-infected with different genotype. Early and sustained virological response noted in DAAs. ALT and viral load decreased faster with DAAs that not achieved after 4 weeks with pegylated interferon. Sustained virological response appears in DAAs and recurrence rate is high in interferon therapy compared to DAAs. Therefore, reinfection has implications for correct treatment efficiency and to select strategies for retreatment cases.

Embora aumentem as taxas de resposta concomitantes no vírus da hepatite C (HCV), há risco de recidiva após o tratamento. Portanto, é um requisito terrível avaliar a resposta do interferon peguilado e antivirais de ação direta em Punjab, Paquistão. O estudo foi conduzido para encontrar a taxa de recorrência da infecção por HCV após o tratamento com interferon peguilado e antivirais de ação direta em Punjab, Paquistão. Este estudo foi conduzido no Departamento de Patologia Nawaz Sharif Medical College Gujrat, enquanto os efeitos do tratamento foram monitorados em diferentes hospitais públicos e privados de Punjab, Paquistão. Total de 973 pacientes que administraram a dose recomendada foram divididos em dois grupos: (i) Terapia baseada em interferon, (ii) antivirais de ação direta (DAAs). Outros parâmetros como ALT e carga viral foram estudados. A taxa de recorrência foi maior em mulheres infectadas com o genótipo 2b e em homens com genótipo misto 3a / 2b após seis meses de terapia antiviral. O genótipo 3a mostrou resposta significativa à terapia após três meses. 32 entre 374 (8,5%) foram positivos após 24 semanas de tratamento com interferon, 29 (7,7%) pacientes têm o mesmo genótipo, enquanto 3 pacientes foram reinfectados com diferentes cepas de HCV. Com DAAs, apenas 27 (4,8%) pacientes foram positivos entre 558 após duas semanas e um paciente reinfectado com genótipo diferente. Resposta virológica precoce e sustentada observada em DAAs. ALT e carga viral diminuíram mais rapidamente com DAAs, que não alcançou após 4 semanas com interferon peguilado. A resposta virológica sustentada aparece em DAAs, e a taxa de recorrência é alta na terapia com interferon em comparação com DAAs. Portanto, a reinfecção tem implicações para a eficiência do tratamento correto e para selecionar estratégias para casos de retratamento.

Homens que fazem sexo com homens e a hepatite C: prevalência e fatores de risco em 12 capitais brasileiras / Men who have sex with men and hepatitis C: prevalence and risk factors in 12 Brazilian capitals

Apesar das políticas preventivas adotadas, a redução da transmissão das infecções sexualmente transmissíveis (ISTs) entre homens que fazem sexo com homens (HSH) tem sido limitada. O risco de infecção pelo vírus da hepatite C (HCV) aumentou entre os grupos populacionais mais vulneráveis incluindo HSH O objetivo do estudo foi estimar a prevalência da infecção pelo HCV e avaliar fatores de risco entre HSH em 12 capitais brasileiras Este estudo foi realizado de junho a dezembro de 2016 por meio do método respondent driven sampling (RDS). Os participantes preencheram um questionário autoaplicável para coletar dados socioeconômicos, demográfico s e comportamentais . Além disso, foi ofertado o teste rápido (TR) para Resultados positivos foram enviados ao Instituto Adolfo Lutz para testes confirmatórios. Foram recrutados 4. 176 participantes e 23 amostras foram enviadas para confirmação. Destas, 16 foram confirmadas, demonstrando prevalência de 0, 7% IC 95%: 0,3% 1,7%). A região Sudeste apresentou prevalência de 0,9% ( IC 95%: 0,3 2,6), seguida pela região Sul, com 0,6 % (IC 95%: 0,2 2,1)2,1). A região Nordeste apresentou prevalência de 0,3% (IC 95%: 0,1 1,0) e a C entro O este 0,1 % (IC%: 0,0 0,7)0,7). Nenhum caso positivo foi encontrado na região Norte . Homens solteiros com mais de 40 anos foram a maioria dos participantes expostos ao HCV. O uso irregular de preservativo s e o número elevado de parceiros sexuais, além da infecção por outras ISTs, foram associados ao aumento da exposição ao HCV. De acordo com os dados apresentados, é necessário implantar políticas de prevenção que se concentrem no segmento de HSH e que tenham estratégias de comunicação mais efetivas. Mostra se necessário o desenvolvimento de conhecimentos que fortaleçam a habilidade e estimulem a motivação para um comportamento mais seguro nessa população Os investimentos nas populações mais vulneráveis são fundamentais para atingir a meta da Organização Mundial da Saúde (OMS ) de eliminar as hepatites virais até 2030. (AU)

Despite the preventive policies adopted, the reduction of the transmission of sexually transmitted infections (STIs) among men who have sex with men (MSM) has been limited. The risk of infection with the Hepatitis C (HCV) has increased among the most vulnerable population groups including MSM The aim of the study was to estimate the prevalence of the infection by HCV and assess risk factors among MSM in 12 Brazilian capitals This study was carried out from June to December 2016 using the method respondent driven sampling (RDS). Participants filled out a self-administered questionnaire to collect socioeconomic data, demographic and behavioral . In addition, the rapid test was offered (TR) for Positive results were sent to Instituto Adolfo Lutz for confirmatory tests. 4, 176 participants were recruited and 23 Samples were sent for confirmation. Of these, 16 were confirmed, demonstrating a prevalence of 0.7% CI 95%: 0.3% 1.7%). The Southeast region presented a prevalence of 0.9% (CI 95%: 0.3 2.6), followed by the South region, with 0.6% (95% CI: 0.2 2.1)2.1). The Northeast region showed a prevalence of 0.3% (CI 95%: 0.1 1.0) and Center West 0.1% (CI%: 0.0 0.7)0.7). None positive case was found in the North region. Single men over 40 years were the majority of participants exposed to HCV. The irregular use of condoms and the high number of sexual partners, in addition to the infection by other I STs, were associated with increased exposure to HCV. In according to the data presented, it is necessary to implement policies of prevention programs that focus on the MSM segment and that have more effective communication strategies. Show if necessary development of knowledge that strengthens the ability and encourages the motivation for safer behavior in this population investments in the most vulnerable populations are fundamental to achieve the World Health Organization (WHO) goal of eliminating viral hepatitis by 2030. (AU)

Perfil da hepatite C em Goiás: epidemiologia, distribuição genotípica e carga viral / Profile of hepatitis C in Goiás: epidemiology, genotypic distribution and viral load

O Virus da Hepatite C (HCV) possui vasta diversidade. Com base nas variações genômicas, existem oito genótipos, designados de G1 a G8, com prevalências distintas de acordo com a região geográfica observada. Objetivo: O objetivo do estudo foi avaliar o perfil epidemiológico, genotípico e carga viral (CV) do HCV. Métodos: Estudo observacional analítico do tipo transversal, com dados de janeiro de 2018 a dezembro de 2021. O estudo analisou dados referentes a genotipagem, CV e do Formulário de Solicitação de CV do HCV, obtidos no Laboratório Estadual de Saúde Pública do estado de Goiás. Resultados: A maioria dos casos de HCV, concentram-se nas macrorregiões de saúde Centro Sudeste (42,90%) e Centro Oeste (34,15%) do Estado, com maior frequência do G1, seguido do G3 e presença dos G2, G4 e G5. O G1 vem diminuindo a frequência no decorrer dos anos, enquanto o G3 aumenta. Em geral, 49,33% dos casos apresentam alta CV (> 1.000.000 UI/mL). Em relação ao sexo, 31,75% dos indivíduos do sexo masculino apresentaram CV nessa mesma faixa, e o sexo feminino com 17,58%. A CV foi consideravelmente alta entre os casos analisados, com o sexo feminino, apresentando CV significativamente menor que o sexo masculino. Foram identificados o subtipo 1d e o G5 incomuns na região Central do Brasil. Conclusão: Os dados apresentados demonstram que o HCV pode estar em expansão, com o aparecimento de novos genótipos, subtipos e demonstra uma mudança na distribuição genotípica, no estado de Goiás nos últimos anos

The Hepatitis C Virus (HCV) has vast diversity. Based on genomic variations, there are eight genotypes, designated from G1 to G8, with different prevalences according to the geographical region observed. Objective: The objective of the study was to evaluate the epidemiological, genotypic and viral load (CV) profile of HCV. Methods: Cross-sectional analytical observational study, with data from January 2018 to December 2021. The study analyzed data relating to genotyping, CV and the HCV CV Request Form, obtained from the State Public Health Laboratory of the state of Goiás. Results: The majority of HCV cases are concentrated in the Central Southeast (42.90%) and Central West (34.15%) health macro-regions of the State, with a higher frequency in G1, followed by G3 and the presence of G2Genotype, G4 and G5. G1 has been decreasing in frequency over the years, while G3 is increasing. In general, 49.33% of cases have high CV (> 1,000,000 IU/mL). In relation to sex, 31.75% of males had CV in the same range, and females had 17.58%. The CV was considerably high among the cases analyzed, with females presenting a significantly lower CV than males. Subtype 1d and G5, uncommon in the Central region of Brazil, were identified. Conclusion: The data presented demonstrate that HCV may be expanding, with the emergence of new genotypes, subtypes and demonstrates a change in genotypic distribution in the state of Goiás in recent years

Prevalence of active HCV infection and genotypic distribution among the general population of district Mardan, Pakistan / Prevalência de infecção HCV ativa a distribuição genotípica entre a população geral do distrito de Mardan, Paquistão

Abstract Hepatitis C virus (HCV) is the serious global public health burden of liver disease. Approximately 170 million people in the world are infected with (HCV). In Pakistan, where the disease has high occurrence rate. The present study envisages an up-to-date prevalence of HCV and genotypic distribution in the general population of Mardan District, Khyber Pakhtunkhwa (KP), Pakistan. The blood samples from 6,538 individuals including 3,263 males and 3,275 females were analyzed for hepatitis C surface antigen by Immuno-chromatographic test (ICT), Enzyme-linked immunosorbent assay (ELISA), and reverse transcription-polymerase chain reaction (PCR). It was found that 396 (12.13%) out of 3263 individuals contained antibodies in their blood against HCV, while among the different age groups, the highest incidences of HCV antibodies were found in the 31-40 age group (11.01%). The ICT positive samples were further screened by nested PCR to determine the existence of active HCV-RNA. It was identified that 7.11% (3263) of the total population (6538) tested was positive, among which the 461 (14.07%) females possessed antibodies in their blood against HCV. Our data showed total HCV infection in the investigated population was 5.78%. Higher percentage of HCV prevalence was detected in males than females in the age group 31-40 and 41-50. To compare the prevalence of HCV genotypes age-wise in male and female genotype 3a was found most prevalent genotype followed by 1a, 2a and 3b, respectively.

Resumo O vírus da hepatite C (HCV) é o grave problema de saúde pública das doenças hepáticas. Aproximadamente 170 milhões de pessoas no mundo estão infectadas com HCV; no Paquistão, a doença tem alto índice de ocorrência. O presente estudo prevê uma prevalência atualizada do HCV e distribuição genotípica na população geral do distrito de Mardan, Khyber Pakhtunkhwa (KP), Paquistão. As amostras de sangue de 6.538 indivíduos, incluindo 3.263 homens e 3.275 mulheres, foram analisadas para o antígeno de superfície da hepatite C por teste imunocromatográfico (ICT), ensaio imunoenzimático (ELISA) e reação em cadeia da polimerase de transcrição reversa (PCR). Verificou-se que 396 (12,13%) de 3.263 indivíduos continham anticorpos no sangue contra o HCV, enquanto entre as diferentes faixas etárias as maiores incidências de anticorpos anti-HCV foram encontradas na faixa etária de 31 a 40 anos (11,01%). As amostras positivas para ICT foram posteriormente rastreadas por nested PCR para determinar a existência de HCV-RNA ativo. Identificou-se que 7,11% (3.263) do total da população (6.538) testada foram positivos, dentre os quais 461 (14,07%) mulheres possuíam anticorpos no sangue contra o HCV. Nossos dados mostraram que a infecção total pelo HCV na população investigada foi de 5,78%. Maior porcentagem de prevalência de HCV foi detectada em homens do que em mulheres nas faixas etárias de 31-40 e 41-50. Para comparar a prevalência de genótipos de HCV com relação à idade no genótipo masculino e feminino 3a foi encontrado o genótipo mais prevalente seguido por 1a, 2a e 3b, respectivamente.

Prevalence of active HCV infection and genotypic distribution among the general population of district Mardan, Pakistan / Prevalência de infecção HCV ativa a distribuição genotípica entre a população geral do distrito de Mardan, Paquistão

Hepatitis C virus (HCV) is the serious global public health burden of liver disease. Approximately 170 million people in the world are infected with (HCV). In Pakistan, where the disease has high occurrence rate. The present study envisages an up-to-date prevalence of HCV and genotypic distribution in the general population of Mardan District, Khyber Pakhtunkhwa (KP), Pakistan. The blood samples from 6,538 individuals including 3,263 males and 3,275 females were analyzed for hepatitis C surface antigen by Immuno-chromatographic test (ICT), Enzyme-linked immunosorbent assay (ELISA), and reverse transcription-polymerase chain reaction (PCR). It was found that 396 (12.13%) out of 3263 individuals contained antibodies in their blood against HCV, while among the different age groups, the highest incidences of HCV antibodies were found in the 31-40 age group (11.01%). The ICT positive samples were further screened by nested PCR to determine the existence of active HCV-RNA. It was identified that 7.11% (3263) of the total population (6538) tested was positive, among which the 461 (14.07%) females possessed antibodies in their blood against HCV. Our data showed total HCV infection in the investigated population was 5.78%. Higher percentage of HCV prevalence was detected in males than females in the age group 31-40 and 41-50. To compare the prevalence of HCV genotypes age-wise in male and female genotype 3a was found most prevalent genotype followed by 1a, 2a and 3b, respectively.

O vírus da hepatite C (HCV) é o grave problema de saúde pública das doenças hepáticas. Aproximadamente 170 milhões de pessoas no mundo estão infectadas com HCV; no Paquistão, a doença tem alto índice de ocorrência. O presente estudo prevê uma prevalência atualizada do HCV e distribuição genotípica na população geral do distrito de Mardan, Khyber Pakhtunkhwa (KP), Paquistão. As amostras de sangue de 6.538 indivíduos, incluindo 3.263 homens e 3.275 mulheres, foram analisadas para o antígeno de superfície da hepatite C por teste imunocromatográfico (ICT), ensaio imunoenzimático (ELISA) e reação em cadeia da polimerase de transcrição reversa (PCR). Verificou-se que 396 (12,13%) de 3.263 indivíduos continham anticorpos no sangue contra o HCV, enquanto entre as diferentes faixas etárias as maiores incidências de anticorpos anti-HCV foram encontradas na faixa etária de 31 a 40 anos (11,01%). As amostras positivas para ICT foram posteriormente rastreadas por nested PCR para determinar a existência de HCV-RNA ativo. Identificou-se que 7,11% (3.263) do total da população (6.538) testada foram positivos, dentre os quais 461 (14,07%) mulheres possuíam anticorpos no sangue contra o HCV. Nossos dados mostraram que a infecção total pelo HCV na população investigada foi de 5,78%. Maior porcentagem de prevalência de HCV foi detectada em homens do que em mulheres nas faixas etárias de 31-40 e 41-50. Para comparar a prevalência de genótipos de HCV com relação à idade no genótipo masculino e feminino 3a foi encontrado o genótipo mais prevalente seguido por 1a, 2a e 3b, respectivamente.

Frequência de esteato-hepatite alcoólica em pacientes portadores do vírus de hepatite C / Frequency of alcoholic steatohepatitis in patients with hepatitis C virus

Introdução: o consumo de álcool é um fator de risco bem conhecido para induzir doença crônica do fígado. O álcool também é um cofator na patogênese induzida pelo vírus da hepatite C (VHC). A infecção crônica pelo VHC pode exacerbar a lesão hepática alcoólica por mecanismos que incluem aumento do estresse oxidativo. Portanto o VHC, concomitantemente com o consumo excessivo de álcool, induz diversos mecanismos fisiopatogênicos que contribuem para a diminuição da depuração viral e para a lesão hepática. Objetivos: 1 ­ avaliar a frequência de esteato-hepatite alcoólica em biópsias de pacientes portadores do vírus da hepatite C; 2 ­ estudar os estágios da fibrose hepática nesses pacientes versus pacientes com e sem ingestão de álcool; 3 ­ analisar os escores bioquímicos e antropométricos desses pacientes. Metodologia: estudo de corte transversal, com pacientes acompanhados no núcleo de hepatologia do Hospital Prof. Edgard Santos da Universidade Federal da Bahia, portadores de hepatite C, com laudos de biópsias disponíveis para avaliar presença de esteato-hepatite alcoólica comprovada pelo registro de consumo de gramas de álcool. Foram considerados etilistas homens que consumiam mais de 30 g por dia e mulheres com consumo maior do que 20 g por dia. As variáveis utilizadas basearam-se em critérios histológicos, epidemiológicos e clínicos aplicados a esses pacientes. Resultados: a amostra total de pacientes portadores de hepatite C analisados foi de 335, sendo 100 indivíduos considerados com ingestão elevada de álcool, e 28,9% dos casos da amostra. A presença de esteatose hepática sem esteato-hepatite foi em 34 indivíduos (10,15%), e os casos de esteato-hepatite aparecem em um total de 30 indivíduos (8,96%). A carga viral elevada dos pacientes, tendo como referência >800.000, esteve em n=102, com 30,4% dos casos de VHC. Conclusão: observou-se, na população de estudo, 43 % os portadores de VHC com uso excessivo de alcool, 8,9 6% tinham esteato-hepatiits e 10,15 % esteatose. Além disso, verificou-se que mais da metade desses pacientes (56,6%) apresentaram grau de fibrose moderada e 53,3%, atividade necroinflamatória leve. A comorbidade mais comum observada foi hipertensão arterial sistêmica (HAS), em 40% dos pacientes.

Introduction: alcohol consumption is a well-known risk factor for inducing chronic liver disease, alcohol is also a cofactor in the pathogenesis induced by Hepatitis C Virus (HCV). Chronic HCV infection can exacerbate alcoholic liver damage by mechanisms including increased oxidative stress. Therefore, HCV, concomitantly with excessive alcohol consumption, induces several pathophysiological mechanisms, which contribute to the decrease in viral clearance and liver damage. Objectives: 1 ­ to assess the frequency of alcoholic steatohepatitis in biopsies of patients with the hepatitis C virus, 2 ­ to study the stages of liver fibrosis in these patients versus in patients with or without alcohol intake, 3 ­ analyze biochemical and anthropometric scores of these patients. Methodology: cross-sectional study, with patients monitored at the hepatology center of Hospital Prof. Edgard Santos from the Federal University of Bahia, carriers of hepatitis C with biopsy reports available to assess the presence of alcoholic steatohepatitis proven by recording the consumption of grams of alcohol, considered an alcoholic being a man, who consumed more than 30 g per day and being woman more than 20g a day. The variables used were based on histological, epidemiological and clinical criteria applied to these patients. Results: the total sample of patients with hepatitis C analyzed was (n=335), with n=100 individuals considered to have high alcohol intake, and 28.9% of the cases in the sample. The presence of hepatic steatosis without steatohepatitis was in 34 individuals (10.15%), and cases of steatohepatitis appear in a total of n=30 individuals (8.96%).The high viral load of patients, with >800,000 as reference, was n=102, with 30.4% of cases of HCV. Conclusion: it was observed, in the study population, 43% of HCV carriers with excessive alcohol use, 8.96% had steatohepatitis and 10.15% steatosis. Furthermore, it was found that more than half of these patients (56.6%) had a moderate degree of fibrosis and 53.3% had mild necroinflammatory activity. The most common comorbidity observed was systemic arterial hypertension (SAH), in 40% of patients.

The behavior of liver diseases in a cohort of Colombian patients with COVID-19 / Comportamiento de las enfermedades hepáticas en una cohorte de pacientes colombianos con COVID-19

Abstract Introduction: Severe acute respiratory syndrome type 2 coronavirus infection (SARS-CoV-2) is receiving the most attention now. The asymptomatic elevation of transaminases is typical in the liver, and liver involvement varies from 14 % to 78 %. The assessment of liver comorbidities is scarce, with prevalence ranging between 2 % and 11 %. Aim: To describe the behavior of a cohort of patients with liver diseases who fell ill with coronavirus disease 2019 (COVID-19). Materials and methods: This retrospective observational study analyzed the behavior of a cohort of patients with liver diseases who fell ill with COVID-19. Results: 543 patients became ill with COVID-19, of which 300 were women (55.3 %). The median age at diagnosis of liver disease was 52 years. The leading causes of liver disease were nonalcoholic steatohepatitis (49.5 %), cholestatic disease (7.7 %), and hepatitis C and B viruses (6.3 %). Alanine aminotransferase (ALT) had a median of 52 U/L (interquartile range [IQR]: 30-98) and aspartate aminotransferase (AST) 32 U/L (IQR: 23-62). Mortality due to viral infection was 5.7 %, with an incidence rate of 2.9 (95 % confidence interval [CI]: 2-4.2). Conclusions: It is a retrospective study but, until the preparation of the manuscript, it had been the first cohort in Colombia to describe the behavior of liver diseases in patients who become ill with COVID-19. No statistically significant differences were found between the causes of liver disease that confer a higher risk of mortality; however, having decompensated cirrhosis is the only condition related to mortality.

Resumen Introducción: la infección por coronavirus del síndrome respiratorio agudo grave de tipo 2 (SARS-CoV-2) concentra la mayor atención en el momento. En el hígado es frecuente la elevación asintomática de transaminasas y la afectación hepática varía del 14 % al 78 %. La evaluación de las comorbilidades hepáticas es escasa, con prevalencias que oscilan entre el 2 % y el 11 %. Objetivo: describir el comportamiento de una cohorte de pacientes con enfermedades hepáticas que presentaron el coronavirus de 2019 (COVID-19). Materiales y métodos: estudio observacional retrospectivo que analizó el comportamiento de una cohorte de pacientes con hepatopatías que enfermaron por COVID-19. Resultados: 543 pacientes padecieron por COVID-19, de los cuales 300 fueron mujeres (55,3 %). La mediana de edad al diagnóstico de la enfermedad hepática fue de 52 años. Las principales causas de las hepatopatías fueron esteatohepatitis no alcohólica (49,5 %), enfermedad colestásica (7,7 %), virus de la hepatitis C y B (6,3 %). La alanina-aminotransferasa (ALT) presentó una mediana de 52 U/L (rango intercuartílico [RIC]: 30-98) y aspartato-aminotransferasa (AST) 32 U/L (RIC: 23-62). La mortalidad por la infección viral fue del 5,7 % con una tasa de incidencia de 2,9 (intervalo de confianza [IC] 95 %: 2-4,2). Conclusiones: es un estudio de carácter retrospectivo; sin embargo, hasta la elaboración del manuscrito es la primera cohorte en Colombia en describir el comportamiento de las enfermedades hepáticas en pacientes que enferman de COVID-19. No se encontraron diferencias estadísticamente significativas entre las causas de hepatopatía que confieran un mayor riesgo de mortalidad; sin embargo, tener una descompensación de cirrosis es la única condición que tiene una relación con la mortalidad.

HIV, Hepatitis B, Hepatitis C, and Syphilis: prevalence and serodiscordance between women and their partners / HIV, hepatite B, hepatite C e sífilis: prevalência e sorodiscordância entre mulheres e seus companheiros

Introduction: The prevention of vertical transmission of sexually transmitted diseases is the object of research by several authors, who reinforce the importance of knowing the serological status of a woman's sexual partner. Objective: To evaluate the prevalence and serodiscordance of HIV, hepatitis B, hepatitis C, and syphilis infections among women admitted to a maternity hospital in southern Brazil and their partners. Methods: 350 women and their partners were interviewed in a service-based cross-sectional study conducted from August 16 to November 23, 2018. Results: 4.0% of the women and 4.3% of the men had one of the infections studied. Among women, 2.0% already knew they were HIV positive, 2.0% had a positive rapid test for syphilis and there was no positive result for hepatitis B or C. A total of 299 (85.4%) partners were located. Of these, 293 (98.0%) agreed to answer the study questionnaire. Of all men interviewed, 281 (95.9%) agreed to undergo an rapid test. Among men, 1.4% already knew they were HIV positive and 0.4% had chronic hepatitis B disease. There was a similar percentage of men with a positive rapid test for syphilis and hepatitis C (1.4%). Regarding couples, 6.8% had some positive test. Most of the positive test subjects were in a serodiscordant relationship (16 serodiscordant couples and 3 positive concordant couples). Conclusion: These results reinforce the importance of testing men to prevent the infection of a negative partner and the vertical transmission of sexually transmitted infections. The high acceptance, by men, to undergo an rapid test at the time of the woman's hospitalization demonstrated the viability of this strategy in the maternity ward.

Introdução: A prevenção da transmissão vertical de doenças sexualmente transmissíveis é objeto de pesquisa de diversos autores, os quais reforçam a importância do status sorológico do parceiro sexual da mulher. Objetivo: Avaliar a prevalência e a sorodiscordância de infecções por HIV, hepatite B, hepatite C e sífilis em mulheres internadas em uma maternidade localizada no Sul do Brasil e seus parceiros. Métodos: Foram entrevistadas 350 mulheres e seus parceiros em um estudo transversal de base de serviço realizado de 16 de agosto a 23 de novembro de 2018. Resultados: Do grupo consultado, 4,0% das mulheres e 4,3% dos homens apresentaram alguma das infecções estudadas. Entre as mulheres, 2% já sabiam ser HIV positivas e 2% apresentaram teste rápido positivo para sífilis. Para hepatite B ou C, não se registrou nenhum resultado positivo. Foram localizados 299 (85,4%) companheiros, destes, 293 (98,0%) aceitaram responder ao questionário do estudo. Do total de homens entrevistados, 281 (95,9%) concordaram em se submeter aos testes rápidos, entre eles, 1,4% já sabiam ser HIV positivos, 0,4% eram portadores crônicos de hepatite B e 1,4% apresentaram testes rápidos positivos para sífilis e hepatite C. Em relação aos casais, 6,8% possuíam algum teste positivo, a maioria (16) era formada de indivíduos sorodiscordantes e 3 de concordantes positivos. Conclusão: Esses resultados reforçam a importância da testagem masculina com a intenção de evitar a infecção do cônjuge negativo e a transmissão vertical das infecções sexualmente transmissíveis. A alta aceitação masculina de se submeter ao teste rápido durante a internação da mulher demonstrou a viabilidade dessa estratégia de testagem na maternidade.

Kashmiri refugees at the verge of hepatitis B and C epidemic in the State of Azad Jammu and Kashmir, Pakistan

ABSTRACT OBJECTIVE To determine the seroprevalence of hepatitis B and C among immigrants residing refugee camps in Muzaffarabad, Azad Kashmir, Pakistan, and to identify possible risk factors for hepatitis B virus (HBV) and hepatitis C virus (HCV) transmission. METHODS Around 1,225 individuals inhabiting Muzaffarabad refugee camps, participated in the study. A qualitative Immuno-Chromatographic Technique was used for initial screening and PCR test was used for detection of HBV and HCV in participants. The major risk factors for HBV and HCV transmission were assessed using a questionnaire approach. RESULTS Around 86 (7.0%) individuals were observed for hepatitis B surface antigen (HBsAg) presence, and 215 (17.5%) individuals were found positive for Anti-HCV. Only 32 (2.6%) individuals were confirmed for HBV DNA and 126 (10.3%) individuals were positive for HCV RNA after PCR. Demographically, both HBsAg and Anti-HCV were found more prevalent in female (4.4% HBsAg and 10.8% Anti-HCV) population as compared to male (2.6% HBsAg and 6.7% Anti-HCV) population. Surprisingly, the HBsAg (23.5%) and Anti-HCV (41.1%) appeared to be more frequent in the age group 62-75 years. Previous history of hepatitis in the family (p < 0.0001), blood transfusion (p = 0.0197) dental treatment (p < 0.0001) and tattooing or piercing on any part of the body (p = 0.0028) were assessed as significant risk factors in HBV and HCV transmission. CONCLUSIONS Presence of 7.0% HBsAg and 17.5% Anti-HCV in a small fragment of the migrant population cannot be overlooked. Lack of awareness among people and negligence of health department could escalate the situation.