Hepatite B crônica e a superinfecção por vírus D em pacientes na Amazônia Ocidental brasileira

Background and Objectives: Once Hepatitis B is a global public health problem, and the disease, when associated with Hepatitis D develops a severe clinical patterns. This study aims to approach this correlation between both hepatitis viruses. In Brazil, HBV and HDV infections have elevated indicators in the western Amazon, where usually is reported clinical severe manifestations of the disease, and also death from fulminant infection. The objective was to compare clinical, biochemical and serological aspects of patients infected by HBV with those patients superinfected by HDV. Method: Descriptive study based on secondary data from medical records of 208 patients. These patients were divided into two (2) groups (HBV and HBV+HDV), followed in Hepatology Clinic from Sanitary Dermatology Hospital in Cruzeiro do Sul city, Acre state, a regional reference healthcenter. Results: 42.8% - of the 208 records analyzed - have presented HBV infection, and 57.2% were diagnosed with coinfection, ie. HBV+HDV, associated hepatitis viruses infection. Both patients group were predominantly male (67.4% = HBV, and 67.2% = HBV+HDV), aged between 12 and 31 years old. Regarding the analysis of clinical, serological, biochemical and hematological, an overview have showed that, the group with associated HBV+HDV infection presented a poorer prognosis compared to the group with HBV monoinfection. Conclusion: It is possible to assert that superinfection by HDV, in the western Brazilian Amazon, is a serious health problem. It is necessary to carry out studies, especially with clinical approach, concerning chronically ill patients. KEYWORDS: hepatitis B. hepatitis D. gastroenterology.Justificativa e objetivos: a hepatite B representa um problema de saúde pública de proporção mundial, sendo que a doença, quando associada à infecção por vírus D, desenvolve padrões clínicos severos. No Brasil, as infecções por vírus B (VHB) e D (VHD) apresentam indicadores elevados na região da Amazônia ocidental, onde são comuns os relatos de quadros graves da doença e mortes por hepatite fulminante. Os objetivos do presente estudo foram correlacionar aspectos clínicos, bioquímicos e sorológicos entre pacientes com infecção por VHB e aqueles superinfectados por VHD. Método: estudo descritivo com informações provenientes de fonte de dados secundários registrados em 208 prontuários de pacientes, divididos em grupos (VHB e VHB+VHD), acompanhados no ambulatório de hepatologia do Hospital de Dermatologia Sanitária na cidade de Cruzeiro do Sul, Acre, centro de referência da regional. Resultados: dos 208 prontuários analisados, 42,8% apresentaram infecção por VHB e 57,2% apresentaram diagnóstico de VHB associada ao VHD. Para ambos os grupos houve predominância do sexo masculino (VHB = 67,4% e VHB+VHD = 67,2%), com faixa etária entre 12 e 31 anos. Quanto à análise dos aspectos clínicos, sorológicos, bioquímicos e hematológicos, de modo geral, o grupo com infecção associada ao vírus D apresentou pior prognóstico frente ao grupo com monoinfecção por vírus B. Conclusão: a superinfecção por vírus D na Amazônia ocidental brasileira representa um grave problema de saúde, sendo necessários novos estudos, principalmente com abordagem clínica, com relação aos pacientes cronicamente afetados pela doença. DESCRITORES: Hepatite B. Hepatite D. Gastroenterologia

Chronic hepatitis B and D: prognosis according to Child-Pugh score

ABSTRACT Objective: compare chronic hepatitis B patients to those superinfected with hepatitis D virus, according to Child-Pugh score regarding disease severity. Method: retrospective descriptive study, performed with 59 patients followed in the ambulatory, of which 22 (37.3%) were chronically infected with hepatitis B virus (Group HBV) and 37 (62.7%) superinfected with Delta virus (Group HBV+HDV); variables of sex, age and items of Child-Pugh score were collected by consulting medical records. Results: out of the patients, 57.6% were male, with a mean age of 30.5 years. Score A, which indicates lesser severity, was found in 100% of group HBV and 78.4% of group HBV+HDV. Score B, which indicates greater severity, was found only in group HBV+HDV in 21.6% of the patients. Conclusion: by means of the Child-Pugh score, it was observed that patients with superinfection by HDV tended to present a worse prognosis