Surveillance of hepatitis C among five high-risk populations in Inner Mongolia Autonomous Region from 2013 to 2021 / 预防医学

Objective@#To investigate the prevalence of hepatitis C virus (HCV) infections among five high-risk populations in Inner Mongolia Autonomous Region, so as to provide insights into improvements in the control strategy for hepatitis C. @*Methods@#The detection of anti-HCV antibody was collected from patients receiving renal dialysis, patients receiving invasive diagnosis and treatment in hospitals, physical examination populations, unpaid blood donors and subjects admitted to family planning clinics in national hepatitis C surveillance sentinels in Inner Mongolia Autonomous Region from 2013 to 2021, and the year-, gender- and age-specific prevalence of anti-HCV antibody was analyzed. @*Results@#The mean prevalence of anti-HCV antibody was 2.19%, 1.81%, 0.05%, 0.10% and 0.03% among 3 600 patients receiving renal dialysis, 3 600 patients receiving invasive diagnosis and treatment in hospitals, 18 000 physical examination populations, 18 000 volunteer blood donors and 3 600 subjects admitted to family planning clinics, respectively. The prevalence of anti-HCV antibody appeared a tendency towards a decline among patients receiving renal dialysis (χ2trend=49.065, P<0.001) and volunteer blood donors (χ2trend=11.419, P=0.001). The prevalence of anti-HCV antibody was higher among male patients receiving invasive diagnosis and treatment in hospitals than among females (2.34% vs. 1.36%; χ2=4.826, P=0.028), and no gender-specific prevalence of anti-HCV antibody was seen among other four high-risk populations (all P>0.05). The highest prevalence of anti-HCV antibody was detected among patients receiving renal dialysis (3.30%) and patients receiving invasive diagnosis and treatment in hospitals at ages of 50 to 59 years (3.35%), while the highest prevalence was found among physical examination populations at ages of 60 years and greater (0.18%). @*Conclusion@#The prevalence of anti-HCV antibody was high among patients receiving renal dialysis and patients receiving invasive diagnosis and treatment in hospitals and low among physical examination populations, volunteer blood donors and subjects admitted to family planning clinics in Inner Mongolia Autonomous Region from 2013 to 2021. Periodical monitoring of anti-HCV antibody is recommended among the elderly.

Daclatasvir Plus Asunaprevir Dual Therapy for Chronic HCV Genotype 1b Infection: Results of Turkish Early Access Program

Abstract: Background. Daclatasvir and asunaprevir dual therapy is approved for the treatment of HCV genotype 1b infection in several countries. Aim. To evaluate the efficacy and safety of daclatasvir and asunaprevir dual therapy in Turkish patients. Material and methods. Sixty-one patients with HCV genotype 1b were enrolled in the Turkish early access program. Most of the patients were in difficult-to-treat category. Patients were visited at each 4 week throughout the follow-up period. Laboratory findings and adverse events were recorded at each visit. Results. Fifty-seven of 61 enrolled patients completed 24 weeks of treatment. Two patients died as a result of underlying diseases at 12-14th weeks of treatment. Two patients stopped the treatment early as a consequence of virological breakthrough, and 2 patients had viral relapse at the post-treatment follow-up. Overall SVR12 rates were 90% (55/61) and 93.2% (55/59) according to intention-to-treat (ITT) and per protocol (PP) analysis respectively. In ITT analysis, SVR12 was achieved by 93% (13/14) in relapsers, 80% (12/15) in interferon-ineligible patients and 91% (20/22) in previous nonresponder patients. SVR12 rates were 86.5% and 91.4% in patients with cirrhosis according to ITT and PP analysis respectively. SVR12 was 95.8% in non-cirrhosis group in both analysis. Patients with previous protease inhibitor experience had an SVR12 of 87.5%. Common adverse events developed in 28.8% of patients. There were no treatment related severe adverse event or grade-4 laboratory abnormality. Conclusions. Daclatasvir and asunaprevir dual therapy is found to be effective and safe in difficult-to-treat Turkish patients with HCV genotype 1b infection.

Hepatitis E virus infection in patients with acute non-A, non-B, non-C hepatitis in Central Brazil

Hepatitis E virus (HEV) infection has a worldwide distribution and represents an important cause of acute hepatitis. This study aims to investigate the occurrence of HEV infection and factors associated with this infection in patients with acute non-A, non-B, non-C hepatitis in Central Brazil. From April 2012 to October 2014, a cross-sectional study was conducted among 379 patients with acute non-A, non-B, non-C hepatitis in the City of Goiania, Central Brazil. Serum samples of all patients were tested for serological markers of HEV infection (anti-HEV IgM and IgG) by ELISA. Positive samples were confirmed using immunoblot test. Anti-HEV IgM and IgG positive samples were tested for HEV RNA. Of the 379 serum samples, one (0.3%) and 20 (5.3%) were positive for anti-HEV IgM and IgG, respectively. HEV RNA was not found in any sample positive for IgM and/or IgG anti-HEV. After multivariate analysis, low education level was independently associated with HEV seropositivity (p = 0.005), as well as living in rural area, with a borderline p-value (p = 0.056). In conclusion, HEV may be responsible for sporadic self-limited cases of acute hepatitis in Central Brazil.

TRIPLE THERAPY IN CHRONIC HEPATITIS C: initial series in a public health program in the South of Brazil / Terapia tripla em pacientes com hepatite C: experiência inicial em um pólo de aplicação do Sul do Brasil

Background Chronic hepatitis C has great impact on world’s health. Current therapy for genotype 1 hepatitis C virus includes protease inhibitors boceprevir and telaprevir, associated to standard therapy - peginterferon alfa + ribavirin. There are no published data in Brazil on the results of this new therapy, and it is interesting an evaluation of what was accomplished up to this moment. Objectives To evaluate virologic response to triple therapy, as well as the safety profile and tolerability. Method This study is a clinical series of patients receiving triple therapy for C hepatitis in a single center of a Public Health System of South Brasil. Out of the 121 patients that initiated the triple therapy, the first patients that finished the treatment and evaluated the sustained virological response (24 weeks after the end of treatment) were included. Results Twenty four genotype 1 chronic hepatitis C monoinfected patients were included. Nineteen (79.2%) patients had been previously treated. Thirteen (54.2%) patients were cirrhotic. Nineteen (79.2%) patients completed the planned therapy. By the end of the treatment, 14 (58.3%) out of 24 patients had undetectable viral load. Sustained virologic response occurred in 12 (50.0%) out of 24 patients, 07 (58.3%) in telaprevir group and 05 (41.7%) in boceprevir group. Out of 24 patients under triple therapy, 58% (n=14) presented anemia. Conclusions In conclusion, despite the small number of patients treated with triple therapy evaluated in the current study, it possibly reflects the population under this therapy in real-life. .

Contexto A hepatite crônica pelo vírus C tem grande impacto na saúde mundial. A terapia atual do genótipo 1 inclui os inibidores de protease (IP) boceprevir e telaprevir, associados à terapia padrão - alfapeginterferona + ribavirina (PR). No Brasil ainda não há estudos publicados sobre os resultados dessa nova terapia, sendo de interesse uma avaliação do que foi realizado até o momento. Objetivos Avaliar a resposta virológica ao tratamento triplo, bem como o perfil de segurança e tolerabilidade. Métodos O estudo consta de série de casos dos pacientes em uso de terapia tripla para o tratamento da hepatite C em um polo de tratamento da Secretaria Estadual da Saúde do Estado do Rio Grande do Sul, Brasil. Dentre os 121 pacientes que estão em uso de terapia tripla (PR e IP) foram apresentados os dados referentes aos primeiros que finalizaram o tratamento e realizaram avaliação da resposta virológica sustentada na semana 24 pós-tratamento. Resultados Foram incluídos 24 pacientes monoinfectados por hepatite C crônica genótipo 1. Dezenove (79%) pacientes eram previamente experimentados. Treze (54,2%) pacientes apresentavam cirrose. Dezenove (79,2%) pacientes completaram o tratamento planejado. Ao final do tratamento, 14 (58,3%) dos 24 pacientes apresentaram carga viral indetectável. Resposta virológica sustentada ocorreu em 12 (50%) dos 24 pacientes, sendo 07 (58,3%) no grupo telaprevir e 05 (41,7%) no grupo boceprevir. Dos 24 pacientes submetidos à terapia tripla, 58% (n=14) apresentaram anemia. Conclusões Embora o presente estudo tenha avaliado um pequeno número de casos, possivelmente reflete a população submetida à terapia tripla na vida real, despida das restrições dos estudos de registro. .

Correlação das diferentes técnicas de biópsia hepática com marcadores séricos de fibrose em pacientes portadores de hepatite C crônica tratados com interferon e ribavirina / Correlation among the different liver biopsy techniques with fibrosis serum markers in patients carrying chronic hepatitis C treated with interferon and ribavirin

Introdução: O vírus da hepatite C tem como principal via de transmissão a parenteral. A biópsia hepática constitui poderosa ferramenta e tem como parâmetros o grau de alteração estrutural e atividade inflamatória, permitindo estadiar as hepatites crônicas. Sendo a biópsia procedimento invasivo, os marcadores sanguíneos como AST, ALT, alfa-fetoproteína e APRI (AST-to-platelet ratio índex) constituem fatores preditores do grau de fibrose. Objetivos: Estabelecer o perfil epidemiológico da hepatite C na população estudada; correlacionar e comparar os resultados das diferentes técnicas de biópsia hepática com marcadores séricos indiretos de comprometimento hepático (plaquetas, alfa-fetoproteína, transaminases) e com APRI, avaliando a fidedignidade destes como preditores de gravidade da lesão hepática. Casuística e método: Estudo observacional, retrospectivo, análise de 100 prontuários escolhidos aleatoriamente de pacientes infectados cronicamente pelo VHC. Todos os pacientes haviam sido submetidos ou estavam na vigência de tratamento com interferon associado à ribavirina. Resultados: 61,3% era do sexo masculino e 71,1% do genótipo tipo 1. A maior taxa de resposta virológica sustentada foi no gênero feminino (60,6% x 36,7%).Obteve-se 34,7% biópsias percutâneas às cegas; 27,5% percutâneas guiadas por USG e 37,8% videolaparoscópicas. A biópsia videolaparoscópica demonstrou maior correlação com marcadores e escore de APRI (p<0,05): as médias de F0-F2 e F3-F4 foram, respectivamente, TGO - 46,1 x 106,5; TGP - 67,5 x 123,6; Plaquetas - 223.863 x 160.500; alfafetoproteína - 3,02 x 11,97; e APRI - 0,07 x 0,24 . Conclusão: O APRI apresentou correlação com os graus de fibrose hepática na análise videolaparoscópica, sendo a técnica mais fidedigna.

Tendencia preliminar del polimorfismo rs12979860 il28b en la población mestiza venezolana / Preliminary tendency of rs12979860 il28b polymorphism in the mestizo Venezuelan population

Introducción: El polimorfismo de un solo nucleótido (SNP) rs12979860 en el gen IL28B del cromosoma 19 que codifica al interferón (IFN)-λ-3, se asocia con respuesta viral sostenida a la terapia combinada de IFN-α pegilado y ribavirina en pacientes con virus de hepatitis C (VHC) genotipo 1. La diferencia alélica de este polimorfismo difiere entre grupos étnicos. Objetivo: Comparar las frecuencias alélicas (FA) y genotípicas (FG) del SNP rs12979860 del gen IL28B entre individuos sanos y pacientes con VHC mestizos venezolanos. Material y métodos: De 34 pacientes con VHC genotipo 1 investigados para este polimorfismo, solamente 19 eran venezolanos de tercera generación, a quienes comparamos con 19 individuos sanos conocidos mestizos. La determinación del polimorfismo se realizó mediante el ensayo TaqMAN SNP empleando el sistema de PCR-tiempo real. Resultados: El alelo más prevalente en la población sana fue el alelo silvestre C (55%) y en los pacientes la frecuencia fue igual para el alelo C y para el alelo mutado T (50%) sin diferencia significativa entre las dos poblaciones. El genotipo predominante fue el heterocigoto (C/T) en pacientes y en controles (80% y 58%) evidenciándose mayor valor en el primer grupo pero no llegando a ser significativo. Predominando en controles vs pacientes se aprecian los genotipos homocigotos C/C (26% vs 10%) y T/T (16% vs 10%). Conclusión: La tendencia preliminar apunta al genotipo heterocigoto C/T del gen IL28B como el más frecuente en la población mestiza venezolana.

Introduction: Single-nucleotide polymorphism (SNP) rs12979860 in the region of the IL28B gene on chromosome 19, coding for the interferon (IFN)-λ-3 are associated with sustained viral response to combined therapy with pegylated IFN-α and ribavirin in patients with hepatitis C virus (HCV) genotype 1. Allelic difference from this polymorphism varies among ethnic groups. Objective: To compare allelic frequencies (AF) and genotypes frequencies (GF) of SNP rs12979860 of the IL28B gene between healthy individuals and mestizos Venezuelan HCV patients. Material and Methods: From 34 patients with HCV genotype 1 investigated for this polymorphism only 19 were third generation mestizo Venezuelan patients who were compared to 19 healthy individuals known mestizos. SNP determination was carried-out by TaqMAN SNP assay employing real-time PCR system. Results: Most prevalent allele in the healthy population was the C wild (55%) while in patients similar frequency was found for C allele or the mutant allele (50% each) with no significant difference. The heterozygote genotype (C/T) was predominant in patients and controls (80% and 58%) with a higher value for the former group but without significance. Homozygote genotypes were more prevalent in controls vs. patients: C/C (26% vs. 10%) and T/T (16% vs. 10%). Conclusion: Preliminary tendency points-out that heterozygote genotype C/T from the IL28B gene is the most frequent in the Venezuelan mestizo population.

Prevalencia del virus de la hepatitis C en las unidades de hemodiálisis de la región occidental cubana / Hepatitis C virus present in hemodialysis units from Cuban western region

La población de hemodiálisis constituye un grupo de alto riesgo en el caso de la infección por el virus de la hepatitis C. Se realizó un análisis multicéntrico de la prevalencia de la infección por el virus de la hepatitis C en las unidades de diálisis de la región occidental aplicando las técnicas serológicas y moleculares, y se observó si existían diferencias significativas en cuanto a la aplicación de ambas técnicas. Se obtuvieron valores elevados de prevalencia de anticuerpos anti-VHC en todas las unidades de diálisis (76 %), así como la calculada aplicando la detección del ARN viral (55 %). No se hallaron diferencias significativas (k) en cuanto a la aplicación de ambas técnicas en la mayoría de las unidades de diálisis analizadas. La elevada prevalencia viral se asocia a la transmisión nosocomial provocada por el incumplimiento de las normas de precaución universal establecidas.

Hemodialysis population is a high risk group related to hepatitis C virus infection. Authors made a multicenter analysis on infection prevalence of hepatitis C virus in dialysis units of western region applying serologic and molecular techniques observing if there significant differences as regards the application of both techniques. We achieved high values of anti-CHV antibody prevalence in all dialysis units (76 %) as well as the estimated prevalence applying viral RNA detection (55 %). There were not significant differences (k) as regards application of both techniques in most of analyzed dialysis units. Viral high prevalence is associated with nosocomial transmission caused by no-fulfillment of established universal precaution standards.

Associação entre a hepatite crônica pelo vírus da hepatite C (VHC) e diabete melito em pacientes monoinfectados pelo VHC e co-infectados com o vírus da imunodeficiência humana / Association between the chronic infection by hepatitis C virus (HCV) and diabetes mellitus in patients monoinfected with the HCV and coinfected with the human immunodeficiency virus

O objetivo deste estudo é estimar a prevalência de diabete melito (DM) em pacientes portadores de hepatite crônica pelo vírus da hepatite C (VHC) e naqueles co-infectados por VHC/HIV. Foram avaliados dois grupos: um com pacientes monoinfectados por VHC e outro com pacientes co-infectados por VHC/HIV. Foram avaliados idade, gênero e cor da pele. Nos monoinfectados foi calculado o índice de massa corporal (IMC). Foram realizados aminotransferases, albumina, bilirrubina total, tempo de protrombina e genotipagem do VHC. A biópsia hepática foi realizada em todos os pacientes. Foram avaliados 135 pacientes monoinfectados, dos quais 30 (22,2%) apresentavam DM, e 117 pacientes co-infectados, sendo 35 (29,9%) com DM (p=0,164). A média geral de idade nos monoinfectados foi de 48,28 ± 9,68 anos, superior ao grupo de co-infectados (40,83 ± 9,01 anos). Na avaliação dos dois grupos houve predomínio do gênero masculino. A maioria dos pacientes apresentava pele de cor branca. Avaliando-se o IMC, observou-se distribuição uniforme, com predomínio de IMC acima de 25 kg/m2, independente da presença de DM. Quando avaliados os exames laboratoriais, observou-se que as aminotransferases foram significativamente mais alteradas naqueles pacientes sem DM. Os demais exames não demonstraram diferenças significativas entre os grupos. Houve maior prevalência de genótipo 2 ou 3, sendo que dentre aqueles co-infectados observou-se correlação entre estes e a presença de DM. Quanto à fibrose, houve predomínio de F3/F4 naqueles com DM. Em conclusão, a prevalência de DM nos pacientes monoinfectados pelo VHC e nos co-infectados por VHC/HIV é alta (AU)

The aim of this study was to estimate the prevalence of Diabeters Mellitus (DM) in chronically HCV infected patients and in those coinfected by HCV/HIV. Two groups were evaluated: one infected with HCV virus and the other with co-infection HCV/HIV. The patients in both groups were evaluated for age, gender and skin color. In the monoinfected group the body mass index (BMI) was calculated. Aminotransferases, albumin, total bilirrubin, protrombin time and HCV genotyping were performed. Liver biopsy was performed in all patients. Thirty (22.2%) of 135 monoinfected patients had DM. DM was observed in 35 (29.9%) of 117 co-infected patients (p=0,164). The age in the monoinfected group was 48.28 ± 9.68 years. It was higher than the co-infected group (40.83 ± 9.01 years). In both groups there was a predominance of males and most patients were white. Regarding BMI it was an uniform distribution and BMI higher than 25 Kg/m2 was more frequent. The aminotransferases were significantly higher in those patients without DM. The other exams did not show significant differences between the groups.There was a higher prevalence of genotype 2 or 3. Among the co-infected a correlation was observed between these genotypes and the presence of DM. Liver biopsy showed a predominance of F3/F4 in those with DM. In conclusion, the prevalence of DM in the HCV monoinfected patients and in those co-infected HCV/HIV is high (AU)

Evidências moleculares da transmissão horizontal do vírus da hepatite C (VHC) entre cônjuges / Molecular evidences for horizontal transmission of HCV inside couples

A transmissão do VHC vem diminuindo após a implementação de diretrizes de triagem de doadores de sangue e adoção de políticas sociais para reduzir o risco de infecção em UDI, entretanto o VHC ainda constitui um grave problema de saúde pública mundial. Em torno de 10% dos pacientes infectados com VHC não referem exposição a nenhum fator de risco conhecido. Alguns estudos demonstraram a presença de RNA em diferentes secreções, sugerindo a existência de outras rotas de transmissão do VHC. Este estudo teve como objetivo analisar as relações filogenéticas de diferentes regiões genômicas do VHC de cônjuges portadores crônicos e correlacioná-las com sequências de portadores crônicos não relacionados atendidos no mesmo ambulatório. Foram selecionados 18 pacientes (9 casais) com genótipo concordante entre eles e 42 controles (14 de cada genótipo encontrados nos casais). Foram amplificadas e sequenciadas as regiões NS3 (~620nt) e NS5B (~360nt). As sequências foram alinhadas usando o programa Clustal X e Bioedit 6.0.7. A presença do sinal filogenético, nas regiões estudadas, foi analisado através do mapeamento da verossimilhança pelo programa Tree-Puzzle. Os modelos evolucionários foram estimados pelo teste de razão de verossimilhança com o auxílio do programa Modeltest e utilizados para as análises das sequências NS3, NS3+NS5B (TrN+I+G) e NS5B(TrNef+I+G). Foram empregados os métodos de distância com algoritmo de agrupamento de vizinhos e máxima verossimilhança com o algoritmo de rearranjo dos braços, seccionando a árvore em dois pedaços e ligando em outras partes, para a construção das árvores, pelo programa PAUP*4b10. Foram calculados os valores de bootstrap, com 1000 réplicas, para a verificação da sustentação de ramos nas topologias. Nas análises foram incluídas sequências referencia do Genbank de diferentes genótipos...

HCV transmission has decreased with the adoption of universal blood donors screening and social policies to reduce risk of infection in IVDU, but HCV is still a worldwide health problem. The epidemiological route of infection cannot be identified in a significant proportion of patients. Some studies demonstrated the presence of viral RNA in different secretions, suggesting the existence of other routes for HCV transmission. The aim of this study was to evaluate the phylogenetical relationships among sequences from different HCV genomic regions from sexual partners of chronic infected patients when analyzed among themselves and when analyzed conjointly with sequences from virus found in non related chronic infected patients attended in the same clinic. Eighteen individuals (9 couples with stable relationship without other risk factors for HCV infection) and forty-two control patients (fourteen from each genotype found in the couples) were selected. NS3 (~620 nts) and NS5B (~360 nts) regions were amplified and sequenced. Sequences were aligned using clustal X 1.81 and Bioedit 6.0.7. Phylogenetic signal/noise ratio in the data set was investigated with a likelihood mapping analysis with the program TREE-PUZZLE. Evolutionary models were chosen by Hierarchical Likelihood Ratio Test (hLRTs) using Modeltest 3.06 and used for analyze NS3, NS3+NS5B (TrN+I+G) and NS5B (TrNef+I+G) sequences. Distance and maximum-likelihood (ML) phylogenetical analyses were performed with PAUP*4b10 and the trees were constructed with NJ and heuristic search. Tree bisection and reconnection (TBR) algorithm respectively.Robustness of trees was evaluated by analyzing 1000 bootstrap replicates. Genbank reference sequences from different genotypes were included in data analysis...

Moleculo-epidemiology of C hepatitis virus infection in harlots in Hanoi

The incidence and genotype of endemic C hepatitis in Hanoi female sex workers at the social re-education centre belonging to Hanoi Office of Invalid – Labor – Social, which was determined in a cross-sectional study – had show that: most of female sex workers there acquired almost genotypes of C hepatitis – 1a, 1b, 1ab, 1c, 6, 6a, 9a. The risk of their hepatitis infection was higher in the group of intravenous drug use than in the groups without drug use

Moleculo-epidemiology of C hepatitis virus in artificial kidney dialysis patients, nemerous transfusion

On 332 blood sample of patients who underwent dialysis with many times of blood transfusion at the Institute of Hematology and blood transfusion, HCV infection was evaluated. Results showed the infection of C hepatits virus of 1a, 1b, 6, 6a genotypes. The infection was associated with the quality of transfused blood. Patients gender age occupation education level, the place where the procedure carried out, marital status, religion, ethnic group, the history of drug use… were not related factors.