El HeberNasvac®, una opción en el tratamiento de la hepatitis B crónica

Introducción: En Cuba se produce la vacuna HeberNasvac® para el tratamiento de la hepatitis B crónica. Su relevancia radica en lograr resultados de control virológico sostenido en una mayor proporción de pacientes. Objetivo: Evaluar seguridad y efectividad de la vacuna terapéutica HeberNasvac® en el tratamiento de la hepatitis B crónica, en la provincia Camagüey en el periodo comprendido de enero de 2019 a diciembre de 2020. Métodos: Se realizó un estudio cuasi experimental de intervención terapéutica, en pacientes atendidos en la Consulta Provincial de hepatitis virales crónicas. El universo estuvo constituido por 24 pacientes adultos, con carga viral detectable al inicio del estudio. La fuente primaria de la investigación estuvo dada por la historia clínica. Resultados: En el primer ciclo fueron más frecuentes la cefalea y los estornudos; y en el segundo ciclo la fiebre y el malestar general. Al concluir el tratamiento la mayoría mostraron mejoría de resultados de las pruebas de función hepática. Antes del tratamiento el mayor número de pacientes presentó una carga viral detectable por encima de 250 copias/mL y después de haber recibido tratamiento varios de los casos resultaron carga no detectable. El tratamiento se consideró con mediana seguridad en el mayor número de pacientes y la efectividad fue alta. Conclusiones: Se presentaron más eventos adversos en el segundo ciclo del tratamiento. Las pruebas de función hepática mostraron mejoría al concluir tratamiento. La carga viral después del tratamiento presentó un descenso. El tratamiento mostró mediana seguridad y efectividad alta.

Introduction: Cuba produces the HeberNasvac® vaccine for the treatment of chronic hepatitis B. Its relevance lies in achieving sustained virological control results in a greater proportion of patients. Objective: To evaluate the safety and effectiveness of the therapeutic vaccine HeberNasvac® in the treatment of chronic hepatitis B, in the province of Camagüey in the period from January 2019 to December 2020. Methods: A quasi-experimental study of therapeutic intervention was carried out in patients treated at the Provincial Consultation of Chronic Viral Hepatitis. The universe consisted of 24 adult patients, with detectable viral load at the beginning of the study. The primary source of the investigation was given by the medical history. Results: In the first cycle, headache and sneezing were more prevalent; and in the second cycle, fever and general malaise were more prevalent. At the end of the treatment, the majority showed improvement in the results of liver function tests. Before treatment, the largest number of patients had a detectable viral load above 250 copies / mL and after receiving treatment, several of the cases resulted in an undetectable load. The treatment was considered to be of medium safety in the largest number of patients and the effectiveness was high. Conclusions: There were more adverse events in the second cycle of treatment. Liver function tests showed improvement at the end of treatment. The viral load after treatment showed a decrease. The treatment showed medium safety and high effectiveness.

Comportamiento y manejo actual de la infección por virus de la hepatitis B / Behavior and current management of hepatitis B virus infection

RESUMEN Introducción: Las hepatitis virales son un problema de salud a nivel mundial, provocan elevada mortalidad y morbilidad. A pesar de los avances en la prevención, diagnóstico y tratamiento de la hepatitis B, esta enfermedad es todavía preocupación de las autoridades sanitarias. Objetivo: Realizar una actualización acerca del comportamiento y manejo actual de la infección por el virus de la hepatitis B. Métodos: Se realizó una revisión bibliográfica durante abril y mayo de 2021, se consultaron 211 artículos en idioma inglés y español en las bases de datos como SciELO, PubMed, Lilacs y Medigraphic, de ellos se utilizaron 30 citas. Se empleó la combinación de términos y operadores booleanos y métodos teóricos como: análisis-síntesis, inducción-deducción e histórico-lógico. Resultados: Se abordó el comportamiento de la infección causada por el virus de la hepatitis B, se hizo hincapié en su epidemiología, características morfológicas y funcionales que permiten su infectividad, evolución y manifestaciones clínicas, complicaciones, tratamiento y perspectivas actuales. Conclusiones: La historia natural de la infección es dinámica y las manifestaciones clínicas dependen de diversos factores. La infección por el virus de la hepatitis B puede causar complicaciones como: la cirrosis hepática y el carcinoma hepatocelular y su principal vía de transmisión es la parenteral. El diagnóstico se realiza a través de técnicas serológicas. Es imprescindible la atención diferenciada a los grupos con riesgo y, aunque se cuenta con una vacuna eficaz, aún existen casos y se han desarrollado tratamientos con resultados positivos.

ABSTRACT Introduction: Viral hepatitis is a global health problem, causing high mortality and morbidity. Despite advances in the prevention, diagnosis and treatment of hepatitis B, this disease is still a concern of health authorities. Objective: Toupdate on current behavior and management of hepatitis B virus infection. Methods: A bibliographic review was carried out during April and May 2021, consulting 211 articles in English and Spanish from databases such as SciELO, PubMed, Lilacs and Medigraphic, of which 30 citations were used. The combination of Boolean terms and operators and theoretical methods such as: analysis-synthesis, induction-deduction and historical-logical were used. Results: The behavior of the infection caused by the hepatitis B virus was addressed, emphasizing its epidemiology, morphological and functional characteristics that allow its infectivity, evolution and clinical manifestations, complications, treatment and current perspectives. Conclusions: The natural history of infection is dynamic, and clinical manifestations depend on various factors. Hepatitis B virus infection can cause complications such as liver cirrhosis and hepatocellular carcinoma, and its main route of transmission is parenterally. The diagnosis is made mainly through serological techniques. Differentiated care for groups at risk is essential and, although there is an effective vaccine, there are still cases and treatments have been developed with positive results.

The fibrogenic process and the unleashing of acute-on-chronic liver failure.

Acute-on-chronic liver failure (ACLF) is a life-threatening condition characterized by a rapid deterioration of previously well-compensated chronic liver diseases. One of the main obstacles in ACLF is the lack of knowledge of the pathogenesis and specific broad-spectrum treatments. An excessive systemic inflammatory response has been proposed to explain the pathogenesis of ACLF; this hypothesis involves stellate cells, which are implicated in many liver homeostatic functions that include vitamin A storage, regulation of sinusoidal blood flow, local inflammation, maintenance of the hepatocyte phenotype and extracellular matrix remodeling. However, when there is damage to the liver, these cells are the main target of the inflammatory stimulus, as a result, the secretion of the extracellular matrix is altered. Activated hepatic stellate cells raise the survival of neutrophils by the stimulation of granulocytes colonies and macrophages, which exacerbates liver inflammation and promotes damage to hepatocytes. Elevation of pathogen-associated molecular patterns is related to liver damage by different pathophysiological mechanisms of decompensation, showing ballooning degeneration and cell death with a predominance of cholestatic infection. Moreover, patients with ACLF present a marked elevation of C-reactive protein together with an elevation of the leukocyte count. Chronic liver disease is a complex pathological state with a heterogeneous pathophysiology in which genetic factors of the host and external triggers interact and culminate in hepatic insufficiency. The better understanding of such interactions should lead to a better comprehension of the disease and to the discovery of new treatment targets that will make acute decompensations preventable and even decrease mortality.

Influence of Treg cells and HBV genotype on sustained response and drug resistance in the treatment with nucleoside drugs

We aimed to investigate the influence of regulatory T cells including CD4+CD25+, CD8+CD28- and hepatitis B virus (HBV) genotype on sustained virological response and tolerance of nucleoside drugs. One hundred and thirty-seven patients were enrolled. Lamivudine was administered to 84 patients. Entecavir was administered to the other 53 patients. Before treatment, biochemical tests, HBV DNA load, HBV serum level, HBV genotype, PB CD3+, CD4+, CD8+, CD4+CD25+/CD3+, and CD8+CD28-/CD3+ frequencies were measured. Based on HBV DNA loads after 4 weeks of therapy, patients were divided into response group and suboptimal response group. The lamivudine group received treatment continuously, and then patients were categorized into non-resistance group and resistance group. Compared with the suboptimal response and resistance groups for lamivudine, CD4+CD25+/CD3+ levels were higher in the response and non-resistance groups (t=4.372, P=0.046; t=7.262, P=0.017). In the non-resistance group, CD8+CD28-/CD3+ frequency was lower than in the resistance group (t=5.527, P=0.037). Virus load and hepatitis B E antigen (HBeAg)-positive rate were significantly lower than in the response and resistance group (t=2.164, P=0.038; X2=4.239, P=0.040; t=2.015, P=0.044; X2=16.2, P=0.000). Incidence of drug resistance was high in patients with virogene type C. For the virological response to entecavir, CD8+CD28-/CD3+ level was significantly lower than that of the suboptimal response group (t=6.283, P=0.036). Response and suboptimal response groups were compared in CD3+, CD4+, CD8+, CD4+CD25+/CD3+ and virus genotype, and differences were not statistically significant (P>0.05). Baseline regulatory T cells including CD4+CD25+/CD3+ and CD8+CD28-/CD3+ frequencies have a relationship with the incidence of rapid virological response and the resistance to nucleoside drugs. Patients with HBV genotype C receiving lamivudine more often underwent drug resistance. Antiviral efficacy and the resistance to lamivudine were closely correlated with baseline factors; the same cannot be found for entecavir.

Evolution of hepatitis B serological markers in HIV coinfected patients: a case study

ABSTRACT OBJECTIVE To describe the evolution of serological markers among HIV and hepatitis B coinfected patients, with emphasis on evaluating the reactivation or seroreversion of these markers. METHODS The study population consisted of patients met in an AIDS Outpatient Clinic in São Paulo State, Brazil. We included in the analysis all HIV-infected and who underwent at least two positive hepatitis B surface antigen serological testing during clinical follow up, with tests taken six months apart. Patients were tested with commercial kits available for hepatitis B serological markers by microparticle enzyme immunoassay. Clinical variables were collected: age, sex, CD4+ T-cell count, HIV viral load, alanine aminotransferase level, exposure to antiretroviral drugs including lamivudine and/or tenofovir. RESULTS Among 2,242 HIV positive patients, we identified 105 (4.7%) patients with chronic hepatitis B. Follow up time for these patients varied from six months to 20.5 years. All patients underwent antiretroviral therapy during follow-up. Among patients with chronic hepatitis B, 58% were hepatitis B “e” antigen positive at the first assessment. Clearance of hepatitis B surface antigen occurred in 15% (16/105) of patients with chronic hepatitis B, and 50% (8/16) of these patients presented subsequent reactivation or seroreversion of hepatitis B surface antigen. Among hepatitis B “e” antigen positive patients, 57% (35/61) presented clearance of this serologic marker. During clinical follow up, 28.5% (10/35) of those who initially cleared hepatitis B “e” antigen presented seroreversion or reactivation of this marker. CONCLUSIONS Among HIV coinfected patients under antiretroviral therapy, changes of HBV serological markers were frequently observed. These results suggest that frequent monitoring of these serum markers should be recommended.

Characteristics of an outpatient chronic hepatitis B virus infection cohort / Caracterização de uma coorte ambulatorial de pacientes com infecção por vírus da hepatite B crônica

ABSTRACT Objective: To characterize a chronic hepatitis B cohort based on initial and follow-up clinical evaluations. Methods: A retrospective and descriptive analysis of clinical and laboratory data from chronic HBsAg adult carriers, without HIV, unexposed to treatment, with at least two outpatient visits, between February 2006 and November 2012. Fisher´s exact test, χ², Wilcoxon, Spearman, multiple comparisons and Kappa tests were applied, the level of significance adopted was 5%, with a 95% confidence interval. Results: 175 patients with mean age of 42.95±12.53 years were included: 93 (53.1%) were men, 152 (86.9%) were negative for hepatitis B e-antigen (HBeAg), 3 (1.7%) had hepatitis C coinfection, 15 (8.6%) had cirrhosis, and 2 (1.1%) had hepatocellular carcinoma. Genotype A predominated. Sixty-six patients (37.7%) had active hepatitis, 6 (3.4%) presented immune tolerance, and 38 (21.7%) were inactive carriers. Exacerbations and/or viral breakthrough were detected in 16 patients (9.1%). In 32 patients (18.3%), hepatitis B virus DNA remained persistently elevated and alanine aminotransferase levels were normal, whereas in 17 (9.7%), there was low hepatitis B virus DNA and alterated alanine aminotransferase. If only initial alanine aminotransferase and hepatitis B virus DNA values were considered, 15 cases of active hepatitis would not have been detected. Advanced fibrosis was more common in HBeAg-positive patients, and it was significantly associated with transaminases, hepatitis B virus DNA, and age. Conclusion: Many patients had active hepatitis, but almost 25%, who were HBeAg non-reactive, were only identified because of combined analyses of the hepatitis B virus DNA and transaminases levels, sometimes associated with histological data, after clinical follow-up. .

RESUMO Objetivo: Caracterizar uma coorte de pacientes com hepatite B crônica, segundo parâmetros iniciais e evolutivos. Métodos: Análise retrospectiva e descritiva dos dados clínicos e laboratoriais de portadores crônicos adultos do HBsAg, sem HIV, virgens de tratamento, com ao menos duas consultas ambulatoriais entre fevereiro de 2006 a novembro de 2012. Empregaram-se os testes exato de Fisher, χ², Wilcoxon, Spearman, Kappa e comparações múltiplas, o nível de significância estatística adotado foi de 5% e intervalo de confiança de 95%. Resultados: Foram incluídos 175 pacientes com média de idade de 42,95±12,53 anos, 93 (53,1%) do sexo masculino, 152 (86,9%) não reagentes para o antígeno e (HBeAg), 3 (1,7%) coinfectados com hepatite C, 15 (8,6%) cirróticos e 2 (1,1%) com carcinoma hepatocelular. Predominou o genótipo A. Constataram-se hepatite ativa em 66 pacientes (37,7%), imunotolerância em 6 (3,4%), estado de portador inativo em 38 (21,7%), exacerbações e/ou escapes virais em 16 (9,1%). Em 32 (18,3%), havia DNA viral persistentemente elevado e alanina aminotransferase normal; em 17 (9,7%), carga viral constantemente baixa e alanina aminotransferase alterada. Se fossem considerados apenas transaminases e DNA viral iniciais, 15 casos de hepatite ativa não teriam sido evidenciados. Fibrose avançada foi mais prevalente em HBeAg reagentes e associou-se direta e significativamente ao DNA do vírus da hepatite, idade e transaminases. Conclusão: Grande parte dos pacientes apresentou hepatite ativa. Porém, aproximadamente um quarto (todos pertencentes ao grupo HBeAg não reagente) foram identificados somente em função da análise conjunta das mensurações sequenciais de DNA do vírus da hepatite e transaminases, por vezes aliada a dados histológicos, após seguimento. .

Antivirais incorporados no Brasil para hepatite B cronica: analise de custo-efetividade / Antivirales incorporados en Brasil para hepatitis B cronica: analisis de costo-efectividad / Incorporated antivirals for chronic hepatitis B in Brazil: a cost-effectiveness analysis

OBJETIVO Avaliar o custo-efetividade de diferentes tratamentos medicamentosos para hepatite B crônica entre pacientes adultos. MÉTODOS Utilizando modelo de Markov, construiu-se coorte hipotética de 40 anos para pacientes HBeAg-positivo ou HBeAg-negativo. Foram comparados os usos de adefovir, entecavir, tenofovir e lamivudina (com terapia de resgate em caso de resistência viral) para tratamento de pacientes adultos com hepatite B crônica, virgens de tratamento, com elevados níveis de alanina aminotransferase, sem evidência de cirrose e sem coinfecção por HIV. Valores para custo e efeito foram obtidos da literatura. A medida do efeito foi expressa em anos de vida ganhos (AVG). Taxa de desconto de 5% foi aplicada. Análise de sensibilidade univariada foi conduzida para avaliar incertezas do modelo. RESULTADOS O tratamento inicial com entecavir ou tenofovir apresentou melhores resultados clínicos. As menores razões custo-efetividade foram de entecavir para pacientes HBeAg-positivo (R$ 4.010,84/AVG) e lamivudina para pacientes HBeAg-negativo (R$ 6.205,08/AVG). Para pacientes HBeAg-negativo, a razão custo-efetividade incremental de entecavir (R$ 14.101,05/AVG) está abaixo do limiar recomendado pela Organização Mundial da Saúde. Análise de sensibilidade mostrou que variação nos custos dos medicamentos pode tornar tenofovir alternativa custo-efetiva tanto para pacientes HBeAg-positivo quanto para HBeAg-negativo. CONCLUSÕES Entecavir é alternativa recomendada para iniciar o tratamento de pacientes com hepatite B crônica no Brasil. Contudo, se houver redução no custo de tenofovir, esta pode se tornar alternativa mais custo-efetiva. .

OBJETIVO Evaluar el costo-efectividad de diferentes tratamientos medicamentosos para hepatitis B crónica entre pacientes adultos. MÉTODOS Utilizando el modelo de Markov, se construyó cohorte hipotética de 40 años para pacientes HBeAg-positivo o HBeAg-negativo. Se compararon los usos de adefovir, entecavir, tenofovir y lamivudina (con terapia de rescate en caso de resistencia viral) para tratamiento de pacientes adultos con hepatitis B crónica, vírgenes de tratamiento, con elevados niveles de alanina aminotransferasa, sin evidencia de cirrosis y sin coinfección por VIH. Valores para costo y efecto fueron obtenidos de la literatura y efecto en años de vida ganados (AVG). Tasa de descuento de 5% fue aplicada. Análisis de sensibilidad univariado fue conducido para evaluar incertidumbres del modelo. RESULTADOS El tratamiento inicial con entecavir o tenofovir presentó mejores resultados clínicos. Los menores cocientes costo-efectividad fueron de entecavir para pacientes HBeAg-positivo (R.010,84/AVG) y lamivudina para pacientes HBeAg-negativo (R.205,08/AVG).Para pacientes HBeAg-negativo, el cociente costo-efectividad incrementado de entecavir (R.101,05/AVG) está por debajo del límite recomendado por la Organización Mundial de la Salud. El análisis de sensibilidad mostró que la variación en los costos de los medicamentos puede tornar tenofovir una alternativa costo-efectiva tanto para pacientes HBeAg-positivo como para los HBeAg-negativo. CONCLUSIONES Entecavir es una alternativa recomendada para iniciar el tratamiento de pacientes con hepatitis B crónica en Brasil. Sin embargo, al haber reducción en el costo de tenofovir, éste puede convertirse en una alternativa más costo-efectiva. .

OBJECTIVE To evaluate the cost-effectiveness of different drug therapies for chronic hepatitis B in adult patients. METHODS Using a Markov model, a hypothetical cohort of 40 years for HBeAg-positive or HBeAg-negative patients was constructed. Adefovir, entecavir, tenofovir and lamivudine (with rescue therapy in cases of viral resistance) were compared for treating adult patients with chronic hepatitis B undergoing treatment for the first time, with high levels of alanine aminotransferase, no evidence of cirrhosis and without HIV co-infection. Values for cost and effect were obtained from the literature, and expressed in effect on life years (LY). A discount rate of 5% was applied. Univariate sensitivity analysis was conducted to assess model uncertainties. RESULTS Initial treatment with entecavir or tenofovir showed better clinical outcomes. The lowest cost-effectiveness ratio was for entecavir in HBeAg-positive patients (R$ 4,010.84/LY) and lamivudine for HBeAg-negative patients (R$ 6,205.08/LY). For HBeAg-negative patients, the incremental cost-effectiveness ratio of entecavir (R$ 14,101.05/LY) is below the threshold recommended by the World Health Organization. Sensitivity analysis showed that variation in the cost of drugs may make tenofovir a cost-effective alternative for both HBeAg-positive and HBeAg-negative patients. CONCLUSIONS Entecavir is the recommended alternative to start treating patients with chronic hepatitis B in Brazil. However, if there is a reduction in the cost of tenofovir, it can become a cost-effective alternative. .

Role of hyaluronic acid and laminin as serum markers for predicting significant fibrosis in patients with chronic hepatitis B

OBJECTIVES: The aim of this study was to evaluate the diagnostic performance of serum HA and LN as serum markers for predicting significant fibrosis in CHB patients. METHODS: Serum HA and LN levels of 87 patients with chronic hepatitis B and 19 blood donors were assayed by RIA. Liver fibrosis stages were determined according to the Metavir scoring-system. The diagnostic performances of all indexes were evaluated by the receiver operating characteristic (ROC) curves. RESULTS: Serum HA and LN concentrations increased significantly with the stage of hepatic fibrosis, which showed positive correlation with the stages of liver fibrosis (HA: r = 0.875, p < 0.001; LN: r = 0.610, p < 0.001). There were significant differences of serum HA and LN levels between F2-4 group in comparison with those in F0-F1 group (p < 0.001) and controls (p < 0.001), respectively. From ROC curves, 185.3 ng/mL as the optimal cut-off value of serum HA for diagnosis of significant fibrosis, giving its sensitivity, specificity, PPV, NPV, LR+, LR- and AC of 84.2 percent, 83.3 percent, 90.6 percent, 73.5 percent, 5.04, 0.19 and 83.9, respectively. While 132.7 ng/mL was the optimal cut-off value of serum LN, the sensitivity, specificity, PPV, NPV, LR+, LR- and AC were 71.9 percent, 80.0 percent, 87.2 percent, 60.0 percent, 3.59 percent, 0.35 percent and 74.7, respectively. Combinations of HA and LN by serial tests showed a perfect specificity and PPV of 100 percent, at the same time sensitivity declined to 63.2 percent and LR+ increased to 18.9, while parallel tests revealed a good sensitivity of 94.7 percent, NPV to 86.4 percent, and LR- declined to 0.08. CONCLUSIONS: Serum HA and LN concentrations showed positive correlation with the stages of liver fibrosis. Detection of serum HA and LN in predicting significant fibrosis showed good diagnostic performance, which would be further optimized by combination of the two indices. HA and LN would be clinically useful serum markers for predicting significant fibrosis in patients with chronic hepatitis B, when liver biopsy is contraindicated.

Conhecimento dos obstetras sobre a transmissão vertical da hepatite B / Knowledge of obstetricians about the vertical transmission of hepatitis B virus

CONTEXTO: A transmissão vertical é responsável por 35 por cento a 40 por cento dos novos casos de hepatite B no mundo e a infecção precoce pelo vírus da hepatite B aumenta o risco de evolução para a hepatite crônica, cirrose e carcinoma hepatocelular. OBJETIVO: Determinar o conhecimento dos obstetras sobre as práticas para o diagnóstico da infecção pelo vírus da hepatite B em gestantes e as condutas para a prevenção desta infecção em recém-nascidos de mães infectadas. MÉTODOS: Foram sorteados aleatoriamente profissionais de saúde cadastrados na Sociedade de Obstetrícia e Ginecologia da Bahia, que foram convidados a responder um questionário anônimo com informações sobre sua formação acadêmica, o local de trabalho, o contato com estudantes e as suas práticas profissionais em relação ao vírus da hepatite B. Adotou-se como critério de exclusão o não exercício atual da obstetrícia e a não residência na Bahia. A análise dos dados foi feita através do programa estatístico Epiinfo e para análise das correlações foi adotado intervalo de confiança de 95 por cento. RESULTADOS: Foram entrevistados 301 obstetras, dos quais 90,3 por cento reconheciam a transmissibilidade vertical do vírus da hepatite B e 81,7 por cento solicitavam algum exame para detecção de hepatite B durante o pré-natal de suas pacientes. Sessenta e seis por cento dos médicos entrevistados referiram o AgHBs como o marcador sorológico mais adequado para avaliar a presença de infecção pelo VHB. Apenas 13,0 por cento destes profissionais indicavam de modo sistemático a vacina contra a hepatite B e a administração de imunoglobulina nas primeiras 12 horas de vida do recém-nascido de mães infectadas. O número de respostas corretas quanto à transmissibilidade vertical do VHB, ao marcador sorológico mais adequado e à conduta para o recém-nascido de mãe infectada foi maior entre os obstetras que possuíam o Título de Especialista em Ginecologia e Obstetrícia que entre os demais profissionais...

CONTEXT: Vertical transmission is responsible for 35 percent-40 percent of the new cases of hepatitis B worldwide and it is associated with an increased risk of chronic hepatitis B, cirrhosis and hepatocellular carcinoma. OBJECTIVE: To describe obstetricians' knowledge on the recommended measures to the diagnosis of the infection by the hepatitis virus B in pregnant women and to prevent the transmission of this infection to the babies of infected mothers. METHODS: Obstetricians registered at the "Sociedade de Ginecologia e Obstetrícia da Bahia", Salvador, BA, Brazil were randomly selected and invited to answer a questionnaire with questions regarding their academic formation, workplace, contact with medical students and their practices about the hepatitis virus B. Individuals who were not currently working as obstetricians or were not living in the state of Bahia were excluded from the study. Data were analyzed with the EpiInfo software with a 95 percent confidence interval. RESULTS: Three hundred and one obstetricians answered the questionnaire: 90.3 percent of them recognized that the hepatitis virus B could be transmitted vertically and 81.7 percent routinely screened their patients for hepatitis virus B infection during prenatal consultations; 66.0 percent considered HBsAg the best serological marker to be employed on the screening. Only 13.0 percent systematically recommended the vaccination against hepatitis virus B and the administration of immunoglobulin to the newborns of infected mothers in the first 12 hours of life. The frequency of correct answers about the vertical transmission of hepatitis virus B, the best serological marker for screening and the management of infected mothers and their newborns was higher among professionals who had the "Título de Especialista em Ginecologia e Obstetrícia (TEGO)" than among the remaining ones (P = 0.018, P = 0.001 and P = 0,002, respectively). CONCLUSION: We observed that the knowledge...

Evaluación bioquímico-inmunológica de infectados crónicos por el virus de la hepatitis B: Comportamiento de la respuesta inmune en sus contactos familiares

La infección crónica por el virus de la hepatitis B (VHB) es una clara e importante causa de morbilidad y mortalidad en el mundo. Un importante problema para el control y la erradicación de la enfermedad es la exisniveles de anti-AgsHB, después del esquema completo de vacunación en consanguíneos y no consanguíneos, resultó ser de tipo negativa en los primeros e infirió la existencia de genes compartidos relacionados con el control de la respuesta anti-AgsHB y con el aclaramiento viral.

Chronic infection by HBV is a clear and important cause of morbidity and mortality worldwide. An important problem, for the control and eradication of this disease is the existance of chronic HBV carriers and their family contacts. A biochemical and immunological study of chronic HBV reservoirs were conducted to determine the relation between the concentrations of HBV surface antigen, detected and quantified by the ELISA method, and the serum viral DNA concentrations; as well as the correlation between the levels of antigenemia and the transaminase values (ALAT). A direct linking was proved between viral DNA and HbsAg levels and also between antigen concentration and ALAT values. A significant percent of carriers with high viral charges and normal enzymatic levels was observed. The performance of immune response to HBV in those persons living with the chronic HBV-infested subjects was analyzed and the frequency of occurence of immune, sensitive and infected persons was estimated resulting in a high number of infected persons and persons living with the chronic patients without protection. Qualitative and quantitative ELISA were used to assess the response of antibodies to HbsAg, induced by vaccines or by normal contacts of blood related and non-related persons in the family, but there was no difference among them. The HbsAg concentration of the carrier was associated with levels of antibodies to HbsAg; after completion of the vaccination program in blood related and non-related subjects, then the association was found to be negative in the former and the existance of shared gens linked to the control of anti-HbsAg response and viral clearing were infered.