Navegando por Palavras-chave "hepatitis C"

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    Anti-HCV reactive blood donors: clinical and epidemiological factors associated with false-reactive results
    (Lippincott Williams & Wilkins, 2008-11-01) Narciso-Schiavon, Janaina L. [UNIFESP]; Schiavon, Leonardo L. [UNIFESP]; Carvalho-Filho, Roberto J. [UNIFESP]; Cardoso, Jaqueline R. [UNIFESP]; Freire, Fernanda C. F. [UNIFESP]; Sampaio, Juliana R. [UNIFESP]; Bordin, Jose O. [UNIFESP]; Soares, Maria Angelica [UNIFESP]; Silva, Antonio Eduardo B. [UNIFESP]; Ferraz, Maria Lucia G. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Background in certain clinical settings, false-reactive anti-hepatitis C virus (HCV) results are rare because the majority of persons being tested have evidence of liver disease and the specificity of the screening assays is high. However, among healthy populations, such as blood donors, mainly in regions with a low prevalence of HCV infection, this situation does occur. in this study, we sought to assess clinical, epidemiological, and laboratory characteristics of blood donors with false-reactiveMethods This retrospective cross-sectional study included 537 anti-HCV reactive blood donors referred to a tertiary care centre for liver diseases.Results the mean age was 36.5 +/- 11.2 years and 71.8% were men. Blood donors of older age (P = 0.010), history of alcohol abuse (P=0.039), past transfusion (P<0.001), intravenous drug use (P<0.001), and with antibody against core antigen of hepatitis B virus reactivity (P=0.003) were less likely to have a false-reactive anti-HCV result. By multivariate analysis, only the absence of parenteral risk factors (prior transfusion and intravenous drug use) was independently associated with false-reactive anti-HCV tests.Conclusion Blood donors with reactive anti-HCV screening tests with no risk factors for parenterally acquired HCV infection are more likely to present with false-reactive results. Eur J Gastroenterol Hepatol 20:1071-1076 (C) 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins.
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    Anti-hepatitis C virus-positive blood donors: are women any different?
    (Wiley-Blackwell, 2008-06-01) Narciso-Schiavon, J. L. [UNIFESP]; Schiavon, L. L. [UNIFESP]; Carvalho-Filho, R. J. [UNIFESP]; Freire, F. C. F. [UNIFESP]; Cardoso, J. R. [UNIFESP]; Bordin, J. O. [UNIFESP]; Silva, A. E. B. [UNIFESP]; Ferraz, M. L. G. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    We sought to assess clinical, epidemiological, biochemical, serological and histological characteristics of anti-hepatitis C virus (HCV)-positive female blood donors and compare them with men. As women are frequently the minority among blood donors, studies evaluating this population usually reflect characteristics of male gender. This retrospective study included 380 blood donors with confirmed positive anti-HCV. the mean age was 36.9 +/- 11.3 years and 33.2% were women. Compared with men, female donors showed higher prevalence of prior transfusion of blood products (P = 0.031) and lower prevalence of intravenous drug use (P = 0.001) and alcohol abuse (P < 0.001). Women exhibited lower medians of alanine aminotransferase (P < 0.001) and gamma-glutamyltransferase (P < 0.001). They also showed higher platelet count (P < 0.001) and prothrombin activity (P = 0.049), and a lower frequency of antibody against core antigen of hepatitis B virus (anti-HBc) positivity (P = 0.032). A higher proportion of spontaneous viral clearance (P = 0.001) and a lower frequency of viraemia (P < 0.001) were observed among women. On liver biopsy, women had lower prevalence of fibrosis stage >= 2. Multivariate analysis identified age (OR = 1.050, 95% CI: 1.019-1.081, P = 0.001) and anti-HBc positivity (OR = 2.184, 95% CI: 1.010-4.722, P = 0.047) as independent predictors of significant fibrosis. Female blood donors presented higher prevalence of spontaneous viral clearance as well as biochemical and histological evidence of less advanced liver disease. These findings could be because of intrinsic characteristics of female gender or secondary to associated factors such as younger age or anti-HBc positivity.
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    Anti-rods/rings: a human model of drug-induced autoantibody generation
    (Frontiers Research Foundation, 2015-02-05) Calise, S. John; Keppeke, Gerson Dierley [UNIFESP]; Andrade, Luiz Eduardo Coelho [UNIFESP]; Chan, Edward K. L.; Univ Florida; Universidade Federal de São Paulo (UNIFESP); Fleury Med & Hlth Labs
    In recent years, autoantibodies targeting subcellular structures described as the rods and rings pattern in HEp-2 ANA have been presented as a unique case of autoantibody generation. These rod and ring structures (RR) are at least partially composed of inosine monophosphate dehydrogenase type 2 (IMPDH2), and their formation can be induced in vitro by several small-molecule inhibitors, including some IMPDH2 inhibitors. Autoantibodies targeting these relatively unknown structures have been almost exclusively observed in hepatitis C virus (HCV) patients who have undergone treatment with pegylated interferon-alpha/ribavirin (IFN/RBV) combination therapy. To date, anti-RR antibodies have not been found in treatment-naive HCV patients or in patients from any other disease groups, with few reported exceptions. Here, we describe recent advances in characterizing the RR structure and the strong association between anti-RR antibody response and HCV patients treated with IFN/RBV, detailing why anti-RR can be considered a human model of drug-induced autoantibody generation.
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    Antinuclear antibody positivity in patients with chronic hepatitis C: clinically relevant or an epiphenomenon?
    (Lippincott Williams & Wilkins, 2009-04-01) Narciso-Schiavon, Janaina L. [UNIFESP]; Freire, Fernanda Caruso F. [UNIFESP]; Suarez, Marcelo Mendes [UNIFESP]; Ferrari, Marcus Vinicius O. [UNIFESP]; Scanhola, Gustavo Quirino [UNIFESP]; Schiavon, Leonardo de Lucca [UNIFESP]; Carvalho Filho, Roberto J. de [UNIFESP]; Ferraz, Maria Lucia G. [UNIFESP]; Silva, Antonio Eduardo B. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Background Serum autoantibodies such as antinuclear antibody (ANA) are frequently detected in patients with chronic hepatitis C virus (HCV) infection, but its relevance is a matter of discussion.Aim To assess the association of ANA positivity with clinical and histological features, and with the outcome of antiviral therapy in patients with HCV infection.Methods Baseline samples from patients with hepatitis C treated with interferon and ribavirin were tested for ANA positivity by indirect immunofluorescence.Results the mean age was 48.3 +/- 11.1 years and 56% were men. Among 234 included patients, 22 patients (9.4%) were positive for ANA. These patients showed significantly higher median alanine aminotransferase level (3.52 vs. 2.39 x upper limit of normal, P=0.009) when compared with ANA-negative patients. Fibrosis stage and necroinflammatory grading were not influenced by ANA positivity. Sustained virological response (SVR) rates were similar between ANA-positive and ANA-negative patients (27 vs. 29%, P=0.882). Alanine aminotransferase flares (>= 1.5-fold the baseline) during treatment were observed in 28 patients (12%), irrespective of the presence of ANA and without any clinical significance.Conclusion Among HCV patients, ANA positivity seems to represent an immunological epiphenomenon. It neither influences clinical, biochemical, and histological features of chronic hepatitis C nor predicts response to antiviral treatment. Eur J Gastroenterol Hepatol 21:350-356 (C) 2009 Wolters Kluwer Health / Lippincott Williams & Wilkins.
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    Clinical and histological impact of previous hepatitis B virus infection in patients with chronic hepatitis C
    (Wiley-Blackwell, 2009-01-01) Carvalho-Filho, Roberto J. [UNIFESP]; Lucca Schiavon, Leonardo de [UNIFESP]; Narciso-Schiavon, Jana-na L. [UNIFESP]; Sampaio, Juliana P. [UNIFESP]; Lanzoni, Valeria P. [UNIFESP]; Gomes Ferraz, Maria L. [UNIFESP]; Benedito Silva, Antonio E. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Recent reports suggest that hepatitis C virus (HCV) carriers with serological markers of prior hepatitis B virus (HBV) infection have more advanced liver fibrosis, irrespective of HBV-DNA detection.We sought to assess the prevalence and impact of previous HBV infection in patients with HCV chronic infection.This cross-sectional study included hepatitis B surface antigen- and human immunodeficiency virus-negative subjects with positive HCV-RNA. All patients had prior parenteral exposure as the probable source of HCV infection. Serum samples were tested for HBV-DNA using a commercial assay. the METAVIR system was used for histological analysis.One-hundred and eleven patients were evaluated. Thirty-one out of 111 patients (28%) tested positive for antihepatitis B core antigen (anti-HBc). HBV-DNA was not detected in any sample. Anti-HBc-positive patients showed higher histological grading, staging and a higher fibrosis progression rate. By multivariate analysis, anti-HBc-positivity was predictive of moderate to severe activity [odds ratio (OR)=3.532; P=0.032] and significant hepatic fibrosis (OR=3.364; P=0.017). After approximately 20 years of infection, advanced liver fibrosis (F3/F4) can be expected in 13% of anti-HBc-negative subjects who acquired HCV before the age of 30 and in 57% of those anti-HBc-positive patients who were infected by HCV after 30 years of age (P < 0.001).Previous HBV infection is common among HCV carriers and may exert a negative impact on the natural history of HCV infection, independently of the presence of significant HBV replication.
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    Direct comparison of diagnostic performance of transient elastography in patients with chronic hepatitis B and chronic hepatitis C
    (Wiley-Blackwell, 2012-04-01) Cardoso, Ana-Carolina; Carvalho-Filho, Roberto J. [UNIFESP]; Stern, Christiane; Dipumpo, Alexandrine; Giuily, Nathalie; Ripault, Marie-Pierre; Asselah, Tarik; Boyer, Nathalie; Lada, Olivier; Castelnau, Corinne; Martinot-Peignoux, Michelle; Valla, Dominique-Charles; Bedossa, Pierre; Marcellin, Patrick; Univ Paris 07; Universidade Federal de São Paulo (UNIFESP)
    Background/ Aims: Accuracy of transient elastography (TE) in hepatitis B virus (HBV) infection has not been well established. We aimed to compare the performances of TE for the assessment of liver fibrosis in patients with chronic HBV or hepatitis C virus (HCV) infection. A secondary analysis was performed to assess whether or not alanine aminotransferase (ALT) levels would impact on the accuracy of TE. Methods: This cross-sectional study, carried out in a single centre, included treatment-naive patients with compensated chronic HBV or HCV infection, consecutively admitted between 2006 and 2008 for a liver biopsy and TE measurement on the same day. Results: A total of 202 HBV patients and 363 HCV subjects were evaluated. Overall diagnostic accuracy of TE in the HBV group was comparable to that observed in HCV patients [area under the receiver-operating characteristics (AUROCs) 0.867 +/-0.026 vs. 0.868 +/-0.019 for predicting F +/-2, P = 0.975; 0.902 +/-0.029 vs. 0.894 +/-0.020 for F +/-3, P = 0.820; and 0.935 +/-0.024 vs. 0.947 +/-0.027 for F4, P = 0.740 respectively]. TE exhibited comparable accuracies, sensitivities, specificities, predictive values and likelihood ratios in HBV and HCV groups. AUROC analysis showed no influence of ALT levels on the performance of TE in HBV individuals. ALT-specific cut-off values did not exhibit significantly higher diagnostic performances for predicting fibrosis in HBV patients with elevated ALT. Conclusions: in HBV patients, TE measurement accurately predicts the absence or presence of significant fibrosis, advanced fibrosis or cirrhosis and shows similar performances as compared to HCV patients. the use of TE cut-off values adjusted to ALT level did not improve performances for estimating liver fibrosis in HBV patients.
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    The effect of early virological response in health-related quality of life in HCV-infected patients
    (Wiley-Blackwell, 2008-03-01) Quarantini, Lucas C. [UNIFESP]; Miranda-Scippa, Angela; Batista-Neves, Susana; Galvao-De-Almeida, Amanda; Lacerda, Acioly L. [UNIFESP]; Moriyama, Tais S. [UNIFESP]; Sampaio, Aline S.; Melcop, Ana C. [UNIFESP]; Schinoni, Maria I.; Oliveira, Irismar R. de; Parana, Raymundo; Bressan, Rodrigo A. [UNIFESP]; Universidade Federal da Bahia (UFBA); Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    Twenty-nine HCV-infected patients were treated with pegylated interferon alpha. Diagnosis was based on serum HCV RNA-PCR positive results and liver biopsy. All patients had elevated serum levels of alanine aminotransferase at the time of the study, but liver disease was compensated. Patients were evaluated at baseline treatment and after 4 and 12 weeks of antiviral treatment with the Medical Outcomes Study 36-item Short-Form Health Survey. the Mini-International Neuropsychiatric Interview was used to exclude previous or current psychiatric diagnoses. Both patients and psychiatrists were blind to the HCV RNA status, and serum HCV RNA test results only became available after the visit at week 12. After antiviral treatment, 16 patients (55.2%) were classified as nonresponders and 13 (44.8%) were classified as responders. When compared to nonresponders, responders had a greater improvement in the HRQOL scores for the mental health domain (P<.019). Differences in other domains were not significant. the present study confirms that active viral infection is one possible reason for the poor Health-Related Quality of Life in this population.
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    Efficacy and tolerance of interferon-alpha in the treatment of chronic Hepatitis C in end-stage renal disease patients on hemodialysis
    (Blackwell Publishing, 2006-04-01) Rocha, C. M.; Perez, R. M.; Ferreira, A. P.; Carvalho-Filho, R. J.; Pace, F. H.; Silva, I. S.; Pestana, JOM; Lanzoni, V. P.; Silva, A. E.; Ferraz, MLG; Universidade Federal de São Paulo (UNIFESP)
    Background: Patients with end-stage renal disease (ESRD) show a high prevalence of hepatitis C, with a negative impact on the survival on hemodialysis and after renal transplantation. We evaluated the efficacy and tolerance of interferon-alpha (IFN-alpha) in HCV-infected ESRD patients on dialysis. Methods: Forty-six HCV-RNA-positive ESRD patients were studied. IFN-alpha regimen consisted of 3 million units three times a week for 12 months, and the patients were followed up for 6 months. End-of-treatment, and sustained biochemical and virological responses were evaluated and tolerance was assessed monthly. Results: A sustained virological response (SVR) was observed in 10/46 patients (22%) and in 10/29 who completed the treatment (34%). Alanine aminotransferase was elevated in 63% of the patients at the beginning of the study and returned to normal levels within the first month in all patients with SVR. Treatment was discontinued because of side effects in 11/46 patients (24%) and six patients (13%) were lost to follow-up. Conclusions: IFN-alpha monotherapy for hepatitis C in dialysis patients shows a high frequency of adverse effects. However, the SVR is high (34%) in patients who complete treatment, emphasizing the importance of careful selection and close follow-up in order to minimize and control possible side effects.
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    Enhanced Liver Fibrosis Panel as a Predictor of Liver Fibrosis in Chronic Hepatitis C Patients
    (Lippincott Williams & Wilkins, 2015-03-01) Fernandes, Flavia F.; Ferraz, Maria Lucia Cardoso Gomes [UNIFESP]; Andrade, Luiz Eduardo Coelho [UNIFESP]; Dellavance, Alessandra [UNIFESP]; Terra, Carlos; Pereira, Gustavo; Pereira, Joao L.; Campos, Frederico; Figueiredo, Fatima; Perez, Renata de Mello [UNIFESP]; Universidade do Estado do Rio de Janeiro (UERJ); Bonsucesso Fed Hosp; Universidade Federal do Rio de Janeiro (UFRJ); Universidade Federal de São Paulo (UNIFESP); Fleury Grp
    Background: Evaluation of fibrosis is crucial in the assessment of chronic hepatitis C (CHC). The enhanced liver fibrosis (ELF) is a serological panel including hyaluronic acid (HA), tissue inhibitor of matrix metalloproteinases-1 (TIMP-1), and amino-terminal propeptide of type III procollagen (PIIINP) that has shown good results in predicting liver fibrosis in distinct scenarios of chronic liver diseases.Aims: We aimed to assess the performance of ELF on the detection of fibrosis and cirrhosis in a CHC patient cohort and to compare the results of ELF and transient elastography (TE-Fibroscan) using liver biopsy as reference.Patients and Methods: One hundred twenty patients were prospectively evaluated by TE and ELF using an ADVIA Centaur automated system. The ELF score was calculated using the manufacturer's algorithm. Biopsies were classified according to the METAVIR score. Receiver operator characteristic curve analyses were performed to evaluate the accuracy of ELF and TE.Results: The area under the receiver operator characteristic curve (AUROC) of ELF for the diagnosis of significant fibrosis was 0.81 [95% confidence interval (CI), 0.73-0.87], for advanced fibrosis was 0.82 (95% CI, 0.74-0.88), and for cirrhosis was 0.78 (95% CI, 0.70-0.85). Using the proposed cutoffs, ELF overestimated fibrosis in 66% (81/120) of cases and underestimated in 3% (3/120). We found no statistically significant difference when comparing the AUROC of ELF and TE for diagnosing fibrosis or cirrhosis.Conclusions: ELF panel is a good noninvasive fibrosis marker and showed similar results to TE in CHC patients. However, new cutoff points need to be established to improve its performance on patients with CHC.
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    Factors associated with the intensity of liver fibrosis in renal transplant patients with hepatitis B virus infection
    (Lippincott Williams & Wilkins, 2007-08-01) Matos, Carla Adriana Loureiro de [UNIFESP]; Perez, Renata de Mello [UNIFESP]; Lemos, Lara Barros [UNIFESP]; Pestana, Jose Osmar Medina [UNIFESP]; Lanzoni, Valeria Pereira [UNIFESP]; Albertoe, Fernando L.; Moreira, Eloisa S.; Silva, Antonio Eduardo Benedito [UNIFESP]; Ferraz, Maria Lucia Cardoso Gomes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Fleury Med Diagnost Ctr
    Background Hepatitis B may show a more aggressive course after kidney transplantation, but the factors associated with the progression of fibrosis in this group have not been identified.Objectives To determine the influence of hepatitis B virus (HBV) viral load and host-related factors on the progression of hepatic fibrosis in hepatitis B virus-infected renal transplant recipients.Patients and methods Renal transplant patients positive for HBV surface antigen (HBsAg) and submitted to a liver biopsy because of evidence of viral replication were included. Patients with advanced fibrosis (METAVIR F3-F4) were compared with patients with mild fibrosis (F0-F2) regarding sex, age, estimated time since infection, post-transplant time, donor type, history of renal transplantation, alanine aminotransferase, anti-hepatitis C virus, HBeAg and quantitative hepatitis B virus-DNA. Logistic regression analysis was applied to identify variables independently associated with more advanced fibrosis.Results Fifty-five patients (75% men, 41 +/- 11 years) with a mean post-transplant time of 5 +/- 4 years were included. HBeAg was detected in 67% of the patients and anti-hepatitis C virus in 35%. The median hepatitis B virus-DNA level was 2.8 x 10(8) copies/ml. Seventeen (31%) patients had advanced fibrosis. Using logistic regression analysis, the only variable that showed an independent association with more advanced stages of fibrosis was post-transplant time (P=0.03, odds ratio: 1.2, 95% confidence interval: 1.02-1.45).Conclusion Hepatitis B virus viral load, although very high, and hepatitis B virus/hepatitis C virus coinfection are not related to the intensity of liver fibrosis in renal transplant patients infected with hepatitis B virus. Post-transplant time was the only factor independently associated with more advanced liver fibrosis, suggesting the influence of immunosuppression on the progression of liver disease in these patients.
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    Factors associated with the progression of hepatic fibrosis in end-stage kidney disease patients with hepatitis C virus infection
    (Lippincott Williams & Wilkins, 2009-12-01) Becker, Vitoria R. [UNIFESP]; Badiani, Rosilene das Graças [UNIFESP]; Lemos, Lara B. [UNIFESP]; Perez, Renata M.; Medina-Pestana, Jose O. [UNIFESP]; Lanzoni, Valeria P. [UNIFESP]; Ferreira, Adalgisa R.; Silva, Antonio Eduardo B. [UNIFESP]; Ferraz, Maria Lucia G. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ Fed Maranhao; Universidade Federal do Rio de Janeiro (UFRJ)
    Background Few studies have evaluated the histological aspects of hepatitis C virus (HCV) infection in hemodialysis patients and the factors related to the progression of hepatic fibrosis in this population have not been defined.Aim To evaluate the influence of host-related factors on the fibrosis progression in end-stage renal disease (ESRD) patients with HCV infection.Methods HCV-infected ESRD patients who submitted to liver biopsy were included. the fibrosis stages were classified according to METAVIR scoring system. for the identification of factors associated with more advanced liver fibrosis, the patients were classified into two groups: group 1, absence of septal fibrosis (F0-1) and group 2, presence of septal fibrosis (F2-4). Groups 1 and 2 were compared regarding demographic, epidemiological, and laboratory variables and logistic regression analysis was used to identify the variables that were independently associated with the presence of septal fibrosis.Results A total of 216 ESRD patients (63% men, 44 +/- 11 years) were included. in the histological analysis, the fibrosis stages were as follows: F0=36%, F1 =41%, F2 = 12%, F3 = 7, and 4% had cirrhosis (F4). in the logistic regression model, the variables that were independently associated with the presence of septal fibrosis were duration of infection, estimated age at infection, coinfection with HBV and aspartate aminotransferase levels.Conclusion These findings support the importance of obtaining an adequate immune response to HBV vaccination and careful monitoring of liver disease in patients who become infected at an advanced age and/or those presenting elevated aspartate aminotransferase levels, as these are the main factors associated with the presence of septal fibrosis in ESRD patients. Eur J Gastroenterol Hepatol 21:1395-1399 (C) 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.
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    Hepatitis C virus infection in renal transplant patients: a comparative study with immunocompetent patients
    (Blackwell Publishing, 2005-12-01) Perez, R. M.; Ferreira, ASP; Souza e Silva, Ivonete Sandra de [UNIFESP]; Medina-Pestana, J. O.; Lanzoni, V. P.; Silva, AEB; Ferraz, MLG; Universidade Federal do Rio de Janeiro (UFRJ); Universidade Federal de São Paulo (UNIFESP)
    The behavior of hepatitis C in states of immunodeficiency is poorly understood and it is still unclear whether the characteristics of hepatitis C virus (HCV) infection in renal transplant patients differ from those observed in immunocompetent subjects. the aim of this study was to compare the biochemical and histologic characteristics of chronic HCV infection between renal transplant and immunocompetent patients. Forty-one HCV-RNA-positive renal transplant patients and 41 immunocompetent controls matched for gender, age at infection and time of infection were included in the study. the groups were compared regarding laboratory and histologic variables. Renal transplant patients showed lower alanine aminotransferase (ALT) levels (p = 0.005) and higher levels of gamma-glutamyltransferase (p = 0.003), alkaline phosphatase (p < 0.001), and direct bilirubin (p < 0.001) when compared with controls. Histologic analysis revealed less intense portal (p < 0.001) and periportal (p = 0.046) inflammatory infiltrate in renal transplant patients but a larger proportion of cases with confluent necrosis (p = 0.043). No difference in the presence of septal fibrosis, hepatic steatosis, bile duct injury and siderosis was observed. However, there was a difference in the presence of lymphoid aggregates, which were less frequent in the renal transplant group (p < 0.001). in conclusion, the characteristics of hepatitis C in renal transplant patients differ from that observed in immunocompetent patients. in renal transplant patients, HCV infection is biochemically characterized by lower ALT levels and higher frequency of cholestasis. Regarding histology, despite lower frequency of lymphoid aggregates and less intense portal/periportal inflammatory infiltrate, a greater lobular damage was observed. the impact of these differences on the progression of fibrosis remains to be established.
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    High frequency of unrecognized mental disorders in HCV-infected patients
    (Elsevier B.V., 2008-01-01) Batista-Neves, Susana Carolina; Quarantini, Lucas C. [UNIFESP]; Almeida, Amanda Galvao de; Bressan, Rodrigo A. [UNIFESP]; Lacerda, Acioly Luiz [UNIFESP]; de-Oliveira, Irismar R.; Parana, Raymundo; Miranda-Scippa, Angela; Universidade Federal da Bahia (UFBA); Universidade Federal de São Paulo (UNIFESP)
    Objective: This study indexed the frequency of psychiatric disorders among hepatitis C virus (HCV)-infected patients.Method: HCV-infected patients treated at a university hospital in the northeastern region of Brazil were evaluated in a cross-sectional study using the Mini International Neuropsychiatric Interview.Results: Ninety HCV-infected outpatients were included in the study and 44 (49%) had at least one psychiatric diagnosis. Among the 26 patients (59.1%) with a current psychiatric morbidity, 22 (84.6%) had gone undiagnosed.Conclusions: HCV-infected patients have a high frequency of unrecognized psychiatric comorbidity. (c) 2008 Elsevier Inc. All rights reserved.
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    Histological evolution of hepatitis C virus infection after renal transplantation
    (Wiley-Blackwell, 2012-11-01) Oliveira Uehara, Silvia Naomi de [UNIFESP]; Emori, Christini Takemi [UNIFESP]; Pereira, Patrícia da Silva Fucuta [UNIFESP]; Perez, Renata M.; Medina Pestana, Jose Osmar; Lanzoni, Valeria Pereira; Souza e Silva, Ivonete Sandra [UNIFESP]; Benedito Silva, Antonio Eduardo [UNIFESP]; Ferraz, Maria Lucia Cardoso Gomes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Rio de Janeiro (UFRJ)
    Background: information regarding histological progression of hepatitis C after renal transplant (RTx) is scarce. Aims: To analyze clinical and laboratory evolution and histological progression of hepatitis C in patients evaluated before and after RTx.Methods: Twenty-two HCV-infected patients submitted to liver biopsy pre- and post-RTx were included. A semiquantitative analysis of necroinflammatory activity and fibrosis staging was performed and the two biopsies were compared.Results: Patients were mostly men (73%) with mean age of 36 +/- 9 yr. Time post-transplant was 4 +/- 2 yr and time between biopsies was 5 +/- 2 yr. An elevation of alanine aminotransferase (p = 0.041) and aspartate aminotransferase (p = 0.004) levels was observed in the post-transplant period. Fibrosis progression after renal transplantation was observed in 11 (50%) of the patients, and necroinflammatory activity worsening was observed in 7 (32%) of the patients. the histological progression occurred even among those without significant histological lesions in pre-transplant biopsy.Conclusion: the findings of this study suggest that the practice of indicating treatment in the pre-transplant phase based mainly on histological disease should be revised, because a high proportion of patients present disease progression. Because interferon cannot be used safely after RTx, treatment should be indicated for all ESRD patients with hepatitis C.
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    Historical epidemiology of hepatitis C virus (HCV) in selected countries
    (Wiley-Blackwell, 2014-05-01) Bruggmann, P.; Berg, T.; Ovrehus, A. L. H.; Moreno, C.; Brandao Mello, C. E.; Roudot-Thoraval, F.; Marinho, R. T.; Sherman, M.; Ryder, S. D.; Sperl, J.; Akarca, U.; Balik, I.; Bihl, F.; Bilodeau, M.; Blasco, A. J.; Buti, M.; Calinas, F.; Calleja, J. L.; Cheinquer, H.; Christensen, P. B.; Clausen, M.; Coelho, H. S. M.; Cornberg, M.; Cramp, M. E.; Dore, G. J.; Doss, W.; Duberg, A. S.; El-Sayed, M. H.; Ergor, G.; Esmat, G.; Estes, C.; Falconer, K.; Felix, J.; Ferraz, Maria Lucia Gomes [UNIFESP]; Ferreira, Paulo Roberto [UNIFESP]; Frankova, S.; Garcia-Samaniego, J.; Gerstoft, J.; Giria, J. A.; Goncales, F. L.; Gower, E.; Gschwantler, M.; Guimaraes Pessoa, M.; Hezode, C.; Hofer, H.; Husa, P.; Idilman, R.; Kaberg, M.; Kaita, K. D. E.; Kautz, A.; Kaymakoglu, S.; Krajden, M.; Krarup, H.; Laleman, W.; Lavanchy, D.; Lazaro, P.; Marotta, P.; Mauss, S.; Mendes Correa, M. C.; Muellhaupt, B.; Myers, R. P.; Negro, F.; Nemecek, V.; Ormeci, N.; Parkes, J.; Peltekian, K. M.; Ramji, A.; Razavi, H.; Reis, N.; Roberts, S. K.; Rosenberg, W. M.; Sarmento-Castro, R.; Sarrazin, C.; Semela, D.; Shiha, G. E.; Sievert, W.; Starkel, P.; Stauber, R. E.; Thompson, A. J.; Urbanek, P.; van Thiel, I.; Van Vlierberghe, H.; Vandijck, D.; Vogel, W.; Waked, I.; Wedemeyer, H.; Weis, N.; Wiegand, J.; Yosry, A.; Zekry, A.; Van Damme, P.; Aleman, S.; Hindman, S. J.; Arud Ctr Addict Med; Univ Leipzig; Odense Univ Hosp; Univ Libre Brussels; Universidade Federal do Rio de Janeiro (UFRJ); Hop Henri Mondor; Hosp Santa Maria; Univ Toronto; Nottingham Univ Hosp NHS Trust; Biomed Res Unit; Inst Clin & Expt Med; Ege Univ; Ankara Univ; Osped Cantonale; Univ Montreal; Adv Tech Hlth Serv Res TAISS; Hosp Valle de Hebron; Hosp Santo Antonio Capuchos; Hosp Puerta Hierro; Univ Fed Rio Grande do Sul; Region Hosp Hovedstaden; Hannover Med Sch; German Liver Fdn; Univ Plymouth; Univ New S Wales; Cairo Univ; Orebro Univ Hosp; Univ Orebro; Ain Shams Univ; Dokuz Eylul Univ; Ctr Dis Anal CDA; Karolinska Inst; Exigo Consultores; Universidade Federal de São Paulo (UNIFESP); Hosp Carlos III; Univ Copenhagen; Direccao Geral Saude; Universidade Estadual de Campinas (UNICAMP); Wilhelminenspital Stadt Wien; Universidade de São Paulo (USP); Med Univ Vienna; Masaryk Univ; Univ Manitoba; Hlth Sci Ctr; European Liver Patients Assoc; Istanbul Univ; Univ British Columbia; Aalborg Univ Hosp; Katholieke Univ Leuven; Univ Western Ontario; Univ Dusseldorf; Univ Zurich Hosp; Univ Calgary; Univ Hosp; Natl Inst Publ Hlth; Univ Southhampton; Dalhousie Univ; Capital Dist Hlth Author; Assembleia Republ; Alfred Hosp; Monash Univ; UCL; Ctr Hosp Porto; JW Goethe Univ Hosp; Cantonal Hosp St Gallen; Egyptian Liver Res Inst & Hosp ELRIAH; Monash Hlth; Catholic Univ Louvain; Med Univ Graz; St Vincents Hosp; Univ Melbourne; Charles Univ Prague; Cent Mil Hosp; Deutsch Leberhilfe eV; Ghent Univ Hosp; Univ Ghent; Hasselt Univ; Med Univ Innsbruck; Natl Liver Inst; Copenhagen Univ Hosp; Univ Antwerp; Karolinska Univ Hosp
    Chronic infection with hepatitis C virus (HCV) is a leading indicator for liver disease. New treatment options are becoming available, and there is a need to characterize the epidemiology and disease burden of HCV. Data for prevalence, viremia, genotype, diagnosis and treatment were obtained through literature searches and expert consensus for 16 countries. for some countries, data from centralized registries were used to estimate diagnosis and treatment rates. Data for the number of liver transplants and the proportion attributable to HCV were obtained from centralized databases. Viremic prevalence estimates varied widely between countries, ranging from 0.3% in Austria, England and Germany to 8.5% in Egypt. the largest viremic populations were in Egypt, with 6358000 cases in 2008 and Brazil with 2106000 cases in 2007. the age distribution of cases differed between countries. in most countries, prevalence rates were higher among males, reflecting higher rates of injection drug use. Diagnosis, treatment and transplant levels also differed considerably between countries. Reliable estimates characterizing HCV-infected populations are critical for addressing HCV-related morbidity and mortality. There is a need to quantify the burden of chronic HCV infection at the national level.
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    HIV and infections of similar transmission patterns in a drug injectors community of Santos, Brazil
    (Lippincott-raven Publ, 1996-05-01) Carvalho, Heráclito Barbosa de; Mesquita, Fábio; Massad, Eduardo [UNIFESP]; Bueno, Regina Carvalho; Lopes, Giselda Turienzo; Ruiz, Milton Artur [UNIFESP]; Burattini, Marcelo Nascimento [UNIFESP]; Universidade de São Paulo (USP); IEPAS; SECRETARIA ESTADO SAUDE SAO PAULO; Universidade Federal de São Paulo (UNIFESP)
    To study the prevalence of HIV and infections with related transmission patterns, we interviewed and obtained blood samples from 110 injecting drug users (IDUs), sampled by snowballing, from the city of Santos in the state of Sao Paulo, Brazil, where the estimated number of IDUs (10,000) comprises similar to 2% of the entire population. Seroprevalence of HIV, hepatitis B and C. syphilis, and HTLV (1 and 2) was assessed and compared with that in 197 blood donors from the same city, matched for age and gender. Risk behavior related to HIV was assessed by a standard questionnaire applied to the IDU sample. Univariate and multivariate analyses of the risk factors were performed. Seroprevalences found were 62% for HIV, 75% for HCV. 75% for HBV, 34% for syphilis, and 25% for HTLV (1 and 2) among IDUs, which compare with 0.0%, 2%, 23%, 12%, and 1% for blood donors, respectively. The risk for parenterally transmitted infections in this IDU community was higher than that for sexually transmitted infections (odds ratio for syphilis, 3.57; hepatitis B. 10.0: and hepatitis C, 100). The results of the multivariate risk analysis showed that daily rate of ID use >5 times/day (OR = 6.73), not changing behavior to avoid AIDS (OR = 3.28), ID use >15 days/month (OR = 2.72), and ID use in the last 2 months (OR = 2.23) were the risk behaviors significantly associated with HIV infection.
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    Incidence of psychiatric side effects during pegylated interferon-alpha retreatment in nonresponder hepatitis C virus-infected patients
    (Blackwell Publishing, 2007-10-01) Quarantini, Lucas C.; Bressan, Rodrigo A.; Galvao, Amanda; Batista-Neves, Susana; Parana, Raymundo; Miranda-Scippa, Angela; Universidade Federal da Bahia (UFBA); Universidade Federal de São Paulo (UNIFESP)
    Objective: Evaluate the incidence of mental disorders using pegylated interferon plus ribavirin retreatment in nonresponder hepatitis C virus-infected patients. Method: the Mini-International Neuropsychiatric Interview ( MINI) was used to evaluate 30 hepatitis C virus-infected interferon-nonresponder patients at baseline and following 4, 12 and 24 weeks of pegylated interferon retreatment. Results: During the pegylated interferon/ ribavirin retreatment, 5(16.6%) patients developed psychiatric side effects: 3(10%) were diagnosed with major depressive disorder, 1(3.3%) had a brief psychotic disorder and 1( 3.3%) presented with panic attacks. Conclusion: This is the first prospective study evaluating the incidence of neuropsychiatric side effects during interferon retreatment of hepatitis C virus-infected patients, suggesting that the risk of acquiring serious psychiatric symptoms during retreatment with interferon-alpha (IFN-alpha) may not be higher than during the first antiviral therapy. This finding challenges the hypothesis that during a second treatment with IFN-alpha, patients with hepatitis C may be at greater risk for neuropsychiatric side effects than naive patients.
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    Interferon-alpha therapy within the first year after acute hepatitis C infection in hernodialysis patients: efficacy and tolerance
    (Lippincott Williams & Wilkins, 2007-02-01) Rocha, Cristina M. [UNIFESP]; Perez, Renata M.; Narciso, Janaina L. [UNIFESP]; Ferreira, Adalgisa P. [UNIFESP]; Lemos, Lara B. [UNIFESP]; Medina-Pestana, Jose O. [UNIFESP]; Silva, Antonio Eduardo B. [UNIFESP]; Ferraz, Maria Lucia G. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Rio de Janeiro (UFRJ)
    Background Interferon monotherapy significantly reduces the chronicity rate of acute hepatitis C in nonuremic patients. in this clinical study, we evaluated the efficacy and tolerance of interferon-alpha( therapy for acute hepatitis C in hemodialysis patients.Methods Patients with acute hepatitis C, established on the basis of seroconversion to anti-hepatitis C virus and the presence of hepatitis C virus RNA, received a low dose of interferon-alpha (3 MU three times per week) for 12 months or a high dose (5 MU three times per week, preceded by a daily induction dose) for 6 months. Response to treatment was defined as undetectable hepatitis C virus RNA at the end of treatment and sustained virological response was defined as persistent negative hepatitis C virus RNA 6 months after the end of treatment.Results Twenty-three patients were treated, 16 with a low dose of interferon-alpha and seven with a high dose. At the end of treatment, hepatitis C virus RNA was undetectable in 16/ 23 patients (70%). of these, 6/23 patients (26%) relapsed and 10/23 (43%) maintained a sustained virological response (38% in lower doses vs. 57% in higher doses). Treatment was well tolerated and only three patients discontinued therapy (13%).Conclusion Interferon-a within the first year after acute hepatitis C in hemodialysis patients was found to be safe and effective, inducing a sustained virological response in 43% of cases. This study supports the routine indication of acute hepatitis C treatment with interferon-alpha for hemodialysis patients, and higher doses administered for a shorter period of time should be tried according to the tolerance of the patients.
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    Is alanine aminotransferase a good marker of histologic hepatic damage in renal transplant patients with hepatitis C virus infection?
    (Blackwell Publishing, 2005-10-01) Perez, R. M.; Ferreira, ASP; Medina-Pestana, J. O.; Lanzoni, V. P.; Silva, AEB; Ferraz, MLG; Universidade Federal do Rio de Janeiro (UFRJ); Universidade Federal de São Paulo (UNIFESP)
    Introduction: Renal transplant (RTx) patients with hepatitis C frequently show normal levels of alanine aminotransferase (ALT) and the significance of ALT in this group has not been established.Aim: To determine the value of ALT as a marker of histologic hepatic damage in RTx patients with hepatitis C virus (HCV) infection.Materials and methods: HCV-RNA-positive RTx patients with a liver biopsy were analyzed regarding staging and the grading of periportal and lobular necroinflammatory activity. Spearman's correlation coefficient was used to determine the correlation between ALT and histologic variables. Sensitivity, specificity and positive and negative predictive values (PPV and NPV) of ALT in the detection of septal fibrosis and interface hepatitis, and/or confluent necrosis were calculated.Results: Fifty-three patients (32 men, 60%), with a mean age of 42 +/- 10 yr and time since transplant of 5 +/- 4 yr were included. Only 27 (51%) patients showed elevated ALT levels, which were associated with septal fibrosis (p = 0.001), interface hepatitis (p < 0.001) and confluent necrosis (p = 0.05). A correlation was observed between ALT and staging (r = 0.50, p < 0.001), periportal necroinflammatory activity (r = 0.59, p < 0.001) and lobular necroinflammatory activity (r = 0.50, p < 0.001). the sensitivity, specificity, PPV and NPV of ALT were 92, 61, 41 and 96%, respectively, for the detection of septal fibrosis, and 87, 77, 74 and 88% for the detection of interface hepatitis and/or confluent necrosis.Conclusion: ALT is a good marker of histologic hepatic lesion in HCV-infected RTx patients and, therefore, liver biopsy can be avoided in patients with persistently normal ALT.
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    Is hepatitis C more aggressive in renal transplant patients than in patients with end-stage renal disease?
    (Lippincott Williams & Wilkins, 2006-05-01) Perez, R. M.; Ferreira, ASP; Medina-Pestana, J. O.; Cendoroglo Neto, Miguel [UNIFESP]; Lanzoni, V. P.; Silva, AEB; Ferraz, MLG; Universidade Federal do Rio de Janeiro (UFRJ); Universidade Federal de São Paulo (UNIFESP)
    Background: the eventual impact of immunosuppression on the natural history of hepatitis C virus (HCV) infection in patients with end-stage renal disease (ESRD) is still unknown because of the lack of comparative data for HCV-infected patients with ESRD and renal transplant patients. the aim of this study was to compare the biochemical and histological characteristics of chronic HCV infection in renal transplants patients and ESRD patients undergoing hemodialysis.Methods: Thirty-eight renal transplant patients and 38 ESRD patients undergoing hemodialysis who were chronically infected with HCV and were matched for gender, age at infection, and estimated time of infection were included in the study. the groups were compared regarding laboratory and histological variables.Results: Renal transplant patients showed similar alanine aminotransferase and higher gamma-glutamyltransferase levels (P = 0.05) when compared with ESRD patients. Comparative analysis of histological variables revealed a higher proportion of cases with septal fibrosis (P = 0.04) and confluent necrosis (P = 0.01) among transplant-recipient patients. No difference between groups was observed regarding the intensity of portal and periportal inflammatory infiltrates. Steatosis was more prevalent among transplant-recipient patients (P < 0.001). There was no difference between groups regarding the prevalence of lymphoid aggregates or bile duct injury.Conclusion: Renal transplant patients had a larger proportion of cases with septal fibrosis and confluent necrosis than did ESRD patients, suggesting that renal transplantation might modify the natural history of hepatitis C in ESRD patients, leading to a more aggressive liver disease.