Aspectos epidemiológicos da infecção pelo vírus da hepatite c e coinfecções com os vírus b e delta no estado do Acre, Amazônia ocidental brasileira

AUTOR(ES)
DATA DE PUBLICAÇÃO

2010

RESUMO

Background. Viral hepatitis are leading complex public health issue worldwide,particularly chronic hepatitis B, C and D because of the risk for cirrhosis andhepatocellular carcinoma development. Amazon basin is for long recognized ashyperendemic for B and D virus but originally supposed to be indene for HCV, althoughits introduction into remote Amazon communities has clearly already occurred, in somesettings with non negligible rates of prevalence. Coinfections with hepatotropic virus havebeen subject of study and attention because of the complexity of viral interferencemechanisms, therapeutic challenges and particularly because of their apparent trend indetermining more severe pictures, both in acute and chronic presentations. The state ofAcre figures in literature as owing one of the highest prevalence within the country.Objectives. The present study aimed to carry out sero-epidemiological and virologicalinvestigation on the prevalence of HCV infection and B and D virus coinfections, in thegeneral population from the countryside of Acre state, in the Western Brazilian Amazon,with the exploration of possible associated factors. Methods. Socio-demographic andepidemiological data were collected by individual interviews and blood samples viavenopuncture, from a 2,144 random population-based sample, representing 11 countiesfrom the western area of the state. Blood samples were submitted to the followingserological tests by commercially available immunoenzymatic methods: anti-HCV,HBsAg, total anti-HBc and anti-HDV. Anti-HCV positive samples were submitted toHCV-RNA detection by RT-PCR. HCV-RNA positive samples were submitted togenotyping by LiPA. Exploration of possible associated factors was measured inmultivariate analysis using logistic regression models. Results. Prevalence of HCVinfection, estimated by HCV-RNA, was elevated (2.5%), higher than national meanprevalence and than rates found in the others neighboring Amazonian states, estimated byserologic al methods. HCV transmission in this region is probably not recent-beginning,remained high, since its introduction, for some years, probably associated with non-safeparenteral injections, had decreased gradually in intensity since then but is probably stillimportant. Notably high prevalence was found in Tarauacá (7.0%) and Cruzeiro do Sul(3.8%) counties. HCV genotype 1b was the most prevalent (42.6%), followed bygenotypes 1a (29.6%), 3 (18.5%) and 2 (5.6%). HDV infection marker was identified in15.9% of the HBsAg carriers. HCV prevalence amongst HBsAg carriers was 4.3% andHBsAg prevalence amongst HCV-infected was 5.6%. Nearly 6% of the sample exhibitedinfection marker for at least one of the three viruses, possibly representing more than40,000 individuals harboring some hepatotropic virus in the state. Amongst the infectedones, nearly 80% presented with monoinfection and 20% with coinfection. Amongst themonoinfected, 53.3% were HBV and 46.7% were HCV. Amongst de coinfections, HDVHBVwas the most common (88.9%), followed by HCV-HBV (7.4%) and triple infection(3.7%). Non safe injection use history, illiteracy and longer service life are probably riskfactors for genotype 3 HCV infection. Male gender is probably a risk factor for HDVinfection and for any virus infection, but probably not for coinfections in general. Thexxireference to having had hepatitis is probably predictive of chronic infection by HBV,HDV, any virus or virus in coinfections.

ASSUNTO(S)

hepatite c hepatites virais crônicas doencas infecciosas e parasitarias hepatitis c, chronic viral hepatitis

ACESSO AO ARTIGO

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