RESUMEN
We report a case of a patient with hepatitis B virus (HBV)-related membranous glomerulonephritis (MGN) who showed improvement after interferon-alpha (IFN-alpha) therapy. A 35-year-old man with nephrotic syndrome and HBV antigens received a 24-week course of IFN-alpha. At the end of therapy there was an elevation in the level of plasma aminotransferase and an increase in proteinuria, which were followed by antigen/antibody seroconversion. This "flare-up" before seroconversion suggests an increase in disease activity in the liver and kidney, demonstrating in vivo HBV involvement in MGN.
Asunto(s)
Adulto , Humanos , Masculino , Antivirales/uso terapéutico , Glomerulonefritis Membranosa/complicaciones , Glomerulonefritis Membranosa/tratamiento farmacológico , Interferón-alfa/uso terapéutico , Hepatitis B/complicaciones , Hepatitis B/tratamiento farmacológico , Proteinuria , Factores de Tiempo , Albúmina Sérica/análisis , Alanina Transaminasa/sangreRESUMEN
HBV infection is endemic in Brazil and acute HBV infection is still a common disease. Objective: To analyze incidence, risk factors and evolution of acute HBV infection. Setting: University Hospital. Patients: 357 patients with acute HBV infection, comparing two periods: 1985-1989 vs. 1990-1994. Results: The overall incidence declined from 50 new cases/year in 1985-89 (30 per cent of all cases) to 25 new cases/year in 1990-94 (8 per cent of all cases). Transmission among male homosexuals (3.9 per cent of cases in 85-89) declined to 1.3 per cent in 90-94 (p>0.05). Amongst health care workers (HCW) it declined from 8.2 per cent to 2.0 per cent (p=0.02). Conversely, heterosexual transmission increased from 4.8 per cent to 10.1 per cent (p=0.06). Chronification of HBV infection following the acute episode was observed in 1.7 per cent. Fulminant hepatic failure was seen in 3.4 per cent. However, 27.2 per cent of patients were lost to follow-up before normalization of the biochemical tests. Conclusions: The different patterns of risk factors observed is probably related to measures for preventing AIDS and to HCW vaccination programs. Chronification following acute episodes was not a common event.
Asunto(s)
Humanos , Adolescente , Anciano , Persona de Mediana Edad , Adulto , Femenino , Hepatitis B/epidemiología , Brasil/epidemiología , Incidencia , Prevalencia , Estudios Retrospectivos , Distribución por Edad , Hepatitis B/transmisiónRESUMEN
A infecçäo pelo virus da hepatite B (VHB) assume grande importância epidemiológica em todo o mundo, especialmente no Brasil, onde determinados grupos de risco apresentam alta prevalência da infecçäo. Dentre estes, destacam-se os profissionais da área da saúde, grupo ao qual devem ser dirigidas medidas profiláticas contra a infeçäo, basicamente através do emprego da vacina contra hepatite B. Com o objetivo de avaliar a resposta à vacina em profissionais da área de saúde, foram estudados 86 indivíduos, que foram vacinados contra hepatite B com três doses de 20 microgramas da vacina H-B-Vax (Merck, Sharp & Dohme), aplicadas aos 0,30 e 180 dias por via intramuscular, no músculo deltóide. Através da análise dos resultados, pudemos observar que homens apresentaram menor resposta à primeira dose de vacina e tendência à obtençäo de títulos médios geométricos inferiores, quando comparados ás mulheres. Estes mesmos achados foram observados quando comparamos fumantes e näo fumantes. Em relaçäo aos grupos etários estudados (indivíduos com menos de 35 anos e com 35 ou mais anos), näo se observou diferença estatisticamente significante na resposta à vacina