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ABSTRACT Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related mortality worldwide. The Brazilian Society of Hepatology (SBH) published in 2020 the updated recommendations for the diagnosis and treatment of HCC. Since then, new data have emerged in the literature, including new drugs approved for the systemic treatment of HCC that were not available at the time. The SBH board conducted an online single-topic meeting to discuss and review the recommendations on the systemic treatment of HCC. The invited experts were asked to conduct a systematic review of the literature on each topic related to systemic treatment and to present the summary data and recommendations during the meeting. All panelists gathered together for discussion of the topics and elaboration of the updated recommendations. The present document is the final version of the reviewed manuscript containing the recommendations of SBH and its aim is to assist healthcare professionals, policy-makers, and planners in Brazil and Latin America with systemic treatment decision-making of patients with HCC.

RESUMO O carcinoma hepatocelular (CHC) é uma das principais causas de mortalidade relacionada a câncer no Brasil e no mundo. A Sociedade Brasileira de Hepatologia (SBH) publicou em 2020 a atualização das recomendações da SBH para o diagnóstico e tratamento do CHC. Desde então, novas evidências científicas sobre o tratamento sistêmico do CHC foram relatadas na literatura médica, incluindo novos medicamentos aprovados que não estavam disponíveis na época do último consenso, levando a diretoria da SBH a promover uma reunião monotemática on-line para discutir e rever as recomendações sobre o tratamento sistêmico do CHC. Um grupo de experts foi convidado para realizar uma revisão sistemática da literatura e apresentar uma atualização, baseada em evidências científicas, sobre cada tópico relacionado ao tratamento sistêmico e a apresentar os dados e recomendações resumidas durante a reunião. Todos os painelistas se reuniram para discutir os tópicos e elaborar as recomendações atualizadas. O presente documento é a versão final do manuscrito revisado, contendo as recomendações da SBH, e seu objetivo é auxiliar os profissionais de saúde, formuladores de políticas e planejadores no Brasil e na América Latina na tomada de decisões sobre o tratamento sistêmico de pacientes com CHC.

https://doi.org/10.1590/s0004-2803.202301000-14

HISTOPATHOLOGICAL, CLINICAL AND EPIDEMIOLOGICAL FEATURES OF HEPATOPORTAL SCLEROSIS IN A REFERRAL CENTER FOR LIVER DISEASE IN NORTHEASTERN BRAZIL
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ARAÚJO, Caio

; NUNES, Vinícius Santos

; SANTOS, Genario

; FREITAS, Luiz Antônio Rodrigues de

; SCHINONI, Maria Isabel

; PARANÁ, Raymundo

Arquivos de Gastroenterologia

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Set 2021, Volume 58 Nº 3 Páginas 276 - 280

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO CONTEXTO: Esclerose hepatoportal EHP ou venopatia portal obliterativa VPO, um dos diagnósticos diferenciais para a hipertensão portal não cirrótica, é caracterizada pelo desaparecimento dos ramos portais, fibrose portal e septal, fibrose sinusoidal e hiperplasia nodular regenerativa HNR. A EHP é um doença espectral, que pode progredir para hipertensão portal severa. Sua etiopatologia é ainda pouco compreendida, especialmente no Brasil, onde ela é provavelmente subdiagnoticada devido as suas similaridades com a forma hepatoesplênica da esquistossomose. OBJETIVO: Analizar o perfil dos pacientes com EHP no Nordeste do Brasil, e demontrar as características patológicas da EHP. MÉTODOS: Analisamos restrospectivamente os casos de VPO em biópsias hepáticas e explantes de um centro de referência em fígado na Bahia, Brasil. A análise qualiquantitativa dos tratos portais e parênquima hepático foi realizada, permitindo a comparação entre os nossos paciente e os achados descritos por outros autores. RESULTADOS: Entre os 62 paciente identificados com EHP, 42% era do sexo masculino, 58% era do sexo feminino. A média de idade no diagnótico foi 48,3 anos. Desse grupo, analizamos a biópsia hepática de 10 pacientes nos quais o diagnóstico de esquistossomose pode ser excluído. Desses pacientes, 100% 10/10 se apresentou com fibrose portal densa e obliteração venosa portal. Atrofia do perênquima hepático estava presente em 60% 6/10 dos pacientes, dilatação sinusiodal em 30% 3/10 a presença de septos portais ocorreu em 50% 5/10 e fibrose portal densa foi achada em todos os pacientes. Hiperplasia nodular regenerativa foi encontrada em 30% dos pacientes. CONCLUSÃO: A EHP parece ser negligenciada e subdiagnosticada no Brasil, devido as suas similaridades com esquistossomose. Em nosso estudo, fibrose portal densa, obliteração dos ramos da veia porta, atrofia do parênquima, dilatação sinusoidal e hiperplasia nodular do parênquima foram os principais achados histopatológicos e foram semelhantes aos descritos em outros países.

ABSTRACT BACKGROUND: Hepatoportal sclerosis HPS or obliterative portal venopathy (OPV), one of the differential diagnoses for non-cirrohtic portal hypertension, is characterized by the disappearance of the portal branches, portal and septal fibrosis, perisinusoidal fibrosis and regenerative nodular hyperplasia (RNH). It is a spectral disease that may progress to severe portal hypertension. Its etiopathogenesis is still little understood, especially in Brazil, it has been probably misdiagnosed due to its histopatological similarities with the hepatosplenic form of schistosomiasis. OBJECTIVE: To analyze the profile of patients with HPS in Northeastern Brazil and to demonstrate the pathological characteristics of HPS. METHODS: We retrospectively analyzed cases of OPV in liver biopsies and explants from a referral center for liver in Bahia - Brazil. The qualitative and quantitative analysis of the portal tracts and liver parenchyma was made so that comparisons could be done among the HPS findings of our population and the findings described by other authors. RESULTS: From the 62 patients identified with HPS, 42% were male, while 58% were female. The average age at diagnosis was 48.3 years. From this group, we analyzed the liver biopsy of 10 patients whose diagnosis of schistosomiasis could be ruled out. From these 100% (10/10) presented dense portal fibrosis and portal venous obliteration. Liver parenchymal atrophy was present in 60% (6/10) of the patients, sinusoidal dilation was present in 30% (3/10), the presence of portal septa occurred in 50% (5/10) and dense portal fibrosis in all patients analyzed. Nodular regenerative hyperplasia was found in 30% (3/10) of the patients. CONCLUSION: HPS seems to be neglected and misdiagnosed in Brazil, due to its similarities with schistossomiasis. In our study dense portal fibrosis, obliteration of the portal vein branches, parenchymal atrophy, sinusoidal dilatation and parenchymal nodular hyperplasia were the main histopathological findings and were similar to that described in other countries.

https://doi.org/10.1590/s0004-2803.202100000-48 90 downloads

Brazilian Society of Hepatology and Brazilian Society of Infectious Diseases Guidelines for the Diagnosis and Treatment of Hepatitis B
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Ferraz, Maria Lucia

; Strauss, Edna

; Perez, Renata Mello

; Schiavon, Leonardo

; Ono, Suzane Kioko

; Pessoa, Mario Guimarães

; Ferreira, Adalgisa Paiva

; Nabuco, Leticia

; Carvalho-Filho, Roberto

; Tovo, Cristiane

; Souto, Francisco

; Abrão, Paulo

; Reuter, Tania

; Dantas, Thor

; Vigani, Aline

; Porta, Gilda

; Ferreira, Marcelo Simão

; Paraná, Raymundo

; Cimerman, Sergio

; Bittencourt, Paulo Lisboa

Brazilian Journal of Infectious Diseases

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Out 2020, Volume 24 Nº 5 Páginas 434 - 451

Resumo: En | Texto: En | PDF: En

Abstract Chronic hepatitis B is an important health problem that can progress to cirrhosis and complications such as hepatocellular carcinoma. There is approximately 290 million of people with chronic hepatitis B virus (HBV) infection worldwide, however only 10% of patients are currently identified.Most part of Brazil is considered of low prevalence of HBV infection but there are some regions with higher frequency of carriers. Unfortunately, many infected patients are not yet identified nor evaluated for treatment.The Brazilian Society of Infectious Diseases (SBI) and the Brazilian Society of Hepatology worked together to elaborate a guideline for diagnosis and treatment of hepatitis B. The document includes information regarding the population to be tested, diagnostic tools, indications of treatment, therapeutic schemes and also how to handle HBV infection in specific situations (pregnancy, children, immunosuppression, etc).Delta infection is also part of the guideline, since it is an important infection in some parts of the country.

https://doi.org/10.1016/j.bjid.2020.07.012 744 downloads

PROSPECTIVE MONITORING OF DRUG USE: DRUG-INDUCED LIVER INJURY IN A PRIMARY HEALTHCARE CENTER
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PRADO, Nília Maria de Brito Lima

; MESSIAS, Gladistone Correia

; SANTOS JUNIOR, Genário Oliveira

; NUNES, Vinícius Santos

; SCHINONNI, Maria Isabel

; PARANÁ, Raymundo

Arquivos de Gastroenterologia

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Out 2019, Volume 56 Nº 4 Páginas 390 - 393

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO CONTEXTO: As lesões hepáticas induzidas por drogas (DILI), ainda são mal compreendidas no Brasil devido a dificuldades diagnósticas ou à falta de relatos. OBJETIVO: Avaliar a frequência de eventos adversos relacionados ao uso de medicamentos em uma unidade básica de saúde, em uma cidade do sudoeste baiano. MÉTODOS: Estudo prospectivo realizado no período de fevereiro a agosto de 2013 em Vitória da Conquista, Bahia, Brasil. Entrevistas foram realizadas com pacientes maiores de 18 anos; os dados clínicos e laboratoriais foram coletados. A escala do CIOMS foi usada para avaliar causalidade dos casos. RESULTADOS: Um total de 149 pacientes, principalmente mulheres afro-brasileiras, receberam acompanhamento. Entre esses pacientes, três casos de hepatotoxicidade foram identificados e os medicamentos associados à DILI foram: nimesulida, budesonida e valaciclovir. CONCLUSÃO: DILI é raro em unidades básicas de saúde. Os três casos foram todos reversíveis, sem necessidade de internação hospitalar. Políticas de saúde que fomentam a prática da farmacovigilância são extremamente importantes para a prevenção e detecção de DILI.

ABSTRACT BACKGROUND: Drug-induced liver injury is still misunderstood in Brazil due to diagnostic difficulties or lack of reporting incidents. OBJECTIVE: To assess the frequency of adverse events related to the use of medicines in a primary healthcare unit, in a city locate southwestern of the state of Bahia, Brazil. METHODS: Prospective study conducted at the Primary Center for Specialized Health (CEMEA), February at August of 2013 in Vitoria da Conquista, Bahia, Brazil. Interviews were conducted with patients over 18 years old, and their clinical and laboratorial data were collected. The CIOMS scale was used to validate the cases. RESULTS: A total of 149 patients, mainly Afro-Brazilian women, received follow-up. Among these patients, three cases of hepatotoxicity were identified, and the medicines associated to drug-induced liver injuries were: nimesulide, budesonide and valacyclovir. CONCLUSION: Drug-induced liver injury is rare in primary healthcare units. It also allowed estimating the incidence of hepatotoxicity induced by allopathic medicines which are standardized by public healthcare authorities.

https://doi.org/10.1590/s0004-2803.201900000-73 1227 downloads

SEQUENCE SIMILARITY BETWEEN THYROID SELF-PROTEIN AND HEPATITIS C VIRUS POLYPROTEIN: possible triggering mechanism of autoimmune thyroiditis
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SOUSA, Maristella de Araújo Carvalho

; PARANÁ, Raymundo

; ANDRADE, Luís Jesuíno de Oliveira

Arquivos de Gastroenterologia

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Set 2016, Volume 53 Nº 3 Páginas 185 - 191

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO Contexto - A exposição a antígenos virais que compartilham sequência de aminoácidos semelhantes a auto-antígenos pode provocar doenças auto-imunes em indivíduos predispostos geneticamente, e a teoria do mimetismo molecular sugere que o mimetismo entre epítopos de vírus e proteínas humanas pode ativar doenças auto-imunes. Objetivo - O objetivo deste estudo foi explorar a possível semelhança entre as sequências de aminoácidos de auto-proteinas da tireóide e proteínas do vírus da hepatite C, utilizando bancos de dados de proteínas e peptídeos imunogênicos, para explicar a doença auto-imune da tireóide. Métodos - Foram realizadas comparações entre as sequências de aminoácidos de poliproteínas do vírus da hepatite C e auto-proteinas da tireóide humana, disponível na base de dados do National Center for Biotechnology Information no Basic Local Alignment Search Tool. Resultados - A semelhança de sequências foi relacionada para cada genótipo de vírus da hepatite C e proteínas da tireóide. As semelhanças entre proteínas da tireóide e os peptídeos virais variaram de 21,0% (31 resíduos idênticos da sequência de 147 aminoácidos) a 71,0% (cinco resíduos idênticos da sequência de 7 aminoácidos). Conclusão - Dados de bioinformática sugerem uma possível ligação entre vírus da hepatite C e doença auto-imune da tireóide. Através de mimetismo molecular observa-se que as semelhanças entre as sequências de poliproteínas virais e auto-proteínas da tireóide pode ser um mecanismo de indução de resposta imune resultando em doença auto-imune da tireóide.

ABSTRACT Background - Exposure to viral antigens that share amino acid sequence similar with self- antigens might trigger autoimmune diseases in genetically predisposed individuals, and the molecular mimicry theory suggests that epitope mimicry between the virus and human proteins can activate autoimmune disease. Objective - The purpose of this study is to explore the possible sequence similarity between the amino acid sequences of thyroid self-protein and hepatitis C virus proteins, using databanks of proteins and immunogenic peptides, to explain autoimmune thyroid disease. Methods - Were performed the comparisons between the amino acid sequence of the hepatitis C virus polyprotein and thyroid self-protein human, available in the database of National Center for Biotechnology Information on Basic Local Alignment Search Tool. Results - The sequence similarity was related each hepatitis C virus genotype to each thyroid antigen. The similarities between the thyroid and the viral peptides ranged from 21.0 % (31 identical residues out of 147 amino acid in the sequence) to 71.0% (5 identical residues out of 7 amino acid in the sequence). Conclusion - Bioinformatics data, suggest a possible pathogenic link between hepatitis C virus and autoimmune thyroid disease. Through of molecular mimicry is observed that sequences similarities between viral polyproteins and self-proteins thyroid could be a mechanism of induction of crossover immune response to self-antigens, with a breakdown of self-tolerance, resulting in autoimmune thyroid disease.

https://doi.org/10.1590/S0004-28032016000300012 2212 downloads

GAMMA GLUTAMYLTRANSFERASE IMPACT IN THERAPEUTIC RESPONSE OF CHRONIC HEPATITIS C: a systematic review of the literature
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QUEIROGA, Maria de Lourdes Albuquerque de

; PARANÁ, Raymundo

; MEDEIROS FILHO, José Eymard Moraes de

; FIGUEIREDO, Giovannini Cesar A

; ARAÚJO, Ananda Peixoto de

; LEITE, Hagley Walson Soares

; AQUINO, Itiel de Souza

; MELO NETO, Leonardo Honório de A

Arquivos de Gastroenterologia

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Set 2015, Volume 52 Nº 3 Páginas 239 - 246

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

ContextoO tratamento padrão da hepatite C crônica consiste na administração de interferon peguilado α2a ou α2b associado à ribavirina. Contudo, podem ser observados efeitos adversos além do alto custo desta terapêutica. Por isso há interesse no conhecimento dos fatores preditivos de resposta virológica sustentada como a gama glutamiltransferase.ObjetivoAvaliar os níveis séricos da gama glutamiltransferase como fator preditivo de resposta terapêutica com interferon peguilado α e ribavirina na hepatite C crônica.MétodosTrata-se de uma revisão sistemática da literatura, conduzida através de consulta às bases eletrônicas de dados PUBMED, LILACS, MEDLINE, SCOPUS e COCHRANE, e busca ativa das referências dos artigos selecionados, no período de janeiro de 2000 a abril de 2013.ResultadosForam identificados 4.785 títulos. Destes, seguindo os critérios de inclusão e exclusão, foram selecionados 273 resumos para a leitura por dois pesquisadores independentes. Após a leitura dos artigos, na íntegra e em consenso, os revisores incluíram dez estudos, para sistematização e qualificação, segundo os critérios da Escala de Oxford. Predominaram os estudos 1B A (Coorte prospectivo - seis estudos), publicações da Alemanha. A frequência de resposta virológica rápida foi identificada em três estudos e resposta virológica precoce em dois estudos, com um total de 392 e 413 pacientes respectivamente; a resposta virológica sustentada foi registrada em nove artigos correspondendo a 3.787 pacientes (76,5%).ConclusãoO nível sérico da gama glutamiltransferase é um fator preditivo de resposta virológica sustentada no tratamento da hepatite C crônica com interferon peguilado α2a ou α2b associado à ribavirina.

BackgroundThe standard treatment of chronic hepatitis C is the administration of pegylated interferon α2a or α2b in combination with ribavirin, but adverse effects can be observed, as well as the high cost of this therapy. Therefore, there is interest in understanding the predictors of sustained virologic response, as the gamma glutamyltransferase.ObjectiveTo evaluate the serum levels of gamma glutamyltransferase as a predictor of response to treatment with pegylated interferon α and ribavirin in chronic hepatitis C.MethodsThis is a systematic review of literature, conducted by consulting PUBMED, LILACS, MEDLINE, SCOPUS, Cochrane electronic databases, and active search of articles selected between January 2000 and April 2013.ResultsA total of 4,785 titles were iden tified. Out of those material, following inclusion and exclusion criteria, 273 abstracts were selected, by two independent researchers. After reading those texts, the reviewers consensually included ten studies for systematization and classification, according to the criteria of the Oxford Scale. 1B studies are predominant (prospective cohort study - six studies). Rapid virologic response and early virological response were considered as estimates for the sustained virological response. The frequency of virologic response was identified in three studies and early virological response in two, with a total of 392 and 413 patients, respectively; sustained virologic response was reported in nine articles corresponding to 3,787 patients (76.5 %).ConclusionGamma glutamyltransferase is a predictor of sustained virologic response in the treatment of chronic hepatitis C with pegylated interferon α2a or α2b associated with ribavirin.

https://doi.org/10.1590/S0004-28032015000300016 2187 downloads

Serum levels of immunoglobulin free light chains in patients with chronic hepatitis C presenting cryoglobulinemia
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Oliveira, Isabela S.

; Cabral, Milena S.

; Jesus, Larissa S.

; Paraná, Raymundo

; Atta, Ajax M.

; Atta, Maria Luiza B. Sousa

Brazilian Journal of Infectious Diseases

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Dez 2014, Volume 18 Nº 6 Páginas 638 - 642

Resumo: En | Texto: En | PDF: En

Hepatitis C virus (HCV) infects B-lymphocytes, provokes cellular dysfunction and causes lymphoproliferative diseases such as cryoglobulinemia and non-Hodgkin's B-cell lymphoma. In the present study, we investigated the serum levels of kappa and lambda free light chains (FLC) of immunoglobulins and the kappa/lambda FLC ratio in Brazilian patients with chronic HCV infection and cryoglobulinemia. We also analyzed the immunochemical composition of the cryoglobulins in these patients. Twenty-eight cryoglobulinemic HCV patients composed the target group, while 37 HCV patients without cryoglobulinemia were included as controls. The median levels of kappa and lambda FLC were higher in patients with cryoglobulinemia compared to controls (p = 0.001 and p = 0.003, respectively), but the kappa/lambda FLC ratio was similar in patients with and without cryoglobulinemia (p> 0.05). The median FLC ratio was higher in HCV patients presenting with advanced fibrosis of the liver compared to HCV patients without fibrosis (p = 0.004). Kappa and lambda FLC levels were strongly correlated with the IgA, IgG and IgM levels in the patients with cryoglobulinemia. In patients without cryoglobulinemia, the kappa FLC level was only correlated with the IgG level, whereas the lambda FLC were weakly correlated with the IgA, IgG and IgM levels. An immunochemical pattern of mixed cryoglobulins (MC), predominantly IgM, IgG, IgA and kappa light chain, was verified in these immune complexes. We concluded that HCV-infected patients presenting cryoglobulinemia have vigorous polyclonal B-lymphocyte activation due to chronic HCV infection and persistent immune stimulation.

https://doi.org/10.1016/j.bjid.2014.07.007 1104 downloads

GRADING SCALE OF VISCERAL ADIPOSE TISSUE THICKNESS AND THEIR RELATION TO THE NONALCOHOLIC FATTY LIVER DISEASE
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ANDRADE, Luís Jesuino de Oliveira

; MELO, Paulo Roberto Santana de

; PARANÁ, Raymundo

; DALTRO, Carla

Arquivos de Gastroenterologia

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Jun 2014, Volume 51 Nº 2 Páginas 118 - 122

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

ContextoA gordura mesentérica é drenada pelo sistema venoso portal, estando relacionada à síndrome metabólica, que é um importante fator de risco para doença de infiltração gordurosa do fígado.ObjetivosGraduar a espessura do tecido adiposo visceral e correlacionar com o grau de doença de infiltração gordurosa do fígado através do exame ultrassonográfico.MétodosForam estudados 352 indivíduos, avaliando-se idade, gênero, medidas da espessura da gordura subcutânea e tecido adiposo visceral, a presença e o grau de doença de infiltração gordurosa do fígado. Foi analisada a relação independente entre tecido adiposo visceral e doença de infiltração gordurosa do fígado, e a regressão linear foi utilizada para prever a tecido adiposo visceral pela espessura da gordura subcutânea.ResultadosA idade média de 225 (63,9%) mulheres e 127 (36,1%) homens foi 47,5 ± 14,0 (18-77) anos, 255 indivíduos apresentaram exames normais, 97 apresentaram doença de infiltração gordurosa do fígado assim distribuídos: 37 grau 1, 32 grau 2 e 28 grau 3. A espessura da gordura subcutânea variou de 0,26 e 3,50 cm, com uma média de 1,3 ± 0,6 cm e a tecido adiposo visceral variou de 0,83 a 8,86 cm, com uma média de 3,6 ± 1,7 cm. A regressão linear demonstrou que para cada aumento de 1 cm da espessura da gordura subcutânea o tecido adiposo visceral aumentará 0,9 cm.ConclusãoO tecido adiposo visceral medido por ultrassonografia é um instrumento útil e parece ser capaz de estimar o risco de doença de infiltração gordurosa do fígado.

ContextThe mesenteric fat is drained by the portal system, being related to the metabolic syndrome which is an important risk factor for non-alcoholic fatty liver disease (NAFLD).ObjectivesGraduate of visceral fat thickness and correlate with the NAFLD degree through ultrasonography method.MethodsWe studied 352 subjects for age, gender, measures of subcutaneous fat thickness and visceral fat thickness as well as the presence and degree of liver fatty. Was analyzed the independent relationship between visceral fat thickness and NAFLD, and linear regression analysis was used in order to predict the visceral fat thickness from subcutaneous fat thickness.ResultsThe mean age of 225 women (63.9%) and 127 men (36.1%) was 47.5 ± 14.0 (18-77) years, 255 subjects had normal examinations, 97 had NAFLD thus distributed, 37 grade 1, 32 grade 2, and 28 grade 3. The subcutaneous fat thickness ranged from 0.26 to 3.50 cm with a mean of 1.3 ± 0.6 cm and visceral fat thickness ranged from 0.83 to 8.86 cm with a mean of 3.6 ± 1.7 cm. Linear regression showed that for every increase of 1 cm in subcutaneous fat thickness the visceral fat thickness will increase 0.9 cm.ConclusionsThe visceral fat thickness measured by ultrasonography is a useful and seems to be able to help estimate the risk of NAFLD.

https://doi.org/10.1590/S0004-28032014000200009 4099 downloads

Hepatitis D virus infection in the Western Brazilian Amazon - far from a vanishing disease
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Braga, Wornei Silva Miranda

; Castilho, Márcia da Costa

; Borges, Fabiane Giovanella

; Leão, Jorge Roberto Di Tommaso

; Martinho, Ana Cristina de Souza

; Rodrigues, Ivo Seixas

; Azevedo, Eliete Pereira de

; Barros Júnior, Gildo Maia de

; Paraná, Raymundo

Revista da Sociedade Brasileira de Medicina Tropical

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Dez 2012, Volume 45 Nº 6 Páginas 691 - 695

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

INTRODUÇÃO: É descrito declínio na ocorrência do vírus da hepatite D (VHD) na Europa e Ásia. Estimamos a prevalência de infecção pelo VHD na Amazônia Ocidental, após a introdução da vacinação contra hepatite B. MÉTODOS: Este é um estudo de corte transversal da prevalência do VHD medido pela ocorrência de anticorpos totais (anti-HD T). RESULTADOS: A prevalência do VHD encontrada foi 41,9% entre os portadores do HBsAg, e esteve associado à idade (RP = 1,96; IC 95% 1,12-3,42; p = 0,01), infecção pelo HBV (RP = 4,38; IC 95% 3,12-6,13; p < 0,001) e história clínica de hepatite (RP =1,44; IC 95% 1,03-2,00; p = 0,03). Fatores de risco mostraram-se associados à biologia do HDV, aspectos clínicos e demográficos como infecção prévia pelo VHB e idade. CONCLUSÕES: O estudo demonstra que a infecção pelo VHD continua sendo um importante problema de saúde pública na região, e que a implantação da vacinação contra o VHB na área rural de Lábrea teve um impacto pouco significativo no controle do VHD, percebe-se que este ainda não desapareceu de áreas hiperendêmicas do VHB, e está longe de poder ser classificado como uma doença em declínio na bacia Amazônica.

INTRODUCTION: A decline in hepatitis D virus (HDV) occurrence was described in Europe and Asia. We estimated HDV prevalence in the Brazilian Amazon following hepatitis B vaccination. METHODS: This is a cross-sectional survey of HDV measured by total antibodies to HDV (anti-HD T). RESULTS: HDV prevalence was 41.9% whiting HBsAg carries and was associated with age (PR = 1.96; 95% CI 1.12-3.42; p = 0.01), hepatitis B virus (HBV) infection (PR = 4.38; 95% CI 3.12-6.13; p < 0.001), and clinical hepatitis (PR =1.44; 95% CI 1.03-2.00; p = 0.03). Risk factors were related to HDV biology, clinical or demographic aspects such as underlying HBV infection, clinical hepatitis and age. CONCLUSIONS: Our study demonstrated that HDV infection continues to be an important health issue in the Brazilian Amazon and that the implementation of the HBV vaccination in rural Lábrea had little or no impact on the spread of HDV. This shows that HDV has not yet disappeared from HBV hyperendemic areas and reminding that it is far from being a vanishing disease in the Amazon basin.

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10.

Thyroid disorders in patients with chronic hepatitis C using interferon-alpha and ribavirin therapy
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Andrade, Luis Jesuino de Oliveira

; Atta, Ajax Mercês

; Atta, Maria Luiza Brito de Sousa

; Mangabeira, Célia Neder Kalil

; Paraná, Raymundo

Brazilian Journal of Infectious Diseases

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Ago 2011, Volume 15 Nº 4 Páginas 377 - 381

Resumo: En | Texto: En | PDF: En

OBJECTIVE: To investigate the frequency of thyroid disorders (TD) in patients with chronic hepatitis C before and during interferon-alpha (IFN-α) and ribavirin (RIB) treatment. STUDY DESIGN: Prospective study. PATIENTS AND METHODS: We prospectively studied 65 anti-HCV and viral RNA positive patients. Free thyroxine, thyroid-stimulating hormone, and thyroid peroxidase antibodies (TPO-Ab) were systematically tested at entry (m0), week 12 (m3) and week 24 (m6) of treatment. RESULTS: Mean age of the 65 patients (38 females and 27 males) was 49.61 ± 11.83 years. Seven (10.76%) patients presented baseline thyroid disorders (m0), three had thyroid dysfunction, and four were TPO-Ab positive. Thyroid disorders occurred in the first 12 weeks of treatment in 11 (16.92%) patients, four with thyroid dysfunction, and seven with TPO-Ab positive (m3). A total of 18 patients (27.69%) developed TD after 24 weeks of treatment, 7 with thyroid dysfunction, and 11 with TPO-Ab positive (m6). The relative risk of developing hypothyroidism found in this study was 1.3 (95% CI: 1.1 to 1.6), hyperthyroidism 1.2 (95% CI: 1.1 to 1.4), and TPO-Ab positivity 7.6 (95% CI: 3.9 to 14.5). The study showed a significant association between female sex and thyroid disease (p = 0.009). CONCLUSION: Thyroid dysfunction and autoimmune TD were observed during IFN-α and RIB therapy.

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11.

Smooth muscle antibodies and cryoglobulinemia are associated with advanced liver fibrosis in Brazilian hepatitis C virus carriers
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Andrade, Luis Jesuino de Oliveira

; Melo, Paulo Roberto Santana de

; Atta, Ajax Mercês

; Atta, Maria Luiza Brito de Sousa

; Jesus, Larissa Santana de

; Sousa, Gabriel Menezes de

; Silva, Carolina Alves Costa

; Paraná, Raymundo

Brazilian Journal of Infectious Diseases

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Fev 2011, Volume 15 Nº 1 Páginas 66 - 68

Resumo: En | Texto: En | PDF: En

Cryoglobulinemia and non-organ-specific-autoantibody are biomarkers of autoimmunity of the chronic infection caused by hepatitis C virus (HCV). In this work, we report the association between the presence of smooth muscle antibodies (SMA) and cryoglobulinemia and chronic liver disease in HCV carriers. Sixty-five untreated HCV patients, 38 women and 27 men were included in this study. Cryoglobulinemia was tested by cryoprecipitation, SMA by indirect fluorescent antibody test, and liver fibrosis and hepatocellular inflammation activity was investigated by histology of liver biopsy using the METAVIR score. The prevalence of SMA in the patients was 33.8% and cryoglobulinemia was demonstrated in 36.9% patients. Cryoglobulinemia and SMA seropositivity was associated with advanced fibrosis (p < 0.05). The presence of SMA and cryoglobulinemia was not associated with hepatocellular inflammation activity, age, carrier gender or HCV genotype. We concluded that liver biopsy should be recommended for HCV carriers that are seropositive for SMA or cryoglobulinemia.

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12.

Impact of psychiatric disorders on the quality of life of brazilian HCV-infected patients
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Batista-Neves, Susana

; Quarantini, Lucas C.

; Galvão-de Almeida, Amanda

; Cardeal, Maurício

; Lacerda, Acioly L.

; Paraná, Raymundo

; Reis de-Oliveira, Irismar

; Bressan, Rodrigo A.

; Miranda-Scippa, Angela

Brazilian Journal of Infectious Diseases

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Fev 2009, Volume 13 Nº 1 Páginas 40 - 43

Resumo: En | Texto: En | PDF: En

The aim of our study was to determine the impact of psychiatric comorbidities on the health-related quality of life of HCV-infected patients. Assessment of clinical, socio-demographic and quality of life data of the patients followed up at a Hepatology unit was performed by using a standard questionnaire and the SF-36 instrument. Psychiatric diagnoses were confirmed by using the Mini International Neuropsychiatric Interview, Brazilian version 5.0.0 (MINI Plus). Evaluation using the MINI plus demonstrated that 46 (51%) patients did not have any psychiatric diagnosis, while 44 (49%) had at least one psychiatric diagnosis. Among patients with a psychiatric comorbidity, 26 (59.1%) had a current mental disorder, out of which 22 (84.6%) had not been previously diagnosed. Patients with psychiatric disorders had lower scores in all dimensions of the SF-36 when compared to those who had no psychiatric diagnosis. Scores of physical functioning and bodily pain domains were lower for those suffering from a current psychiatric disorder when compared to those who had had a psychiatric disorder in the past. Females had lower scores of bodily pain and mental health dimensions when compared to males. Scores for mental health dimension were also lower for patients with advanced fibrosis. The presence of a psychiatric comorbidity was the variable that was most associated with the different scores in the SF-36, compared to other variables such as age, gender, aminotransferase levels, and degree of fibrosis.

3994 downloads Citado 4 vezes em SciELO

13.

Occult B infection in the Brazilian northeastern region: a preliminary report
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Almeida, Delvone

; Tavares-Neto, José

; Trepo, Christian

; Almeida, Alessandro

; Mello, Caroline

; Chemin, Isabelle

; Paraná, Raymundo

Brazilian Journal of Infectious Diseases

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Ago 2008, Volume 12 Nº 4 Páginas 310 - 312

Resumo: En | Texto: En | PDF: En

A sentinel study on viral hepatitis is currently being carried out in the village of Cavunge in a semiarid rural region of the state of Bahia, northeastern Brazil. This study has identified individuals in whom anti-HBc IgG was the only serological marker for hepatitis B virus (HBV). This serological pattern may constitute evidence of occult HBV infection. This study Investigated the possibility of occult hepatitis B virus infection in individuals in a rural community who tested positive for anti-HBc IgG alone. A cross-sectional population-based study. ELISA III was performed on serum samples to test for serological viral markers, and ultrasensitive PCR (US-PCR) was used to assess viremia. Among the 1,536 serum samples, 3.6% (n=55) were positive for anti-HBc alone. Four years after this first serological survey, 31 of those 55 individuals (56.3%) were retested, and 11 (35.5%) remained anti-HBc positive alone. Two of these 31 (6.5%) were HBV-DNA positive based on US-PCR, with normal aminotransferase levels in both cases. Cases of occult hepatitis B infection were identified in this semiarid rural community of northeastern Brazil, where endemicity of HBV is moderate.

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14.

Hepatotropic viruses in the Brazilian Amazon: a health threat
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Paraná, Raymundo

; Vitvitski, Ludmila

; Pereira, Joao Eduardo

Brazilian Journal of Infectious Diseases

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Jun 2008, Volume 12 Nº 3 Páginas 253 - 256

Resumo: En | Texto: En | PDF: En

Viral Hepatitis B, C and D are a serious public health problem in Brazil and other South American countries, mainly in the Amazonian region. Despite the paucity of clinical and epidemiological studies, a high prevalence of Hepatitis viruses has often been described in this area. Genotype F of Hepatitis B and Genotype III of Hepatitis D have been found to be quite prevalent in this area and preliminary studies have implicated both genotypes in carcinogenesis and peculiar pathogenic liver mechanisms. Initial epidemiological studies have further demonstrated a high prevalence of Hepatitis C in the western Brazilian Amazon. The geographic, cultural, ethnic and environmental aspects of this region may favor hepatotropic virus dissemination, as well as rendering difficult the implementation of governmental programs in the treatment of patients and prevention of disease dissemination.

2306 downloads Citado 6 vezes em SciELO

15.

Thyroid dysfunction in hepatitis C individuals treated with interferon-alpha and ribavirin: a review
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Andrade, Luis Jesuíno de Oliveira

; Atta, Ajax Mercês

; D'Almeida Junior, Argemiro

; Paraná, Raymundo

Brazilian Journal of Infectious Diseases

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Abr 2008, Volume 12 Nº 2 Páginas 144 - 148

Resumo: En | Texto: En | PDF: En

Hepatitis C (HCV) is now the main cause of chronic hepatic disease, cirrhosis and hepatocellular carcinoma. Several extrahepatic diseases have been associated with chronic HCV infection, and in most cases appear to be directly related to the viral infection. Thyroid disorders are common in patients with chronic HCV. Some patients with chronic hepatitis C experience thyroid problems, and thyroid dysfunction may also be a side effect of interferon-based treatment. The principal risk factor for developing thyroid disease in the course of antiviral therapy is the previous positivity for anti-thyroid antibodies (anti-thyroid peroxidase) especially in older women. Screening for autoantibodies and serum thyroid-stimulating hormone is recommended before, during and after interferon-alpha treatment, and patients should be informed of the risk of thyroid dysfunction. This review includes a summary of thyroid disease associated with chronic HCV infection, interferon-alpha and ribavirin for treatment of HCV and potential to induce thyroid dysfunction.

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