Co-infection with hepatitis C virus (HCV) and human T-lymphotropic virus types 1 (HTLV-1) and 2 (HTLV-2) in a reference outpatient clinic in São Paulo: epidemiologic, clinical, laboratory and histological evaluation / Coinfecção pelo vírus da hepatite C (VHC) e vírus linfotrópicos de células T humanas dos tipos 1 (HTLV-1) ou 2 (HTLV-2) em ambulatório de referência de São Paulo: avaliação epidemiológica, clínica, laboratorial e histológica

Flávio Augusto de Pádua Milagres

Co-infection with hepatitis C virus (HCV) and human T-lymphotropic virus types 1 (HTLV-1) and 2 (HTLV-2) is expected, as these viruses share common infection routes. Due to the relevance of these viral infections in Brazil and the existing gaps in knowledge about HCV/HTLV co-infection, we carried out this cross-sectional survey. A cohort of co-infected patients was compared to HCV-infected subjects, in regard to socio-demographic features, risk factors for viral acquisition, clinical and laboratory data, as well as liver histopathologic findings. Based on established serologic and molecular diagnostic algorithms, we selected HCV-viremic adult patients who attended the Hospital das Clínicas-FMUSP outpatient clinic from January 1993 to August 2005, whether or not they presented co-infection with HTLV-1 or HTLV-2. HBV and HIV-infected individuals were excluded from the sample. We collected patientssociodemographic characteristics, risk of exposure to blood-borne or sexually-transmitted viral agents, signs and symptoms related to HCV or HTLV disease, as well as laboratory data that included hematologic counts and liver function tests. Histopathologic findings were systematically reviewed, in accordance to the Ishaks scoring system. Patients from the HCV, HCV/HTLV-1 and HCV/HTLV-2 groups, were then compared by means of the X2 or Kruskal-Wallis tests for categorical or continuous variables, respectively. In addition, Fischers linear discriminant analysis was applied to define classification functions that better identified the combined effect of variables important for discrimination of the study groups. Finally, the discriminating accuracy of the model was evaluated by cross-validation, using the leave-one-out technique. The study sample comprised 85 patients, 55 in the HCV group, 24 in the HCV/HTLV-1 group and 6 in the HCV/HTLV-2 group. In bivariable analysis, no significant difference was found among groups in regard to socio-demographic features, smoking, risk factors for viral acquisition, such as blood transfusion, tattooing, acupuncture, or number of sexual partners. In contrast, alcohol consumption, use of intravenous drugs or inhaled cocaine and sexual partnership with an intravenous drug user were more frequent in the HCV/HTLV-2 group, whereas patients in the HCV group more often reported a sexual partner with hepatitis. As far as clinical data are concerned, abdominal pain was the only variable to be reported differently, being more prevalent in the HCV group. Even though within normal ranges, co-infected patients presented higher median platelet counts, whereas aminotransferase and GGT levels were higher among HCV-infected subjects. No significant difference was seen in liver histopathologic findings, though HCV liver disease-associated abnormalities, such as fibrosis and necroinflammatory activity were often found in patients from the three groups. Classification functions, defined by discriminating analysis included as relevant variables sex, age, intravenous drug use and sexual partner with hepatitis. Cross-validation yielded high (87.3%) and intermediate (66,7%) discriminating accuracies for the HCV and HCV/HTLV-2 functions. However, this method was not shown clinically useful to distinguish HCV/HTLV-1 co-infected patients.

AUTOR(ES)

DATA DE PUBLICAÇÃO

RESUMO

ASSUNTO(S)

ACESSO AO ARTIGO

Documentos Relacionados