Objective: Patients with chronic hepatitis C (CHC) have a poorer quality of life than those with other chronic liver diseases. However, some of the factors that determine health-related quality of life (HRQOL) in these patients, such as the degree of liver fibrosis, are still controversial. Therefore, the aim of the present study was to investigate the impact of CHC on HRQOL by conducting clinical, psychiatric, and sociodemographic evaluations. Methods: One hundred and twenty-four consecutive patients attending a referral center for hepatitis were evaluated using the Mini-International Neuropsychiatry Interview, the Hamilton Depression Rating Scale, the Hospital Anxiety and Depression Scale, and the Medical Outcomes Study 36-Item Short-Form Health Survey. Multiple linear regression analyses were used to quantify independent associations between HRQOL and the clinical, psychiatric, and sociodemographic variables of interest. Results: Reduced HRQOL was independently associated with major depressive disorder (MDD) and with elevated levels of alanine aminotransferase, but was not associated with hepatic cirrhosis. Conclusions: MDD rather than the grade of liver fibrosis was strongly associated with HRQOL impairment in patients with CHC. These findings highlight that, in patients with CHC, the psychological effects of the disease deserve more attention and the implementation of integrated medical, psychiatric, and psychological care may be helpful.

Therapeutic failure of benznidazole (BZ) is widely documented in Chagas disease and has been primarily associated with variations in the drug susceptibility of Trypanosoma cruzi strains. In humans, therapeutic success has been assessed by the negativation of anti-T. cruzi antibodies, a process that may take up to 10 years. A protocol for early screening of the drug resistance of infective strains would be valuable for orienting physicians towards alternative therapies, with a combination of existing drugs or new anti-T. cruzi agents. We developed a procedure that couples the isolation of parasites by haemoculture with quantification of BZ susceptibility in the resultant epimastigote forms. BZ activity was standardized with reference strains, which showed IC50 to BZ between 7.6-32 µM. The assay was then applied to isolates from seven chronic patients prior to administration of BZ therapy. The IC50 of the strains varied from 15.6 ± 3-51.4 ± 1 µM. Comparison of BZ susceptibility of the pre-treatment isolates of patients considered cured by several criteria and of non-cured patients indicates that the assay does not predict therapeutic outcome. A two-fold increase in BZ resistance in the post-treatment isolates of two patients was verified. Based on the profile of nine microsatellite loci, sub-population selection in non-cured patients was ruled out.

The immune response is crucial for protection against disease; however, immunological imbalances can lead to heart and digestive tract lesions in chagasic patients. Several studies have evaluated the cellular and humoral immune responses in chagasic patients in an attempt to correlate immunological findings with clinical forms of Chagas disease. Moreover, immunoglobulins and cytokines are important for parasitic control and are involved in lesion genesis. Here, cytokine and IgG isotype production were studied, using total epimastigote antigen on sera of chagasic patients with indeterminate (IND, n = 27) and cardiac (CARD, n = 16) forms of the disease. Samples from normal, uninfected individuals (NI, n = 30) were use as controls. The results showed that sera from both IND and CARD patients contained higher levels of Trypanosoma cruzi-specific IgG1 (IgG1) antibodies than sera from NI. No difference in IgG2 production levels was observed between NI, IND and CARD patients, nor was a difference in IL-10 and IFN-³ production detected in the sera of IND, CARD and NI patients. However, IND patients displayed a positive correlation between IL-10 and IFN-³ levels in serum, while CARD patients showed no such correlation, indicating an uncontrolled inflammatory response in CARD patients. These findings support the hypothesis that a lack of efficient regulation between IFN-³ and IL-10 productions in CARD patients may lead to cardiac immunopathology.

A abordagem antropológica foi empregada para investigar o universo de representações (maneiras de pensar) e comportamentos (maneiras de agir) associados à doença de Chagas, por um grupo de trabalhadores de um serviço público de Belo Horizonte (infectados/não infectados). Procurou-se também avaliar as repercussões deste universo de representações e comportamentos sobre a vida dos indivíduos infectados. A coleta e a análise dos dados, inspirou-se no modelo dos "sistemas de signos, significados e ações", elaborado por Corin et al. (1989, 1992). Foram entrevistados 16 informantes chave, selecionados entre os trabalhadores soro-positivos e 12 entre os trabalhadores soro-negativos, com o objetivo de comparar as maneiras de pensar e agir, predominantes nesses dois grupos. A análise dos dados, permitiu identificar diversos elementos do contexto que vêm maximizar as limitações impostas pela doença de Chagas, e que devem ser levados em conta no planejamento de campanhas educativas e na elaboração de modelos de atenção ao paciente chagásico.

An anthropological approach was employed to investigate the universe of representations (ways of thinking) and behaviors (ways of acting) associated with Chagas disease in a group of public service workers in Belo Horizonte (both infected and not infected with Trypanosoma cruzi). An attempt was also made to evaluate the repercussions of this universe of representations and behaviors on the lives of the infected individuals. The collection and analysis of the data followed the "systems of signs, meanings, and actions" model developed by Corin et al. (1989, 1992). Sixteen seropositive and 12 seronegative workers were interviewed to compare their ways of thinking and acting towards the disease. Data analysis allowed identification of diverse elements within a context that maximized the limitations imposed by Chagas disease. These should be taken into account in the planning of educational campaigns and elaboration of health care models for Chagas patients.

A abordagem antropológica foi empregada para investigar o universo de representações (maneiras de pensar) e comportamentos (maneiras de agir) associados à doença de Chagas, por um grupo de trabalhadores de um serviço público de Belo Horizonte (infectados/não infectados). Procurou-se também avaliar as repercussões deste universo de representações e comportamentos sobre a vida dos indivíduos infectados. A coleta e a análise dos dados, inspirou-se no modelo dos "sistemas de signos, significados e ações", elaborado por Corin et al. (1989, 1992). Foram entrevistados 16 informantes chave, selecionados entre os trabalhadores soro-positivos e 12 entre os trabalhadores soro-negativos, com o objetivo de comparar as maneiras de pensar e agir, predominantes nesses dois grupos. A análise dos dados, permitiu identificar diversos elementos do contexto que vêm maximizar as limitações impostas pela doença de Chagas, e que devem ser levados em conta no planejamento de campanhas educativas e na elaboração de modelos de atenção ao paciente chagásico.

An anthropological approach was employed to investigate the universe of representations (ways of thinking) and behaviors (ways of acting) associated with Chagas disease in a group of public service workers in Belo Horizonte (both infected and not infected with Trypanosoma cruzi). An attempt was also made to evaluate the repercussions of this universe of representations and behaviors on the lives of the infected individuals. The collection and analysis of the data followed the "systems of signs, meanings, and actions" model developed by Corin et al. (1989, 1992). Sixteen seropositive and 12 seronegative workers were interviewed to compare their ways of thinking and acting towards the disease. Data analysis allowed identification of diverse elements within a context that maximized the limitations imposed by Chagas disease. These should be taken into account in the planning of educational campaigns and elaboration of health care models for Chagas patients.