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OBJECTIVES: The primary objective was to evaluate Liver-Related Events (LREs), including hepatic decompensation (ascites, hemorrhagic varices and encephalopathy) and Hepatocellular Carcinoma (HCC), as well as changes in liver stiffness during the follow-up period among patients who achieved a Sustained Virological Response (SVR) after treatment for chronic Hepatitis C Virus (HCV) infection. METHODS: A total of 218 patients with HCV were treated, and those who achieved an SVR were followed up for 3-years. Transient Elastography (TE) using FibroScan® was performed at various time points: before treatment, at the end of treatment, at 6-months post-treatment, at 1-year post-treatment, at 2-years post-treatment, and at 3-years post-treatment. RESULTS: At 6-months post-treatment, a Liver Stiffness Measurement (LSM) cutoff of > 19 KPa was identified, leading to a 14.5-fold increase in the hazard of negative outcomes, including decompensation and/or HCC. The analysis of relative changes in liver stiffness between pre-treatment and 6-months posttreatment revealed that a reduction in LSM of -10 % was associated with a -12 % decrease in the hazard of decompensation and/or HCC, with this trend continuing as the LSM reduction reached -40 %, resulting in a -41 % hazard of decompensation and/or HCC. Conversely, an increase in the relative change during this period, such as an LSM increase of +10 %, led to a + 14 % increase in the hazard of decompensation. In cases where this relative change in LSM was +50 %, the hazard of decompensation increased to +92. CONCLUSION: Transient elastography using FibroScan® can be a good tool for monitoring HCV patients with SVR after treatment to predict LREs in the long term.
Assuntos
Antivirais , Carcinoma Hepatocelular , Técnicas de Imagem por Elasticidade , Hepatite C Crônica , Cirrose Hepática , Neoplasias Hepáticas , Resposta Viral Sustentada , Humanos , Técnicas de Imagem por Elasticidade/métodos , Masculino , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/virologia , Feminino , Pessoa de Meia-Idade , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/complicações , Hepatite C Crônica/diagnóstico por imagem , Antivirais/uso terapêutico , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/virologia , Seguimentos , Fatores de Tempo , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/virologia , Resultado do Tratamento , Adulto , Idoso , Valor Preditivo dos TestesRESUMO
Abstract Objectives The primary objective was to evaluate Liver-Related Events (LREs), including hepatic decompensation (ascites, hemorrhagic varices and encephalopathy) and Hepatocellular Carcinoma (HCC), as well as changes in liver stiffness during the follow-up period among patients who achieved a Sustained Virological Response (SVR) after treatment for chronic Hepatitis C Virus (HCV) infection. Methods A total of 218 patients with HCV were treated, and those who achieved an SVR were followed up for 3-years. Transient Elastography (TE) using FibroScan® was performed at various time points: before treatment, at the end of treatment, at 6-months post-treatment, at 1-year post-treatment, at 2-years post-treatment, and at 3-years post-treatment. Results At 6-months post-treatment, a Liver Stiffness Measurement (LSM) cutoff of > 19 KPa was identified, leading to a 14.5-fold increase in the hazard of negative outcomes, including decompensation and/or HCC. The analysis of relative changes in liver stiffness between pre-treatment and 6-months posttreatment revealed that a reduction in LSM of -10 % was associated with a -12 % decrease in the hazard of decompensation and/or HCC, with this trend continuing as the LSM reduction reached -40 %, resulting in a -41 % hazard of decompensation and/or HCC. Conversely, an increase in the relative change during this period, such as an LSM increase of +10 %, led to a + 14 % increase in the hazard of decompensation. In cases where this relative change in LSM was +50 %, the hazard of decompensation increased to +92. Conclusion Transient elastography using FibroScan® can be a good tool for monitoring HCV patients with SVR after treatment to predict LREs in the long term.
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Extrahepatic manifestations are common in people with hepatitis C virus (HCV). Cognitive changes are pointed out, but the mechanisms are still uncertain. The aim of this systematic review was to analyze studies involving spectroscopic magnetic resonance in people infected with HCV, which also included cognitive tests. The research occurred in six databases (Directory of Open Access Journals, Lilacs, Medcaribe, Medline, Scielo and ScienceDirect) and the selection of studies was carried out in two stages: search for titles and abstracts, then reading of the full articles, excluding those that did not meet the eligibility criteria. 12,888 titles and abstracts were selected, but only 6 articles were included in the review. Impairments in attention, concentration, speed of information processing, memory, verbal fluency and executive functions were identified as well as an increase in the Cho/Cr and mI/Cr ratios and a reduction in the NAA/Cr ratio in some included studies. Longitudinal studies, with more homogeneous samples and methods, as well as with better controlled confounding factors, are necessary to adequately identify the effect of HCV on the brain.
Assuntos
Transtornos Cognitivos , Hepatite C Crônica , Humanos , Hepatite C Crônica/patologia , Imageamento por Ressonância Magnética , Encéfalo/patologia , CogniçãoRESUMO
The chronic hepatitis C (CHC) treatment is currently based on the use of direct-acting antivirals (DAAs), and patients infected with hepatitis C virus genotype 3 (GT3) have emerged as a more difficult-to-cure population. The NS5A inhibitor daclatasvir (DCV) and sofosbuvir (SOF), an NS5B viral polymerase inhibitor, are among the drugs that compose more effective and safer treatment regimens. The virus genetic variability is related to resistance-associated substitutions (RASs) that adversely impact DAAs effectiveness. The aims of this study were to analyze the association of NS5A and NS5B RASs and other clinical factors with DAAs regimens effectiveness in patients with GT3 CHC infection. This was a prospective cohort study performed in a Brazilian university hospital. Individuals older than 18 years with GT3 CHC treated with SOF + DCV ± ribavirin (RBV) or SOF + peginterferon (PEG) + RBV were included. Blood samples were collected at baseline and post-treatment. A total of 121 patients were included. Sustained virological response rates were 87.6% for the SOF + DCV ± RBV group and 80.0% for the SOF + PEG + RBV arm. Cirrhosis, prior treatment with interferon/PEG + RBV, and baseline NS5A RAS were associated with higher risk of treatment failure. The NS5A analysis suggested that A30K, Y93H, and RAS at site 62 were related to failure. Interestingly, a likely compensatory effect was shown between A30K and A62T. Emergence of Y93H was always associated with RAS at position 62. The RASs dynamics comprehension is an important tool to indicate more effective treatment for GT3 patients.
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Antivirais , Hepatite C Crônica , Humanos , Antivirais/uso terapêutico , Antivirais/farmacologia , Hepatite C Crônica/complicações , Hepacivirus/genética , Estudos Prospectivos , Sofosbuvir/uso terapêutico , Sofosbuvir/farmacologia , Ribavirina/uso terapêutico , Ribavirina/farmacologia , Resultado do Tratamento , Quimioterapia Combinada , Genótipo , Farmacorresistência Viral/genéticaRESUMO
RESUMEN Objetivo : Presentar la experiencia clínica con antivirales de acción directa (AAD) para hepatitis C crónica en pacientes VIHpositivos. Materiales y métodos : Serie de casos longitudinal y prospectiva de pacientes VIH-positivos tratados con AAD para hepatitis C crónica entre mayo de 2019 y abril de 2020 en el Servicio de Infectología del Hospital Nacional Guillermo Almenara Irigoyen, EsSalud. El desenlace primario fue la respuesta viral sostenida del virus de hepatitis C (VHC) a las 12 semanas de completada la terapia con AAD. Los desenlaces secundarios fueron tolerabilidad y seguridad. Resultados : Diez pacientes fueron incluidos en el estudio, dos fueron mujeres (20%). Dos pacientes presentaron cirrosis (20%). La totalidad de los pacientes tuvo la carga viral del VIH suprimida antes de la terapia con AAD. Los pacientes recibieron un esquema de 12 semanas con base en sofosbuvir: uno con daclatasvir por separado, y los nueve restantes con velpatasvir combinados en una sola tableta por día. La respuesta viral sostenida del VHC fue evaluable en nueve casos. En estos, la carga viral del VHC fue no detectable. No se registraron ocurrencias en cuanto a tolerabilidad y seguridad durante la terapia con los AAD indicados. Conclusiones : La presente investigación es la primera experiencia clínica en Perú con AAD para hepatitis C crónica en pacientes VIH-positivos. La respuesta virológica, la tolerabilidad y la seguridad frente a daclatasvir y velpatasvir, cada uno junto o combinado con sofosbuvir, fueron óptimas en la serie de casos presentada.
ABSTRACT Objective : To present the clinical experience with direct-acting antivirals (DAAs) for chronic hepatitis C in HIV-positive patients. Materials and methods : Longitudinal and prospective case series of HIV-positive patients treated with DAAs for chronic hepatitis C between May 2019 and April 2020 at the Infectious Diseases Service of Hospital G. Almenara, EsSalud. The primary outcome was sustained virologic response to hepatitis C virus (HCV) 12 weeks after completion of DAA therapy. Secondary outcomes were tolerability and safety. Results : Ten patients were included in the study, two were women (20%). Two patients had cirrhosis (20%). All patients had suppressed HIV viral load prior to DAA therapy. Patients received a 12-week regimen based on sofosbuvir: one with daclatasvir separately, and the remaining nine with velpatasvir combined in a single tablet per day. The sustained virological response of HCV was evaluable nine cases. In these, the HCV viral load was undetectable. No occurrences were recorded regarding tolerability and safety during therapy with the indicated DAAs. Conclusions : This present investigation is the first clinical experience in Peru with DAAs for chronic hepatitis C in HIV-positive patients. Virologic response, tolerability, and safety against daclatasvir and velpatasvir, each in conjunction or in combination with sofosbuvir, were optimal in the case series presented.
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ABSTRACT The chronic hepatitis C (CHC) treatment is currently based on the use of direct-acting antivirals (DAAs), and patients infected with hepatitis C virus genotype 3 (GT3) have emerged as a more difficult-to-cure population. The NS5A inhibitor daclatasvir (DCV) and sofosbuvir (SOF), an NS5B viral polymerase inhibitor, are among the drugs that compose more effective and safer treatment regimens. The virus genetic variability is related to resistance-associated substitutions (RASs) that adversely impact DAAs effectiveness. The aims of this study were to analyze the association of NS5A and NS5B RASs and other clinical factors with DAAs regimens effectiveness in patients with GT3 CHC infection. This was a prospective cohort study performed in a Brazilian university hospital. Individuals older than 18 years with GT3 CHC treated with SOF + DCV ± ribavirin (RBV) or SOF + peginterferon (PEG) + RBV were included. Blood samples were collected at baseline and post-treatment. A total of 121 patients were included. Sustained virological response rates were 87.6% for the SOF + DCV ± RBV group and 80.0% for the SOF + PEG + RBV arm. Cirrhosis, prior treatment with interferon/PEG + RBV, and baseline NS5A RAS were associated with higher risk of treatment failure. The NS5A analysis suggested that A30K, Y93H, and RAS at site 62 were related to failure. Interestingly, a likely compensatory effect was shown between A30K and A62T. Emergence of Y93H was always associated with RAS at position 62. The RASs dynamics comprehension is an important tool to indicate more effective treatment for GT3 patients.
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OBJECTIVES: Co-infection with hepatitis A or B viruses may aggravate liver injury in patients infected with hepatitis C virus (HCV). However, few studies have assessed co-infection with hepatitis E virus (HEV) and HCV. Therefore, this study aimed to assess the prevalence and impact of HEV infection among Brazilian patients with chronic HCV infection. METHODS: This observational study included adult patients with chronic HCV infection who were naive to antiviral therapy from January 2013 to March 2016. A total of 181 patients were enrolled, and HEV serology and PCR were performed for all patients. RESULTS: Seropositivity for anti-HEV IgG was detected in 22 (12.0%) patients and anti-HEV immunoglobulin M in 3 (1.6%). HEV RNA showed inconclusive results in nine (4.9%) patients and was undetectable in the remaining patients. HEV serology positive patients had more severe liver disease, characterized by liver fibrosis ≥3 versus ≤2 (p<0.001), Aspartate Aminotransferase-to-Platelet Ratio Index of ≥1.45 (p=0.003), and Fibrosis-4 score of ≥3.25 (p=0.001). Additionally, the odds of HEV-positive patients developing diabetes mellitus were 3.65 (95% CI 1.40-9.52) times the corresponding odds of HEV-negative patients. A case-control-based histological analysis (n=11 HEV-HCV-positive patients and n=22 HCV-positive patients) showed no significant differences between the groups. CONCLUSIONS: This prevalence is higher than that reported in previous studies of the general population in Brazil. Thus, HEV infection may influence the severity of liver disease and may represent an additional risk of developing diabetes mellitus in patients with HCV infection.
Assuntos
Humanos , Adulto , Vírus da Hepatite E/genética , Hepatite E/complicações , Hepatite C , Hepatite C Crônica/complicações , Diabetes Mellitus/epidemiologia , Coinfecção , RNA Viral , Anticorpos Anti-Hepatite , Prevalência , Hepatite E/epidemiologia , Hepacivirus/genéticaRESUMO
PURPOSE: To identify factors associated with the development of adverse drug reactions (ADR) in ribavirin therapeutic regimens. METHODS: A multicenter, prospective study was conducted in three public health hospitals in Rio de Janeiro between November 2015 and March 2018. Inclusion criteria were defined by patient follow-up at pharmaceutical consultation at the time of drug dispensing as those who used sofosbuvir in combination with simeprevir, daclatasvir, and/or ribavirin. All patients were invited to participate in the study during the first interview. Adverse drug reactions were reported according to the treatment regimen and frequency of occurrence. Statistical analysis was used to compare adverse reactions between treatments and their associated factors. RESULTS: A total of 405 patients were included in the study (mean age 59.6 ± 9.6 years); 61.0% were female, 88.1% were infected with genotype 1, and 65.4% were cirrhotic. The most prescribed treatment was the combination of sofosbuvir, daclatasvir, and ribavirin (55.3%). The majority of patients reported at least one ADR during treatment (83.2%), of which fatigue, anemia, and headache were the most common. Being female (OR = 1.86, [1.08-3.20]) and use of ribavirin (OR: 2.39; 95% CI [1.38-4.13]) were predictors for the development of ADR, which was also associated with development of anemia (OR: 10.28; 95% CI: [5.78-18.30]). Treatment efficacy was 98.1%. CONCLUSIONS: Direct-acting antiviral has been shown to be safe and effective. Therefore, use of ribavirin is questionable due to associated adverse reactions and similar efficacy to other treatments.
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Anemia/epidemiologia , Antivirais/efeitos adversos , Fadiga/epidemiologia , Cefaleia/epidemiologia , Hepatite C Crônica/tratamento farmacológico , Ribavirina/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anemia/induzido quimicamente , Antivirais/administração & dosagem , Brasil/epidemiologia , Carbamatos , Quimioterapia Combinada/efeitos adversos , Quimioterapia Combinada/métodos , Fadiga/induzido quimicamente , Feminino , Cefaleia/induzido quimicamente , Humanos , Imidazóis/administração & dosagem , Imidazóis/efeitos adversos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Vigilância de Produtos Comercializados/estatística & dados numéricos , Estudos Prospectivos , Pirrolidinas , Ribavirina/administração & dosagem , Fatores de Risco , Sofosbuvir/administração & dosagem , Sofosbuvir/efeitos adversos , Valina/análogos & derivadosRESUMO
Chronic hepatitis C (CHC) has a high prevalence in the world. In addition to hepatic complications with cirrhosis in about 20% of patients and high risk for hepatocarcinoma, extrahepatic manifestations may also occur. Cardiac involvement in patients with CHC is associated with several factors, such as increased risk for coronary artery disease, primary cardiomyopathies, or hemodynamic and electrophysiological changes observed in liver cirrhosis. Furthermore, antiviral treatment may, in rare cases, causes cardiovascular adverse effects. Cardiac arrhythmias are the main form of clinical presentation, and, often, markers of poor prognosis in individuals with advanced liver disease. Although some mechanisms that justify these changes have already been reported, many questions remain unanswered, especially about the true involvement of the hepatitis C virus in the genesis of primary cardiac abnormalities, and the risk factors for cardiac-related complications of antiviral treatment
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Humanos , Masculino , Feminino , Hepatite C Crônica , Cardiomiopatias/fisiopatologia , Antivirais/efeitos adversos , Antivirais/uso terapêutico , Arritmias Cardíacas , Ribavirina/efeitos adversos , Doença da Artéria Coronariana , Interferons/efeitos adversos , Interferons/uso terapêutico , Interações Medicamentosas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/terapia , Cirrose HepáticaRESUMO
Summary Objective: Chronic hepatitis C (CHC) continues to be a critical problem. The liver fibrosis score is the most valuable tool in determining treatment and prognosis. Liver biopsy is still considered a gold method but, due to unmet needs, new non-invasive markers are required. The aim of this study was to investigate any possible relationship between serum angiotensin-converting enzyme (ACE) levels and the stages of liver fibrosis in patients with CHC. Method: A total 100 CHC and 100 healthy subjects were enrolled in this study. The relationship between serum ACE level and the stages liver fibrosis was investigated using three different formats, as follows: (group [G]-I, classic Ishak's Score from F1 to F6; G-II, mild [F1-2], moderate [F3-4] and severe [F5-6]; G-III, mild [≤ F2] and advanced [F > 2]). The clinical usability of serum ACE level for both groups was also investigated. Results: Median serum ACE levels were higher in the healthy group than in CHC (42.5 [7-119] vs. 36 [7-91] U/I, p=0.002). There was no statistical difference among the three different fibrosis groups (G-I, G-II, G-III, p=0.797, p=0.986, and p=0.874) and no correlation between serum ACE level and the stages of liver fibrosis (r=0.026, p=0.923). The usability of serum ACE for evaluated patients with CHC and healthy subjects were calculated as 47% and 64%, respectively. Conclusion: Our study indicated that there is no relationship or correlation between serum ACE levels and stages of liver fibrosis in patients with CHC. The assessment of serum ACE level using genetically corrected reference values may provide more accurate results.
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Humanos , Masculino , Feminino , Adulto , Idoso , Peptidil Dipeptidase A/sangue , Hepatite C Crônica/sangue , Cirrose Hepática/diagnóstico , Polimorfismo Genético/genética , Índice de Gravidade de Doença , Biomarcadores/sangue , Estudos de Casos e Controles , Cirrose Hepática/patologia , Pessoa de Meia-IdadeRESUMO
Se presenta el caso de un paciente varón de 56 años quien es evaluado por presentar a nivel del dorso de ambas manos cicatrices hiperpigmentadas e hipopigmentadas, asociadas a quistes de milia. Se le realizó estudios del metabolismo de las porfirinas y biopsia cutánea de las lesiones los cuales resultaron compatibles con porfiria cutánea tarda. En el laboratorio inicial se encontró elevación de los valores de transaminasas, identificándose posteriormente infección crónica por virus de hepatitis C. Con la finalidad de tratar la infección viral y resolver el compromiso dérmico, considerado como manifestación extrahepática del virus hepatitis C, se inició tratamiento con interferón pegilado y ribavirina evolucionando favorablemente con respuesta viral rápida, carga viral no detectable hasta la actualidad (36 semanas de tratamiento), disminución del nivel de transaminasas séricas y mejoría de las lesiones dérmicas.
The present case is a 56 year old male who present hyperpigmented and hypopigmented scars in both hands, associated with the presence of milia cysts. It was studied the metabolism of porphyrins and skin biopsy of the lesions which were compatible with porphyria cutanea tarda. In the initial laboratory, elevated transaminases values were found and subsequently identified chronic infection of hepatitis C virus. In order to treat viral infection and resolve the dermal commitment; considered extrahepatic manifestation of hepatitis C virus, treatment was started with pegylated interferon and ribavirin, with favorably development and rapid viral response, with undetectable viral load until now (24 weeks of treatment), decreased level of serum transaminases and improvement of skin lesions.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Porfiria Cutânea Tardia/etiologia , Hepatite C Crônica/complicações , Antivirais/uso terapêutico , Ribavirina/uso terapêutico , Biópsia , Deformidades Adquiridas da Mão/etiologia , Deformidades Adquiridas da Mão/patologia , Interferons/uso terapêutico , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/tratamento farmacológico , Quimioterapia CombinadaRESUMO
OBJECTIVES: Although liver biopsy is the gold standard for determining the degree of liver fibrosis, issues regarding its invasiveness and the small amount of liver tissue evaluated can limit its applicability and interpretation in clinical practice. Non-invasive evaluation methods for liver fibrosis can address some of these limitations. The aim of this study was to evaluate the accuracy of transient elastography-FibroScan®, acoustic radiation force impulse (ARFI), enhanced liver fibrosis (ELF), the aspartate aminotransferase-to-platelet ratio index (APRI), and the FIB-4 index compared with liver biopsy in hepatitis C. METHODS: We evaluated chronic hepatitis C patients who were followed at the Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, Department of Gastroenterology of University of São Paulo School of Medicine, São Paulo, Brazil, and who underwent liver biopsy. The accuracy of each method was determined by a receiver operating characteristic (ROC) curve analysis, and fibrosis was classified as significant fibrosis (≥F2), advanced fibrosis (≥F3), or cirrhosis (F4). The Obuchowski method was also used to determine the diagnostic accuracy of each method at the various stages of fibrosis. In total, 107 FibroScan®, 51 ARFI, 68 ELF, 106 APRI, and 106 FIB-4 analyses were performed. RESULTS: A total of 107 patients were included in the study. The areas under the ROC curve (AUROCs) according to fibrosis degree were as follows: significant fibrosis (≥F2): FibroScan®: 0.83, FIB-4: 0.76, ELF: 0.70, APRI: 0.69, and ARFI: 0.67; advanced fibrosis (≥F3): FibroScan®: 0.85, ELF: 0.82, FIB-4: 0.77, ARFI: 0.74, and APRI: 0.71; and cirrhosis (F4): APRI: 1, FIB-4: 1, FibroScan®: 0.99, ARFI: 0.96, and ELF: 0.94. The accuracies of transient elastography, ARFI, ELF, APRI and FIB-4 determined by the Obuchowski method were F0-F1: 0.81, 0.78, 0.44, 0.72 and 0.67, respectively; F1-F2: 0.73, 0.53, 0.62, 0.60, and 0.68, respectively; F2-F3: 0.70, 0.64, 0.77, 0.60, and 0.67, respectively; and F3-F4: 0.98, 0.96, 0.82, 1, and 1, respectively. CONCLUSION: Transient elastography remained the most effective method for evaluating all degrees of fibrosis. The accuracy of all methodologies was best at F4.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Hepatite C Crônica/diagnóstico por imagem , Cirrose Hepática/diagnóstico por imagem , Análise de Variância , Aspartato Aminotransferases/sangue , Biópsia , Técnicas de Imagem por Elasticidade/métodos , Hepatite C Crônica/sangue , Hepatite C Crônica/patologia , Cirrose Hepática/sangue , Cirrose Hepática/patologia , Fígado/diagnóstico por imagem , Fígado/patologia , Contagem de Plaquetas/métodos , Estudos Prospectivos , Padrões de Referência , Valores de Referência , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Estatísticas não ParamétricasRESUMO
Objetivo: Conhecer a prevalência dos genótipos do vírus da hepatite C, comparando-a com os dados de trabalhos semelhantes realizados no país. Métodos: Estudo observacional descritivo retrospectivo, no qual foi analisado o banco de dados do Laboratório Central de Saúde Pública do Espírito Santo, para verificação de exames realizados no período de dezembro de 2004 a dezembro de 2012. Resultados: Foram analisados 1.649 registros de pacientes anti-HCV positivos submetidos à detecção da quantificação do RNA do vírus da hepatite C e genotipagem. O RNA viral foi detectado em 72,71% dos pacientes analisados. O genótipo mais prevalente foi o 1, com 79,10%, seguido do 3, com 16,70%, do 2, com 3,24% e do 4, com 0,96%. Não tiveram sua genotipagem descrita 151 portadores do vírus. Os subgenótipos mais frequente dentre os examinados foram os tipos 1a e 1b, apresentando, inclusive, um genótipo duplo 2a/2c. Conclusão: Os dados refletiram a situação epidemiológica em relação aos portadores crônicos e prevalência de genótipos.
Objective: To know the prevalence of genotypes of hepatitis C virus, comparing it with data from similar studies conducted in Brazil. Methods: Retrospective descriptive observational study in which we analyzed the database of the Central Public Health Laboratory of the state of Espirito Santo, to check the exams performed from December 2004 to December 2012. Results: The records of 1649 patients who were anti-HCV-positive and underwent HCV RNA detection and genotypingwere analyzed. The viral RNA was detected in 72.71 % of these patients. The most prevalent genotype was genotype 1 with 79.10 %, followed by 16.70% with genotype 3, 3.24 % with genotype 2, and 0.96 % with genotype 4. The genotyping of 151 carriers of the virus was not described. The most common subgenotypes were types 1a and 1b, even with a double 2a/2c genotype. Conclusions: Data reflect the epidemiological situation regarding chronic carriers and prevalence of genotypes.
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Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Genótipo , Hepatite C Crônica/epidemiologia , Prevalência , Estudos RetrospectivosRESUMO
Abstract: Necrolytic acral erythema is a rare skin disease associated with hepatitis C virus infection. We report a case of a 31-year-old woman with hepatitis C virus infection and decreased zinc serum level. Physical examination revealed scaly, lichenified plaques, well-demarcated with an erythematous peripheral rim located on the lower limbs. After blood transfusion and oral zinc supplementation the patient presented an improvement of lesions.
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Humanos , Feminino , Adulto , Hepatite C/complicações , Eritema/etiologia , Dermatoses da Perna/etiologia , Zinco/deficiência , Zinco/uso terapêutico , Hepatite C/patologia , Hepatite C/tratamento farmacológico , Erupções Liquenoides/patologia , Eritema/patologia , Eritema/tratamento farmacológico , Dermatoses da Perna/patologia , Dermatoses da Perna/tratamento farmacológicoRESUMO
Abstract Sarcoidosis is a disease which still has uncertain etiology. Possible environmental causes are cited in the literature, like organic and inorganic particles and infectious agents. Recent studies have demonstrated the occurrence of sarcoidosis in patients with chronic C hepatitis; however, this association remains without statistical or causal evidence. In this report a case of sarcoidosis associated with chronic hepatitis C will be described, with subcutaneous lesions, considered rare, and good response to treatment with colchicine and prednisone. The hepatitis C virus was isolated in sarcoid tissue and the association between the two diseases will be discussed.
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Humanos , Feminino , Pessoa de Meia-Idade , Sarcoidose/tratamento farmacológico , Prednisona/uso terapêutico , Colchicina/uso terapêutico , Hepatite C Crônica/tratamento farmacológico , Glucocorticoides/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Sarcoidose/etiologia , Sarcoidose/patologia , Reação em Cadeia da Polimerase , Resultado do Tratamento , Hepatite C Crônica/complicaçõesRESUMO
A hepatite crônica causada pelo vírus C (VHC) constitui problema relevante de saúde pública no mundo. A infecção associada a esse vírus é considerada causa significativa de cirrose e respectivas complicações: hipertensão portal, descompensação da função hepática e carcinoma hepatocelular. A atividade física é amplamente incentivada no tratamento de diversas doenças crônicas. Entretanto, pouco tem sido pesquisado sobre o efeito da atividade física no curso evolutivo da hepatopatia associada ao VHC. Ainda, sabe-se que indivíduos com hepatite C crônica podem desenvolver outras afecções devido à inatividade física que podem interferir no curso da doença viral. Portanto, o objetivo do presente estudo foi realizar revisão bibliográfica sobre a relação entre atividade física e hepatite C crônica.
Chronic hepatitis caused by hepatitis C virus (HCV) is relevant for the public health problem in the world. The infection associated with this virus is considered a significant cause of cirrhosis and its complications: portal hypertension, decompensation of the liver function and hepatocellular carcinoma. Physical activity is widely encouraged in the treatment of various chronic diseases. However, little has been done on the effect of physical activity on the evolutionary course of the HCV-related liver disease. It is known that individuals with chronic hepatitis C may develop other disorders due to physical inactivity that may interfere in the course of the viral disease. Therefore, the objective of the present study was to conduct a literature review on the relationship between physical activity and chronic hepatitis C.
RESUMO
Ascite quilosa (AQ) é condição rara, sendo caracterizada pelo acúmulo de linfa na cavidade abdominal. Os linfomas constituem-se, em adultos, em sua causa mais frequente; enquanto cirrose e/ou trombose da veia porta são especialmente raras. Este relato apresenta paciente com 36 anos de idade, masculino, com cirrose associada à hepatite C crônica e alcoolismo, emagrecimento de 15 kg e ascite leitosa, com predominância de triglicérides (1.500 mg/dL). Os métodos de imagem identificaram a concomitância de trombose de veia porta e cavernoma. A melhora clínica significativa foi obtida com a administração de nutrição parenteral total associada ao octreotide. A abstinência ao álcool não foi conseguida e houve reaparecimento da AQ e deterioração da condição clínica. O prognóstico da AQ em vigência de cirrose hepática é ruim. O tratamento deve ser individualizado de acordo com a condição clínica subjacente.
Chylous ascites (QA) is a rare condition, being characterized by the accumulation of lymph in the abdominal cavity. In adults, lymphomas constitute its most frequent cause; while cirrhosis and/or thrombosis of the portal vein are especially rare. This report presents a male patient, 36 years old, with chronic hepatitis C-related cirrhosis and alcoholism, 15 kg weight loss, and milky ascites with a predominance of triglycerides (1,500 mg/dL). The imaging methods identified the concomitance of thrombosis of the portal vein and cavernoma. The significant clinical improvement was obtained with the administration of total parenteral nutrition associated with octreotide. Alcohol abstinence was not achieved resulting in QA reappearance and deterioration of the clinical condition. The prognosis of QA in term of liver cirrhosis is bad. The treatment should be individualized according to the underlying clinical condition.
RESUMO
Purpose: To identify the effect of pegylated interferon α-2b and ribavirin treatment in the ocular fundus examination, visual acuity, and visual field. Methods: Prospective observational study was performed at the Hepatology Clinic of São José Regional Hospital and at the Vitreoretinal Department at the Sadalla Amin Ghanem Eye Hospital in patients with chronic hepatitis C before and during treatment with pegylated interferon α-2b together with ribavirin. Results: Six (37.5%) of 16 patients developed retinopathy during the treatment, two of which (12.5%) presented retinal hemorrhage, and four patients (6 eyes) presented cotton-wool spots (25%) that regressed during the treatment. One patient (6.25%) presented transient decrease in visual acuity during the treatment and recovered spontaneously without specific therapy. Conclusion: Recommended treatment methods for hepatitis C may cause transient retinopathy, commonly without any damage to visual function in most patients. Although ocular involvement is rare, follow-up with an ophthalmologist is recommended during the course of the hepatitis C medication. .
Objetivo: Identificar possíveis mudanças no exame de fundo de olho após o início do tratamento, bem como alterações na acuidade visual e campo visual. Métodos: Estudo observacional prospectivo realizado na Clínica de Hepatologia do Hospital Regional de São José e no Departamento de Vítreo e Retina do Hospital de Olhos Sadalla Amin Ghanem, em pacientes com hepatite C crônica antes e durante o tratamento com interferon peguilado α-2b associado à ribavirina. Resultados: Six (37,5%) dos 16 participantes desenvolveram retinopatia durante o tratamento, dois dos quais (12,5%) apresentaram hemorragia retiniana unilateral, e quatro pacientes com exsudatos algodonosos (25%), seis olhos, que regrediu durante o tratamento. Um participante (6,25%) apresentou diminuição transitória da acuidade visual durante o tratamento com recuperação espontaneamente sem tratamento específico. Conclusão: O tratamento recomendado para a hepatite C pode estar associado com o desenvolvimento de retinopatia transitória, geralmente sem dano à função visual na maioria dos pacientes. Embora o envolvimento ocular seja raro, o acompanhamento com o médico oftalmologista é recomendado durante todo o uso da medicação. .
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Antivirais/efeitos adversos , Fundo de Olho , Hepatite C Crônica/tratamento farmacológico , Interferon-alfa/efeitos adversos , Polietilenoglicóis/efeitos adversos , Doenças Retinianas/induzido quimicamente , Ribavirina/efeitos adversos , Angiofluoresceinografia , Estudos Prospectivos , Fatores de Risco , Proteínas Recombinantes/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Acuidade Visual/efeitos dos fármacos , Campos Visuais/efeitos dos fármacosRESUMO
Brazilian Guidelines to HCV treatment (2007) recommended that the first choice treatment for patients with chronic hepatitis C (CHC) and genotype 2 or 3 is interferon alpha (IFN) plus ribavirin (RBV) for 24 weeks. The aim of this study is compare the cost and effectiveness to Hepatitis C treatment in patients with genotype 2 or 3 of peginterferon alpha (PEG) as the first choice of treatment within PEG for those that do not respond to IFN. The target population is CHC patients with genotype 2 or 3 in Brazil. The interventions are: PEG-SEC (first IFN plus RBV for 24 weeks, after, for non-responders and relapsers subsequently PEG plus RBV for 48 weeks); PEG-FIRST24 (PEG+RBV for 24 weeks). The type of the study is cost-effectiveness analysis. The data sources are: Effectiveness data from meta-analysis conducted on the Brazilian population. Treatment cost from Brazilian micro costing study is converted into USD (2010). The perspective is the Public Health System. The outcome measurements are Sustained Viral Response (SVR) and costs. PEG-FIRST24 (SVR: 87.8%, costs: USD 8,338.27) was more effective and more costly than PEG-SEC (SVR: 79.2%, costs: USD 5,852.99). The sensitivity analyses are: When SVR rates with IFN was less than 30% PEG-FIRST is dominant. On the other hand, when SVR with IFN was more then 75% PEG-SEC is dominant (SVR=88.2% and costs USD $ 3,753.00). PEG-SEC is also dominant when SVR to PEG24 weeks was less than 54%. In the Brazilian context, PEG-FIRST is more effective and more expensive than PEG-SEC. PEG-SEC could be dominant when rates of IFN therapy are higher than 75% or rates of PEG24 therapy are lower than 54%.
O protocolo brasileiro de tratamento da Hepatite C (2007) recomendava como primeira escolha para pacientes com hepatite C crônica e portadores de genótipo 2 ou 3 o tratamento com interferona alfa (IFN) associada à ribavirina (RBV), por 24 semanas. O objetivo deste estudo é comparar o custo e a efetividade para pacientes com hepatite C crônica e portadores do genótipo 2 ou 3 o uso de peguinterferon (PEG) como primeiro escolha com o PEG como secunda escolha para aqueles que não responderam ao tratamento com IFN. A população alvo compreende pacientes com hepatite C crônica portadores de genótipo 2 ou 3 no Brasil. As intervenções são: PEG-SEC (IFN + RBV por 24 semanas, para os não respondedores e recidivantes tratamento subsequente com PEG + RBV por 48 semanas; PEG-FIRST24 (PEG + RBV por 24 semanas). O tipo de estudo envolvido é Análise de Custo Efetividade. Os dados de efetividade são provenientes de um metanálise de estudos brasileiros e os dados de custo do tratamento de um estudo de custo do contexto brasileiro. A perspectiva é o Sistema Público de Saúde. Os desfechos avaliados foram Resposta Viral Sustentada (RVS) e Custos. PEG-FIRST24 (RVS: 87,8%, costs: USD 8.338,27) foi mais efetivo e apresentou maior custo que PEG-SEC (RVS: 79,2%, custo USD 5.852,99). A análise de sensibilidade demonstrou que PEG-SEC é dominado por PEG-FIRST24 quando RVS com IFN for menor que 30%. Por outro lado, quando RVS com IFN for maior que 75% PEG-SEC é dominante (RVS=88.2% e custo USD $ 3.753,00). PEG-SEC é também dominante quando RVS para PEG24 for menor que 54%. Conclusão: No contexto brasileiro, PEG-FIRST é mais efetivo e mais custoso que PEG-SEC. PEG-SEC poderia ser dominante quando as taxas de RVS do tratamento com IFN forem superiores a 75% ou as taxas de PEG24 forem inferiores a 54%.
Assuntos
Terapêutica/economia , Análise Custo-Benefício/estatística & dados numéricos , Hepatite C Crônica/classificação , Genótipo , Custos e Análise de Custo/classificação , Fator Regulador 2 de Interferon/classificação , Fator Regulador 3 de InterferonRESUMO
Urticarial vasculitis is a rare clinicopathologic entity characterized by urticarial lesions that persist for more than 24 hours and histologic features of leukocytoclastic vasculitis. Patients can be divided into normocomplementemic or hypocomplementemic. The authors report the case of a healthy 49-year-old woman with a 1-year history of highly pruritic generalized cutaneous lesions and finger clubbing. Laboratory tests together with histopathologic examination allowed the diagnosis of hypocomplementemic urticarial vasculitis, chronic hepatitis C and type II mixed cryoglobulinemia. The patient started symptomatic treatment and was referred to a gastroenterologist for management of the hepatitis C, with progressive improvement of the skin condition. The development of hypocomplementemic urticarial vasculitis in the context of chronic hepatitis C is exceedingly rare and possible pathogenic mechanisms are discussed.
A vasculite urticariforme é uma entidade clinico-patológica rara caracterizada por lesões urticariformes com duração superior a 24 horas e uma vasculite leucocitoclásica na histologia. É dividida em normo e hipocomplementêmica. Os autores relatam o caso de uma mulher saudável de 49 anos, com lesões cutâneas intensamente pruriginosas e baqueteamento digital com 1 ano de evolução. O estudo efectuado permitiu efectuar os diagnósticos de vasculite urticariforme hipocomplementêmica, hepatite C crônica e crioglobulinêmia mista tipo II. A doente iniciou tratamento sintomático e foi referenciada para a Gastroenterologia para orientação da hepatite, com melhoria progressiva das lesões cutâneas. O desenvolvimento de vasculite urticariforme hipocomplementêmica no contexto de hepatite C crónica é raro e os possíveis mecanismos patogênicos são discutidos.