Assuntos
Hepatite C Crônica/epidemiologia , Hepatite D Crônica/epidemiologia , Vírus Delta da Hepatite/isolamento & purificação , Necrose Hepática Massiva/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Hepacivirus/isolamento & purificação , Anticorpos Anti-Hepatite/isolamento & purificação , Vírus da Hepatite B/isolamento & purificação , Hepatite B Crônica/diagnóstico , Hepatite B Crônica/virologia , Hepatite C Crônica/complicações , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/virologia , Hepatite D Crônica/complicações , Hepatite D Crônica/diagnóstico , Hepatite D Crônica/virologia , Vírus Delta da Hepatite/genética , Vírus Delta da Hepatite/imunologia , Humanos , Povos Indígenas/estatística & dados numéricos , Masculino , Necrose Hepática Massiva/diagnóstico , Necrose Hepática Massiva/virologia , Pessoa de Meia-Idade , RNA Viral/isolamento & purificação , Venezuela/epidemiologia , Adulto JovemRESUMO
BACKGROUND: The Amazon region is one of the main endemic areas of hepatitis delta in the world and the only one related to the presence of genotype 3 of the delta virus. OBJECTIVE: To analyze the profile, mortality and survival of cirrhotic patients submitted to liver transplantation for chronic hepatitis delta virus and compare with those transplanted by hepatitis B virus monoinfection. METHODS: Retrospective, observational and descriptive study. From May 2002 to December 2011, 629 liver transplants were performed at the Walter Cantídio University Hospital, of which 29 patients were transplanted due to cirrhosis caused by chronic delta virus infection and 40 by hepatitis B chronic monoinfection. The variables analyzed were: age, sex, MELD score, Child-Pugh score, upper gastrointestinal bleeding and hepatocellular carcinoma occurrence before the transplantation, perioperative platelet count, mortality and survival. RESULTS: The Delta Group was younger and all came from the Brazilian Amazon Region. Group B presented a higher proportion of male patients (92.5%) compared to Group D (58.6%). The occurrence of upper gastrointestinal bleeding before transplantation, MELD score, and Child-Pugh score did not show statistical differences between groups. The occurrence of hepatocellular carcinoma and mortality were higher in the hepatitis B Group. The survival in 4 years was 95% in the Delta Group and 75% in the B Group, with a statistically significant difference (P=0.034). Patients with hepatitis delta presented more evident thrombocytopenia in the pre-transplantation and in the immediate postoperative period. CONCLUSION: The hepatitis by delta virus patients who underwent liver transplantation were predominantly male, coming from the Brazilian Amazon region and with similar liver function to the hepatitis B virus patients. They had a lower incidence of hepatocellular carcinoma, more marked perioperative thrombocytopenia levels and frequent episodes of upper gastrointestinal bleeding. Patients with hepatitis by delta virus had lower mortality and higher survival than patients with hepatitis B virus.
Assuntos
Hepatite B Crônica/mortalidade , Hepatite D Crônica/mortalidade , Cirrose Hepática/mortalidade , Transplante de Fígado/mortalidade , Adulto , Plaquetas/química , Brasil/epidemiologia , Carcinoma Hepatocelular/mortalidade , Feminino , Hepatite B Crônica/complicações , Hepatite D Crônica/complicações , Hepatite D Crônica/cirurgia , Vírus Delta da Hepatite/genética , Humanos , Estimativa de Kaplan-Meier , Cirrose Hepática/cirurgia , Cirrose Hepática/virologia , Neoplasias Hepáticas/mortalidade , Transplante de Fígado/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por SexoRESUMO
ABSTRACT BACKGROUND: The Amazon region is one of the main endemic areas of hepatitis delta in the world and the only one related to the presence of genotype 3 of the delta virus. OBJECTIVE: To analyze the profile, mortality and survival of cirrhotic patients submitted to liver transplantation for chronic hepatitis delta virus and compare with those transplanted by hepatitis B virus monoinfection. METHODS: Retrospective, observational and descriptive study. From May 2002 to December 2011, 629 liver transplants were performed at the Walter Cantídio University Hospital, of which 29 patients were transplanted due to cirrhosis caused by chronic delta virus infection and 40 by hepatitis B chronic monoinfection. The variables analyzed were: age, sex, MELD score, Child-Pugh score, upper gastrointestinal bleeding and hepatocellular carcinoma occurrence before the transplantation, perioperative platelet count, mortality and survival. RESULTS: The Delta Group was younger and all came from the Brazilian Amazon Region. Group B presented a higher proportion of male patients (92.5%) compared to Group D (58.6%). The occurrence of upper gastrointestinal bleeding before transplantation, MELD score, and Child-Pugh score did not show statistical differences between groups. The occurrence of hepatocellular carcinoma and mortality were higher in the hepatitis B Group. The survival in 4 years was 95% in the Delta Group and 75% in the B Group, with a statistically significant difference (P=0.034). Patients with hepatitis delta presented more evident thrombocytopenia in the pre-transplantation and in the immediate postoperative period. CONCLUSION: The hepatitis by delta virus patients who underwent liver transplantation were predominantly male, coming from the Brazilian Amazon region and with similar liver function to the hepatitis B virus patients. They had a lower incidence of hepatocellular carcinoma, more marked perioperative thrombocytopenia levels and frequent episodes of upper gastrointestinal bleeding. Patients with hepatitis by delta virus had lower mortality and higher survival than patients with hepatitis B virus.
RESUMO CONTEXTO: A região Amazônica é uma das principais áreas endêmicas da hepatite delta no mundo e a única relacionada com a presença do genótipo 3 do vírus delta. OBJETIVO: Analisar o perfil, mortalidade e sobrevida dos pacientes cirróticos submetidos a transplante hepático por hepatite crônica pelo vírus delta e comparar com os transplantados pela monoinfecção do vírus da hepatite B. MÉTODOS: Estudo retrospectivo, observacional e descritivo. Entre maio de 2002 a dezembro de 2011, foram realizados 629 transplantes de fígado no Hospital Universitário Walter Cantídio, dos quais 29 pacientes foram transplantados por cirrose causada pela infecção crônica do vírus delta e 40 pela monoinfecção crônica da hepatite B. As variáveis analisadas foram: origem, idade, sexo, escore de MELD, classificação de Child-Pugh, ocorrência de hemorragia digestiva alta e carcinoma hepatocelular antes do transplante, número de plaquetas perioperatória, mortalidade e sobrevida. RESULTADOS: O Grupo Delta foi mais jovem e todos oriundos da região Amazônica Brasileira. O Grupo B apresentou maior proporção de pacientes do sexo masculino (92,5%) em relação ao Grupo D (58,6%). A ocorrência de hemorragia digestiva alta antes do transplante, escore de MELD e classificação de Child-Pugh não obtiveram diferenças estatísticas entre os grupos. A ocorrência de carcinoma hepatocelular e a mortalidade foram maiores no grupo com hepatite B. A sobrevida em 4 anos foi de 95% no Grupo delta e 75% no Grupo B com diferença estatisticamente significante (P=0,034). Pacientes com hepatite delta, apresentaram mais acentuada plaquetopenia no pré-transplante e no pós-operatório imediato. CONCLUSÃO: Os pacientes com hepatite por vírus delta submetidos ao transplante hepático eram predominantemente homens, vindos da região da Amazônia brasileira e com função hepática semelhante a dos pacientes com vírus da hepatite B. Apresentavam menor incidência de carcinoma hepatocelular, níveis de trombocitopenia perioperatória mais acentuados e episódios frequentes de hemorragia digestiva alta. Os pacientes com hepatite por vírus delta apresentaram menor mortalidade e maior sobrevida que os pacientes com vírus da hepatite B.
Assuntos
Humanos , Masculino , Feminino , Adulto , Transplante de Fígado/mortalidade , Hepatite B Crônica/mortalidade , Hepatite D Crônica/mortalidade , Cirrose Hepática/mortalidade , Plaquetas/química , Brasil/epidemiologia , Vírus Delta da Hepatite/genética , Estudos Retrospectivos , Transplante de Fígado/estatística & dados numéricos , Distribuição por Sexo , Carcinoma Hepatocelular/mortalidade , Hepatite B Crônica/complicações , Hepatite D Crônica/cirurgia , Hepatite D Crônica/complicações , Estimativa de Kaplan-Meier , Cirrose Hepática/cirurgia , Cirrose Hepática/virologia , Neoplasias Hepáticas/mortalidade , Pessoa de Meia-IdadeRESUMO
Disseminated histoplasmosis is an invasive fungal infection documented in patients with impaired cellular immunity coming from endemic areas (America, Asia, Africa). We report two cases of disseminated histoplasmosis in AIDS patients paradigmatic of the multifaceted nature of the disease, which may be an expression either of an advanced state of immunosuppression or the immune reconstitution inflammatory syndrome (IRIS).
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/etiologia , Síndrome da Imunodeficiência Adquirida/complicações , Histoplasmose/etiologia , Hospedeiro Imunocomprometido , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Brasil , Ácido Desoxicólico/uso terapêutico , Diagnóstico Diferencial , Combinação de Medicamentos , Feminino , Hepatite B Crônica/complicações , Hepatite D Crônica/complicações , Histoplasmose/diagnóstico , Histoplasmose/tratamento farmacológico , Homossexualidade Masculina , Humanos , Infecções Fúngicas Invasivas , Itália , Masculino , Fatores de Risco , Tailândia , Resultado do Tratamento , Voriconazol/uso terapêuticoRESUMO
We retrospectively investigated the characteristics, patterns of disease progression, outcome and difficulties in the management in 11 patients with concurrent autoimmune hepatitis (AIH) and HBV or HCV infections (5 HCV and 6 HBV including 2 with HDV co-infection) since there are scarce data on this issue. HCV or HBV diagnosis preceded that of AIH in all patients by many years. At initial clinical and histological assessment almost half of patients had cirrhosis (45.5%) with the group of AIH and HCV carrying the highest frequency (4/5; 80%). In two thirds of patients, mostly with HCV and HBV/HDV, AIH was assumed to be IFNalpha-induced and experienced difficulties in achieving sustained virological response. On the contrary, the outcome of patients with HBV and AIH was better compared to those with AIH and HCV or HDV. In conclusion, chronic viral hepatitis infections concomitant with AIH are often very difficult to recognize and therefore, a significant delay in AIH diagnosis in this specific group of patients is usual. HBV patients with concomitant AIH seem to carry the most favorable outcome compared to those with HCV probably because of the use of nucleos(t)ide analogues which contrary to IFN-alpha can control HBV replication with no adjacent effect, related to exacerbation of autoimmune phenomena.
Assuntos
Hepatite B Crônica/terapia , Hepatite C Crônica/terapia , Hepatite Autoimune/terapia , Adulto , Idoso , Antivirais/efeitos adversos , Estudos de Coortes , Coinfecção , Diagnóstico Tardio , Progressão da Doença , Feminino , Hepatite B Crônica/complicações , Hepatite C Crônica/complicações , Hepatite D Crônica/complicações , Hepatite D Crônica/terapia , Hepatite Autoimune/complicações , Hepatite Autoimune/diagnóstico , Humanos , Interferon-alfa/efeitos adversos , Cirrose Hepática , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
OBJECTIVE: We evaluated the influence of hepatitis B virus (HBV) genotype on the course of disease in patients coinfected with HBV and hepatitis delta virus (HDV). METHODS: We evaluated HBV genotypes in 190 patients, 140 of whom had chronic HBV monoinfection and 50 of whom had chronic HBV-HDV coinfection. Real-time polymerase chain reactions for the amplification of HBV DNA and HDV RNA were developed, and we compared the patient groups with respect to HBV genotype, viral load, alanine aminotransferase (ALT) and bilirubin levels, and disease severity. RESULTS: Coinfected patients had higher ALT and bilirubin levels as well as a higher prevalence of liver cirrhosis and liver carcinoma. ALT levels were higher among individuals coinfected with HDV and HBV genotype F than among individuals infected only with HBV genotype F. Among HDV-HBV-coinfected patients, HDV load was lower among those infected with HBV genotype A than among those infected with HBV genotype D or genotype F. CONCLUSION: Liver inflammation and HDV load are influenced by HBV genotype in individuals coinfected with HBV and HDV.
Assuntos
Vírus da Hepatite B/genética , Hepatite B Crônica/sangue , Hepatite B Crônica/complicações , Hepatite D Crônica/complicações , Adulto , Alanina Transaminase/sangue , Anticorpos Antivirais/sangue , Bilirrubina/sangue , Primers do DNA , DNA Viral/genética , Genótipo , Antígenos E da Hepatite B/imunologia , Vírus da Hepatite B/isolamento & purificação , Vírus Delta da Hepatite/isolamento & purificação , Humanos , Icterícia/epidemiologia , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
The genotypes of hepatitis B (HBV) and delta (HDV) viruses circulating among Venezuelan Amerindian populations, where these viruses are endemic, were determined by sequencing of PCR amplified products from HBsAg positive sera. HDV genotype I (n = 7, 6 from West Amerindians), and III (n = 5, 4 from South Amerindians), were found. Only one HDV genotype I isolate was associated with HBV genotype D, 4 HDV genotype I and 2 HDV genotype III infected individuals were co-infected with HBV genotype F. The failure to detect the South American HDV genotype III in West Amerindians might be related to the outbreak of fulminant hepatitis with high mortality rate occurred between 1979 and 1982, probably affecting more the Amerindians infected with HDV genotype III. These results suggest the circulation of HDV genotype I among Amerindians, probably introduced through European immigrations, and that this HDV genotype is able to replicate in association with HBV genotype F.