Tratamento da infecção pelo vírus da hepatite C em candidatos a transplante renal submetidos a diálise: impacto orçamentário no SUS / Hepatitis C treatment in patients on dialysis awaiting renal transplantation: a budget impact analysis

Trata-se de uma análise de impacto orçamentário derivada dos resultados do estudo "Custo-efetividade do tratamento da infecção pelo vírus da hepatite C em candidatos a transplante renal submetidos a diálise". Teve como objetivo estimar o impacto orçamentário da ampliação da oferta do tratamento da infecção pelo vírus da hepatite C (VHC) para candidatos a transplante renal. Para tal, foi construído um modelo de Markov, a fim de estimar o custo médio do tratamento de diferentes proporções da população-alvo. Foram estimados os casos prevalentes e incidentes da infecção na população em diálise, candidata a transplante renal, em um horizonte de tempo de dez anos. Com base nestas estimativas, foi calculado o valor a ser despendido pelo SUS para tratar a população-alvo em três cenários diferenciados, caracterizados pela proporção da população submetida ao tratamento. Os valores encontrados foram comparados com o gasto do sistema para garantia de terapias de substituição renal no período de um ano, identificando-se que o custo do tratamento de toda a população candidata a transplante, infectada pelo VHC, corresponde a 0,3 por cento do valor despendido com TRS pelo SUS.

This is an analyses of the budget impact derived from the cost-effectiveness study on the hepatitis C treatment in candidates for renal transplantation under dialysis. It aims to estimate the budget impact of an offer of hepatitis C treatment for all candidates for renal transplantation. A Markov model was developed to estimate the mean cost for treatment of distinct proportions of the target population. The prevalence and incidence of hepatitis C in the candidates for renal transplantation in the dialysis population was also estimated in a horizon of ten years. Based on these estimative, we calculate the amount needed for treatment of this population in three distinct scenarios characterized by a proportion of the population under treatment. The values were compared with the expense of the system to guarantee renal replacement therapies in one year, identifying the cost of treatment of all candidates for transplant, infected with HCV, corresponding to 0.3 percent of the amount spent with renal transplantation within the SUS.

Viral hepatitis infection and insulin resistance: a review of the pathophysiological mechanisms / Hepatitis virales y resistencia a la insulina: revisión de los mecanismos fisiopatológicos

Viral hepatitis is a common cause of morbidity in Mexico. Insulin resistance (IR) is related to the liver damage caused by some viral infections, especially chronic infections. Chronic viral infection is an important risk factor for the development of type 2 diabetes mellitus, disease that is currently among the 10 main causes of morbidity and the most common cause of mortality. Although several studies have reported an association between IR and hepatitis B virus or hepatitis C virus (HCV) infection, the pathophysiology has been studied thoroughly only for the association between IR and HCV infection. It is thought that HCV infection causes direct damage through the action of the core proteins, which induces an inflammatory state characterized by secretion of proinflammatory cytokines that interfere with normal insulin signaling and disturb glucose, lipid and protein metabolism. This review summarizes the mechanisms by which viral infection is thought to induce IR.

Las hepatitis virales son una causa común de morbilidad en México. La resistencia a la insulina (RI) ha sido relacionada con el daño hepático causado por infecciones virales crónicas, haciendo de ellas un factor de riesgo para el desarrollo de diabetes mellitus tipo 2, problema de salud que se encuentra entre las primeras 10 causas de morbilidad y es la primera de mortalidad. Aunque varios estudios han reportado una asociación entre la RI y la infección con virus de la hepatitis B y virus de la hepatitis C, sólo con el último se ha estudiado su fisiopatología. Se ha sugerido que produce daño directo a través de proteínas de su núcleo e induce un estado inflamatorio que interfiere con la señalización normal de insulina, resultando en una alteración del metabolismo de glucosa, lípidos y proteínas. Esta revisión resume los mecanismos por los que se sugiere que estas infecciones inducen RI.

Role of acute viral hepatitis as a confounding factor in antituberculosis treatment induced hepatotoxicity.

BACKGROUND & OBJECTIVE: Drug induced hepatotoxicity (DIH) is an important and commonly encountered adverse effect with antituberculosis (anti-TB) treatment. Acute viral hepatitis (AVH) is an important confounding reason which clinically, biochemically and histologically mimics DIH. METHODS: The contributory role of acute viral hepatitis as a confounding factor in patients with normal baseline liver functions who developed acute hepatitis while receiving short-course anti-TB treatment was prospectively studied. The sera of all patients who developed acute hepatitis were analysed for markers for hepatitis A, B, C and E viruses. RESULTS: Viral hepatitis was present in 15 of the 102 (14.7%) patients who developed acute hepatitis while receiving anti-TB treatment with hepatitis E virus being the most common cause Later onset of acute hepatitis [58 (5-133) vs. 26 (3-221) days; P=0.04], large elevations in aspartate aminotransferase (AST) [371 (30-2643) vs. 212 (63-1990 IU/l); P=0.03] and alanine aminotransferase (ALT) [388 (31-2997) vs. 225 (52- 1670 IU/l); P= 0.002] and a longer time for normalization of deranged liver functions [36.7 +/- 13.3 vs. 24.5 +/- 19.3 days; P=0.02] indicated acute viral hepatitis as the cause of liver function derangement. INTERPRETATION & CONCLUSION: Our findings showed AVH in 14.7 per cent patients who developed hepatotoxicity while an anti-TB treatment. Therefore, in endemic areas, viral hepatitis should be sought after and excluded in all patients suspected to have DIH before attributing the hepatotoxic effect to the anti-TB drugs.

Serum levels of bcl-2 and cellular oxidative stress in patients with viral hepatitis.

PURPOSE: This study was conducted to investigate the presence of bcl-2 protein in the serum of patients with viral hepatitis and to find out if there is any correlation between bcl-2 protein levels and cellular oxidative stress in the pathogenesis of viral hepatitis. METHODS: This study was carried out on 130 patients with viral hepatitis, 70 with chronic hepatitis, 30 with liver cirrhosis and 30 with hepatocellular carcinoma (HCC) in addition to 20 healthy persons as the control. Serum bcl-2 protein was estimated by enzyme-linked immunosorbent assay, serum malondialdehyde (MDA), nitric oxide (NO) and antioxidant enzymes (GSH, GSH-px, GR and SOD) were measured using spectrophotometric analysis. RESULTS: bcl-2 protein level was significantly elevated in the serum of HCC, cirrhosis and chronic hepatitis groups as compared to control group. There were significant positive correlations between higher bcl-2 protein level and viral hepatitis markers (HBsAg, anti-HCV antibodies) in HCC and cirrhotic patients as compared to chronic hepatitis group. An increase in oxidative stress markers (MDA, NO) and a decrease in antioxidant enzyme activities (SOD, GSH and GSH-px) were observed. However, there was a negative correlation between bcl-2 levels and GR in all studied patient groups. CONCLUSIONS: The release of oxidative free radicals, deficiency in antioxidant enzymes and the expression of bcl-2 protein might play a role in the pathogenesis of viral hepatitis. The ability to measure bcl-2 protein in the serum could be useful as a prognostic marker of cancer patients.

Intestinal Permeability in Patients with Viral and Alcoholic Liver Disease / 대한소화기학회지

BACKGROUND/AIMS: Increased intestinal permeability has been possible contributing factors to the pathogenesis of alcoholic liver disease. Moreover, it can contribute to the development of bacterial infection and intestinal endotoxemia in patients with liver cirrhosis. This study aimed to examine the difference of intestinal barrier dysfunction between alcoholic and viral liver disease patients through the comparison of the intestinal permeabilities of patients with clinical characteristics. METHODS: Intestinal permeabilities were measured in 18 healthy controls, 41 patients with alcoholic liver disease (17 cases of alcoholic liver disease without cirrhosis and 24 cases of alcoholic liver cirrhosis) and 46 patients with viral liver disease (14 cases of chronic viral hepatitis and 32 cases of viral liver cirrhosis) by measuring 24 hour urine excretion of 51Cr-EDTA. RESULTS: The intestinal permeability was significantly increased in the patients with alcoholic liver disease without cirrhosis (5.62 +/- 2.80%), alcoholic liver cirrhosis (5.29 +/- 2.48%) and viral liver cirrhosis (3.15 +/- 1.39%) compared with that in control subjects (1.99 +/- 0.53%). On the contrary, it was not increased in the patients with chronic viral hepatitis (2.05 +/- 0.57%) versus controls. The significant correlation was not found between intestinal permeability and clinical and laboratory findings. CONCLUSIONS: The intestinal permeability was elevated in patients with alcoholic liver disease compared to those with viral liver cirrhosis. The pathophysiology of liver injury secondary to intestinal epithelial damage may be different between alcoholic and viral liver diseases.

Role of bone mineral densimetry in chronic viral hepatits patients

A total of 40 patients [29 males and 11 females] aged between 12 and 80 years presented with chronic liver diseases was submitted to bone densitometry examinations. The patients were divided into three groups: Group 1 was composed of 15 cases with positive HCV chronic liver diseases, group 2 was composed of 15 cases with positive HBV chronic liver diseases and group 3 was composed of 10 cases of normal control subjects. Bone densitometry and dual- energy X-ray absorptiometry [DEXA] scan proved to be the most valuable technique for the assessment of osteoporosis in patients with chronic liver diseases

El espectro creciente de las hepatitis virales / The growing spectrum of viral hepatitis

El conocimiento de las hepatitis se remonta por lo menos al siglo VIII, pero éste ha avanzado vertiginosamente en los últimos 30 años gracias a factores como la aplicación de técnicas de inmunoquímica, microscopía electrónica, estudios epidemiológicos tanto clínicos como experimentales, técnicas de ingeniería genética, etc. Este trabajo revisa aspectos históricos de estas afecciones, las lateraciones histológicas hepáticas y manifestaciones clínicas que desencadenan. También describe las características principales de los virus A, B, C y E, la respuesta inmune que produce cada uno de ellos, su forma de infectar y la evolución, complicaciones y posibilidades de prevención de la enfermedad que desencadenan. Se comentan los resultados de los tratamientos con antivirales e interferón para las infecciones crónicas por virus B y C

Conceptos actuales en hepatitis por virus B (VHB) y virus C (VHC) / Contemporary concepts on hepatitis due to virus B (VHB) and virus C (VHC)

Los conocimientos que en materia de hepatitis viral se han obtenido en los últimos veinte años son impresionantes, lo cual nos ha permitido conocer con más precisión la historia natural de la enfermedad, la etiopatogenia, el cuadro clínico, el tratamiento y hasta la prevención. Los estudios de tamizaje a las sangres de donadores ha permitido disminuir notablemente la transmisión de la hepatitis viral tipo B que se adquiría por la vía transfusional. Sin embargo, la carencia de marcadores serológicos para prevenir la transmisión por la sangre de la hepatitis no-A, no-B, que recientemente conocemos como hepatitis C, explica el porqué la mayor parte de las hepatitis postransfusión en la actualidad son debidas al virus C. En esta revisión se pretende destacar los aspectos más relevantes de la biología de los virus B y C, así como las implicaciones que en la clínica pueden tener, destacando lo complejo pero fascinante que resulta el estudio de microorganismos que son capaces de desequilibrar al organismo humano, llevándolo incluso hasta la muerte