VHC e HTLV-I: aspectos clínicos e epidemiológicos da co-infecção

The hepatitis C virus (HCV), which infects 3% of the world population, about 170 million people, and the HTLV-I virus (human T-cell lymphotropic virus I), responsible for endemic infections in various regions of the world, are highly prevalent in the Northeast of Brazil. The co-infection by both viruses, HLTV and HCV, has not been well understood as far as clinical and epidemiologic aspects are concerned. Physicians from this region urge to understand it better because of the wide epidemiological impact of those viruses in Bahia State. There is great knowledge about each virus individually, however the infection consequences have been poorly examined up to the moment. Because of their characteristics, which infect the immune system cells, and the fact that they result in different modulations of the host immune response, a natural alteration of the evolution process is expected when both viruses are present. Through a systematic review of scientific papers, meaningful data concerning the co-infection HCV/HTLV-I as well as the information about its effects on the host were collected for this analysis. Due to the few numbers of published papers or books related to that subject, this researcher has come to the conclusion that there is still a great gap to be fulfilled in this area. Thus, this paper aims at providing the physicians with some useful bibliographic review about the recent progress concerning this co-infection in order to contribute towards the understanding of its impact on patients’ lives.O vírus da hepatite C (VHC), que infecta cerca de 3% da população mundial, o que equivale aproximadamente a 170 milhões de pessoas, e o human T-cell lymphotropic virus-I (HTLV-I), responsável por infecção endêmica em diversas regiões do mundo, são entidades que possuem uma alta prevalência em nosso meio. A co-infecção pelos dois vírus ainda é muito pouco entendida nos seus aspectos clínicos e epidemiológicos. É de especial importância o seu conhecimento por médicos baianos, uma vez que o Estado da Bahia é um dos possíveis locais em que a co-infecção tem impacto epidemiológico importante. Existe um grande conhecimento acerca de cada vírus individualmente, porém as repercussões da co-infecção têm sido muito pouco estudadas. Por suas características de infectarem células do sistema imune e levarem a diferentes modulações na resposta imunológica do organismo, esperam-se alterações na evolução natural da infecção por estes dois vírus. Através da revisão sistemática de publicações, procurou-se levantar dados sobre a co-infecção VHC/HTLV-I e seus efeitos sobre o organismo. Devido à escassez de trabalhos publicados acerca deste tema, concluiu-se que há uma grande lacuna de conhecimento a ser explorada. Dessa forma, objetiva-se uma revisão bibliográfica útil ao médico clínico sobre o recente avanço do conhecimento da co-infecção, a fim de colaborar para o entendimento do impacto na vida de pacientes infectados por esses dois vírus

Quality of life, work ability and oral health among patients with chronic liver diseases

This study aimed to explore the associations between health-related quality of life and work ability with the oral health status of patients with chronic liver disease. A cross-sectional study included 150 patients with chronic liver disease, consecutively seen at University Hospital, Salvador, Brazil. Oral health was evaluated by the Decayed, Missing, and Filled Teeth (DMFT) index and by the presence of gingivitis and periodontitis. Salivary flow was ?reduced? when <1.0 mL/min. Health-related quality of life was evaluated by using the 36-Item Short Form Health Survey questionnaire (SF-36); work ability was evaluated by the Work Ability Index questionnaire. All health-related quality of life indicators were systematically lower among the 99 patients with reduced salivary flow than among the 51 patients with normal salivary flow. Physical Functioning, Role-Physical, and Physical Component Summary scores were strongly correlated (P< 0.005 or less) with the number of Missing Teeth and with DMFT index. Reduced salivary flow was associated (P< 0.05) with poor work ability. Patients with poor or moderate work ability presented higher (P< 0.001) means of the DMFT index than those with good or excellent work ability. Patients with chronic liver disease who present poor oral health presented low health-related quality of life and poor work ability. These findings reinforce the need of these patients for specialized stomatological care

Integrable semi-discretization of the massive Thirring system in laboratory coordinates

Several integrable semi-discretizations are known in the literature for the massive Thirring system in characteristic coordinates. We present for the first time an integrable semi-discretization of the massive Thirring system in laboratory coordinates. Our approach relies on the relation between the continuous massive Thirring system and the Ablowitz-Ladik lattice. The Backlund transformation for solutions to the Ablowitz-Ladik lattice and the time evolution of the massive Thirring system in laboratory coordinates are combined together in the derivation of the Lax system for the integrable semi-discretization of the massive Thirring system.Comment: 10 pages, 0 figure

Drug induced liver damage in a universitary hospital

Background: Drug Induced Liver Injury (DILI) is responsible for wide spectrum of liver injury. Clinically, these events are presented in various forms and for reaching a different diagnosis other injury causes must be excluded. Aim: Identify and characterize cases of hepatotoxicity induced by drugs, herbal and dietary supplements in University Hospital in Brazil. Material and Methods: Observational and retrospective study. Was collected in records of University Hospital, between August 2009 at August 2014. The causality of the drug reactions suspected were evaluated Council for International Organizations of Medical Sciences (CIOMS). Results: We selected 30 suspected cases, 50% was female and average was 39 years. The therapeutic classes most common was: anti-infectives; antineoplastic agents; central nervous system drugs, anabolic steroid and herbal and dietary supplements (HDS). Cholestatic or mixed injury was observed in 73% these cases; 60% were highly probable, according to CIOMS.  Conclusion: DILI is caused by a wide variety of drugs, dietary supplements and dietary supplements. Anti-infectives and chemotherapy were responsible for much of the respons

Lack of association of indoleamine 2,3-dioxygenase polymorphisms with interferon-alpha-related depression in hepatitis C

Background: Major depression is a frequent adverse effect of interferon-alpha (IFN-alpha) therapy. Although the indoleamine 2,3-dioxygenase (IDO) enzyme seems to be involved in the pathophysiology of IFN-alpha-induced depression, no pharmacogenetic study has investigated Whether variation in the IDO gene modifies vulnerability to this adverse effect.Methods: A cross-sectional study assessing 277 hepatitis C patients recruited in two specialized outpatient clinics of Brazil. They were interviewed with the Mini International Neuropsychiatric Interview (MINI) approximately 1 month after the end of IFN-alpha plus ribavirin therapy. Genomic DNA of individuals was extracted from venous blood. Three IDO single-nucleotide polymorphisms (SNPs) were genotyped (rs3824259; rs10089084 and rs35099072).Results: MINI indicated that 21.3% of the sample met criteria for a major depressive episode during the course of IFN-alpha therapy. No association with the diagnosis of a major depressive episode during the course of IFN-alpha therapy was observed genotype or allele-wise (p > 0.05). Current major depression and/or current anxiety disorder was significantly associated with IFN-alpha-related depression (p 0.05).Conclusions: Our results suggest no influence of the variants in the IDO gene and the diagnosis of interferon-alpha-related depression in the Brazilian population. Interferon-alpha-related depression may impose persistent psychopathology on at least 15% of the depressed patients even 2 years after antiviral therapy termination. the cross-sectional design is a limitation of our study, predisposing memory bias. Prospective pharmacogenetic studies are warranted to continue investigation of the impact of IDO polymorphisms on the development of IFN-alpha-induced depression. (C) 2011 Elsevier Inc. All rights reserved.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ Fed Bahia, Sch Med, Dept Neurosci & Mental Hlth, BR-41170290 Salvador, BA, BrazilUniv Fed Bahia, Univ Hosp, Psychiat Serv, BR-41170290 Salvador, BA, BrazilUniversidade Federal de São Paulo, Sch Med, Dept Psychiat, São Paulo, BrazilUniversidade Federal de São Paulo, Sch Med, LiNC, São Paulo, BrazilUniversidade Federal de São Paulo, Sch Med, Inst Psychiat, São Paulo, BrazilUniversidade Federal de São Paulo, Sch Med, Dept Psychobiol, São Paulo, BrazilUniv Fed Bahia, Sch Med, Dept Gastroenterol, BR-41170290 Salvador, BA, BrazilUniversidade Federal de São Paulo, Sch Med, Hepatitis Unit, São Paulo, BrazilUniversidade Federal de São Paulo, Sch Med, Hosp São Paulo, São Paulo, BrazilHarvard Univ, Sch Publ Hlth, Dept Soc Human Dev & Hlth, Cambridge, MA 02138 USAUniversidade Federal de São Paulo, Sch Med, Dept Psychiat, São Paulo, BrazilUniversidade Federal de São Paulo, Sch Med, LiNC, São Paulo, BrazilUniversidade Federal de São Paulo, Sch Med, Inst Psychiat, São Paulo, BrazilUniversidade Federal de São Paulo, Sch Med, Dept Psychobiol, São Paulo, BrazilUniversidade Federal de São Paulo, Sch Med, Hepatitis Unit, São Paulo, BrazilUniversidade Federal de São Paulo, Sch Med, Hosp São Paulo, São Paulo, BrazilCNPq: 471592/2008-0CNPq: 142262/2008-0Web of Scienc

Telaprevir twice daily is noninferior to telaprevir every 8 hours for patients with chronic hepatitis C.

Background & Aims We performed an open-label, multicenter, phase 3 study of the safety and efficacy of twice-daily telaprevir in treatment-naive patients with chronic hepatitis C virus (HCV) genotype 1 infection, including those with cirrhosis. Methods Patients were randomly assigned to groups treated with telaprevir 1125 mg twice daily or 750 mg every 8 hours plus peginterferon alfa-2a and ribavirin for 12 weeks; patients were then treated with peginterferon alfa-2a and ribavirin alone for 12 weeks if their level of HCV RNA at week 4 was <25 IU/mL or for 36 weeks if their level was higher. The primary objective was to demonstrate noninferiority of telaprevir twice daily versus every 8 hours in producing a sustained virological response 12 weeks after the end of therapy (SVR12) (based on a -11% lower limit of the 95% lower confidence interval for the difference between groups). Results At baseline, of 740 patients, 85% had levels of HCV RNA ≥800,000 IU/mL, 28% had fibrosis (F3-F4), 14% had cirrhosis (F4), 57% were infected with HCV genotype 1a, and 71% had the non-CC IL28B genotype. Of patients who were treated with telaprevir twice daily, 74.3% achieved SVR12 compared with 72.8% of patients who were treated with telaprevir every 8 hours (difference in response, 1.5%; 95% confidence interval, -4.9% to 12.0%), so telaprevir twice daily is noninferior to telaprevir every 8 hours. All subgroups of patients who were treated with telaprevir twice daily versus those who were treated every 8 hours had similar rates of SVR12. The most frequent adverse events (AEs) in the telaprevir phase were fatigue (47%), pruritus (43%), anemia (42%), nausea (37%), rash (35%), and headache (26%); serious AEs were reported in 9% of patients. Rates of AEs and serious AEs were similar or slightly higher among patients treated with telaprevir every 8 hours. Conclusions Based on a phase 3 trial, telaprevir twice daily is noninferior to every 8 hours in producing SVR12, with similar levels of safety and tolerability. These results support use of telaprevir twice daily in patients with chronic HCV genotype 1 infection, including those with cirrhosis. ClinicalTrials.gov, Number: NCT0124176

Peginterferon alfa-2a (40KD) (PEGASYS®) plus ribavirin (COPEGUS®) in retreatment of chronic hepatitis C patients, nonresponders and relapsers to previous conventional interferon plus ribavirin therapy

Peginterferon alfa plus ribavirin is currently the treatment of choice for chronic hepatitis C. Peginterferon alfa-2a (40KD) plus ribavirin has given an overall sustained virological response of 18% in F3/F4 previous nonresponder US patients. We evaluated the effectiveness of peginterferon alfa-2a (40KD) plus ribavirin in Brazilian patients who were relapsers or nonresponders to previous interferon-based therapy. One-hundred-thirty-four patients with biopsy-proven chronic hepatitis C, HCV RNA positive, elevated ALT and who were either relapsers (n=37) or nonresponders (n=97) to at least 24 weeks of conventional interferon/ribavirin therapy were retreated with peginterferon alfa-2a (40KD) 180mg/qw and ribavirin 800mg bid for 48 weeks. Efficacy was assessed as virological response (defined as undetectable HCV RNA) at the end of treatment (EoT) and at the end of follow-up (SVR - Sustained Virological Response). Safety assessments consisted of clinical and laboratory evaluations. In the patient sample, 72% were genotype 1 and 34% were cirrhotic. In an intention-to-treat analysis, relapser patients showed 78% EoT response and 51% SVR. Nonresponders showed 57% EoT response and 26% SVR. Positive predictive factors of SVR were non-1 genotype and relapser state. Six percent of the patients interrupted treatment because of adverse events and 45% had dose reduction (mainly associated with leucopenia and anemia). Brazilian patient relapsers and nonresponders to conventional interferon and ribavirin treatment can achieve a sustained virological response when retreated with peginterferon alfa-2a (40KD) and ribavirin. The safety profile is similar to that of naive patients.Federal University of São PauloSanta Casa de Misericórdia Gastroenterology ServiceFederal University of ParáFederal University of Juiz de ForaSão Paulo University Medical School of Ribeirão PretoEmílio Ribas InstituteFederal University of Minas GeraisMedical School of São José do Rio PretoFederal University of AlagoasFederal University of Santa CatarinaFederal University of BahiaTropical Medicine FundationOswaldo Cruz HospitalFederal University of ParaíbaRocheUNIFESPSciEL

Seroepidemiology of hepatitis B in individuals born between1945-1985 on a brazilian regional metropolis

 Background: hepatitis B prevalence can be influenced by social/cultural behavior and the Baby Boomer (BB) generation(1945-1964) may have been more susceptible to this infection. Objectives: We investigated the seroprevalence of markers for HBV infection and vaccination and its association with main risk factors. Methodology: a random sample of individuals aged 30-70 years old in a public clinical laboratory from a metropolitan area of Bahia/Brazil were tested for HBsAg/Total Anti-HBc/Anti-HBs/Anti-HBc-IgM and a socio-demographic questionnaire was applied. Results: of the650 participants, 349 were 51-70 yo (BB) and 301 were non-BB. The prevalences were HBsAg (2.3%), Total Anti-HBc (17.1%) and Anti-HBs (27.4%). Anti-HBcIgM (2.7%) was performed in 112 participants sera who had contact/infection with HBV. The laboratory profiles were characterized as susceptibility (68%), vaccine response (14.8%) and contact/infection with HBV (17.2%). BB participants were more susceptible and less vaccinated than non-BB. The higher frequency of contact/infection status was observed in the BB generation. Statistically significant differences were found for the contact/infection status in males(50,9%) illicit drug use (11,6%), syringe/needle sharing (7,1%), and blood transfusion (10,7%). Non-BB with contact/ infection profile reported more tattoo/piercing and BB reported higher use of glass syringes. Conclusion: the majority of the study population was susceptible to infection but participants older than 50 years showed both, a higher frequency of this profile and also a higher frequency of contact/infection status, thus suggesting the need for greater health care attention for this age group

Hepatitis C Virus Infection as a Traumatic Experience

Objective The purpose of this study was to evaluate whether individuals consider their HCV infection to be a potentially traumatic experience. Additionally, we investigated its association with Post-Traumatic Stress Disorder (PTSD) and the impact of PTSD diagnosis on health-related quality of life (HRQoL) in HCV infected subjects. Methods We conducted a cross-sectional survey of 127 HCV-infected outpatients recruited at a University Hospital in Salvador, Brazil. All subjects answered an orally-administered questionnaire to gather clinical and socio-demographic data. We investigated traumatic experiences and the subject's perception of the disease using the Trauma History Questionnaire. PTSD and other psychiatric diagnoses were assessed through the Mini International Neuropsychiatric Interview-Brazilian Version 5.0.0 (M.I.N.I. PLUS). HRQoL was assessed using Short-Form 36 (SF-36). Results Approximately 38.6% of the patients considered hepatitis C to be a traumatic experience. Of these, 60.7% had a PTSD diagnosis. PTSD was associated with significant impairment in quality of life for individuals in seven SF-36 domains as shown bymultivariate analysis: Role-Physical (β: −24.85; 95% CI: −42.08; −7.61), Bodily Pain (β: −19.36; 95% CI: −31.28; −7.45), General Health (β: −20.79; 95% CI: −29.65; −11.92), Vitality (β: −11.92; 95% CI: −20.74; −3.1), Social Functioning (β: −34.73; 95% CI: −46.79; −22.68), Role-Emotional (β: −26.07; 95% CI: −44.61; −7.53), Mental Health (β: −17.46; 95% CI: −24.38; −10.54). Conclusion HCV is frequently a traumatic experience and it is strongly associated with PTSD diagnosis. PTSD significantly impaired HRQoL