Adalgisa de Souza Paiva Ferreira (original) (raw)

Papers by Adalgisa de Souza Paiva Ferreira

Research paper thumbnail of Unexpected distribution of hepatitis C virus genotypes in patients on hemodialysis and kidney transplant recipients

Journal of Medical Virology, 2003

The distribution of hepatitis C virus (HCV) genotypes in patients on hemodialysis and in kidney t... more The distribution of hepatitis C virus (HCV) genotypes in patients on hemodialysis and in kidney transplant recipients was compared with that observed in a control group composed of HCV-infected individuals from the general population. A total of 340 patients were included in the study: 46 with end-stage renal disease on regular hemodialysis treatment, 22 kidney transplant recipients and 272 controls matched for sex and age at a 4:1 ratio (controls to patient). HCV genotype was determined by sequencing of the 5' untranslated region of the HCV genome. No difference was observed in the distribution of HCV genotypes in hemodialysis patients and renal transplant patients (P = 0.47). However, when each of these groups was compared with the control group, a significant difference was detected in the genotype distribution (P < 0.001). In hemodialysis and renal transplant patients the most prevalent subtype was 1a, followed by 1b, 3, and other less prevalent genotypes (2, 4, and 5), whereas in the control group the most prevalent subtype was 1b, followed by 3, 1a, and others. That observation may reflect differences in the epidemiology of HCV infection, viral characteristics and host factors in renal patients in comparison to the control group.

Research paper thumbnail of Occult hepatitis B in patients on hemodialysis: a review

Annals of Hepatology

The hepatitis B virus (HBV) is one of the most frequently transmitted agents in dialysis units. O... more The hepatitis B virus (HBV) is one of the most frequently transmitted agents in dialysis units. Occult hepatitis B is characterized by HBV infection without detectable surface antigen (HBsAg) in the patient's serum, a positive or negative HBV DNA marker result in the serum and a positive result in the liver tissue, which leads to the potential risk of transmission during renal replacement therapy service. There is variation in occult hepatitis B prevalence rates in this population across various studies that may be related to numerous factors. The presence of occult hepatitis B in individuals undergoing renal replacement therapy is important with regard to both the possibility of transmission and the consequences for the patient, especially the development of chronic liver disease and reactivation of the disease after renal transplantation.

Research paper thumbnail of Efficacy and Safety of Glecaprevir/Pibrentasvir in Treatment-Naïve Adults with Chronic Hepatitis C Virus Genotypes 1-6 in Brazil

Annals of hepatology, 2020

INTRODUCTION AND OBJECTIVES Glecaprevir/pibrentasvir is a highly effective and well tolerated tre... more INTRODUCTION AND OBJECTIVES Glecaprevir/pibrentasvir is a highly effective and well tolerated treatment for hepatitis C infection. Brazilian patients were not included in the original development studies for glecaprevir/pibrentasvir. This study aimed to assess safety and efficacy of glecaprevir/pibrentasvir in treatment-naïve Brazilian adults without cirrhosis or with compensated cirrhosis. PATIENTS AND METHODS EXPEDITION-3 was a Phase 3, open-label, multicenter study in treatment-naïve Brazilian adults with hepatitis C infection genotype 1-6. Patients without cirrhosis (F2 or F3) or with compensated cirrhosis (F4) received 8 or 12 weeks of glecaprevir/pibrentasvir, respectively. The primary efficacy endpoint was the rate of sustained virologic response at post-treatment Week 12. Secondary endpoints were on-treatment virologic failure and relapse rates. Baseline polymorphisms were assessed in NS3 and NS5A. Adverse events and laboratory abnormalities were monitored. RESULTS 100 patie...

Research paper thumbnail of HBV resistance frequency in nucleos(t)ide analogue-untreated patients from different Brazilian regions

Trabalho apresentado no The Annual Meeting of the American Association for the Study Liver Diseas... more Trabalho apresentado no The Annual Meeting of the American Association for the Study Liver Disease, 63., Boston, 2012.

Research paper thumbnail of Brazilian Society of Hepatology and Brazilian Society of Infectious Diseases Guidelines for the Diagnosis and Treatment of Hepatitis B

The Brazilian Journal of Infectious Diseases

Research paper thumbnail of Possível ductopenia induzida por droga

Ged Gastroenterol Endosc Dig, Jun 1, 2002

Research paper thumbnail of Mutation in the a-determinant of the S gene of the hepatitis B virus associated with concomitant HBsAg and anti-HBs in a population in northeastern Brazil

Journal of Medical Virology, 2016

The concomitant presence of HBsAg and anti-HBs in hepatitis B virus (HBV) infections mainly resul... more The concomitant presence of HBsAg and anti-HBs in hepatitis B virus (HBV) infections mainly results from isolated mutations in the a determinant, which causes changes HBsAg antigenicity. This in turn causes variants unsusceptible to the neutralizing action of anti-HBs, thus permitting immune escape. Therefore, this study had the aim of identifying subjects with this profile among HBsAg carriers identified in an HBV prevalence study. The study included participants enrolled in a study of viral hepatitis prevalence from the state of Maranhão in northeastern Brazil. These participants had tested positive for HBsAg and anti-HBs and had quantified HBV DNA. All samples were evaluated for HBsAg, anti-HBs, and anti-HBc. Mutations were sought in the a determinant located in the S gene's major hydrophilic region (MHR). Among the 3,987 individuals evaluated, 92 (2.3%) were HBsAg carriers. Among these, three had the atypical HBsAg and anti-HBs-positive profile (3.26%). All were identified as subgenotype D4. Only one individual had two S gene mutations, within the a determinant (Y134N/T140I). The frequency of individuals concomitantly positive for HBsAg and anti-HBs was low in the patient sample. Only one individual had mutations in the S gene a determinant, which is known to be associated with this profile. Nevertheless, the existence of immune escape in communities can have great importance, especially for evaluating immunization programs. This article is protected by copyright. All rights reserved.

Research paper thumbnail of Unexpected findings of hepatitis B and delta infection in northeastern Brazil: A public health alert

Research paper thumbnail of Direct antiviral therapy for treatment of hepatitis C: A real-world study from Brazil

Research paper thumbnail of High Prevalence of Hepatitis B Subgenotype D4 in Northeast Brazil: an Ancient Relic from African Continent?

Research paper thumbnail of How are HCV-infected patients being identified in Brazil: a multicenter study

The Brazilian Journal of Infectious Diseases

Research paper thumbnail of Alcohol use and associated factors among physicians and nurses in northeast Brazil

Research paper thumbnail of Does infection by the C hepatitis virus reduce the vaccine response for the B hepatitis virus among a population under dialysis?

Jornal Brasileiro de Nefrologia

Vaccination is the most effective tool in preventing transmission of Hepatitis B Virus (HBV). The... more Vaccination is the most effective tool in preventing transmission of Hepatitis B Virus (HBV). The patient with chronic kidney disease (CKD) on dialysis appear to be at greater risk of becoming infected with this virus and does not show the same vaccine response when compared to patients without uremia. To evaluate the results related to the HBV vaccine and identify factors associated with the response in patients with CKD on hemodialysis. Individuals with HBsAG and negative anti-HBC, under hemodialysis were assessed in two units of São Luis, Maranhão and were undergone full vaccination schedule for HBV. They were divided in groups: anti-HBs10 mUI/mL and compared as to age, gender, presence of diabetes mellitus (DM), time on dialysis and anti-HCV status. Logistic regression analysis was performed to identify factors independently associated with the vaccine response. p10mUI/Ml (or = 5.239 IC: 1.279-21.459, p = 0.021). The rate of vaccine response to HBV in patients with CKD on dialysis was 70% and the lack of anti-HCV infection was associated with seroconversion of anti-HBs suggesting that infection by the hepatitis C virus may be a factor that decreases the response of the HBV vaccine in dialysis CKD patients.

Research paper thumbnail of Efficacy and Tolerance of IFN Therapy in Hemodialysis Patients With Acute HCV Infection

Research paper thumbnail of Effectiveness and safety of first-generation protease inhibitors in clinical practice: Hepatitis C virus patients with advanced fibrosis

World journal of gastroenterology : WJG, Jan 14, 2015

To evaluates the effectiveness and safety of the first generation, NS3/4A protease inhibitors (PI... more To evaluates the effectiveness and safety of the first generation, NS3/4A protease inhibitors (PIs) in clinical practice against chronic C virus, especially in patients with advanced fibrosis. Prospective study and non-experimental analysis of a multicentre cohort of 38 Spanish hospitals that includes patients with chronic hepatitis C genotype 1, treatment-naïve (TN) or treatment-experienced (TE), who underwent triple therapy with the first generation NS3/4A protease inhibitors, boceprevir (BOC) and telaprevir (TVR), in combination with pegylated interferon and ribavirin. The patients were treatment in routine practice settings. Data on the study population and on adverse clinical and virologic effects were compiled during the treatment period and during follow up. One thousand and fifty seven patients were included, 405 (38%) were treated with BOC and 652 (62%) with TVR. Of this total, 30% (n = 319) were TN and the remaining were TE: 28% (n = 298) relapsers, 12% (n = 123) partial r...

Research paper thumbnail of Occult hepatitis B in patients on hemodialysis: a review

Annals of hepatology

The hepatitis B virus (HBV) is one of the most frequently transmitted agents in dialysis units. O... more The hepatitis B virus (HBV) is one of the most frequently transmitted agents in dialysis units. Occult hepatitis B is characterized by HBV infection without detectable surface antigen (HBsAg) in the patient's serum, a positive or negative HBV DNA marker result in the serum and a positive result in the liver tissue, which leads to the potential risk of transmission during renal replacement therapy service. There is variation in occult hepatitis B prevalence rates in this population across various studies that may be related to numerous factors. The presence of occult hepatitis B in individuals undergoing renal replacement therapy is important with regard to both the possibility of transmission and the consequences for the patient, especially the development of chronic liver disease and reactivation of the disease after renal transplantation.

Research paper thumbnail of Hepatitis Delta virus genotype 8 infection in Northeast Brazil: Inheritance from African slaves?

Virus Research, 2011

Hepatitis Delta virus (HDV) is endemic worldwide, but its prevalence varies in different geograph... more Hepatitis Delta virus (HDV) is endemic worldwide, but its prevalence varies in different geographical areas. While in the Brazilian Amazon, HDV is known to be endemic and to represent a significant public health problem, few studies have assessed its prevalence in other regions in the country. This study evaluated the seroprevalence of HDV among HBsAg chronic carriers from Maranhão state, a region located in the Northeast of Brazil. Among 133 patients, 5 had anti-HD, of whom 3 had HDV RNA. HDV genotypes were characterized by Bayesian phylogenetic analysis of nucleotide sequences from the HDAg coding region. HDV-3 was identified in one patient who lives in Maranhão, but was born in Amazonas state (Western Amazon basin). Phylogenetic analysis shows that this HDV-3 sequence grouped with other HDV-3 sequences isolated in this state, which suggests that the patient probably contracted HDV infection there. Surprisingly, the other two patients were infected with HDV-8, an African genotype. These patients were born and have always lived in Urbano Santos, a rural county of Maranhão state, moreover they had never been to Africa and denied any contact with people from that continent. This is the first description of the HDV-8 in non-native African populations. This genotype may have been introduced to Brazil through the slaves brought to the country from the West Africa regions during the 16-18th centuries. Our results indicate that the need of clinical and epidemiological studies to investigate the presence of this infection in other areas in Brazil.

Research paper thumbnail of Effect of host-related factors on the intensity of liver fibrosis in patients with chronic hepatitis C virus infection

Brazilian Journal of Infectious Diseases, 2002

There is increasing interest in the identification of factors associated with liver disease progr... more There is increasing interest in the identification of factors associated with liver disease progression in patients infected with hepatitis C virus (HCV). We assessed host-related factors associated with a histologically advanced stage of this disease and determined the rate of liver fibrosis progression in HCV-infected patients. We included patients submitted to liver biopsy, who were anti-HCV and HCV RNA positive, who showed a parenteral risk factor (blood transfusion or intravenous drug use), and who gave information about alcohol consumption.Patients were divided into two groups for analysis: group 1-grades 0 to 2; group 2-grades 3 to 4. The groups were compared in terms of sex, age at the time of infection, estimated duration of infection and alcoholism. The rate of fibrosis progression (index of fibrosis) was determined based on the relationship between disease stage and duration of infection (years). Logistic regression analysis revealed that age at the time of infection (P<0.01; 95% CI 1.06-1.22) and the duration of infection (P<0.01; 95% CI 1.06-1.32) were independently associated with a more advanced stage of hepatitis C. The median index of fibrosis was 0.14 for the group as a whole. A significant difference in the index of fibrosis was observed between patients aged < 40 years at infection (median = 0.11) and patients aged ≥ ≥ ≥ ≥ ≥ 40 years (median = 0.47). The main factors associated with a more rapid fibrosis progression were age at the time of infection and the estimated duration of infection. Patients who acquired HCV after 40 years of age showed a higher rate of fibrosis progression.

Research paper thumbnail of HBV carrying drug-resistance mutations in chronically infected treatment-naive patients

Antiviral Therapy, 2015

Background: Nucleoside/nucleotide analogue (NA) treatment causes selection pressure for HBV strai... more Background: Nucleoside/nucleotide analogue (NA) treatment causes selection pressure for HBV strains carrying mutations conferring NA resistance. Drug-resistance mutations occur in the reverse transcriptase (RT) region of the HBV polymerase gene and spontaneously arise during viral replication. These mutations can also alter the hepatitis B surface (HBs) protein and in some cases reduce binding to HBs antibodies. The spread of NA-resistant HBV may impact the efficacy of antiviral treatment and hepatitis B immunization programmes. In this study, we used direct sequencing to assess the occurrence of HBV carrying known mutations that confer NA resistance in the largest cohort of treatment-naive patients with chronic hepatitis B (CHB) to date. Methods: HBV DNA samples isolated from 702 patients were sequenced and the RT region subjected to mutational analysis. Results: There was high genetic variability among the HBV samples analysed: A1 (63.7%), D3 (14.5%), A2 (3.3%), A3 (0.1%), B1 (0.1%), B2 (0.1%), C2 (0.9%), D1 (0.9%), D2 (4.6%), D4 (5.1%), D unclassified subgenotype (0.7%), E (0.6%), F2a (4.6%), F4 (0.4%) and G (0.4%). HBV strains harbouring mutations conferring NA resistance alone or combined with compensatory mutations were identified in 1.6% (11/702) of the patients. Conclusions: HBV strains harbouring resistance mutations can comprise the major population of HBV quasispecies in treatment-naive patients. In Brazil, there is a very low frequency of untreated patients who are infected with these strains. These findings suggest that the spread and natural selection of drug-resistant HBV is an uncommon event and/or most of these strains remain unstable in the absence of NA selective pressure.

Research paper thumbnail of Lack of Impact of Hepatitis C Virus Coinfection in End-Stage Renal Disease Patients With Hepatitis B Virus Infection

Transplantation Proceedings, 2005

Introduction. Hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection results in more sev... more Introduction. Hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection results in more severe forms of liver disease in nonuremic patients; however, the impact of HCV coinfection is not clearly known in end-stage renal disease (ESRD) patients with HBV infection. We sought to determine the impact of HCV coinfection in HBV-infected ESRD patients. Patients and Methods. The HBsAg-positive ESRD patients evaluated between March 1999 and May 2003 were divided into two groups: group B, HBV infection alone, and group BC, HBV-HCV coinfection (anti-HCV-positive). Both groups were compared regarding epidemiological, laboratory, and histological findings. A liver biopsy was obtained in cases with evidence of viral replication and/or elevated alanine aminotransferase. Results. One hundred patients (73% men) with mean age of 42 Ϯ 11 years (55 patients in group B and 45 in group BC) were studied. Comparison between groups showed a difference in time on hemodialysis and duration of infection, which were higher in group BC (P Ͻ .001 and P ϭ .001, respectively) and in history of blood transfusion, which was also more frequent in group BC (P ϭ .04). Liver biopsies, obtained from 15 patients in group B and 28 patients in group BC, showed no difference in frequency of septal fibrosis (60% in group B vs 48% in group BC, P ϭ .46) or interface hepatitis (73% vs 71%, P ϭ .99). Conclusions. HBV-HCV coinfection was related to a longer time on hemodialysis, longer duration of infection, and history of blood transfusion. Contrary to nonuremic patients, HCV coinfection was not associated with more severe forms of liver disease in ESRD patients.

Research paper thumbnail of Unexpected distribution of hepatitis C virus genotypes in patients on hemodialysis and kidney transplant recipients

Journal of Medical Virology, 2003

The distribution of hepatitis C virus (HCV) genotypes in patients on hemodialysis and in kidney t... more The distribution of hepatitis C virus (HCV) genotypes in patients on hemodialysis and in kidney transplant recipients was compared with that observed in a control group composed of HCV-infected individuals from the general population. A total of 340 patients were included in the study: 46 with end-stage renal disease on regular hemodialysis treatment, 22 kidney transplant recipients and 272 controls matched for sex and age at a 4:1 ratio (controls to patient). HCV genotype was determined by sequencing of the 5&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; untranslated region of the HCV genome. No difference was observed in the distribution of HCV genotypes in hemodialysis patients and renal transplant patients (P = 0.47). However, when each of these groups was compared with the control group, a significant difference was detected in the genotype distribution (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). In hemodialysis and renal transplant patients the most prevalent subtype was 1a, followed by 1b, 3, and other less prevalent genotypes (2, 4, and 5), whereas in the control group the most prevalent subtype was 1b, followed by 3, 1a, and others. That observation may reflect differences in the epidemiology of HCV infection, viral characteristics and host factors in renal patients in comparison to the control group.

Research paper thumbnail of Occult hepatitis B in patients on hemodialysis: a review

Annals of Hepatology

The hepatitis B virus (HBV) is one of the most frequently transmitted agents in dialysis units. O... more The hepatitis B virus (HBV) is one of the most frequently transmitted agents in dialysis units. Occult hepatitis B is characterized by HBV infection without detectable surface antigen (HBsAg) in the patient's serum, a positive or negative HBV DNA marker result in the serum and a positive result in the liver tissue, which leads to the potential risk of transmission during renal replacement therapy service. There is variation in occult hepatitis B prevalence rates in this population across various studies that may be related to numerous factors. The presence of occult hepatitis B in individuals undergoing renal replacement therapy is important with regard to both the possibility of transmission and the consequences for the patient, especially the development of chronic liver disease and reactivation of the disease after renal transplantation.

Research paper thumbnail of Efficacy and Safety of Glecaprevir/Pibrentasvir in Treatment-Naïve Adults with Chronic Hepatitis C Virus Genotypes 1-6 in Brazil

Annals of hepatology, 2020

INTRODUCTION AND OBJECTIVES Glecaprevir/pibrentasvir is a highly effective and well tolerated tre... more INTRODUCTION AND OBJECTIVES Glecaprevir/pibrentasvir is a highly effective and well tolerated treatment for hepatitis C infection. Brazilian patients were not included in the original development studies for glecaprevir/pibrentasvir. This study aimed to assess safety and efficacy of glecaprevir/pibrentasvir in treatment-naïve Brazilian adults without cirrhosis or with compensated cirrhosis. PATIENTS AND METHODS EXPEDITION-3 was a Phase 3, open-label, multicenter study in treatment-naïve Brazilian adults with hepatitis C infection genotype 1-6. Patients without cirrhosis (F2 or F3) or with compensated cirrhosis (F4) received 8 or 12 weeks of glecaprevir/pibrentasvir, respectively. The primary efficacy endpoint was the rate of sustained virologic response at post-treatment Week 12. Secondary endpoints were on-treatment virologic failure and relapse rates. Baseline polymorphisms were assessed in NS3 and NS5A. Adverse events and laboratory abnormalities were monitored. RESULTS 100 patie...

Research paper thumbnail of HBV resistance frequency in nucleos(t)ide analogue-untreated patients from different Brazilian regions

Trabalho apresentado no The Annual Meeting of the American Association for the Study Liver Diseas... more Trabalho apresentado no The Annual Meeting of the American Association for the Study Liver Disease, 63., Boston, 2012.

Research paper thumbnail of Brazilian Society of Hepatology and Brazilian Society of Infectious Diseases Guidelines for the Diagnosis and Treatment of Hepatitis B

The Brazilian Journal of Infectious Diseases

Research paper thumbnail of Possível ductopenia induzida por droga

Ged Gastroenterol Endosc Dig, Jun 1, 2002

Research paper thumbnail of Mutation in the a-determinant of the S gene of the hepatitis B virus associated with concomitant HBsAg and anti-HBs in a population in northeastern Brazil

Journal of Medical Virology, 2016

The concomitant presence of HBsAg and anti-HBs in hepatitis B virus (HBV) infections mainly resul... more The concomitant presence of HBsAg and anti-HBs in hepatitis B virus (HBV) infections mainly results from isolated mutations in the a determinant, which causes changes HBsAg antigenicity. This in turn causes variants unsusceptible to the neutralizing action of anti-HBs, thus permitting immune escape. Therefore, this study had the aim of identifying subjects with this profile among HBsAg carriers identified in an HBV prevalence study. The study included participants enrolled in a study of viral hepatitis prevalence from the state of Maranhão in northeastern Brazil. These participants had tested positive for HBsAg and anti-HBs and had quantified HBV DNA. All samples were evaluated for HBsAg, anti-HBs, and anti-HBc. Mutations were sought in the a determinant located in the S gene&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s major hydrophilic region (MHR). Among the 3,987 individuals evaluated, 92 (2.3%) were HBsAg carriers. Among these, three had the atypical HBsAg and anti-HBs-positive profile (3.26%). All were identified as subgenotype D4. Only one individual had two S gene mutations, within the a determinant (Y134N/T140I). The frequency of individuals concomitantly positive for HBsAg and anti-HBs was low in the patient sample. Only one individual had mutations in the S gene a determinant, which is known to be associated with this profile. Nevertheless, the existence of immune escape in communities can have great importance, especially for evaluating immunization programs. This article is protected by copyright. All rights reserved.

Research paper thumbnail of Unexpected findings of hepatitis B and delta infection in northeastern Brazil: A public health alert

Research paper thumbnail of Direct antiviral therapy for treatment of hepatitis C: A real-world study from Brazil

Research paper thumbnail of High Prevalence of Hepatitis B Subgenotype D4 in Northeast Brazil: an Ancient Relic from African Continent?

Research paper thumbnail of How are HCV-infected patients being identified in Brazil: a multicenter study

The Brazilian Journal of Infectious Diseases

Research paper thumbnail of Alcohol use and associated factors among physicians and nurses in northeast Brazil

Research paper thumbnail of Does infection by the C hepatitis virus reduce the vaccine response for the B hepatitis virus among a population under dialysis?

Jornal Brasileiro de Nefrologia

Vaccination is the most effective tool in preventing transmission of Hepatitis B Virus (HBV). The... more Vaccination is the most effective tool in preventing transmission of Hepatitis B Virus (HBV). The patient with chronic kidney disease (CKD) on dialysis appear to be at greater risk of becoming infected with this virus and does not show the same vaccine response when compared to patients without uremia. To evaluate the results related to the HBV vaccine and identify factors associated with the response in patients with CKD on hemodialysis. Individuals with HBsAG and negative anti-HBC, under hemodialysis were assessed in two units of São Luis, Maranhão and were undergone full vaccination schedule for HBV. They were divided in groups: anti-HBs10 mUI/mL and compared as to age, gender, presence of diabetes mellitus (DM), time on dialysis and anti-HCV status. Logistic regression analysis was performed to identify factors independently associated with the vaccine response. p10mUI/Ml (or = 5.239 IC: 1.279-21.459, p = 0.021). The rate of vaccine response to HBV in patients with CKD on dialysis was 70% and the lack of anti-HCV infection was associated with seroconversion of anti-HBs suggesting that infection by the hepatitis C virus may be a factor that decreases the response of the HBV vaccine in dialysis CKD patients.

Research paper thumbnail of Efficacy and Tolerance of IFN Therapy in Hemodialysis Patients With Acute HCV Infection

Research paper thumbnail of Effectiveness and safety of first-generation protease inhibitors in clinical practice: Hepatitis C virus patients with advanced fibrosis

World journal of gastroenterology : WJG, Jan 14, 2015

To evaluates the effectiveness and safety of the first generation, NS3/4A protease inhibitors (PI... more To evaluates the effectiveness and safety of the first generation, NS3/4A protease inhibitors (PIs) in clinical practice against chronic C virus, especially in patients with advanced fibrosis. Prospective study and non-experimental analysis of a multicentre cohort of 38 Spanish hospitals that includes patients with chronic hepatitis C genotype 1, treatment-naïve (TN) or treatment-experienced (TE), who underwent triple therapy with the first generation NS3/4A protease inhibitors, boceprevir (BOC) and telaprevir (TVR), in combination with pegylated interferon and ribavirin. The patients were treatment in routine practice settings. Data on the study population and on adverse clinical and virologic effects were compiled during the treatment period and during follow up. One thousand and fifty seven patients were included, 405 (38%) were treated with BOC and 652 (62%) with TVR. Of this total, 30% (n = 319) were TN and the remaining were TE: 28% (n = 298) relapsers, 12% (n = 123) partial r...

Research paper thumbnail of Occult hepatitis B in patients on hemodialysis: a review

Annals of hepatology

The hepatitis B virus (HBV) is one of the most frequently transmitted agents in dialysis units. O... more The hepatitis B virus (HBV) is one of the most frequently transmitted agents in dialysis units. Occult hepatitis B is characterized by HBV infection without detectable surface antigen (HBsAg) in the patient's serum, a positive or negative HBV DNA marker result in the serum and a positive result in the liver tissue, which leads to the potential risk of transmission during renal replacement therapy service. There is variation in occult hepatitis B prevalence rates in this population across various studies that may be related to numerous factors. The presence of occult hepatitis B in individuals undergoing renal replacement therapy is important with regard to both the possibility of transmission and the consequences for the patient, especially the development of chronic liver disease and reactivation of the disease after renal transplantation.

Research paper thumbnail of Hepatitis Delta virus genotype 8 infection in Northeast Brazil: Inheritance from African slaves?

Virus Research, 2011

Hepatitis Delta virus (HDV) is endemic worldwide, but its prevalence varies in different geograph... more Hepatitis Delta virus (HDV) is endemic worldwide, but its prevalence varies in different geographical areas. While in the Brazilian Amazon, HDV is known to be endemic and to represent a significant public health problem, few studies have assessed its prevalence in other regions in the country. This study evaluated the seroprevalence of HDV among HBsAg chronic carriers from Maranhão state, a region located in the Northeast of Brazil. Among 133 patients, 5 had anti-HD, of whom 3 had HDV RNA. HDV genotypes were characterized by Bayesian phylogenetic analysis of nucleotide sequences from the HDAg coding region. HDV-3 was identified in one patient who lives in Maranhão, but was born in Amazonas state (Western Amazon basin). Phylogenetic analysis shows that this HDV-3 sequence grouped with other HDV-3 sequences isolated in this state, which suggests that the patient probably contracted HDV infection there. Surprisingly, the other two patients were infected with HDV-8, an African genotype. These patients were born and have always lived in Urbano Santos, a rural county of Maranhão state, moreover they had never been to Africa and denied any contact with people from that continent. This is the first description of the HDV-8 in non-native African populations. This genotype may have been introduced to Brazil through the slaves brought to the country from the West Africa regions during the 16-18th centuries. Our results indicate that the need of clinical and epidemiological studies to investigate the presence of this infection in other areas in Brazil.

Research paper thumbnail of Effect of host-related factors on the intensity of liver fibrosis in patients with chronic hepatitis C virus infection

Brazilian Journal of Infectious Diseases, 2002

There is increasing interest in the identification of factors associated with liver disease progr... more There is increasing interest in the identification of factors associated with liver disease progression in patients infected with hepatitis C virus (HCV). We assessed host-related factors associated with a histologically advanced stage of this disease and determined the rate of liver fibrosis progression in HCV-infected patients. We included patients submitted to liver biopsy, who were anti-HCV and HCV RNA positive, who showed a parenteral risk factor (blood transfusion or intravenous drug use), and who gave information about alcohol consumption.Patients were divided into two groups for analysis: group 1-grades 0 to 2; group 2-grades 3 to 4. The groups were compared in terms of sex, age at the time of infection, estimated duration of infection and alcoholism. The rate of fibrosis progression (index of fibrosis) was determined based on the relationship between disease stage and duration of infection (years). Logistic regression analysis revealed that age at the time of infection (P<0.01; 95% CI 1.06-1.22) and the duration of infection (P<0.01; 95% CI 1.06-1.32) were independently associated with a more advanced stage of hepatitis C. The median index of fibrosis was 0.14 for the group as a whole. A significant difference in the index of fibrosis was observed between patients aged < 40 years at infection (median = 0.11) and patients aged ≥ ≥ ≥ ≥ ≥ 40 years (median = 0.47). The main factors associated with a more rapid fibrosis progression were age at the time of infection and the estimated duration of infection. Patients who acquired HCV after 40 years of age showed a higher rate of fibrosis progression.

Research paper thumbnail of HBV carrying drug-resistance mutations in chronically infected treatment-naive patients

Antiviral Therapy, 2015

Background: Nucleoside/nucleotide analogue (NA) treatment causes selection pressure for HBV strai... more Background: Nucleoside/nucleotide analogue (NA) treatment causes selection pressure for HBV strains carrying mutations conferring NA resistance. Drug-resistance mutations occur in the reverse transcriptase (RT) region of the HBV polymerase gene and spontaneously arise during viral replication. These mutations can also alter the hepatitis B surface (HBs) protein and in some cases reduce binding to HBs antibodies. The spread of NA-resistant HBV may impact the efficacy of antiviral treatment and hepatitis B immunization programmes. In this study, we used direct sequencing to assess the occurrence of HBV carrying known mutations that confer NA resistance in the largest cohort of treatment-naive patients with chronic hepatitis B (CHB) to date. Methods: HBV DNA samples isolated from 702 patients were sequenced and the RT region subjected to mutational analysis. Results: There was high genetic variability among the HBV samples analysed: A1 (63.7%), D3 (14.5%), A2 (3.3%), A3 (0.1%), B1 (0.1%), B2 (0.1%), C2 (0.9%), D1 (0.9%), D2 (4.6%), D4 (5.1%), D unclassified subgenotype (0.7%), E (0.6%), F2a (4.6%), F4 (0.4%) and G (0.4%). HBV strains harbouring mutations conferring NA resistance alone or combined with compensatory mutations were identified in 1.6% (11/702) of the patients. Conclusions: HBV strains harbouring resistance mutations can comprise the major population of HBV quasispecies in treatment-naive patients. In Brazil, there is a very low frequency of untreated patients who are infected with these strains. These findings suggest that the spread and natural selection of drug-resistant HBV is an uncommon event and/or most of these strains remain unstable in the absence of NA selective pressure.

Research paper thumbnail of Lack of Impact of Hepatitis C Virus Coinfection in End-Stage Renal Disease Patients With Hepatitis B Virus Infection

Transplantation Proceedings, 2005

Introduction. Hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection results in more sev... more Introduction. Hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection results in more severe forms of liver disease in nonuremic patients; however, the impact of HCV coinfection is not clearly known in end-stage renal disease (ESRD) patients with HBV infection. We sought to determine the impact of HCV coinfection in HBV-infected ESRD patients. Patients and Methods. The HBsAg-positive ESRD patients evaluated between March 1999 and May 2003 were divided into two groups: group B, HBV infection alone, and group BC, HBV-HCV coinfection (anti-HCV-positive). Both groups were compared regarding epidemiological, laboratory, and histological findings. A liver biopsy was obtained in cases with evidence of viral replication and/or elevated alanine aminotransferase. Results. One hundred patients (73% men) with mean age of 42 Ϯ 11 years (55 patients in group B and 45 in group BC) were studied. Comparison between groups showed a difference in time on hemodialysis and duration of infection, which were higher in group BC (P Ͻ .001 and P ϭ .001, respectively) and in history of blood transfusion, which was also more frequent in group BC (P ϭ .04). Liver biopsies, obtained from 15 patients in group B and 28 patients in group BC, showed no difference in frequency of septal fibrosis (60% in group B vs 48% in group BC, P ϭ .46) or interface hepatitis (73% vs 71%, P ϭ .99). Conclusions. HBV-HCV coinfection was related to a longer time on hemodialysis, longer duration of infection, and history of blood transfusion. Contrary to nonuremic patients, HCV coinfection was not associated with more severe forms of liver disease in ESRD patients.