RESUMO
INTRODUCTION AND OBJECTIVES: Research has shown that hepatitis B (HBV) and Delta virus (HDV) are a worldwide public health problem. This study aims to estimate the prevalence rates of HBV and HDV infection in five municipalities of Maranhão, Northeastern Brazil. MATERIALS AND METHODS: A total sample between 3856 and 4000 individuals. Questionnaires were used to register sociodemographic characteristics and factors associated with transmission. Patients were tested for hepatitis B virus surface antigen (HBsAg), anti-hepatitis B core antigen (anti-HBc), and antibodies against hepatitis Delta virus (anti-HDV). Factors associated with HBV were detected by means of multivariate Poisson regression. RESULTS: Overall, 3983 subjects were included. Ninety-two of the participants were HBsAg-positive (2.30%, 95% CI 1.80-2.80), and anti-HBc was detected in 1535 (38.50%, 95% CI 37-40). The factors associated with the presence of anti-HBc were: (1) Municipality (P<0.001); Age (P<0.001); School education (P<0.001); Illicit drug use (P=0.001); non-HBV vaccine (P=0.041). Among the HBsAg carriers, eight were anti-HDV-positive (8.69%, 95% CI 2.90-14.40). The most frequent HBV genotype was D4. The only HDV genotype was HDV-8. CONCLUSION: HBV exhibited intermediate endemicity in the studied region. Traditional factors were associated with exposure to the virus. The presence of the HDV was confirmed. The most frequent HBV and HDV genotypes were unlike the ones currently described in Brazil.
Assuntos
Hepatite B/complicações , Hepatite B/epidemiologia , Hepatite D/complicações , Hepatite D/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Hepatite B/diagnóstico , Hepatite D/diagnóstico , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Hepatitis delta virus (HDV) infections in hepatitis B virus (HBV) carriers are the most severe form of viral hepatitis. HDV prevalence is high in the Brazilian Amazon, but studies in other regions of the country are still scarce and often underestimated its prevalence by including a small numbers of individuals. OBJECTIVE: This study aimed to determine the serological prevalence of hepatitis D, the genotypes circulating and to evaluate the associated risk factors for acquisition of HDV in Minas Gerais state, Brazil. METHODS: We screened plasma samples (n = 498) from HBV chronic carriers for anti-HD antibodies using a commercial enzyme-linked immunosorbent assay (ELISA) kit. For those samples that were positive for anti-HD antibodies, we performed a reverse transcriptase (RT) nested-polymerase chain reaction (nested-PCR) in order to detect the viral genome and identify the viral genotypes circulating in the state. FINDINGS: The prevalence was 6.22% (31/498). Blood transfusion was the only risk factor associated with HDV infection [risk ratio: 3.73; 95% confidence interval (CI): 1.44 to 9.65]. For 26 anti-HD positive patients, HDAg gene sequences were determined and in all patients HDV genotype 1 was found. CONCLUSIONS: This study confirmed the circulation of HDV in Minas Gerais, an area previously considered non-endemic for hepatitis D in Brazil. The prevalence found in this study is much higher when compared to other studies performed in Brazil, probably because the population in our study was selected with minimal bias. Furthermore, in 26 anti-HD positive plasma samples, we were also able to detect the viral genome, indicating that these patients were experienced an active infection at the time of sample collection. These findings emphasise the importance of anti-HD testing in HBV infected individuals, which may contribute to this disease control in Brazil.
Assuntos
Anticorpos Anti-Hepatite/sangue , Hepatite B Crônica/epidemiologia , Hepatite D/epidemiologia , Vírus Delta da Hepatite , RNA Viral/genética , Adolescente , Adulto , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Genótipo , Hepatite B Crônica/complicações , Hepatite D/complicações , Hepatite D/diagnóstico , Vírus Delta da Hepatite/genética , Vírus Delta da Hepatite/imunologia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular , Filogenia , Prevalência , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de Risco , Adulto JovemRESUMO
Acquired hepatocerebral degeneration is a neurological syndrome with typical clinical (extrapyramidal and neuropsychiatric) symptoms and brain magnetic resonance imaging findings (high T1 signal in the globus pallidus). It occurs mainly in patients with advanced liver disease, such as in patients co-infected with hepatitis B virus (HBV) and hepatitis delta virus (HDV). However, there are no reports relating HBV/HDV coinfection and acquired hepatocerebral degeneration. This report presents the case of a 49-year-old woman with characteristics of acquired hepatocerebral degeneration and liver cirrhosis due to HBV/HDV coinfection, and presents the main theories of the physiopathology of this condition.
Assuntos
Hepatite B/complicações , Hepatite D/complicações , Degeneração Hepatolenticular/virologia , Cirrose Hepática/virologia , Coinfecção/virologia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Abstract Acquired hepatocerebral degeneration is a neurological syndrome with typical clinical (extrapyramidal and neuropsychiatric) symptoms and brain magnetic resonance imaging findings (high T1 signal in the globus pallidus). It occurs mainly in patients with advanced liver disease, such as in patients co-infected with hepatitis B virus (HBV) and hepatitis delta virus (HDV). However, there are no reports relating HBV/HDV coinfection and acquired hepatocerebral degeneration. This report presents the case of a 49-year-old woman with characteristics of acquired hepatocerebral degeneration and liver cirrhosis due to HBV/HDV coinfection, and presents the main theories of the physiopathology of this condition.
Assuntos
Humanos , Feminino , Hepatite D/complicações , Hepatite B/complicações , Degeneração Hepatolenticular/virologia , Cirrose Hepática/virologia , Coinfecção/virologia , Pessoa de Meia-IdadeRESUMO
BACKGROUND: In Colombia, cases of Hepatitis D virus (HDV) infection have been officially described since 1985 mainly in Amerindian population from Sierra Nevada de Santa Marta (North Caribbean Coast), Uraba (North West), and Amazon (South East). The last official report of a clinical case of HDV infection in Colombia was registered in 2005. OBJECTIVES: The aims of this study were to identify cases of HDV and/or Hepatitis B virus (HBV) infection in asymptomatic Amerindians from Amazonas state, South East Colombia, and to describe the circulating viral genotypes in this population. STUDY DESIGN: The study population was recruited in 19 Amerindian communities in the Amazonas state. Individuals over 18 years old were screened by rapid test for Hepatitis B surface Antigen (HBsAg). Blood samples obtained from individuals positives for HBsAg in the rapid-test assay were analyzed for HBsAg, anti-HBc, anti-HDV IgM/IgG by ELISA. The detection of HBV DNA and HDV RNA was performed by PCR amplification. The viral genotype was determined by sequencing and phylogenetic analysis. RESULTS: A total of 23/861 individuals were positive for HBsAg detection by rapid test. Serological and/or molecular markers of HDV infection were demonstrated in 43.5 % (10/23) of samples from Amerindians. The phylogenetic analysis demonstrated the exclusive circulation of HBV subgenotype F1b of and HDV 3 in this population. CONCLUSIONS: A high frequency of HBV/HDV infection was found in Amerindian population from Amazonas State, Colombia (43.5 %, 10/23). Nine cases were identified in a population of 861 asymptomatic Amerindian individuals; one symptomatic case (with diagnosis of end-stage hepatic disease) was also identified in the study. The circulation of HDV 3 and HBV subgenotype F1b suggests a constant flow of these viral genotypes as a result of the interaction of the Amerindian populations from Amazon basin. Further studies are necessary to confirm whether HBV subgenotype F1b is the prevalent in the population from South East region in Colombia.
Assuntos
Vírus da Hepatite B/isolamento & purificação , Hepatite B/complicações , Hepatite B/epidemiologia , Hepatite D/complicações , Hepatite D/epidemiologia , Vírus Delta da Hepatite/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Doenças Assintomáticas , Colômbia/epidemiologia , DNA Viral/sangue , Ensaio de Imunoadsorção Enzimática , Feminino , Genótipo , Anticorpos Anti-Hepatite/sangue , Antígenos de Superfície da Hepatite B/sangue , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Indígenas Centro-Americanos , Masculino , Pessoa de Meia-Idade , Filogenia , Reação em Cadeia da Polimerase , Prevalência , RNA Viral/sangue , Análise de Sequência de DNA , Adulto JovemRESUMO
HDV infection still remains a serious public health problem in Amazonia. There are few data regarding the biomolecular aspects of HBV/HDV co-infection in this region. We studied 92 patients HBsAg(+) /anti-HDV IgG(+) followed at the Hepatitis Referral Centers of Porto Velho (RO), Rio Branco and Cruzeiro do Sul (AC), Brazil, from March 2006 to March 2007 for whom the HDV and/or the HBV genotype could be determined. The HDV genotype could be determined in 90 patients, while the HBV genotypes could be positively determined in 74. HBV subgenotype F2 is the most prevalent (40.2%), followed by the subgenotypes A1 (15.2%) and D3 (8.7%), while 16.4% were other subgenotypes or genotypes, 4.3% were discordant and 15.2% were unamplifiable. Surprisingly, HDV genotype 3 (HDV-3) was found in all of the HBV/HDV-infected patients that could be genotyped for HDV, confirming that HDV-3 can associate with non-F HBV genotypes. However, a HDV-3 mutant was found in 29.3% of patients and was more frequently associated with non-F HBV genotypes (P < 0.001) than were nonmutant strains, suggesting that the mutation may facilitate association of HDV-3 with non-F HBV genotypes.
Assuntos
Coinfecção/epidemiologia , Vírus da Hepatite B/genética , Hepatite B/epidemiologia , Hepatite D/epidemiologia , Vírus Delta da Hepatite/genética , Mutação , Brasil/epidemiologia , Genótipo , Anticorpos Anti-Hepatite/sangue , Hepatite B/complicações , Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B/classificação , Hepatite D/complicações , Vírus Delta da Hepatite/classificação , Humanos , Imunoglobulina G/sangue , Dados de Sequência Molecular , RNA Viral/química , RNA Viral/genética , Análise de Sequência de DNARESUMO
Hepatitis delta virus (HDV) is widely distributed and associated with fulminant hepatitis epidemics in areas with high prevalence of HBV. Several studies performed in the 1980s showed data on HDV infection in South America, but there are no studies on the viral dynamics of this virus. The aim of this study was to conduct an evolutionary analysis of hepatitis delta genotype 3 (HDV/3) prevalent in South America: estimate its nucleotide substitution rate, determine the time of most recent ancestor (TMRCA) and characterize the epidemic history and evolutionary dynamics. Furthermore, we characterized the presence of HBV/HDV infection in seven samples collected from patients who died due to fulminant hepatitis from Amazon region in Colombia and included them in the evolutionary analysis. This is the first study reporting HBV and HDV sequences from the Amazon region of Colombia. Of the seven Colombian patients, five were positive for HBV-DNA and HDV-RNA. Of them, two samples were successfully sequenced for HBV (subgenotypes F3 and F1b) and the five samples HDV positive were classified as HDV/3. By using all HDV/3 available reference sequences with sampling dates (n=36), we estimated the HDV/3 substitution rate in 1.07 × 10(-3) substitutions per site per year (s/s/y), which resulted in a time to the most recent common ancestor (TMRCA) of 85 years. Also, it was determined that HDV/3 spread exponentially from early 1950s to the 1970s in South America. This work discusses for the first time the viral dynamics for the HDV/3 circulating in South America. We suggest that the measures implemented to control HBV transmission resulted in the control of HDV/3 spreading in South America, especially after the important raise in this infection associated with a huge mortality during the 1950s up to the 1970s. The differences found among HDV/3 and the other HDV genotypes concerning its diversity raises the hypothesis of a different origin and/or a different transmission route.
Assuntos
Vírus da Hepatite B/genética , Hepatite B/virologia , Hepatite D/virologia , Vírus Delta da Hepatite/genética , Falência Hepática Aguda/virologia , Adolescente , Adulto , Teorema de Bayes , Coinfecção , Colômbia , Evolução Molecular , Feminino , Genes Virais , Genótipo , Hepatite B/complicações , Hepatite D/complicações , Vírus Delta da Hepatite/classificação , Humanos , Masculino , Modelos Genéticos , Filogenia , Análise de Sequência de RNA , Adulto JovemAssuntos
Vírus da Hepatite B/patogenicidade , Hepatite B/epidemiologia , Hepatite D/epidemiologia , Vírus Delta da Hepatite/patogenicidade , África/epidemiologia , Ásia/epidemiologia , Brasil/epidemiologia , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/virologia , DNA Viral/genética , Vírus da Hepatite B/genética , Vírus da Hepatite B/fisiologia , Hepatite D/complicações , Vírus Delta da Hepatite/genética , Humanos , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/virologia , Reação em Cadeia da Polimerase , Estudos Prospectivos , RNA Viral/genética , Estudos Retrospectivos , Turquia/epidemiologia , Replicação ViralRESUMO
Hepatitis B (HBV) is a public health problem worldwide; one-third of the population has already been in contact with HBV, and 350 million people are chronic carriers of virus. The appearance of hyperimmune gamma globulin and antiviral drugs has allowed that group to undergone hepatic transplantation, achieving satisfactory results to prevent a relapse. But the use of hyperimmune gamma globulin has an extremely high cost, and combined therapies with new antiviral drugs seem to be a therapeutic alternative. We analyzed 21 patients with hepatitis B associated or not with Delta hepatitis over a mean follow-up period of 19.5 months, concluding that use of only nucleotide analogues has sufficient to achieve satisfactory results.
Assuntos
Antivirais/uso terapêutico , Hepatite B/cirurgia , Hepatite D/cirurgia , Transplante de Fígado/imunologia , Adenina/análogos & derivados , Adenina/uso terapêutico , Adulto , Idoso , Aspartato Aminotransferases/sangue , Feminino , Guanina/análogos & derivados , Guanina/uso terapêutico , Hepatite B/complicações , Hepatite B/tratamento farmacológico , Hepatite B/prevenção & controle , Vírus da Hepatite B/efeitos dos fármacos , Vírus da Hepatite B/genética , Hepatite D/complicações , Hepatite D/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Organofosfonatos/uso terapêutico , Reação em Cadeia da Polimerase , Recidiva , Estudos Retrospectivos , Adulto JovemRESUMO
Comorbidities in human immunodeficiency virus infection are of great interest due to their association with unfavorable outcomes and failure of antiretroviral therapy. This study evaluated the prevalence of coinfection by human immunodeficiency virus and viral hepatitis in an endemic area for hepatitis B in the Western Amazon basin. Serological markers for hepatitis B virus, hepatitis C virus and hepatitis D virus were tested in a consecutive sample of all patients referred for treatment of human immunodeficiency virus or acquired immunodeficiency syndrome. The variables sex, age, origin and exposure category were obtained from medical records and from the sexually transmitted diseases and acquired immunodeficiency syndrome surveillance database. Among 704 subjects, the prevalence of chronic hepatitis B carriage was 6.4 percent and past infection 40.2 percent. The presence of hepatitis B was associated with birth in hyperendemic areas of the Amazon basin, male sex and illegal drug use. The overall prevalence of hepatitis C was 5 percent and was associated with illegal drug use. The prevalence of hepatitis B and C among human immunodeficiency virus or acquired immunodeficiency syndrome patients in the Western Amazon basin was lower than seen elsewhere and is probably associated with the local epidemiology of these viruses and the degree of overlap of their shared risk factors. An opportunity presents itself to evaluate the prevention of hepatitis C through harm reduction policies and hepatitis B through vaccination programs among human immunodeficiency virus or acquired immunodeficiency syndrome patients.
Co-morbidades na infecção pelo vírus da imunodeficiência humana são de grande interesse devido à associação com desfechos desfavoráveis e falhas na terapia anti-retroviral. Este estudo avalia a prevalência de co-infecção entre o vírus da imunodeficiência humana e hepatites virais, em uma área endêmica de hepatite B, na Amazônia Ocidental. Marcadores sorológicos para o Vírus da hepatite B, Vírus da hepatite C e vírus da hepatite D foram testados em uma amostra de pacientes referenciado para o tratamento em ambulatório para pacientes com infecção pelo vírus da imunodeficiência humana ou síndrome da imunodeficiência adquirida. As variáveis: sexo, idade, origem e categoria de exposição, foram obtidas dos prontuários médicos e do banco de dados da Coordenação Estadual de Doenças sexualmente transmissíveis. Entre os 704 indivíduos incluídos, a prevalência de portador crônico do vírus da hepatite B foi 6,4 por cento e de infecção passada 40,2 por cento. O vírus da hepatite B esteve associado com o local de nascimento em áreas hiperendêmicas da Amazônia, sexo masculino e uso de drogas ilícitas. A prevalência de hepatite C foi 5 por cento, estando associada com uso de drogas ilícitas. A prevalência dos vírus da hepatite B e C, entre indivíduos vivendo com o vírus da imunodeficiência humana e síndrome da imunodeficiência adquirida, na Amazônia ocidental, foi mais baixa que as observadas em estudos com populações de outras regiões. Provavelmente, estes resultados estão associados à epidemiologia local destes vírus, e ao grau de superposição dos fatores de risco associados à infecção na população estudada. O estudo apresenta oportunidade de avaliar a prevenção da hepatite C e B, através de medidas de redução de danos e programa de vacinação em indivíduos vivendo com vírus da imunodeficiência humana e síndrome da imunodeficiência adquirida.