ABSTRACT
OBJECTIVE To estimate the prevalence of hepatitis C virus infection in Brazil's inmate population. METHODS Systematic review on hepatitis C virus infection in the inmate population. Brazilian studies published from January 1, 1989 to February 20, 2014 were evaluated. The methodological quality of the studies was assessed using a scale of 0 to 8 points. RESULTS Eleven eligible studies were analyzed and provided data on hepatitis C virus infection among 4,375 inmates from seven states of Brazil, with a mean quality classification of 7.4. The overall hepatitis C virus prevalence among Brazilian inmates was 13.6% (ranging from 1.0% to 41.0%, depending on the study). The chances of inmates being seropositive for hepatitis C virus in the states of Minas Gerais (MG), Sergipe (SE), Mato Grosso do Sul (MS), Rio Grande do Sul (RS), Goiás (GO) and Espirito Santo (ES) were 84.0% (95%CI 0.06;0.45), 92.0% (95%CI 0.04;0.13), 88.0% (95%CI 0.09;0.18), 74.0% (95%CI 0.16;0.42), 84.0% (95%CI 0.08;0.31) and 89.0% (95%CI 0.01;0.05) respectively, lower than that observed in the Sao Paulo state (seroprevalence of 29.3%). The four studies conducted in the city of Sao Paulo revealed a lower prevalence in more recent studies compared to older ones. CONCLUSIONS The highest prevalence of hepatitis C virus infection in Brazil's inmate population was found in Sao Paulo, which may reflect the urban diversity of the country. Despite Brazilian studies having good methodological quality to evaluate the prevalence of the hepatitis C virus, they are scarce and lack data on risk factors associated with this infection, which could support decisions on prevention and implementation of public health policies for Brazilian prisons.
Subject(s)
Hepatitis C/epidemiology , Prisoners/statistics & numerical data , Brazil/epidemiology , Hepacivirus/immunology , Hepatitis C Antibodies/blood , Humans , Prevalence , Risk FactorsABSTRACT
OBJECTIVE To estimate the prevalence of hepatitis C virus infection in Brazil's inmate population.METHODS Systematic review on hepatitis C virus infection in the inmate population. Brazilian studies published from January 1, 1989 to February 20, 2014 were evaluated. The methodological quality of the studies was assessed using a scale of 0 to 8 points.RESULTS Eleven eligible studies were analyzed and provided data on hepatitis C virus infection among 4,375 inmates from seven states of Brazil, with a mean quality classification of 7.4. The overall hepatitis C virus prevalence among Brazilian inmates was 13.6% (ranging from 1.0% to 41.0%, depending on the study). The chances of inmates being seropositive for hepatitis C virus in the states of Minas Gerais (MG), Sergipe (SE), Mato Grosso do Sul (MS), Rio Grande do Sul (RS), Goiás (GO) and Espirito Santo (ES) were 84.0% (95%CI 0.06;0.45), 92.0% (95%CI 0.04;0.13), 88.0% (95%CI 0.09;0.18), 74.0% (95%CI 0.16;0.42), 84.0% (95%CI 0.08;0.31) and 89.0% (95%CI 0.01;0.05) respectively, lower than that observed in the Sao Paulo state (seroprevalence of 29.3%). The four studies conducted in the city of Sao Paulo revealed a lower prevalence in more recent studies compared to older ones.CONCLUSIONS The highest prevalence of hepatitis C virus infection in Brazil's inmate population was found in Sao Paulo, which may reflect the urban diversity of the country. Despite Brazilian studies having good methodological quality to evaluate the prevalence of the hepatitis C virus, they are scarce and lack data on risk factors associated with this infection, which could support decisions on prevention and implementation of public health policies for Brazilian prisons.
RESUMOOBJETIVO Estimar prevalência de infecção pelo vírus da hepatite C entre a população carcerária no Brasil.MÉTODOS Revisão sistemática sobre infecção pelo vírus da hepatite C em populações carcerárias. Foram avaliados estudos brasileiros publicados a partir de 1 de janeiro de 1989 até 20 de fevereiro de 2014. A qualidade metodológica dos estudos foi avaliada utilizando-se escala de zero a oito pontos.RESULTADOS Onze estudos elegíveis foram analisados, os quais forneceram dados sobre a infecção pelo vírus da hepatite C de 4.375 detentos de sete estados do Brasil, com classificação em média de qualidade de 7,4. A prevalência de infecção pelo vírus da hepatite C na população carcerária brasileira foi 13,6%, (variando de 1,0% a 41,0%, dependendo do estudo). As chances de os indivíduos serem soropositivos para o vírus da hepatite C nos estados de Minas Gerais, Sergipe, Mato Grosso do Sul, Rio Grande do Sul, Goiás e Espírito Santo foram 84,0% (IC95% 0,06;0,45), 92,0% (IC95% 0,04;0,13), 88,0% (IC95% 0,09;0,18), 74% (IC95% 0,16;0,42), 84,0% (IC95% 0,08;0,31) e 89,0% (IC95% 0,01;0,05), respectivamente, inferiores àquela observada no estado de São Paulo (soroprevalência de 29,3%). Os quatro estudos realizados na cidade de São Paulo mostraram menor prevalência em estudos mais recentes em comparação aos mais antigos.CONCLUSÕES A maior prevalência de infecção pelo vírus da hepatite C em população carcerária do Brasil foi encontrada em São Paulo, o que pode refletir a diversidade urbana do País. Apesar de os estudos brasileiros apresentarem boa qualidade metodológica para avaliação da prevalência do vírus da hepatite C, são escassos e faltam dados sobre fatores de risco associados a esta infecção, dados esses que poderiam auxiliar nas decisões de prevenção e implementação de políticas em saúde pública para as prisões brasileiras.
Subject(s)
Humans , Prisoners/statistics & numerical data , Hepatitis C/epidemiology , Brazil/epidemiology , Prevalence , Risk Factors , Hepacivirus/immunology , Hepatitis C Antibodies/bloodABSTRACT
Restoration of the immune system after highly active antiretroviral therapy (HAART) resulting from a quantitative and qualitative process of cell immune activity recovery may evolve with adverse clinical phenomena, known as the immune reconstitution inflammatory syndrome (IRIS). It can occur in association with several opportunist infections, although most reported cases have been related to mycobacterial infection caused by Mycobacterium tuberculosis and Mycobacterium avium. We describe three clinical cases of mycobacterial infection with different presentation patterns of IRIS after HAART. In each of these patients, immune reconstitution led to clinical manifestation of a latent infection, or clinical worsening of preexisting lesions, or manifestation of new lesions in the central nervous system. Clinical aspects of IRIS are presented in the paper and clinical management options for this event are carefully discussed.
Subject(s)
AIDS-Related Opportunistic Infections/complications , HIV Infections/immunology , Mycobacterium Infections/complications , Systemic Inflammatory Response Syndrome/complications , Adult , Antiretroviral Therapy, Highly Active , HIV Infections/drug therapy , Humans , Male , Middle Aged , Mycobacterium avium Complex/isolation & purification , Mycobacterium avium-intracellulare Infection/complications , Mycobacterium avium-intracellulare Infection/diagnosis , Mycobacterium avium-intracellulare Infection/microbiology , Mycobacterium tuberculosis/isolation & purification , Tuberculosis, Central Nervous System/complications , Tuberculosis, Central Nervous System/diagnosis , Tuberculosis, Central Nervous System/microbiology , Tuberculosis, Pulmonary/complications , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/microbiologyABSTRACT
A thirty three year-old, male patient was admitted at the Hospital of the São Paulo University School of Medicine, at the city of São Paulo, Brazil, with complaint of pains, tingling and decreased sensibility in the right hand for the last four months. This had progressed to the left hand, left foot and right foot, in addition to a difficulty of flexing and stretching in the left foot. Tests were positive for HBeAg, IgM anti-HBc and HBsAg, thus characterizing the condition of acute hepatitis B. The ALT serum level was 15 times above the upper normal limit. Blood glucose, cerebral spinal fluid, antinuclear antibodies (ANA) and anti-HIV and anti-HCV serum tests were either normal or negative. Electroneuromyography disclosed severe peripheral neuropathy with an axon prevalence and signs of denervation; nerve biopsy disclosed intense vasculitis. The diagnosis of multiple confluent mononeuropathy associated to acute hepatitis B was done. This association is not often reported in international literature and its probable cause is the direct action of the hepatitis B virus on the nerves or a vasculitis of the vasa nervorum brought about by deposits of immune complexes.
Subject(s)
Hepatitis B/complications , Mononeuropathies/complications , Acute Disease , Adult , Humans , Male , Mononeuropathies/pathologyABSTRACT
A thirty three year-old, male patient was admitted at the Hospital of the São Paulo University School of Medicine, at the city of São Paulo, Brazil, with complaint of pains, tingling and decreased sensibility in the right hand for the last four months. This had progressed to the left hand, left foot and right foot, in addition to a difficulty of flexing and stretching in the left foot. Tests were positive for HBeAg, IgM anti-HBc and HBsAg, thus characterizing the condition of acute hepatitis B. The ALT serum level was 15 times above the upper normal limit. Blood glucose, cerebral spinal fluid, antinuclear antibodies (ANA) and anti-HIV and anti-HCV serum tests were either normal or negative. Electroneuromyography disclosed severe peripheral neuropathy with an axon prevalence and signs of denervation; nerve biopsy disclosed intense vasculitis. The diagnosis of multiple confluent mononeuropathy associated to acute hepatitis B was done. This association is not often reported in international literature and its probable cause is the direct action of the hepatitis B virus on the nerves or a vasculitis of the vasa nervorum brought about by deposits of immune complexes
Subject(s)
Humans , Male , Adult , Acute Disease , Mononeuropathies/parasitology , Mononeuropathies/complications , Hepatitis B/complicationsABSTRACT
A thirty three year-old, male patient was admitted at the Hospital of the Säo Paulo University School of Medicine, at the city of Säo Paulo, Brazil, with complaint of pains, tingling and decreased sensibility in the right hand for the last four months. This had progressed to the left hand, left foot and right foot, in addition to a difficulty of flexing and stretching in the left foot. Tests were positive for HBeAg, IgM anti-HBc and HBsAg, thus characterizing the condition of acute hepatitis B. The ALT serum level was 15 times above the upper normal limit. Blood glucose, cerebral spinal fluid, antinuclear antibodies (ANA) and anti-HIV and anti-HCV serum tests were either normal or negative. Electroneuromyography disclosed severe peripheral neuropathy with an axon prevalence and signs of denervation; nerve biopsy disclosed intense vasculitis. The diagnosis of multiple confluent mononeuropathy associated to acute hepatitis B was done. This association is not often reported in international literature and its probable cause is the direct action of the hepatitis B virus on the nerves or a vasculitis of the vasa nervorum brought about by deposits of immune complexes
Subject(s)
Humans , Male , Adult , Mononeuropathies , Hepatitis B , Acute Disease , MononeuropathiesSubject(s)
Male , Female , Adult , Middle Aged , AIDS-Related Opportunistic Infections/complications , AIDS-Related Opportunistic Infections/drug therapy , AIDS-Related Opportunistic Infections/microbiology , Acquired Immunodeficiency Syndrome/complications , Drug Resistance, Microbial , Drug Resistance, Multiple , Mycobacterium tuberculosis , Tuberculosis/complications , Tuberculosis/drug therapy , BrazilSubject(s)
Male , Female , Adult , Middle Aged , Humans , AIDS-Related Opportunistic Infections/complications , AIDS-Related Opportunistic Infections/drug therapy , AIDS-Related Opportunistic Infections/microbiology , Acquired Immunodeficiency Syndrome/complications , Drug Resistance, Multiple , Mycobacterium tuberculosis , Rifampin/pharmacology , Tuberculosis/complications , Tuberculosis/drug therapy , Tuberculosis/microbiology , BrazilABSTRACT
A resistência do M. tuberculosis às drogas anti-tuberculose em pacientes com a Síndrome da Imunodeficiência Adquirida tornou-se objeto de atencão internacional nesta década. Com o objetivo de avaliar a freqüênciade resistência, o perfil de sensibilidade do M. tuberculosis às drogas e os fatores predisponentes à resistência foi realizado um levantamento retrospectivo dos prontuários de pacientes com Síndrome de Imunodeficiência Adquirida atendidos no Centro de Referência e Treinamento DST/AIDS da Secretaria de Estado da Saúde de São Paulo, com tuberculose diagnosticada no período de outubro/1990 a junho/1997. Os 431 casos selecionados para o estudo apresentaram cultura positiva com identificacão de M. tuberculosis e testes de avaliacão de sensibilidade à Isoniazida, Rifampicina, Pirazinamida, Estreptomicina e Etambutol. Na casuística houve predomínio do sexo masculino (85,4 por cento), da faixa etária de 25 a 45 anos (82,5 por cento), de homossexuais e usuários de drogas quanto às categorias de exposicão à infeccão pelo HIV
Subject(s)
Humans , AIDS-Related Opportunistic Infections , Acquired Immunodeficiency Syndrome/complications , Antitubercular Agents , Drug Resistance , Mycobacterium tuberculosis , Tuberculosis, Multidrug-Resistant/epidemiology , BrazilABSTRACT
A resistência do M. tuberculosis às drogas anti-tuberculose em pacientes com a Síndrome da Imunodeficiência Adquirida tornou-se objeto de atenção internacional nesta década. Com o objetivo de avaliar a freqüênciade resistência, o perfil de sensibilidade do M. tuberculosis às drogas e os fatores predisponentes à resistência foi realizado um levantamento retrospectivo dos prontuários de pacientes com Síndrome de Imunodeficiência Adquirida atendidos no Centro de Referência e Treinamento DST/AIDS da Secretaria de Estado da Saúde de Säo Paulo, com tuberculose diagnosticada no período de outubro/1990 a junho/1997. Os 431 casos selecionados para o estudo apresentaram cultura positiva com identificaçäo de M. tuberculosis e testes de avaliaçäo de sensibilidade à Isoniazida, Rifampicina, Pirazinamida, Estreptomicina e Etambutol. Na casuística houve predomínio do sexo masculino (85,4 por cento), da faixa etária de 25 a 45 anos (82,5 por cento), de homossexuais e usuários de drogas quanto às categorias de exposiçäo à infecçäo pelo HIV
Subject(s)
Humans , AIDS-Related Opportunistic Infections , Antitubercular Agents , Mycobacterium tuberculosis/drug effects , Drug Resistance , Acquired Immunodeficiency Syndrome/complications , Tuberculosis, Multidrug-Resistant/epidemiology , BrazilABSTRACT
A resistência do M. tuberculosis às drogas anti-tuberculose em pacientes com a Síndrome da Imunodeficiência Adquirida tornou-se objeto de atencão internacional nesta década. Com o objetivo de avaliar a freqüênciade resistência, o perfil de sensibilidade do M. tuberculosis às drogas e os fatores predisponentes à resistência foi realizado um levantamento retrospectivo dos prontuários de pacientes com Síndrome de Imunodeficiência Adquirida atendidos no Centro de Referência e Treinamento DST/AIDS da Secretaria de Estado da Saúde de São Paulo, com tuberculose diagnosticada no período de outubro/1990 a junho/1997. Os 431 casos selecionados para o estudo apresentaram cultura positiva com identificacão de M. tuberculosis e testes de avaliacão de sensibilidade à Isoniazida, Rifampicina, Pirazinamida, Estreptomicina e Etambutol. Na casuística houve predomínio do sexo masculino (85,4 por cento), da faixa etária de 25 a 45 anos (82,5 por cento), de homossexuais e usuários de drogas quanto às categorias de exposicão à infeccão pelo HIV
Subject(s)
Humans , AIDS-Related Opportunistic Infections , Drug Resistance , Antitubercular Agents , Mycobacterium tuberculosis , Tuberculosis, Multidrug-Resistant/epidemiology , Acquired Immunodeficiency Syndrome/complications , BrazilABSTRACT
No periodo de 1992 a dezembro de 1994, foram obtidas culturas positivas para M. tuberculosis e foram realizados testes de sensibilidade a drogas em 228 pacientes atendidos no Centro de Referencia DST/AIDS-SP. Atraves da revisao dos prontuarios de todos os casos verificamos resistencia a uma ou mais drogas em 47 (20.6 por cento), dos quais 25 (10.9 por cento), que relatavam tratamento pregresso, foram considerados como portadores de resistencia adquirida. Dos antecedentes investigados, somente os fatores tratamento previo e alcoolismo foram independentemente associados a ocorrencia de resistencia. A sobrevivencia dos pacientes portadores de cepas resistentes foi menor que a dos pacientes acometidos por M. tuberculosis nao resistentes. Concluimos que nesta casuistica a resistencia do M. tuberculosis aos tuberculostaticos foi predominantemente do tipo adquirida.
Subject(s)
Humans , Tuberculosis/therapy , Mycobacterium tuberculosis/isolation & purification , Drug Resistance, Microbial , Microbial Sensitivity Tests , HIV Infections , Acquired Immunodeficiency Syndrome/etiologyABSTRACT
O complexo Myocobacterium avium (CMA) e frequentemente isolado de pacientes com complicacoes tardias de Sindrome de Imunodeficiencia Adquirida (AIDS), especialmente na America do Norte e Europa. Entretanto, existem poucos relatos do isolamento deste complexo a partir do sistema nervoso central (SNC) nestes paises da Africa e America Latina. Neste trabalho relatamos o isolamento do CMA do liquor de 11 pacientes portadores de AIDS dentre 1723 (0,63 por cento) atendidos no Centro de Referencia e Treinamento-AIDS, de Sao Paulo, e discutimos a significancia deste achado.
