Predictors of HBeAg status and hepatitis B viraemia in HIV-infected patients with chronic hepatitis B in the HAART era in Brazil

<p>Abstract</p> <p>Background</p> <p>HBV-HIV co-infection is associated with an increased liver-related morbidity and mortality. However, little is known about the natural history of chronic hepatitis B in HIV-infected individuals under highly active antiretroviral therapy (HAART) receiving at least one of the two drugs that also affect HBV (TDF and LAM). Information about HBeAg status and HBV viremia in HIV/HBV co-infected patients is scarce. The objective of this study was to search for clinical and virological variables associated with HBeAg status and HBV viremia in patients of an HIV/HBV co-infected cohort.</p> <p>Methods</p> <p>A retrospective cross-sectional study was performed, of HBsAg-positive HIV-infected patients in treatment between 1994 and 2007 in two AIDS outpatient clinics located in the São Paulo metropolitan area, Brazil. The baseline data were age, sex, CD4 T+ cell count, ALT level, HIV and HBV viral load, HBV genotype, and duration of antiretroviral use. The variables associated to HBeAg status and HBV viremia were assessed using logistic regression.</p> <p>Results</p> <p>A total of 86 HBsAg patients were included in the study. Of these, 48 (56%) were using combination therapy that included lamivudine (LAM) and tenofovir (TDF), 31 (36%) were using LAM monotherapy, and 7 patients had no previous use of either one. Duration of use of TDF and LAM varied from 4 to 21 and 7 to 144 months, respectively. A total of 42 (48. 9%) patients were HBeAg positive and 44 (51. 1%) were HBeAg negative. The multivariate analysis revealed that the use of TDF for longer than 12 months was associated with undetectable HBV DNA viral load (serum HBV DNA level < 60 UI/ml) (<it>p </it>= 0. 047). HBeAg positivity was associated with HBV DNA > 60 UI/ml (p = 0. 001) and ALT levels above normality (<it>p </it>= 0. 038).</p> <p>Conclusion</p> <p>Prolonged use of TDF containing HAART is associated with undetectable HBV DNA viral load. HBeAg positivity is associated with HBV viremia and increased ALT levels.</p

Prevalence of intestinal nematodes in alcoholic patients

We report the results of a retrospective study on the frequency of intestinal nematodes among 198 alcoholic and 440 nonalcoholic patients at the University Hospital Cassiano Antonio Moraes in Vitória, ES, Brazil. The control sample included 194 nonalcoholic patients matched according to age, sex and neighborhood and a random sample of 296 adults admitted at the same hospital. Stool examination by sedimentation method (three samples) was performed in all patients. There was a significantly higher frequency of intestinal nematodes in alcoholics than in controls (35.3% and 19.2%, respectively), due to a higher frequency of Strongyloides stercoralis (21.7% and 4.1%, respectively). Disregarding this parasite, the frequency of the other nematodes was similar in both groups. The higher frequency of S. stercoralis infection in alcoholics could be explained by immune modulation and/or by some alteration in corticosteroid metabolism induced by chronic ethanol ingestion. Corticosteroid metabolites would mimic the worm ecdisteroids, that would in turn increase the fecundity of females in duodenum and survival of larvae. Consequently, the higher frequency of Strongyloides larvae in stool of alcoholics does not necessarily reflect an increased frequency of infection rate, but only an increased chance to present a positive stool examination using sedimentation methods

Prevalence of anti-hepatits A antibodies in children of different socioeconomic conditions in Vila Velha, ES

This report describes the prevalence of anti-HAV antibodies in children from elementary school in the Municipality of Vila Velha, ES, Brazil. Anti-HAV antibodies were investigated by ELISA method in the serum of 606 children (four to fourteen years old) from three elementary schools, located in neighborhoods with varying household monthly income levels: São José School, 200 chidren, household income higher than US$700; São Torquato School, 273 children, US$200 to 300; and Cobi School, 133 children, less than US$200. From each children data on age, gender, skin color, sanitary conditions, frequency of contact with sea or river water and family history of hepatitis were recorded. Anti-HAV antibodies were present in 38.6% of all children, 9% in São José School, 49.1% in São Torquato School and 61.7% in Cobi School. Logistic regression analysis demonstrated a positive correlation of positive anti-HAV test with age, non white color of the skin, absence of sewage treatment and domestic water filter, and a past history of hepatitis. The prevalence of anti-HAV antibodies in school children in Vila Velha, ES, was lower than that observed in the same age group in North and Northeast Brazil and was significantly higher in children from families with low socioeconomic status. In addition the results indicate a changing epidemiologic pattern of hepatitis A in our country, with an increasing number of children and adolescents with high risk for HAV infection, mainly in high socioeconomic class. A consideration must be given to the feasibility of vaccination programs for children and adolescents in our country

Pancreatite crônica: resultados do tratamento cirúrgico em 74 pacientes

OBJETIVO: Analisar as indicações, técnicas e resultados do tratamento cirúrgico de 74 pacientes operados por complicações da pancreatite crônica. MÉTODO: Foram pacientes consecutivos, estudados prospectivamente pelo preenchimento de um protocolo individual, no período de 1971 a 2000. Foram realizadas cirurgias de derivação e ressecção. O acompanhamento foi feito pelo agendamento de consultas no ambulatório, por convocação por cartas e telefonemas. RESULTADOS: Dos 270 pacientes com pancreatite crônica, acompanhados pelo Serviço, 74 (27,4%) foram operados. Destes 74 pacientes, 97,7% eram do sexo masculino e a idade variou de 15 a 63 anos, com média de 39,4 anos para alcoolistas e 33,1 para aqueles com outras etiologias. O alcoolismo foi a causa da doença em 68 pacientes (90,5%) e os outros casos estiveram relacionados a hiperparatiroidismo(1), pancreatite hereditária (1), fibrose retroperitoneal (1) e em três casos a etiologia não foi definida. As seguintes causas únicas ou associadas definiram a indicação cirúrgica:1. dor em 44,6% dos pacientes; 2. compressão de vias biliares em 28,4%; 3. pseudocistos em 12,2%; 4. fístulas internas em 10,8%. Cinqüenta pacientes (67,5%) foram submetidos a operações de derivação e 24 (32,5%) a cirurgias de ressecção. Oito pacientes derivados (16,0%) complicaram, ocorrendo três óbitos; dez ressecados (41,6%) complicaram, com cinco óbitos. Os óbitos estiveram relacionados a abscessos, às deiscências e às hemorragias cirúrgicas. CONCLUSÕES: As cirurgias de derivação mostraram-se mais seguras e as complicações que evoluíram com infecção foram as mais graves e ocorreram com mais freqüência nas ressecções

Consumo, digestibilidade total e desempenho de novilhos Nelore recebendo dietas contendo diferentes proporções de silagens de Brachiaria brizantha cv. Marandu e de sorgo Intake, apparent total tract digestibility and production of Nellore steers fed diets containing different proportions of Brachiaria brizantha cv. Marandu and sorghum silages

Avaliaram-se o consumo e a digestibilidade total dos nutrientes e o desempenho de novilhos Nelore recebendo dietas contendo silagens de capim-braquiarão e de sorgo como fonte de volumoso nas proporções de 100:0, 67:33, 33:67 e 0:100, com base na matéria seca. Foram utilizados 24 novilhos Nelore, castrados, com peso médio inicial de 380 kg, distribuídos em um delineamento em blocos casualizados, com seis repetições, recebendo 60% de volumoso e 40% de concentrado, com base na matéria seca. O ensaio teve duração de 78 dias - 15 dias de adaptação seguidos de três períodos de 21 dias. Os consumos médios de matéria seca (MS), matéria orgânica (MO), proteína bruta (PB), extrato etéreo (EE), carboidratos não-fibrosos (CNF) e nutrientes digestíveis totais (NDT), assim como a taxa de passagem, aumentaram linearmente com o incremento da silagem de sorgo nas dietas. Tendência semelhante foi observada para o ganho de peso médio diário, estimando-se acréscimos de 0,00313 kg/unidade de silagem de sorgo adicionada. As digestibilidades totais de MS, MO, PB e fibra em detergente neutro (FDN) também apresentaram comportamento linear crescente com o incremento dos níveis de silagem de sorgo. Contudo, as digestibilidades aparentes do EE e dos CNF não foram influenciadas pelas dietas, registrando-se, respectivamente, valores médios de 80,1 e 89,5%. A associação de 67% de silagem de sorgo e 33% de silagem de capim-braquiarão consistiu em como boa alternativa de volumoso para a alimentação de novilhos Nelore, uma vez que promoveu consumo e ganho de peso próximos aos observados para a dieta contendo apenas silagem de sorgo.<br>The objective of this trial was to study intake, apparent total tract digestibility, and production of Nellore steers fed diets containing the following ratios of Brachiaria brizantha and sorghum silages: 100:0, 67:33, 33:67, and 0:100 on dry matter (DM) basis. Twenty-four castrated steers averaging 380 kg at the beginning of the trial and receiving a forage:concentrate ratio of 60:40 (DM basis) were used in a randomized complete block design (six replicates per treatment). The experiment lasted 78 days with three 21-days periods and 15 days for diet adaptation. The average intakes of DM, organic matter (OM), crude protein (CP), ether extract (EE), non-fiber carbohydrates (NFC), and total digestible nutrients (TDN) as well as passage rate all increased linearly with the increment of sorghum silage in the diet. Similarly, average body weight gain increased 0.00313 kg per unit of sorghum silage included in the diet. Apparent total tract digestibilities of DM, OM, CP, and neutral detergent fiber (NDF) also increased linearly when sorghum silage replaced Brachiaria brizantha silage in the diet whereas those of EE and NFC did not change significantly averaging 80.1 and 89.5%, respectively. It can be concluded that a Brachiaria brizantha:sorghum silages ratio of 67:33 can be fed to Nellore steers because it resulted in similar intake and body weight gain compared to the diet containing only sorghum silage