A hepatite B tem sido uma grande ameaça aos pacientes de hemodiálise. Para investigar o perfil da infecção pelo vírus da hepatite B (VHB) na população de hemodiálise de Goiânia _ Brasil Central, 282 pacientes foram estudados. A prevalência de marcadores do VHB (AgHBs, anti-HBc e anti-HBs) foi de 56,7% (IC 95%: 51,1 _ 62,7) variando de 33,3% a 77,7% entre as unidades de diálise. O VHB-DNA foi detectado nas amostras AgHBs positivas em 67,6% e 88,2%, nas AgHBs e AgHBe em 91,3% e 100%, e nas AgHBe e anti-HBe soro reativas em 18,2% e 63,6% por hibridização e PCR, respectivamente. O tempo de tratamento hemodialítico mostrou-se estatisticamente associado à soropositividade ao VHB. Somente 10% dos pacientes relataram vacinação para a hepatite B. Assim, uma prevalência elevada para infecção pelo VHB nesta população e o risco aumentado do tempo de tratamento hemodialítico sugerem a transmissão ambiental deste vírus, enfatizando a necessidade urgente de reavaliação das medidas de controle e prevenção adotadas nestas unidades.

Hepatitis B has proved to be a major health hazard in hemodialysis patients. In order to investigate the hepatitis B virus (HBV) infection profile in the hemodialysis population of Goiânia city - Central Brazil, all dialysis patients (N=282) were studied. The prevalence of any HBV marker (HBsAg, anti-HBs, and anti-HBc) was 56.7% (95% CI: 51.1-62.7), ranging from 33.3% to 77.7% depending on dialysis unit. HBV-DNA was detected in 67.6% and 88.2% of the HBsAg-positive serum samples, in 91.3% and 100% of the HBsAg/HBeAg-positive samples, and in 18.2% and 63.6% of the HBsAg/anti-HBe-reactive sera by hybridization and PCR, respectively. The length of time on hemodialysis was significantly associated with HBV seropositivity. Only 10% of the patients reported received hepatitis B vaccination. The findings of a high HBV infection prevalence in this population and the increased risk for HBV infection on long-term hemodialysis suggest the environmental transmission, emphasizing the urgent need to evaluate strategies of control and prevention followed in these units.

Aproximadamente 400 pacientes de hemodiálise tratados em 5 diferentes unidades no Rio de Janeiro foram acompanhados durante 1 ano para presença de marcadores virais de hepatite B e C. Durante o mesmo período, amostras foram também de 35 pacientes ambulatoriais de diálise peritonial contínua (CAPD) e de 242 funcionários das unidades. Dependendo da unidade em estudo foram detectadas prevalências de anti-HCV variando de 47% a 82% (média 65%). Pacientes de CAPD demonstraram uma baixa prevalência de 17%. A prevalência de anti-HCV em funcionários foi de 2.9%. Observamos uma taxa de ataque de hepatite C de 11.5% por ano na população paciente de hemodiálise anti-HCV-negativo. Uma média de 9.4% de pacientes de hemodiálise eram portadores crônicos do vírus da hepatite B (VHB) (taxa de 1.8% a 20.4%), enquanto 48.9% apresentaram marcadores de infecção passada de HBV. A taxa de ataque de HBV foi de 4.5% por ano (taxa de 0% a 6%). Esses resultados indicam uma alarmante prevalência alta de anti-HCV em pacientes de hemodiálise dessa região estudada.

Nearly 400 hemodialysis patients treated at 5 different hemodialysis units in Rio de Janeiro were tested for one year for the presence of hepatitis C and B markers. During the same period, samples were also obtained from 35 continuous ambulatory peritoneal dialysis (CAPD) patients and from 242 health care workers. Depending on the hemodialysis unit studied, anti-HCV prevalence rates ranging from 47% to 82% (mean 65%) were detected. CAPD patients showed a lower prevalence of 17%. The prevalence of antibodies against hepatitis C virus (anti-HCV) among health care workers was 2.9%. We observed a hepatitis C attack rate of 11.5% per year in the anti-HCV-negative hemodialysis patient population. An average of 9.4% of the hemodialysis patients were chronic carriers of hepatitis B virus (HBV) (range 1.8% - 20.4%), while 48.9% showed markers of previous HBV infection. The HBV attack rate was 4.5% per year (range 0% - 6%). These results indicate an alarming high prevalence of anti-HCV among hemodialysis patients of this studied region.

Ainda são raros os dados sobre a infecção pelo vírus da hepatite C (HCV) na região central do Brasil. Neste estudo, 2.350 doadores voluntários de sangue foram avaliados, resultando em prevalências para o anti-HCV de 2,2%, pelo ELISA de segunda geração, e de 1,4%, após o ensaio confirmatório "line immunoassay". Anticorpos contra os antígenos "core", NS4 e NS5 do HCV foram detectados em 81,8%, 72,7% e 57,5% das amostras positivas no "line immunoassay", respectivamente. A viremia do HCV foi observada em 76,6% dos doadores anti-HCV positivos. A positividade na reação em cadeia da polimerase (PCR) mostrou-se relacionada a reatividade aos diferentes antígenos do HCV no "line immunoassay". A maioria dos doadores positivos tiveram história prévia de exposição parenteral. A combinação de ALT> 50 UI/l e positividade ao anti-HBc parece não ser eficaz como marcadores indiretos para a infecção pelo HCV, entretanto a dosagem do ALT e a detecção de anti-HCV são indicadas na triagem de doadores de sangue brasileiros.

Data concerning HCV infection in Central Brazil are rare. Upon testing 2,350 voluntary blood donors from this region, we found anti-HCV prevalence rates of 2.2% by a second generation ELISA and 1.4% after confirmation by a line immunoassay. Antibodies against core, NS4, and NS5 antigens of HCV were detected in 81.8%, 72.7%, and 57.5%, respectively, of the positive samples in the line immunoassay. HCV viremia was present in 76.6% of the anti-HCV-positive blood donors. A relation was observed between PCR positivity and serum reactivity in recognizing different HCV antigens in the line immunoassay. The majority of the positive donors had history of previous parenteral exposure. While the combination of ALT>50 IU/l and anti-HBc positivity do not appear to be good surrogate markers for HCV infection, the use of both ALT anti-HCV tests is indicated in the screening of Brazilian blood donors.

The prevalence of hepatitis B and C infection has been determined in a seroepidemiological survey among blood donors from the south of Brazil (Florianópolis, State of Santa Catarina). These markers has also been correlated with the levels of alanine aminotransferase (ALT), a surrogate marker to prevent post-transfusion hepatitis. Sera from 5000 donors were randomly collected in the period of April to November 1991. The prevalences of HBsAg, anti-HBs and anti-HBc were respectively 0.78, 7.02 and 13.98. The anti-HCV prevalence after confirmation testing with line immunoassay (LIA), was 1.14. Normal values of ALT ( < = 32 U/ml) were found in 59.78, values slightly above the mean (ALT between 32-70 U/ml) in 37.74 and high values of ALT ( > = 70 U/ml) in 2.48. The positivity of anti-HCV antibodies increased with the elevation of ALT levels. This correlation was not observed in relation to HBsAg. There exists a diversity in the recognition of HCV epitopes among HCV positive donors. Via the confirmation test used, we could observe that 94.7 of donors recognize the structural core antigen. Besides that, we observed that 5.26 of the HCV reactive sera recognized only epitopes located in the NS4 and/or NS5 region, indicating the importance of these epitopes for the improvement of assays.