ABSTRACT
Abstract Chronic hepatitis B is an important health problem that can progress to cirrhosis and complications such as hepatocellular carcinoma. There is approximately 290 million of people with chronic hepatitis B virus (HBV) infection worldwide, however only 10% of patients are currently identified.Most part of Brazil is considered of low prevalence of HBV infection but there are some regions with higher frequency of carriers. Unfortunately, many infected patients are not yet identified nor evaluated for treatment.The Brazilian Society of Infectious Diseases (SBI) and the Brazilian Society of Hepatology worked together to elaborate a guideline for diagnosis and treatment of hepatitis B. The document includes information regarding the population to be tested, diagnostic tools, indications of treatment, therapeutic schemes and also how to handle HBV infection in specific situations (pregnancy, children, immunosuppression, etc).Delta infection is also part of the guideline, since it is an important infection in some parts of the country.
Subject(s)
Child , Female , Humans , Pregnancy , Hepatitis B, Chronic , Gastroenterology , Hepatitis B , Liver Neoplasms , Brazil , Hepatitis B virus , Hepatitis B, Chronic/diagnosis , Hepatitis B, Chronic/drug therapy , Hepatitis B/diagnosis , Hepatitis B/drug therapyABSTRACT
Chronic hepatitis B is an important health problem that can progress to cirrhosis and complications such as hepatocellular carcinoma. There is approximately 290 million of people with chronic hepatitis B virus (HBV) infection worldwide, however only 10% of patients are currently identified. Most part of Brazil is considered of low prevalence of HBV infection but there are some regions with higher frequency of carriers. Unfortunately, many infected patients are not yet identified nor evaluated for treatment. The Brazilian Society of Infectious Diseases (SBI) and the Brazilian Society of Hepatology worked together to elaborate a guideline for diagnosis and treatment of hepatitis B. The document includes information regarding the population to be tested, diagnostic tools, indications of treatment, therapeutic schemes and also how to handle HBV infection in specific situations (pregnancy, children, immunosuppression, etc). Delta infection is also part of the guideline, since it is an important infection in some parts of the country.
Subject(s)
Gastroenterology , Hepatitis B, Chronic , Hepatitis B , Liver Neoplasms , Brazil , Child , Female , Hepatitis B/diagnosis , Hepatitis B/drug therapy , Hepatitis B virus , Hepatitis B, Chronic/diagnosis , Hepatitis B, Chronic/drug therapy , Humans , PregnancyABSTRACT
BACKGROUND: Continuous long-term treatment is recommended to reduce the hepatitis B virus (HBV) viral load. However, as a consequence, resistance mutations can emerge and be transmitted to other individuals. The polymerase (POL) gene overlaps the surface (S) gene. Thus, during treatment, mutations in the POL gene may lead to changes in hepatitis B surface antigen (HBsAg). The purpose of this study was to evaluate the frequency of lamivudine and vaccine escape mutations in HBsAg-positive blood donors from the city of Santos and in untreated HBV mono-infected patients from the city of São Paulo, Brazil. METHODS: HBV DNA was extracted from 80 serum samples, of which 61 were from volunteer blood donors and 19 were from untreated HBV patients. A fragment of the POL/S genes containing 593 base pairs was amplified using nested PCR. Thirty four were PCR-positive and sequencing was performed using an ABI Prism 3130 Genetic Analyzer. Alignments and mutation mapping were performed using BioEdit software. RESULTS: HBV DNA from 21 blood donors and 13 untreated patient samples were characterized using nucleotide sequencing PCR products from the POL/S genes. We were able to detect one sample with the resistance mutation to lamivudine rtM204V + rtL180M (2.94%), which was found in a volunteer blood donor that has never used antiviral drugs. The other samples showed only compensatory mutations, such as rtL80F (5.88%), rtL80V (2.94%), rtL82V + rtV207L (2.94%), rtT128P (5.88%), rtT128N/S (2.94%) and rtS219A (5.88%). We found modifications in the S gene in 14 of the 34 samples (41.16%). The mutations detected were as follows: sM133L + sI195T (2.94%), sI195M (2.94%), sP120T (2.94%), sY100S/F (2.94%), sY100C (17.64%), sI/T126P + sQ129P (2.94%), sM198I + sF183C (2.94%) and sS210R (5.88%). CONCLUSIONS: Our results suggest the transmission of lamivudine-resistant forms. Thus, the evaluation of HBV-infected subjects for lamivudine resistance would improve treatment regime. Moreover, the mutations in the S gene may impair HBsAg antigenicity and contribute to HBsAg failure detection and vaccine escape.
Subject(s)
Antiviral Agents/pharmacology , Drug Resistance, Viral , Hepatitis B Surface Antigens/immunology , Hepatitis B virus/drug effects , Hepatitis B virus/genetics , Hepatitis B, Chronic/virology , Lamivudine/pharmacology , Adult , Brazil , DNA, Viral/chemistry , DNA, Viral/genetics , DNA, Viral/isolation & purification , Diagnostic Errors , False Negative Reactions , Female , Hepatitis B Surface Antigens/blood , Hepatitis B Vaccines/immunology , Hepatitis B, Chronic/diagnosis , Hepatitis B, Chronic/drug therapy , Humans , Immune Evasion , Male , Mutation, Missense , Polymerase Chain Reaction , Sequence Analysis, DNAABSTRACT
Recent studies suggest that GB virus C/hepatitis G virus (GBV-C/HGV) infection in HIV-positive individuals is associated with a slower progression to AIDS, leading to a lower HIV viral load and higher counts of CD4(+) T cells, although many studies have failed to demonstrate these beneficial effects. We developed a Real-Time PCR (TaqMan RT qPCR) to quantify the viral load of GBV-C/HGV in 102 HIV-1-infected patients, who were also evaluated for the presence of anti-E2. The prevalence of GBV-C/HGV infection was 21% among infected patients and the mean plasma viral load was 3.62 ± 0.64 log(10) copies/ml. Despite the high prevalence, there was no statistical difference when we compared the mean viral load (p≤0.46) and the average count of CD4(+) (p≤0.29) and CD8(+) (p≤0.64) among patients infected by GBV-C/HGV and HIV and patients infected only by HIV. This fact can be explained by the number of patients included in the study. Nevertheless, compared to other studies, we observed a discrete number of patients with undetectable HIV load and lower median viral load in the group presenting GBV-C/HGV RNA. Our study suggests that there may be an impact on HIV viral load in GBV-C/HGV-coinfected patients. However, further studies are needed to elucidate the molecular and cellular mechanisms involved in this viral interaction, previously reported in other studies, with the aim of contributing to the development of new targets for drugs against HIV.
Subject(s)
Acquired Immunodeficiency Syndrome/immunology , Flaviviridae Infections/immunology , GB virus C/immunology , HIV-1/immunology , Hepatitis, Viral, Human/immunology , Viral Load/immunology , Acquired Immunodeficiency Syndrome/epidemiology , Brazil/epidemiology , CD4 Lymphocyte Count , CD4-Positive T-Lymphocytes , CD8-Positive T-Lymphocytes , Coinfection , Female , Flaviviridae Infections/epidemiology , Hepatitis, Viral, Human/epidemiology , Humans , Male , Real-Time Polymerase Chain ReactionABSTRACT
OBJECTIVES: To translate the HIV/AIDS-Targeted Quality of Life Instrument (HAT-QoL) into Brazilian Portuguese, culturally adapt it, and evaluate its psychometric properties (validity and reliability) as a Brazilian version. METHODS: This cross-sectional study was carried out at the laboratory of infectious diseases at Escola Paulista de Medicina (Universidade Federal de São Paulo). Data were collected on clinical and sociodemographic characteristics of 106 HIV-infected individuals who answered the HAT-QoL and the SF-36. Pearson's correlation coefficient was used to measure construct validity. Reliability was assessed using Cronbach's alpha and intraclass correlation coefficients. RESULTS: The sample was 70.8% male. The mean age was 39.9 years, with 40.5% of the participants being homosexual or bisexual. Eleven (10.4%) patients had a CD4 cell count Subject(s)
Acquired Immunodeficiency Syndrome
, HIV Infections
, Quality of Life
, Surveys and Questionnaires
, Acquired Immunodeficiency Syndrome/diagnosis
, Adult
, Aged
, Cross-Sectional Studies
, Female
, HIV Infections/diagnosis
, Humans
, Language
, Male
, Middle Aged
, Young Adult
ABSTRACT
OBJETIVO: Traduzir para português brasileiro, adaptar culturalmente e avaliar as propriedades psicométricas (validade e confiabilidade) de um questionário de qualidade de vida (HIV/AIDS-Targeted Quality of Life Instrument, HAT-QoL) específico para pacientes infectados pelo HIV. MÉTODO: Estudo transversal realizado no ambulatório de infectologia da Escola Paulista de Medicina da Universidade Federal de São Paulo. Coletaram-se características sociodemográficas e clínicas de 106 indivíduos infectados pelo HIV, que responderam os questionários de qualidade de vida HAT-QoL e SF-36. O coeficiente de correlação de Pearson aferiu a validade de construto. Para avaliar a confiabilidade foram calculados o alfa de Cronbach e o coeficiente de correlação intraclasse. RESULTADOS: A proporção de homens na amostra foi de 70,8 por cento. A média de idade foi 39,9 anos. Dos participantes, 40,5 por cento eram homo ou bissexuais. Onze (10,4 por cento) pacientes tinham contagem de células CD4 < 200 células/mm3. Entre os nove domínios do HAT-QoL, sete (função geral, satisfação com a vida, preocupações com a saúde, preocupações com a medicação, aceitação do HIV, confiança no profissional e função sexual) apresentaram efeito teto substancial. O domínio "função sexual" foi o que apresentou efeito teto mais alto (63,2 por cento). O domínio preocupações financeiras apresentou efeito chão substancial (30,2 por cento). Associações estatisticamente significativas foram observadas entre os domínios do HAT-QoL e características sociodemográficas e clínicas e domínios do questionário SF-36. A consistência interna foi satisfatória (alfa de Cronbach = 0,73 a 0,90). A reprodutibilidade inter e intraobservador foi muito alta (0,87 a 0,98 e 0,82 a 0,97, respectivamente). CONCLUSÃO: O HAT-QoL em português brasileiro é um instrumento válido, confiável e que pode contribuir para avaliar o impacto da infecção pelo HIV sobre a qualidade de vida de pacientes brasileiros.
OBJECTIVES: To translate the HIV/AIDS-Targeted Quality of Life Instrument (HAT-QoL) into Brazilian Portuguese, culturally adapt it, and evaluate its psychometric properties (validity and reliability) as a Brazilian version. METHODS: This cross-sectional study was carried out at the laboratory of infectious diseases at Escola Paulista de Medicina (Universidade Federal de São Paulo). Data were collected on clinical and sociodemographic characteristics of 106 HIV-infected individuals who answered the HAT-QoL and the SF-36®. Pearson's correlation coefficient was used to measure construct validity. Reliability was assessed using Cronbach's alpha and intraclass correlation coefficients. RESULTS: The sample was 70.8 percent male. The mean age was 39.9 years, with 40.5 percent of the participants being homosexual or bisexual. Eleven (10.4 percent) patients had a CD4 cell count < 200 cells/mm3. A substantial ceiling effect was observed in 7 of 9 HAT-QoL domains (overall function, life satisfaction, health worries, medication worries, HIV acceptance, provider trust, and sexual function). Sexual function was the domain with the highest ceiling effect (63.2 percent). A substantial floor effect (30.2 percent) was observed for financial worries. Statistically significant associations were observed between the HAT-QoL domains and clinical and sociodemographic characteristics, as well as with SF-36 domains. Internal consistency was satisfactory (Cronbach's alpha = 0.730.90). Inter- and intra-observer reproducibility was very high (0.870.98 and 0.820.97, - respectively). CONCLUSION: The Brazilian Portuguese version of the HAT-QoL is valid, reliable, and may contribute to evaluating the impact of HIV infection on the quality of life of patients in Brazil.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Acquired Immunodeficiency Syndrome , HIV Infections , Quality of Life , Surveys and Questionnaires , Acquired Immunodeficiency Syndrome/diagnosis , Cross-Sectional Studies , HIV Infections/diagnosis , Language , Young AdultSubject(s)
Reproducibility of Results , Validation Study , Quality of Life , Brazil , HIV Infections , Surveys and Questionnaires , Cross-Sectional Studies , Acquired Immunodeficiency Syndrome , Reproducibility of Results , Validation Study , Quality of Life , Acquired Immunodeficiency Syndrome , Language , Young Adult , BrazilSubject(s)
Antiretroviral Therapy, Highly Active/adverse effects , HIV Infections/drug therapy , HIV Protease Inhibitors/adverse effects , Metabolic Diseases/chemically induced , HIV Infections/metabolism , HIV-Associated Lipodystrophy Syndrome/chemically induced , Humans , Insulin Resistance/physiology , Metabolic Syndrome/chemically induced , Obesity/chemically inducedSubject(s)
Humans , Antiretroviral Therapy, Highly Active/adverse effects , HIV Infections/drug therapy , HIV Protease Inhibitors/adverse effects , Metabolic Diseases/chemically induced , HIV Infections/metabolism , HIV-Associated Lipodystrophy Syndrome/chemically induced , Insulin Resistance/physiology , Metabolic Syndrome/chemically induced , Obesity/chemically inducedABSTRACT
O presente trabalho teve por objetivo a realizaçäo de electrococleografia em indivíduos normais. O exame foi realizado segundo a técnica inicialmente descrita por Aran, usando-se cliques como estímulo sonoro. Foram estudados 34 indivíduos, sendo comparadas 21 mulheres com 13 homens. Foram avaliados os parâmetros mais importantes em relaçäo ao potencial de açäo do nervo acústico, a saber: 1. O limiar. 2. A amplitude. 3. O tempo de latência. 4. A forma de onda
