Risk Factors for Infection with Different Hepatitis C Virus Genotypes in Southern Brazil

Objectives. To investigate the proportion of different genotypes in countryside microregions in southern Brazil, and their association with risk factors. Methods. Cross-sectional study including a convenience sample of patients who tested positive for HCV-RNA and were referred to a regional health center for genotyping, from December 2003 to January 2008. Data were obtained through the National Disease Surveillance Data System, from laboratory registers and from patient charts. Identification of genotypes was carried out using the Restriction Fragment Length Polymorphism “in house” technique. Independent associations with genotypes were evaluated in multinomial logistic regression and prevalence rates of genotypes were estimated with modified Poisson regression. Results. The sample consisted of 441 individuals, 41.1 ± 12.0 years old, 56.5% men. Genotype 1 was observed in 41.5% (95% CI 37.9–48.1) of patients, genotype 2 in 19.3% (95% CI 15.0–23.6), and genotype 3 in 39.2% (95% CI 35.6–43.0). HCV genotype was significantly associated with gender and age. Dental procedures were associated with higher proportion of genotype 2 independently of age, education, and patient treatment center. Conclusions. The hepatitis C virus genotype 1 was the most frequent. Genotype 2 was associated with female gender, age, and dental procedure exposition

Risk factors for infection with different hepatitis C virus genotypes in southern Brazil

Objectives. To investigate the proportion of different genotypes in countryside microregions in southern Brazil, and their association with risk factors. Methods. Cross-sectional study including a convenience sample of patients who tested positive for HCV-RNA and were referred to a regional health center for genotyping, from December 2003 to January 2008. Data were obtained through the National Disease Surveillance Data System, from laboratory registers and from patient charts. Identification of genotypes was carried out using the Restriction Fragment Length Polymorphism “in house” technique. Independent associations with genotypes were evaluated in multinomial logistic regression and prevalence rates of genotypes were estimated with modified Poisson regression. Results. The sample consisted of 441 individuals, 41.1 ± 12.0 years old, 56.5% men. Genotype 1 was observed in 41.5% (95% CI 37.9–48.1) of patients, genotype 2 in 19.3% (95% CI 15.0–23.6), and genotype 3 in 39.2% (95% CI 35.6–43.0). HCV genotype was significantly associated with gender and age. Dental procedures were associated with higher proportion of genotype 2 independently of age, education, and patient treatment center. Conclusions. The hepatitis C virus genotype 1 was the most frequent. Genotype 2 was associated with female gender, age, and dental procedure exposition

Hepatic steatosis among people living with HIV in Southern Brazil : prevalence and risk factors

Chronic liver disease is an important cause of morbidity and mortality among people living with human immunodefciency virus (HIV) and is frequently related to non-alcoholic fatty liver disease (NAFLD). The objective is to estimate the prevalence and risk factors of hepatic steatosis among consecutive patients with stable HIV infection on antiretroviral therapy (ART). Also, the use of transient elastography (TE) as a mean to identify a subgroup at risk for non-alcoholic steatohepatitis (NASH) and/or liver fbrosis. HIV infected patients were enrolled between August2016 and February2017. Inclusion criteria: ≥18 years with undetectable HIV viral load. Exclusion criteria: pregnancy; alcohol intake ≥20g/day and co-infection B or C viruses. Patients underwent ultrasound (US) to diagnose liver steatosis. Signifcant fbrosis (≥F2) was estimated if at least one of the following were present: APRI>1.0, FIB4>3 and/ or liver stifness ≥7.1kPa. Subjects with TE≥7.1kPa were proposed a liver biopsy and NAFLD Scoring System (NAS)≥3 was considered as diagnosis of NASH. A total of 98 patients were included. Liver steatosis was diagnosed in 31 patients (31.6%) and was independently associated with male gender, BMI, ALT and total bilirubin levels. The prevalence of signifcant fbrosis assessed by TE, APRI and FIB4 was 26.9%, 6.4% and 3.2%, respectively. Seven patients had a TE result ≥7.1kPa. NASH was found in 5 (83.3%). Among HIV infected patients undergoing ART, almost one third have NAFLD. Neither TE, APRI or FIB4 were able to act as surrogates for signifcant liver fbrosis. Nevertheless, TE≥7.1kPa was able to accurately select a subgroup of patients at risk for NASH

Comparison between potential risk factors for cardiovascular disease in people living with HIV/AIDS in areas of Brazil

Introduction: Coronary heart disease and its risk factors depend on genetic characteristics, behaviors, and habits, all of which vary in different regions. The use of antiretroviral therapy (ARV) has increased the survival of people living with HIV/AIDS (PLWHA), who begin to present mortality indicators similar to the general population. This study aimed to compare the prevalence of factors potentially associated with coronary heart disease in three cohorts of PLWHA from three different regions of Brazil. Methodology: The study population was composed of participants of the cohorts of Pernambuco, Goiás, and Rio Grande do Sul states. In these sites, adult patients attending reference centers for treatment of HIV/AIDS were consecutively enrolled. Results: Pernambuco and Goiás had a higher proportion of males and of individuals with high-risk high-density lipoprotein (HDL). Pernambuco also had a greater proportion of individuals with hypertension, elevated triglycerides, and CD4 counts below 200 cells/mm3. Lower education was more frequent in Rio Grande do Sul, and the use of cocaine was higher in this state. Conclusions: The results confirm the importance of risk factors for coronary heart disease in PLHIV and highlight differences in the three cohorts. Specific measures against smoking and sedentary lifestyle, avoidance of advanced stages of immunosuppression, and appropriate treatment of dyslipidemia and dysglicemia are urgently needed to cope with the disease in Brazil

Epidemiologia da infecção pelo vírus da hepatite C em portadores do vírus da imunodeficiência humana : genótipos e fatores de risco

Base teórica: O vírus da imunodeficiência humana (HIV) é responsável pela contaminação de mais de 38,6 milhões de pessoas no mundo, sendo que 4 a 5 milhões estão co-infectadas pelo vírus da hepatite C (HCV). No Brasil, estima-se que aproximadamente 0,5% da população brasileira adulta seja portadora do HIV. A prevalência de co-infecção é altamente variável, dependendo das prevalências das infecções pelo HCV, pelo HIV e de usuários de drogas nas populações estudada. O genótipo do HCV é um dos principais fatores prognósticos para a resposta viral sustentada após tratamentos com interferon e, consequentemente, determinante também da relação de custo-benefício do tratamento. Estudos realizados em diferentes partes do mundo mostraram prevalências distintas dos genótipos do HCV entre países e entre regiões de um mesmo país. Estudos envolvendo centros gaúchos têm mostrado prevalência elevada do genótipo 3 em relação à maioria dos estados brasileiros. Poucos dados sobre a genotipagem em pacientes co-infectados estão disponíveis em nosso meio. Na medida em que a sobrevida dos pacientes com AIDS aumenta, através do controle de infecções oportunistas e manutenção da imunidade, a hepatopatia crônica relacionada à infecção pelo HCV em portadores do HIV torna-se uma das importantes causas de morbimortalidade entre os portadores do HIV, exigindo, por parte dos gestores e serviços de saúde em todo mundo atenção crescente. Objetivos: Determinar a prevalência e os fatores associados à co-infecção HIV-HCV e aos genótipos do HCV em pacientes em atendimento em um centro de referência ambulatorial para tratamento do HIV/AIDS em Porto Alegre, Brasil. Verificar também a prevalência de resolução espontânea da hepatite C e características associadas. Métodos: Estudo Transversal: foram revisados todos os prontuários de pacientes registrados no serviço para determinação da prevalência de co-infecção. Estudo de Caso-Controle: foram consecutivamente incluídos como casos, os portadores de co-infecção HIV-HCV, e como controles, os pacientes com sorologia negativa para o HCV em atendimento com o mesmo médico. Pesquisa do HCV-RNA e genotipagem do HCV foi realizada em todos os casos. Resultados: Entre os 1313 pacientes em acompanhamento, foram anti-HCV positivos 357 (31,2%) dos 1143 pacientes para os quais se obteve sorologia para o HCV. Através de amostragem consecutiva foram incluídos 227 casos (63% homens; 40,3±8,7 anos) e 370 controles (44,6% homens; 38,9±9,8 anos). Após análise por regressão logística permaneceram associados à co-infecção sexo masculino, menor escolaridade, compartilhamento de objetos de higiene pessoal, uso de drogas injetáveis, uso de cocaína inalada, uso de crack, e consumo de maconha. Menor contagem de linfócitos CD4 e história de tuberculose também foi observada entre os pacientes co-infectados HIV-HCV. Entre os 207 indivíduos que realizaram pesquisa do HCV-RNA foi detectada viremia em 83,6% dos casos. Observou-se o genótipo 1 em 81,5%, genótipo 2 em 1,7% e genótipo 3 em 16,2%. Conclusão: Neste estudo identificaram-se fatores de risco para co-infecção pelo HCV em portadores do HIV. As características associadas à transmissão sexual não foram confirmadas. Acrescentou-se informação sobre um novo fator de risco - o compartilhamento de objetos de uso pessoal – ao conjunto de exposições associadas à co-infecção HIV-HCV. A alta prevalência de co-infecção encontrada e o amplo predomínio do genótipo 1 devem ter implicação direta sobre o planejamento de políticas públicas para a prevenção, o diagnóstico e o tratamento dos portadores do HIV.Introdution: It has been estimated that 38.6 million people are infected by the human immunodeficiency virus (HIV) all over the world, being 4 to 5 million coinfected with hepatitis C virus (HCV). In Brazil, it is estimated that about 0.5% of the adult population is infected with HIV. The prevalence of HIV-HCV coinfection is directly associated with the characteristics of the population under study, particularly the use of injecting drugs, the source of the participants, and the frequency of each infection. Of the risk factors shared by HIV and HCV infections, injecting drug use (IDU) has been shown to be the most important, followed by exposure to contaminated blood at transfusions. However, 25-30% of individuals infected with HCV deny exposure to parenteral risk factors. The response rate to HCV infection treatment is lower than 50%, and treatments may have clinically important adverse effects. The response to HCV treatment depends on the genotype of the virus. Beside the prognostic importance, HCV genotype is a key factor for the cost-effectiveness of treatment. Study Aims: This study investigated the prevalence of HIV-HCV coinfection, HCV RNA carriers, and HCV genotypes in patients attending to an AIDS outpatient reference center in Southern Brazil. Independent risk factors for HIV-HCV coinfection using a hierarchical conceptual approach to multivariate analysis were detected. Methods: Cross Sectional Study: all registries from 3490 patients with HIV infection were reviewed. Case-Control Study: Cases were HIV infected subjects identified among 357 patients coinfected by HCV. Controls were selected among 786 patients with HIV infection and anti-HCV negative test. Results: The registry has 3490 patients recorded. Of this total, 1313 (37.6%) were currently under follow up, and 1143 were tested for anti-HCV. The prevalence of anti-HCV was 31.2% (95%CI 28.5-33.9%). Two hundred and twenty seven cases, out of 357, and 370 controls, out of 786, were interviewed, and 207 had RNA HCV testing performed. Genotype 1 was more frequent (81.5%; 95% CI 75.7-87.3), followed by genotype 3 (16.2%; 95% CI 10.7-21.7), and few genotype 2 cases (1.7%; 95% CI 0-3.6). HCV RNA was negative in 16.4% of the study participants. Male gender, being 30 to 49 years of age, elementary school education, family income lower than one minimum wage (approximately US$160), earlier age of the first sexual intercourse, higher number of sexual partners in the previous month, sharing of personal hygiene objects, using of injecting drugs, and the use of crack cocaine were associated to HIV-HCV coinfection even after adjustment for confounding factors. The practicing of anal sex became statistically associated with HIV-HCV coinfection only after multivariate analysis. Conclusion: About a third of the patients on treatment for HIV/AIDS in Porto Alegre present coinfection by HCV. The virus with genotype 1 is the most prevalent among the infected by HIV, but beside male gender, there is no apparent reason for this distribution. Despite the presence of infection by HIV, some patients have spontaneous clearing of the HCV. A small innoculum may favor the spontaneous negativation of RNA HCV. We identified a risky profile for HCV coinfection in patients with HIV. The risk of sharing personal hygiene objects is a novel finding and may explain part of the transmission of virus C even in non-AIDS patients. The high prevalence of coinfection by HCV in patients under treatment for HIV, with the predominance of genotype 1 virus, have direct implications for the planning of public health policies for the treatment of persons infected with HIV

Effect of sustained virologic response on the incidence of hepatocellular carcinoma in patients with HCV cirrhosis

Background and objectives: Evidence suggests that sustained virologic response to interferon treatment decreases incidence of hepatocellular carcinoma in patients with hepatitis C virus cirrhosis. This study was designed to compare the incidence of hepatocellular carcinoma among cirrhotic patients exposed to interferon based treatment with or without achieving a sustained virological response, in order to evaluate the role of interferon itself in the prevention hepatocellular carcinoma. Methods: A cohort of 85 patients with compensated hepatitis C cirrhosis was followed after treatment with interferon and ribavirin. Sustained virological response was defi ned as negative polymerase chain reaction assay 24 weeks after the end of treatment. Patients were followed every 6 months with ultrasound and alpha-fetoprotein. Hepatocellular carcinoma was diagnosed by the fi nding of a focal liver lesion greater than 2 cm with arterial hypervascularization on two imaging techniques and/or by liver biopsy. Results: The mean follow-up time was 32.1 ± 20 months for patients who achieved a sustained virological response and 28.2 ± 18 months among 47 patients (55%) without SVR. Hepatocellular carcinoma was diagnosed in 1 (3%) vs. 8 (17%) responders and non responders respectively (p = 0.02). Conclusion: Patients with cirrhosis due to hepatitis C virus who achieved sustained virological response had signifi cantly lower incidence of hepatocellular carcinoma when compared to those without treatment response. Interferon treatment without achieving sustained virological response does not seem to protect against hepatocellular carcinoma