Previous hepatitis E virus infection, cirrhosis and insulin resistance in patients with chronic hepatitis C

ABSTRACT Background: Hepatitis E virus (HEV) infection in patients with pre-existing liver disease has shown high morbidity and lethality. The consequences of HEV superinfection in patients with chronic hepatitis C virus (HCV) infection are not fully understood. This study aimed to evaluate the association between the presence of anti-HEV antibodies, liver cirrhosis, and insulin resistance. Methods: A total of 618 patients chronically infected with HCV were included from three reference centers for viral hepatitis in São Paulo, Brazil. Presence of anti-HEV IgG was assessed by enzyme-linked immunosorbent assay (WANTAI HEV-IgG ELISA). Results: The seroprevalence of anti-HEV in patients with cirrhosis was significantly higher than in patients without cirrhosis (13.2% vs 8%, OR = 1.74, p = 0.04). Seropositivity for anti-HEV, adjusted for sex, age, and HCV genotype showed an association trend with hepatic cirrhosis (aOR = 1.75, p = 0.059). Presence of HEV antibodies, adjusted for age, body mass index and cirrhosis, was shown to be independently associated with insulin resistance (aOR: 4.39; p = 0.045). Conclusion: Patients with chronic hepatitis C are under risk of hepatitis E virus superinfection in Brazil. The trend toward association between cirrhosis and previous HEV infection suggests that it may accelerate liver fibrosis in patients with chronic hepatitis C. In addition, previous infection by HEV is independently associated with insulin resistance in the studied population, which may be an extra-hepatic manifestation of hepatitis E that persists after resolution of the active infection, and may contribute to fibrosis progression.

Seroprevalence of hepatitis E virus in chronic hepatitis C in Brazil

ABSTRACT Background and aims: Hepatitis E virus infection in patients with underlying chronic liver disease is associated with liver decompensation and increased lethality. The seroprevalence of hepatitis E virus in patients with chronic hepatitis C in Brazil is unknown. This study aims to estimate the seroprevalence of hepatitis E virus in patients with chronic hepatitis C and to describe associated risk factors. Methods: A total of 618 patients chronically infected with hepatitis C virus from three reference centers of São Paulo, Brazil were included. Presence of anti-HEV IgG was assessed by enzyme-linked immunosorbent assay (WANTAI HEV-IgG ELISA). Results: Out of the 618 patients tested, 10.2% turned out positive for anti-HEV IgG (95% CI 8.0-12.8%). Higher seroprevalence was found independently associated with age over 60 years (OR = 2.04; p = 0.02) and previous contact with pigs (OR = 1.99; p = 0.03). Conclusions: Patients with chronic hepatitis C are under risk of hepatitis E virus superinfection in São Paulo. Contact with pigs is a risk factor for the infection, suggesting a possible zoonosis with oral transmission.

Perfuraçäo de alça ileal por tuberculose em portadores da síndrome da imunodeficiência adquirida / Ileal loops perforation due to tuberculosis in AIDS patients with acquired inmunodeficiency syndrome

Objetivo do estudo: pesquisar a etiologia e o tratamento do abdome agudo perfurativo em portadores da síndrome de imumnodeficiência adquirida, em particular no caso de tuberculose intestinal. Tipo de estudo: clínico, através da conduta clínica e cirúrgica para a perfuraçäo intestinal por tuberculose em aidéticos. Local: Enfermaria de Moléstias Infecciosas do hospital Ipiranga - Inamps - S. Paulo. Pacientes: dois pacientes, adultos jovens do sexo masculino. Intervençöes: duas laparotomias para abdome agudo perfurativo, por perfuraçäo tuberculosa de alça ileal. Medidas e resultados: um dos pacientes veio a falecer no pós-operatório imediato em conseqüência do precário estado geral em que se encontrava. Outro teve boa evoluçäo e ainda continua sendo seguido ambulatorialmente. A laparotomia imediata, a oclusäo da perfuraçäo e a biópsia realizada, que permitiu chegar a uma etiologia, contribuíram para a boa evoluçäo do segundo paciente. Conclusöes: a literatura responsabiliza o citomegalovírus como sendo o principal causador da perfuraçäo intestinal em aidéticos. Em nossos pacientes, a etiologia foi tuberosa e talvez essa possa ser uma causa importante de abdome agudo perfurativo em portadores de AIDS em nosso meio, dada a grande pervalência de tuberculose nesse tipo de doente no Brasil