Accuracy of the urine point-of-care circulating cathodic antigen assay for diagnosing Schistosomiasis mansoni infection in Brazil: A multicenter study.

BACKGROUND: The World Health Organization recommends a market-ready, urine-based point-of-care diagnostic test for circulating cathodic antigens (CCA) to determine the prevalence of S. mansoni. This study evaluated the performance of the URINE CCA (SCHISTO) ECO TESTE® (POC-ECO), which is currently available in Brazil. METHODS: Residents from eight sites with different prevalence estimates provided one urine sample for POC-ECO and one stool sample for Kato-Katz (KK) and Helmintex® (HTX) testing as an egg-detecting reference for infection status. RESULTS: None of the study sites had significantly higher POC-ECO accuracy than KK. CONCLUSIONS: POC-ECO is not currently recommended in Brazilian schistosomiasis elimination programs.

Accuracy of the urine point-of-care circulating cathodic antigen assay for diagnosing Schistosomiasis mansoni infection in Brazil: A multicenter study

ABSTRACT Background: The World Health Organization recommends a market-ready, urine-based point-of-care diagnostic test for circulating cathodic antigens (CCA) to determine the prevalence of S. mansoni. This study evaluated the performance of the URINE CCA (SCHISTO) ECO TESTE® (POC-ECO), which is currently available in Brazil. Methods: Residents from eight sites with different prevalence estimates provided one urine sample for POC-ECO and one stool sample for Kato-Katz (KK) and Helmintex® (HTX) testing as an egg-detecting reference for infection status. Results: None of the study sites had significantly higher POC-ECO accuracy than KK. Conclusions: POC-ECO is not currently recommended in Brazilian schistosomiasis elimination programs.

APOL1 genotyping via buccal mucosa cell samples to establish risk of kidney disease.

Two alleles (G1 and G2) of the apolipoprotein 1 gene (APOL1) predispose people of African descent to developing or accelerating the course of certain types of kidney disease. Population studies to determine the frequency of the G1 and G2 alleles are important to inform resource allocation by public health authorities. Traditionally, APOL1 genotyping is carried out in blood samples. However, sample collection, transport, and storage is cumbersome. Here we compared APOL1 genotyping in blood and buccal mucosa cell samples obtained from 23 individuals. Alleles G0 (wild), G1, and G2, as well as genotypes G0/G0, G0/G1, G1/G1, G0/G2, G1/G2, and G2/G2 were detected using both blood and buccal mucosa cells with 100% coincidence. Our data indicate that buccal mucosa cell samples may represent a suitable alternative to blood samples for APOL1 genotyping in the field.

Seroprevalence and Spatial Distribution of Hepatitis C Virus in Bahia, Brazil.

In Salvador, which is the capital of the Brazilian state of Bahia, it has been estimated that 1.5% of the general population is infected with hepatitis C virus (HCV); however, the circulation of HCV throughout the state remains unknown. The present retrospective study aimed to determine anti-HCV seroprevalence and describe the geographic distribution of hepatitis C in Bahia. Data from HCV serological tests submitted to the Bahia Central Laboratory of Public Health between 2004 and 2013 were analyzed. Serology for HCV was performed using the AxSYM anti-HCV enzymatic microparticle immunoassay and chemiluminescence immunoassay. A subgroup of samples with detectable HCV-RNA was genotyped using the linear array hepatitis C virus genotyping assay. A total of 247,837 samples were analyzed. The median age of the studied population was 31 years (interquartile range, 25-44 years), and the female:male ratio was 3.9:1. The global seroprevalence of HCV in Bahia was estimated to be 1.3% (3,230/247,837), corresponding to an infection rate of 21.2/100,000 inhabitants. The seroprevalence of HCV was higher among males and increased with age. The presence of anti-HCV antibodies was detected throughout all mesoregions of Bahia, and the municipality with the highest infection rate was Ipiaú (112.04 cases/100,000 inhabitants). Genotypes 1 and 3 were found to be the most prevalent, followed by genotypes 2, 4, and 5. Our results provide evidence of the widespread distribution of previous HCV infection throughout the state of Bahia.

Antimicrobial-resistant enterobacteria in surface waters with fecal contamination from urban and rural communities.

INTRODUCTION: Inadequate wastewater treatment and fecal contamination have a strong environmental impact on antimicrobial resistance (AMR). This study evaluated the profile of AMR enterobacteria and fecal contamination from four surface waters: Jiquiriça-Brejões River and Cabrito, Tororó, and Abaeté Lagoons. METHODS: We analyzed AMR ß-lactamase genes using the polymerase chain reaction method and fecal contamination using Coliscan®. RESULTS: We found high levels of fecal contamination, ß-lactamase producers, and AMR genes (blaOXA-48, blaSPM, and blaVIM) in all waterbodies. CONCLUSIONS: Poor sanitation evidenced by fecal contamination and human activities around these surface waters contributed to the distribution and increase in AMR enterobacteria.

Blocking IL-10 signaling with soluble IL-10 receptor restores in vitro specific lymphoproliferative response in dogs with leishmaniasis caused by Leishmania infantum.

rIL-10 plays a major role in restricting exaggerated inflammatory and immune responses, thus preventing tissue damage. However, the restriction of inflammatory and immune responses by IL-10 can also favor the development and/or persistence of chronic infections or neoplasms. Dogs that succumb to canine leishmaniasis (CanL) caused by L. infantum develop exhaustion of T lymphocytes and are unable to mount appropriate cellular immune responses to control the infection. These animals fail to mount specific lymphoproliferative responses and produce interferon gamma and TNF-alpha that would activate macrophages and promote destruction of intracellular parasites. Blocking IL-10 signaling may contribute to the treatment of CanL. In order to obtain a tool for this blockage, the present work endeavored to identify the canine casIL-10R1 amino acid sequence, generate a recombinant baculovirus chromosome encoding this molecule, which was expressed in insect cells and subsequently purified to obtain rcasIL-10R1. In addition, rcasIL-10R1 was able to bind to homologous IL-10 and block IL-10 signaling pathway, as well as to promote lymphoproliferation in dogs with leishmaniasis caused by L. infantum.

Antimicrobial-resistant enterobacteria in surface waters with fecal contamination from urban and rural communities

Abstract INTRODUCTION: Inadequate wastewater treatment and fecal contamination have a strong environmental impact on antimicrobial resistance (AMR). This study evaluated the profile of AMR enterobacteria and fecal contamination from four surface waters: Jiquiriça-Brejões River and Cabrito, Tororó, and Abaeté Lagoons. METHODS: We analyzed AMR β-lactamase genes using the polymerase chain reaction method and fecal contamination using Coliscan®. RESULTS: We found high levels of fecal contamination, β-lactamase producers, and AMR genes (blaOXA-48, blaSPM, and blaVIM) in all waterbodies. CONCLUSIONS: Poor sanitation evidenced by fecal contamination and human activities around these surface waters contributed to the distribution and increase in AMR enterobacteria.

Prevalence of Infection of Biomphalaria glabrata by Schistosoma mansoni and the risk of urban Schistosomiasis mansoni in Salvador, Bahia, Brazil.

INTRODUCTION: Biomphalaria glabrata is considered to be responsible for the incidence of schistosomiasis in Brazil. Therefore, surveillance of areas where schistosomiasis is prevalent is fundamental for public health planning. This study was aimed to evaluate B. glabrata populations in water bodies of the city of Salvador, determine their distribution, estimate the prevalence of Schistosoma mansoni infections, characterize shed cercariae, and identify transmission foci. METHODS: Malacological surveys were carried out in 17 water collections from Salvador. Snail species were identified based on shell and mantle characteristics. Snails were evaluated for S. mansoni infection by exposure to light and via real time polymerase chain reaction (qPCR) using S. mansoni-18S rRNA subunit specific primers. RESULTS: 1,403 B. glabrata were collected. Classical cercarial shedding indicated that 5 snails (0.4%) were positive for S. mansoni. A higher prevalence of infections was found in Horta de Saramandaia (5.5%) and Lagoa do IAT (1.9%). Non-Schistosoma larvae, such as Xiphidiocercaria, Strigeidae, Spirorchiidae and Clinostomidae, were observed in 3.2% of the snails. S. mansoni DNA was detected in 6.2% snails via qPCR. CONCLUSIONS: B. glabrata is widely distributed in Salvador, as indicated by 7 water collections associated with a risk of schistosomiasis transmission. To our knowledge, this is the first study to identify B. glabrata eliminating cercariae of Clinostomidae, Strigeidae, and Spirorchiidae in Salvador. We propose that qPCR may be employed in combination with classical cercarial shedding. Estimating S. mansoni prevalence in snails by only considering the results of light exposure method classical into account may underestimate the problem.

Seroprevalence of Trypanosoma cruzi infection among blood donors in the state of Bahia, Brazil.

INTRODUCTION: Chagas disease (CD) affects 5.7-7.0 million individuals worldwide, and its prevalence reached 25.1% in the state of Bahia, Brazil. There is an association between the prevalence of CD, the socioeconomic status of the population, and the risk of re-emergence due to non-vectorial transmission, such as blood transfusion. This study determined the seroprevalence of T. cruzi infection among blood donors in the state of Bahia, located in northeastern Brazil, and their epidemiological profile during a 10-year period. METHODS: We performed a descriptive cross-sectional study involving a database review. Data were collected from patients with non-negative results for T. cruzi infection during a 10-year period. RESULTS: A total of 3,084 (0.62%) samples were non-negative for T. cruzi infection in an initial serological screening, and 810 (0.16%) samples were non-negative in the second screening. The correlation between infection and age (30 years or older) and between infection and lower educational level (12 years or less) in the first and second screening was statistically significant. The seroprevalence of T. cruzi infection was higher in men in the first screening. In addition, 99.52% of the municipalities of Bahia had at least one case of CD. Livramento de Nossa Senhora and Salvador presented the highest disease prevalence and recurrence, respectively. CONCLUSIONS: The seroprevalence of T. cruzi infection in these populations was lower than that found in other studies in Brazil but was comparatively higher in densely-populated areas. The demographic characteristics of our population agreed with previous studies.

Prevalence of infection of biomphalaria glabrata by schistosoma mansoni and the risk of urban schistosomiasis mansoni in Salvador, Bahia, Brazil

Abstract INTRODUCTION: Biomphalaria glabrata is considered to be responsible for the incidence of schistosomiasis in Brazil. Therefore, surveillance of areas where schistosomiasis is prevalent is fundamental for public health planning. This study was aimed to evaluate B. glabrata populations in water bodies of the city of Salvador, determine their distribution, estimate the prevalence of Schistosoma mansoni infections, characterize shed cercariae, and identify transmission foci. METHODS: Malacological surveys were carried out in 17 water collections from Salvador. Snail species were identified based on shell and mantle characteristics. Snails were evaluated for S. mansoni infection by exposure to light and via real time polymerase chain reaction (qPCR) using S. mansoni-18S rRNA subunit specific primers. RESULTS: 1,403 B. glabrata were collected. Classical cercarial shedding indicated that 5 snails (0.4%) were positive for S. mansoni. A higher prevalence of infections was found in Horta de Saramandaia (5.5%) and Lagoa do IAT (1.9%). Non-Schistosoma larvae, such as Xiphidiocercaria, Strigeidae, Spirorchiidae and Clinostomidae, were observed in 3.2% of the snails. S. mansoni DNA was detected in 6.2% snails via qPCR. CONCLUSIONS: B. glabrata is widely distributed in Salvador, as indicated by 7 water collections associated with a risk of schistosomiasis transmission. To our knowledge, this is the first study to identify B. glabrata eliminating cercariae of Clinostomidae, Strigeidae, and Spirorchiidae in Salvador. We propose that qPCR may be employed in combination with classical cercarial shedding. Estimating S. mansoni prevalence in snails by only considering the results of light exposure method classical into account may underestimate the problem.

Seroprevalence of trypanosoma cruzi infection among blood donors in the state of Bahia, Brazil

Abstract INTRODUCTION: Chagas disease (CD) affects 5.7-7.0 million individuals worldwide, and its prevalence reached 25.1% in the state of Bahia, Brazil. There is an association between the prevalence of CD, the socioeconomic status of the population, and the risk of re-emergence due to non-vectorial transmission, such as blood transfusion. This study determined the seroprevalence of T. cruzi infection among blood donors in the state of Bahia, located in northeastern Brazil, and their epidemiological profile during a 10-year period. METHODS: We performed a descriptive cross-sectional study involving a database review. Data were collected from patients with non-negative results for T. cruzi infection during a 10-year period. RESULTS: A total of 3,084 (0.62%) samples were non-negative for T. cruzi infection in an initial serological screening, and 810 (0.16%) samples were non-negative in the second screening. The correlation between infection and age (30 years or older) and between infection and lower educational level (12 years or less) in the first and second screening was statistically significant. The seroprevalence of T. cruzi infection was higher in men in the first screening. In addition, 99.52% of the municipalities of Bahia had at least one case of CD. Livramento de Nossa Senhora and Salvador presented the highest disease prevalence and recurrence, respectively. CONCLUSIONS: The seroprevalence of T. cruzi infection in these populations was lower than that found in other studies in Brazil but was comparatively higher in densely-populated areas. The demographic characteristics of our population agreed with previous studies.

[Knowledge and practices in Aedes aegypti control among different social subjects in Salvador, Bahia State, Brazil]. / Saberes e práticas sobre controle do Aedes aegypti por diferentes sujeitos sociais na cidade de Salvador, Bahia, Brasil.

Due to the persistence of dengue and other arbovirus infections in Brazil, the government has stepped up measures to combat the Aedes aegypti mosquito vector. The responsibilities of community endemic disease workers (CEDW) and community health workers (CHW) include acting as intermediaries and disseminating knowledge in the community. The aim of this study was to analyze knowledge and practices in dengue control by different social subjects: residents and CEDW/CHW. Interviews were held with residents, field and mobilization CEDW, and CHW in two neighborhoods in Salvador, Bahia State, using focus groups. Residents expressed uncertainty on the form of transmission and hazards of dengue. Field CEDW voiced conflicting feelings due to the need to inform the community on issues over which they lack any control, while expressing personal dissatisfaction with their work and a feeling of underappreciation due to their lack of training. Mobilization CEDW blamed the population and emphasized their own importance as the solution to dengue control. CHW failed to reflect their field experience in their discourse and felt they had no responsibility over vector control. All the groups agreed that government is to blame for dengue and that the solution lies in education. There is an evident need for regular educational interventions, based on dialogue and awareness-raising to deal with residents' daily reality, drawing individuals (residents and CHW) into the knowledge-building process. Under the prevailing methodology, the dissemination of information and knowledge is insufficient to promote community improvements for dengue control.

Saberes e práticas sobre controle do Aedes aegypti por diferentes sujeitos sociais na cidade de Salvador, Bahia, Brasil / Knowledge and practices in Aedes aegypti control among different social subjects in Salvador, Bahia State, Brazil / Conocimientos y prácticas sobre el control del Aedes aegypti realizado por diferentes sujetos sociales en la ciudad de Salvador, Bahía, Brasil

Resumo: Devido à persistência da dengue e de outras arboviroses no Brasil, o poder público tem intensificado as ações de combate ao mosquito vetor Aedes aegypti. Os agentes de combate às endemias (ACE) e agentes comunitários de saúde (ACS), dentre outras atribuições, tornaram-se interlocutores e disseminadores de conhecimento na comunidade. O objetivo deste trabalho foi analisar os saberes e práticas sobre controle da dengue por diferentes sujeitos sociais: moradores e agentes. Foram realizadas entrevistas com moradores, ACE de campo e de mobilização e ACS em dois bairros de Salvador, Bahia, por meio da metodologia de grupo focal. Os moradores demonstraram incerteza sobre a forma de contágio e o perigo da dengue. Os ACE de campo apresentam-se em conflito, pela necessidade de informar à comunidade sobre aspectos que não dominam e demonstram um descontentamento pessoal no trabalho com um sentimento de desvalorização pela falta de qualificação. Os ACE de mobilização culpam a população e enfatizam a importância de si próprios como solução para o controle da dengue. Os ACS não apropriaram sua experiência de campo em seu discurso e se sentem desobrigados com respeito ao controle vetorial. Todos os grupos entrevistados concordam que a culpa da dengue recai sobre o poder público, e a solução para o problema está na educação. Percebe-se uma grande necessidade de intervenções educativas regulares, pautadas no diálogo e na sensibilização para lidar com a realidade cotidiana dos moradores, trazendo os indivíduos (moradores e agentes) como sujeitos do processo de construção de conhecimento. Pois, na metodologia atual, a disseminação de informação e conhecimento não é suficiente para promover melhorias na comunidade para o controle da dengue.

Abstract: Due to the persistence of dengue and other arbovirus infections in Brazil, the government has stepped up measures to combat the Aedes aegypti mosquito vector. The responsibilities of community endemic disease workers (CEDW) and community health workers (CHW) include acting as intermediaries and disseminating knowledge in the community. The aim of this study was to analyze knowledge and practices in dengue control by different social subjects: residents and CEDW/CHW. Interviews were held with residents, field and mobilization CEDW, and CHW in two neighborhoods in Salvador, Bahia State, using focus groups. Residents expressed uncertainty on the form of transmission and hazards of dengue. Field CEDW voiced conflicting feelings due to the need to inform the community on issues over which they lack any control, while expressing personal dissatisfaction with their work and a feeling of underappreciation due to their lack of training. Mobilization CEDW blamed the population and emphasized their own importance as the solution to dengue control. CHW failed to reflect their field experience in their discourse and felt they had no responsibility over vector control. All the groups agreed that government is to blame for dengue and that the solution lies in education. There is an evident need for regular educational interventions, based on dialogue and awareness-raising to deal with residents' daily reality, drawing individuals (residents and CHW) into the knowledge-building process. Under the prevailing methodology, the dissemination of information and knowledge is insufficient to promote community improvements for dengue control.

Resumen: Debido a la persistencia del dengue y de otras arbovirosis en Brasil, el poder público ha intensificado las acciones de combate al mosquito vector Aedes aegypti. Los ACE (agentes de combate a endemias) y los ACS (agentes comunitarios de salud), entre otras atribuciones, se convirtieron en interlocutores y promotores de conocimiento sobre enfermedades en sus comunidades. El objetivo de este trabajo fue analizar los conocimientos y prácticas sobre el control del dengue por parte de los diferentes sujetos sociales implicados: residentes y agentes. Se realizaron entrevistas a residentes, ACE de campo y de movilización, así como ACS, en dos barrios de Salvador, Bahía, mediante una metodología de grupo focal. Los residentes mostraron inseguridad sobre la forma de contagio, así como el peligro que supone el dengue. Los ACE de campo se encontraron en conflicto, por su necesidad de informar a la comunidad sobre aspectos que no dominan, además de demostrar un descontento personal en el trabajo, unido a un sentimiento de desvalorización, por su falta de cualificación. Los ACE de movilización culpan a la población y enfatizan la importancia de ellos mismos como solución para el control del dengue. Los ACS no se apropiaron de su experiencia de campo en su discurso y no se sienten obligados al control vectorial. Todos los grupos entrevistados concuerdan en que la culpa del dengue recae sobre el poder público, y la solución para el problema está en la educación. Se percibe una gran necesidad de intervenciones educativas regulares, pautadas en el diálogo y en la sensibilización para lidiar con la realidad cotidiana de los residentes, considerando a los individuos (residentes y agentes) como sujetos del proceso de construcción del conocimiento. Así pues, en la metodología actual, la divulgación de información y conocimiento no es suficiente para promover mejoras en las comunidades, con el fin de controlar el dengue.

Genotyping of HBV and tracking of resistance mutations in treatment-naïve patients with chronic hepatitis B.

BACKGROUND AND AIMS: Resistance mutation analogs to nucleos(t)ides have been described in treatment-naïve patients with chronic hepatitis B (CHB), with clinical implications. The aim of this study was to investigate primary resistance mutations and genotypes circulating in patients naïve to chronic hepatitis B, in the Northern and Northeastern regions of Brazil. METHODS: We conducted a study of resistance mutations and genotypic characterization of hepatitis B virus (HBV) in 189 treatment-naïve patients chronically infected with HBV. RESULTS: Drug resistance-associated mutations located in the RT domain of the P gene (rtHBV) were found in 6% of the treatment-naïve patients from the Northeastern Region. The mutations were rtA194T, rtL180M + rtM204V, rtS202I, rtM204I, and rtA181S. No patient in the Northern Region had the resistance mutation. In the gene S region, the frequency of vaccine escape mutations was 2.4% in the Northeastern Region and 8.6% in the Northern Region. CONCLUSION: This information before the start of treatment may contribute to clinical decision making, reducing treatment failure and the risk of progression to cirrhosis and hepatocellular carcinoma for CHB.

Avaliação do protocolo clínico e diretrizes terapêuticas para o tratamento para hepatite B crônica nas regiões nordeste e norte do Brasil / Analysis of clinical protocol and guidelines therapeutic for treatment for chronic hepatitis B in northeast Brazil and regions north

No Brasil o tratamento para Hepatite B cônica, tem sido disponibilizado pelo Sistema Único de Saúde há mais de 10 anos. O objetivo foi analisar o tratamento dos pacientes com hepatite B crônica, em dois Centros de Referência em Hepatites Virais na Região Nordeste e Norte do Brasil, comparando com o Protocolo Clínico e Diretrizes Terapêuticas da Hepatite B do Ministério da Saúde. Foram incluídos no estudo 527 pacientes em atendimento ambulatorial. No algoritmo 4.1 foi observado que existe uma dificuldade em seguir a recomendação do Ministério da Saúde, nos dois serviços de referência, 78,9% e 72% Região Nordeste e Norte respectivamente. O algoritmo 4.2, foi o algoritmo que apresentou no geral mais de 90% de seguimento na recomendação do Protocolo Clínico, devido que os pacientes são na sua grande maioria AgHBe negativo. O algoritmo 4.3 aproximadamente 85% dos pacientes da Região Nordeste estava dentro da recomendação do Protocolo Clínico para Hepatite B crônica, entretanto, nenhum paciente da Região Norte. O Protocolo Clínico de Diretrizes Terapêuticas para Hepatite B foi um grande passo e avanço. Uma ferramenta importantíssima dentro da realidade do tratamento para Hepatite B e foi possível incorporar novas drogas e indicadores de tratamento embasados na Medicina Baseada em Evidencias e nos Consensos Internacionais pelo Ministério da Saúde.

In Brazil the treatment for Hepatitis B conical, has been provided by the National Health System for over 10 years. The aim was to analyze the treatment of patients with chronic hepatitis B in two reference centers in Viral Hepatitis in the Northeast and North of Brazil, compared to the Clinical Protocol and Therapeutic Guidelines Hepatitis B of the Ministry of Health. The study included 527 patients in outpatient care. In algorithm 4.1 it was observed that there is a difficulty in following the recommendation of the Ministry of Health in two reference centers, 78.9% and 72% northeast and north respectively. The 4.2 algorithm, the algorithm was presented in general more than 90% follow-up on the recommendation of the Clinical Protocol because patients are mostly negative HBeAg. The algorithm 4.3 approximately 85% of patients in the Northeast was in the recommendation of the Clinical Protocol for chronic hepatitis B, however, no patients in the Northern Region. The Clinical Protocol Therapeutic Guidelines for Hepatitis B was a big step and advance. An important tool within the reality of treatment for hepatitis B and it was possible to incorporate new drugs and treatment indicators grounded in Evidence-Based Medicine and the International Consensus by the Ministry of Health.

HDV genotypes in the Western Brazilian Amazon region: A preliminary report.

In Brazil, hepatitis delta virus (HDV) is only reported in Western Amazonia, where severe cases of acute and chronic HDV hepatitis have been described. The study area was chosen in the States of Acre and Rondonia where most cases of hepatitis B virus (HBV)/HDV are reported. From December 2003 to October 2004, 40 HBsAg carriers with anti-HDV IgM were selected. An epidemiologic questionnaire, including demographic and clinical/epidemiologic variables was filled out. HDV amplification and genotyping were performed. Genotype I was detected in 22 patients (55.0%), whereas genotype III was identified in 18 (45.0%). Patients who were infected with genotype I were older (45.1 +/- 17.8 years) than patients infected with genotype III (32.8 +/- 10.9 years; P = 0.01). No symptoms were reported by 21 (52.5%) patients. Otherwise, 19 (47.5%) had symptoms (fatigue, abdominal pain, weight loss, and decompensated liver disease) that motivated them to seek medical care. Genotype III carriers were more symptomatic, but no statistical significance was achieved. Our preliminary results show that HDV genotypes I and III are present in Brazilian Amazonia and that HDV genotype III is not limited to the Amerindian population.

Prevalence of hepatitis C virus infection and HCV genotypes among hemophiliacs in the State of Bahia, Northeastern Brazil: analysis of serological and virological parameters

O objetivo deste estudo foi analisar parâmetros sorológicos e virológicos em hemofílicos no Estado da Bahia. O anti-VHC foi investigado por ELISA em uma coorte de 268 hemofílicos A/B sob acompanhamento em uma unidade de referência do Estado da Bahia. A viremia do VHC e genótipos foram determinados em um subgrupo de 66 hemofílicos soropositivos para o anti-VHC. A soroprevalência do anti-VHC entre os hemofílicos foi de 42,2% (IC 95% 36,5-48,1) e foi associada significativamente (p<0,05) a idade >10 anos, presenca de anticorpos antifator VIII/IX e outros marcadores sorológicos de infeccão. Nenhum dos hemofílicos com idade inferior a 5 anos foram anti-VHC positivos. A viremia foi detectada em 77,3% (51/66), sendo o genótipo 1 do VHC (74%) o mais prevalente, seguido pelos genótipos 3 (22%) e 2 (4%). Nossos resultados indicam que a prevalência do VHC é ainda alta entre os hemofílicos, muito embora a transmissão não tenha sido observada entre os menores de 5 anos.

Prevalence of hepatitis C virus infection and HCV genotypes among hemophiliacs in the State of Bahia, Northeastern Brazil: analysis of serological and virological parameters.

The objective of the present study was to analyze HCV serological and virological parameters from hemophiliacs in the State of Bahia. Anti-HCV was investigated by ELISA in a cohort of 268 hemophiliacs A/B who were followed-up in a reference unit for hemotherapy in the State of Bahia. HCV viremia and genotypes were also determined from a subset of 66 anti-HCV seropositive hemophiliacs. Seroprevalence among hemophiliacs was 42.2% (95% CI 36.5-48.1) and was significantly higher (p<0.05) according to age > or =10 years, presence of factor VIII/IX inhibitory antibodies and other infection markers. None of the hemophiliacs less than 5 years of age were anti-HCV seropositive. Viremia was detectable in 77.3% (51/66). HCV genotype 1 (74%) was the most prevalent followed by genotype 3 (22%) and genotype 2 (4%). Our results indicate that HCV prevalence is still high among hemophiliacs, although HCV transmission was not observed in young hemophiliacs.

Epidemiologia molecular do vírus da hepatite C (VHC) na cidade de Salvador-BA / Molecular epidemiology of hepatitis C virus (HCV) in the city of Salvador-BA

O VHC é um vírus RNA (VHC-RNA) hepatotrópico associado com um alto risco à cronificação, cirrose e carcinoma hepatocelular. Nos últimos anos, técnicas moleculares para a detecção do VHC-RNA e a genotipagem têm se tomado ferramentas indispensáveis para a avaliação de pacientes com hepatite crônica C. O objetivo principal foi realizar um estudo de epidemiologia molecular para determinar a prevalência de infecção e a distribuição dos genótipos do VHC em uma amostra de base populacional e em populações sob risco. Para o estudo de base populacional foram coletados 1308 amostras de soros de indivíduos selecionados através de uma aleatorização estratificada da população de Salvador (amostra do Programa Bahia Azul). Para o estudo em grupos sob risco, foram coletadas amostras de soro de 127 pacientes com anticorpo anti- VHC positivo provenientes do HUPESIUFBA, de 66 hemofilicos da HEMOBA e de 97 hemodialisados de sete clínicas de Salvador, voluntários na pesquisa. A prevalência de infecção pelo VHC foi estimada a partir da avaliação dos resultados de soroprevalência do anticorpo anti-VHC obtidos através do ELISA de 2ana. geração e confirmação pelo RIBA e/ou RT-PCR, método in-house. Quando possível, foi colhida uma segunda amostra de soro para confirmação dos resultados de RIBA ou RT-PCR negativos. Nas amostras VHC-RNA positivas foi realizada a genotipagem através da R T - PCR, utilizando-se primers genótipo-específicos dirigidos contra a região do core ou através da análise do RFLP da região 5'UTR do VHC-RNA. A prevalência de infecção pelo VHC na população em geral de Salvador, em hemofilicos e hemodialisados foi de 1,5%, 32,6% e 7,1 %, respectivamente. A infecção na população em geral foi associada com idade superior a 20 anos (p<0,05), 12 ou mais anos de escolaridade p<0,01), nível de renda mediano (p<0,05) e residência no bairro da Barra (p<0,05), uma vizinhança de classe média-alta da cidade de Salvador...