Chronic hepatitis C infection: influence of the viral load, genotypes, and GBV-C/HGV coinfection on the severity of the disease in a Brazilian population.

The distributions of the different genotypes of the hepatitis C virus (HCV) and GBV-C virus (GBV-C/HGV) vary geographically and information worldwide is still incomplete. In particular, there are few data on the distribution of genotypes (and their relationship to the severity of liver disease) in South America. Findings are described in 114 consecutive patients from Northeast Brazil (median age 52 years, range 18-72 years) who had abnormal levels of serum aminotransferases and seropositivity for HCV RNA. The patients were recruited from an outpatient clinic between November 1997 and April 1998. Quantitative HCV RNA and GBV-C/HGV RNA estimations were carried out by double-nested polymerase chain reaction (PCR) using primers from the 5'-untranslated regions (UTRs) of the genomes. HCV genotypes were determined by restriction fragment length polymorphism (RFLP) analysis with 5'-UTR primers and by PCR with type-specific 5'-UTR primers. GBV-C/HGV-RNA genotypes were determined by RFLP with specific 5'-UTR primers and phylogenetic trees were constructed using the Neighbour-Joining and Drawtree programs. Histological features were graded and staged according to international criteria. Of the 114 patients, 35 (30.7%) patients had cirrhosis and 22 (27.8%) had mild, 51 (64.6%) had moderate, and 6 (7.6%) had severe chronic hepatitis. Median HCV viral load was 10(6) genome equivalents per millilitre (range 10(4)-10(9)/ml). Frequencies of genotypes were 5.3% type 1a, 44.7% type 1b, 3.5% type 2, 41.2% type 3, and 5.3% mixed types. GBV-C/HGV-RNA was detected in the sera of 12 (10.5%) patients and was distributed among three phylogenetic groups. There were no significant differences between patients with the predominant HCV genotypes (1b and 3) with respect to gender, age group, viral load, severity of liver disease, or coinfection with GBV-C/HGV.

Hepatites B e C na esquistossomose mansoni / B and C Hepatitis in schistosomiasis mansoni

Foram estudados 234 pacientes com essquistossomose mansoni, sendo 44 com a forma hepatintestinal (EHI), 143 com a forma hepatesplenica compensada (EHEC) e 47 com a forma descompensada (EHED), além de 50 individuos controles. Dos 234 pacientes, 133 (57por cento) tinham pelo menos um marcador sorológico dis HBV e hcv. A frequencia do HBsAg foi significativamente maior (21por cento vs. 6por cento vs. 2por cento) nos com EHED do que nos com EHEC ou nos com EHI (p<0,001. Dos 19 (8por cento) AgHBs positivos,14 (74por cento) foram ant-HBe (um com EHI, sete com EHEC e seis com EHED),incluindo sete (37 por cento) HBV-DNA positivos. Em relaçao ao HCV, 47 (20por cento) dos 234 pacientes foram anti-HCV poistivos, apresentaram também HCV-RNA no soro, sendo11 (69,8 por cento) dos 16 com EHEC,17 (56,7 por cento) dos com EHED e um com EHI. O HCV_DNA foi detectado tambem em cinco pacientes anti-HCV negativos com EHED, totalizando 22 pacientes cm infeccao pelo HCV. Nos 108 pacientes com EHE ( 13 HBsAg positivos, 25 anti-HCV positivos para ambos os marcadores submetidos a esplenectomia) em que foi realizada biópsia hepatica dos com EHEC apresentava hepatite cronica ativa. Os achados deste estudo sugerem que a infecçao concomitante pelos virus das hepatites B e C é importante fator contribuinte para a gravidade da doença hepatica na esquistossomose mansoni