Hepatitis: D'Oliveira A

Medeiros FS, Tavares-Neto J, D'Oliveira A, Paraná R. · Hospital Universitario Alcides Carneiro de la Universidad Federal de Campina Grande, Brasil. · Acta Gastroenterol Latinoam. · Pubmed #17955725 No free full text.

Abstract: Visceral Leisshimaniosis or Kalazar is a parasitic infection caused by Leishimania Donovani subspecies. It is transmitted by phlebotomineos and may lead to liver and spleen enlargements as well as immunological impairment. Sometimes it is described liver injury simulating acute or chronic viral hepatitis and even portal hypertension. The liver injury makes difficult the diffencial diagnosis of Kalazar and other liver diseases in endemic regions. OBJECTIVE: To define and clarify the liver injury spectrum described in published cases reports. METHODS: Systematic revision of published data on Kalazar and liver injury using the following databank: LILACS, MEDLINE and EMBASE. Only paper published in French, English, Portuguese and Spanish were taken into consideration. The procedures for systematic review recommended by the NHS Centre for Reviews and Dissemination, University of Cork, were adopted. The paper quality classification was based on the number of reported variables previously defined in our study RESULTS: Only 11/28 (55%) publications were included in our analysis because they filled the minimal required data. Acute and chronic liver disease were well documented in these articles. Serum albumin and prothombine time were associated with severity of liver disease (P < .05). CONCLUSION: "Liver involvement, even when it is severe, may occur at tha begining of the disease. Kalazar should be considered as a differential diagnosis of cholestasis, acute and chronic liver injury as well as portal hypertension in children.

Bénet T, D'Oliveira A, Voirin N, Livrozet JM, Cotte L, Peyramond D, Chidiac C, Touraine JL, Fabry J, Trepo C, Allard R, Vanhems P. · Laboratoire d'Epidémiologie et de Santé Publique, UMR 5558, Université Claude Bernard Lyon 1, and Département d'Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France. · J Viral Hepat. · Pubmed #17875008 No free full text.

Abstract: The rate of human immunodeficiency virus (HIV) disease progression or death of individuals coinfected with hepatitis C virus (HCV) is conflicting. The complete-case analysis systematically used, excludes patients unscreened for HCV. Our objective was to assess if rate of survival differed between HIV-infected patients screened and unscreened for HCV in a hospital-based prospective cohort study. Patients were enrolled in the Lyon section of the French Hospital Database on HIV between 1 July 1992 and 31 May 2005. A multivariate Cox regression model was used to analyse the association of HCV screening with survival. Of 3244 patients, 299 (9.2%) were not screened for HCV. The populations screened and unscreened differed by the proportion of acquired immune deficiency syndrome at baseline, presumed route of infection, CD4 cell count category at baseline, mean duration of follow-up, mean number of visits per year, type of antiretroviral therapy and survival. The rate of progression to death was higher for non-HCV-screened vs HCV-screened patients: the incidence rate among HCV-screened patients was 22.9/1000 patient-years; the incidence rate among HCV-unscreened patients was 52.4/1000 patient-years. The adjusted hazards ratio of death was 2.48 [95% confidence interval (1.83-3.35); P < 0.001] for patients with unknown HCV status compared with others. In conclusion, unscreened or unknown HCV status was associated with an increased risk of death in our hospital cohort. Important prognostic factors are related to, or confounded by the practice of HCV screening.

Paraná R, Kay A, Molinet F, Viana S, Silva LK, Salcedo JM, Tavares-Neto J, Lobato C, Rios-Leite M, Matteoni L, D'Oliveira A, Tauil P, Trépo C. · Gonçalo Moniz Research Center, Salvador, Brazil; INSERM Unit 271, Université Claude Bernard Lyon 1, IFR 62, Lyon, France. · Am J Trop Med Hyg. · Pubmed #16968924 links to  free full text

Abstract: In Brazil, hepatitis delta virus (HDV) is only reported in Western Amazonia, where severe cases of acute and chronic HDV hepatitis have been described. The study area was chosen in the States of Acre and Rondonia where most cases of hepatitis B virus (HBV)/HDV are reported. From December 2003 to October 2004, 40 HBsAg carriers with anti-HDV IgM were selected. An epidemiologic questionnaire, including demographic and clinical/epidemiologic variables was filled out. HDV amplification and genotyping were performed. Genotype I was detected in 22 patients (55.0%), whereas genotype III was identified in 18 (45.0%). Patients who were infected with genotype I were older (45.1 +/- 17.8 years) than patients infected with genotype III (32.8 +/- 10.9 years; P = 0.01). No symptoms were reported by 21 (52.5%) patients. Otherwise, 19 (47.5%) had symptoms (fatigue, abdominal pain, weight loss, and decompensated liver disease) that motivated them to seek medical care. Genotype III carriers were more symptomatic, but no statistical significance was achieved. Our preliminary results show that HDV genotypes I and III are present in Brazilian Amazonia and that HDV genotype III is not limited to the Amerindian population.

Lobato C, Tavares-Neto J, Rios-Leite M, Trepo C, Vitvitski L, Parvaz P, Zoulim F, D'Oliveira A, Paraná R. · CPgMS-State of Acre Cooperation Program with University of Bahia, Bahia, Brazil. · J Gastroenterol Hepatol. · Pubmed #16704537 No free full text.

Abstract: BACKGROUND: Hepatitis B is endemic in the Amazon region. METHODS: Serological markers for hepatitis B virus (HBV) were determined in 266 household members for hepatitis B surface antigen (HBsAg)-positive women (G1) and 395 household members for HBsAg-negative women (G2), randomly selected in Acre State Women's Medical Care Program, in order to evaluate the prevalence of HBV in this population. Before blood sample collection an epidemiological questionnaire was applied. RESULTS: The overall prevalence of HBV carriers (HBsAg) and exposed individuals (anti-HBc, IgG) was, respectively, 21.1% and 60.5% in G1 and 2.8% and 27.4% in G2 (P < 0.0000001). The frequency of HBsAg was higher among siblings from group G1 (75%) compared to the absence of any HBsAg-positive sibling in G2 (P < 0.00006). The HBV markers in other family members was as follows: G1 parents, 27.3% vs 4.5% (P < 0.03), sexual partners, 21.1% vs 2.5% (P < 0.04), and offspring, 10.4% vs 1.5% (P < 0.04). A low prevalence of HBsAg and anti-HBc (IgG) was observed for the last offspring of G2 mothers compared to the high prevalence among children of G1 mothers (0% vs 18.2%, P < 0.01 and 2.3% vs 59.1%, P < 0.0000005, respectively), with children younger than 1 year being the most affected. The frequency of the habit of sharing toothbrushes and the presence of at least one HBsAg carrier were higher in G1 than in G2 (P < 0.0001 and P < 0.000002), respectively. Genotypes A, D and G were found to be predominant by Innolipa test. There were cases that reacted to more than one genotype. CONCLUSION: Intrafamilial transmission of HBV is evident in the present study and is possibly associated with the presence of more than one HBV carrier in the family and the shared use of toothbrushes among household contacts. Genotype analysis confirms intrafamilial transmission.

D'Oliveira A, Voirin N, Allard R, Peyramond D, Chidiac C, Touraine JL, Fabry J, Trepo C, Vanhems P. · Laboratory of Epidemiology and Public Health, INSERM U271, 69373 Lyon, France. · J Viral Hepat. · Pubmed #15850476 No free full text.

Abstract: To report the prevalence and the risk factors for hepatitis C virus (HCV) infection in a hospital cohort of 2691 sexually human immunodeficiency virus (HIV)-infected patients. The patients were enrolled in the Lyon section of the French Hospital Database on HIV between 1992 and 2002. Baseline characteristics were analysed. The detection of HCV-antibodies (Ab) was used for diagnosis. The HCV-Ab prevalence rate was 5.7 and 12.89% for individuals infected by HIV after homosexual intercourse or heterosexual intercourse, respectively. HCV-Ab was three times more frequently found among patients infected with HIV after heterosexual intercourse compared with patients infected with HIV after homosexual intercourse (adjusted OR: 3.2, 95% CI: 2.28-4.62, multiple logistic regression). The risk of HCV infection among HIV-infected individuals differed according to sexual behaviour. The determinants associated with HCV transmission through the sexual route needs to be explored further.