Distribution of hepatitis C virus genotypes among different exposure categories in the State of Par��, Brazilian Amazon

INTRODUCTION: Epidemiological studies concerning HCV genotypic distribution in the Brazilian Amazon are scarce. Thus, this study determined the patterns of distribution of HCV genotypes among different exposure categories in the State of Par��, Brazilian Amazon. METHODS: A cross-sectional study was conducted on 312 HCV-infected individuals belonging to different categories of exposure, who were attended at the HEMOPA, CENPREN and a private hemodialysis clinic in Bel��m. They were tested for HCV antibodies using an immunoenzymatic test, RNA-HCV, using real-time PCR and HCV genotyping through phylogenetic analysis of the 5' UTR. The population groups were epidemiologically characterized according to data collected in a brief interview or medical consultation. RESULTS: Genotype 1 predominated in all the different categories of HCV exposure. HCV genotypic distribution among blood donors comprised genotypes 1 (94%) and 3 (6%). All patients with chronic hematologic diseases had HCV genotype 1. The genotypic distribution in illicit-drug users comprised genotypes 1 (59.6%) and 3 (40.4%). In patients under hemodialysis, genotypes 1 (90.1%), 2 (3.3%), and 3 (6.6%) were detected. Finally, the frequency of genotypes 1 and 3 was significantly different between the groups: BD and DU, PUH and DU, PUH and PCHD and PCHD and DU. CONCLUSIONS: The genotypic frequency and distribution of HCV in different categories of exposure in the State of Par�� showed a predominance of genotype 1, regardless of the possible risk of infection.

Hepatitis B and C virus infection among Brazilian Amazon riparians

INTRODUCTION: Viral hepatitis is a major public health concern in Brazil. There are few past studies on this issue, especially among riparian communities. This study aims at determining the seroprevalence of viral hepatitis B and C in the riparian community of Pacu�� Island, within the Camet�� municipality of Par�� State, Brazil. Moreover, this study aims to investigate the principal risk factors that this community is exposed to. METHODS: The current study has accessed blood samples from 181 volunteers who have answered an epidemiological questionnaire. Analyses on serological markers have been tested with commercial ELISA kits for detecting HBsAg, total anti-HBc, anti-HBs, and anti-HCV. Within seroreactive patients for HCV, RT-PCR and line probe assay have been performed to identify the viral genotype. RESULTS: In the serological marker analysis for hepatitis B, no reactivity for HBsAg, rate of 1.1% for total anti-HBc, and rate of 19.3% for anti-HBs have been observed. On hepatitis C, 8.8% seroprevalence has been found, in which 62.5% have gotten viral RNA. Among the risk factors studied, the following have been highlighted: non-use of condoms, sharing of cutting instruments, use of illicit drugs, and reports of family disease with HBV or HCV. CONCLUSIONS: The vaccination coverage against HBV is low, and the high prevalence of HCV within this community has been observed.

Coopera����o e conflito entre brit��nicos e portugueses na ��sia. Dos primeiros contactos em Bombaim (c.1600-1740)

A aquisi����o da ilha de Bombaim pela coroa inglesa e a consequente conviv��ncia fronteiri��a com o Estado da ��ndia constituiu uma novidade relacional e diplom��tica entre os poderes portugu��s e brit��nico, n��o s�� no ��ndico como em todo o espa��o ultramarino. Esta nova situa����o projectou a recentemente forjada e renovada alian��a anglo-portuguesa para um diferente plano, at�� ent��o n��o experienciado. De facto, o acordo de 1661 estipulou que o Estado da ��ndia entregasse parte do seu territ��rio a uma coroa europeia, o que significava uma mudan��a no seu paradigma de actua����o e a partilha de fronteiras comuns com um vizinho europeu, ���consentido��� e aliado. A isto adicionava-se o facto da popula����o residente em Bombaim, constitu��da por uma forte comunidade de grandes foreiros portugueses e jesu��tas, passar a estar sujeita aos dictames da coroa inglesa. Todos estes pressupostos constitu��ram uma novidade para o Estado da ��ndia e para os seus s��bditos e exigiram, necessariamente, uma adapta����o no modo de interac����o com t��o pr��ximo vizinho. O mesmo se ter�� passado com os oficiais brit��nicos, numa primeira fase da coroa (1665-1668) e doravante da East India Company, para quem o dom��nio territorial no espa��o asi��tico constitu��a uma experi��ncia nova. Esta realidade t��o pr��xima entre as duas pot��ncias europeias originou, necessariamente, a eclos��o de problemas e tens��es entre as duas estruturas de poder. Ser�� a partir desta conjuntura sugestiva que procuraremos compreender como o entendimento anglo-portugu��s na Europa foi transposto e gerido na esfera ultramarina, atrav��s da an��lise do caso paradigm��tico de Bombaim. A gest��o da alian��a naquele espa��o assumiu contornos espec��ficos e de dif��cil administra����o, pois a dist��ncia ditava uma maior autonomia decis��ria das autoridades de Goa e Bombaim, nem sempre em conson��ncia com as directrizes europeias. A interac����o na regi��o de Bombaim e espa��os adjacentes foi pautada pela flexibilidade e, por isso, caracterizou-se por momentos de antagonismo, coopera����o e conflito aberto. Nestes ���encontros de (in)conveni��ncia���, ambos os lados procuraram tirar partido das din��micas conjunturais da pol��tica indiana, o mesmo aplicando-se no sentido inverso, adaptando-se alinhamentos e rupturas consoante os interesses imediatos. Bombaim foi, assim, singular no relacionamento anglo-portugu��s na ��sia, o que n��o implica que n��o se procure compreender as resson��ncias da intera����o entre portugueses e brit��nicos noutros espa��os do subcontinente indiano (como Madrasta) ou contrapor os modos de actua����o da EIC noutros locais (como Cochim). Na disserta����o em curso, propomos efectuar um estudo de longo tempo, que analise de forma sistem��tica a transversal as din��micas relacionais entre brit��nicos e portugueses desde a introdu����o brit��nica na ��sia at�� �� perda portuguesa da Prov��ncia

A percep����o da ordem e a consci��ncia do tempo em Mari no per��odo Paleo-Babil��nico (s��c. XIX- XVIII a. C.)

O presente estudo tem como objectivo estudar as quest��es do tempo e da ordem no reino de Mari. A an��lise destas quest��es evidencia dois aspectos importantes: por um lado, a converg��ncia de duas culturas distintas ��� uma cultura ac��dica, tipicamente mesopot��mica, e uma cultura amorrita, mais ocidental ��� num mesmo espa��o e, por outro lado, a import��ncia do reino de Mari como um estudo de caso que retrata, por vezes com grande pormenor, a influ��ncia da penetra����o dos povos n��madas nas terras da Mesopot��mia e as suas repercuss��es nos v��rios dom��nios da vida p��blica. Estudar a ordem implica compreender a organiza����o do mundo e da sociedade, bem como a rela����o entre as esferas humana e celeste. Estudar o tempo implica, por sua vez, entender como o homem se posiciona no espa��o, como entende a sua hist��ria e o seu destino. Uma an��lise focada nestes dois temas permitir-nos-��, pois, compreender qual era o verdadeiro sentido da vida e do mundo para o homem de Mari. Como veremos, para o mariota, a vida assentava numa intensa din��mica na qual a fam��lia detinha o papel principal: era ela que o enquadrava na sociedade, que lhe permitia participar nos destinos da vida p��blica e receber as devidas honras ap��s a morte. Nesta perspectiva, a fam��lia e os la��os de sangue adquiriam um papel preponderante em v��rios dom��nios da vida humana. Eram os la��os consangu��neos que imperavam aquando da escolha de aliados e partid��rios. Por outro lado, o culto do parentesco impunha uma vis��o da hist��ria segundo a qual o tempo passado se afirmava como o grande modelo te��rico das ac����es desenvolvidas no quotidiano (no presente). Paralelamente �� fam��lia, o homem de Mari acreditava que no mundo divino residia a sua verdadeira esperan��a de levar uma vida feliz. A imagem de uma teocracia, onde homem e deus partilhavam o mesmo destino, �� transversal a todo o pensamento e ac����o do homem de Mari. Nesta tese, propomos desenvolver um estudo de conjunto, uma an��lise transversal que abranja todos os aspectos da vida social e humana: a religi��o, a pol��tica, a cultura e a sociedade

Vitamin C effects in mice experimentally infected with Trypanosoma cruzi QM2 strain

INTRODUCTION: To evaluate the efficacy of vitamin C in reducing the consequences generated by the production of free radicals in the acute and chronic phases of Chagas disease, two different doses of ascorbic acid were administered orally to 60 mice infected by Trypanosoma cruzi QM2 strain. METHODS: The animals were divided into six groups: G1, G2, and G3 for the acute phase study, and G'1, G'2, and G'3 for the chronic stage. The groups G1 and G'1 received 8.6x10-4mg/g of vitamin C daily, whereas G2 and G'2 received 7.14x10-3mg/g daily. The other groups, G3 and G'3, were considered placebos and received 10��L of mineral water. RESULTS: The study of the acute phase showed statistically significant differences between G1 and the other groups at various count days of the parasitemia evolution. The multiplying parasite was slower in G1 until the 11th day, but on the 22nd day it had greater parasitemia than in G2 and G3, and from the 36th day on, parasitemia stabilized at higher levels. However, when the histopathology of acute and chronic phases is considered, one does not note significant differences. CONCLUSIONS: The administration of two different doses of vitamin C was not able to protect mice and to contain the oxidative stress caused by free radicals formed by the metabolism of oxygen (reactive oxygen species) and nitrogen (reactive nitrogen species).

Avalia����o da monitoriza����o di��ria da prote��na C-Reativa no doente cr��tico

RESUMO: O objectivo desta Tese de Doutoramento foi estudar o valor da Prote��na CReactiva(PCR) como marcador de infec����o e sepsis. Por defini����o, um marcador da infec����o n��o est�� presente se o doente n��o est�� infectado, deve aparecer concomitantemente ou idealmente preceder a instala����o da infec����o, deve desaparecer com a institui����o de terap��utica antimicrobiana adequada e permanecer elevado se a infec����o for refract��ria ao tratamento. Do ponto de vista biol��gico, a PCR �� o prot��tipo das prote��nas de fase aguda, com uma marcada eleva����o da sua concentra����o s��rica em resposta a diversos est��mulos inflamat��rios em particular infec����es bacterianas. A sua concentra����o s��rica depende apenas da intensidade do est��mulo e da velocidade de s��ntese hep��tica, n��o sendo influenciada por nenhum factor ou tratamento a n��o ser que este tenha influ��ncia directa sobre o est��mulo desencadeante, o que a torna um marcador de infec����o com grande potencial. Nesta Tese comparou-se a PCR com marcadores cl��ssicos de infec����o, temperatura e contagem leucocit��ria, em diversas situa����es cl��nicas analisando doentes com infec����es documentadas e doentes controlos, sem infec����o. Globalmente os resultados dos trabalhos desta Tese mostram que a PCR �� um bom marcador de infec����o de acordo com a defini����o previamente apresentada. Em conjunto com a restante avalia����o cl��nica e laboratorial, a monitoriza����o di��ria da PCR nos doentes sem infec����o mostrou ser ��til como sentinela da infec����o, isto ��, apresenta valores baixos nos doentes sem infec����o e sobe precocemente nos doentes que desenvolvem uma infec����o. Nos doentes com infec����o documentada revelou um ser bom marcador de resposta �� terap��utica e evolu����o cl��nica, diminuindo naqueles que melhoravam e persistindo elevada nos que tinham mau progn��stico, bem assim como identificar diferentes perfis evolutivos. Em suma, a monitoriza����o di��ria da PCR mostrou utilidade ao longo de todo o internamento na Unidade de Cuidados Intensivos, quer na presen��a quer na aus��ncia de infec����o. Deste todo, a monitoriza����o di��ria da PCR pode a possibilitar uma utiliza����o mais racional e judiciosa da terap��utica antimicrobiana, contribuindo dessa forma para uma diminui����o da toxicidade e da press��o antibi��tica, menor risco de emerg��ncia de resist��ncias e finalmente diminui����o dos custos. Uma vez que, os doentes internados nas Unidades de Cuidados Intensivos apresentam as mesmas doen��as que os restantes doentes admitidos no hospital apenas se distinguindo pela sua maior gravidade, poder-se-�� extrapolar que a PCR tamb��m �� potencialmente um bom marcador de infec����o nestes doentes. ----------------ABSTRACT: The aim of this PhD Thesis was to assess the value of C-Reactive Protein (CRP) as a marker of infection and sepsis. A marker of infection should be absent in a non-infected patient, should increase alongside or ideally precede the development of an infection, and finally should assess the therapeutic response, that is to say decrease or even disappear with adequate antimicrobial therapy or on the opposite remain elevated if the infection is refractory to the prescribed treatment. The biology of CRP makes it the prototype of acute phase proteins, with marked and sharp elevations of its serum concentration in response to several inflammatory stimulus in particular bacterial infections. Besides, CRP level depends only of the intensity of the stimulus and the rate of hepatic synthesis. Its concentration is not modified by any therapy or intervention. Only those interventions affecting the inflammatory process responsible for the acute phase reaction can change the CRP level. These properties make CRP a potentially good marker of infection. In this Thesis the value of CRP was studied in comparison to traditional markers of infection, like temperature and white cell count, in different clinical situations analysing patients with documented infections and a control group without infection. The aggregated results of the analysis presented in this Thesis illustrate that CRP could be used as a marker of infection. In conjunction with other clinical and laboratory manifestations of sepsis, daily CRP measurement in patients without infection was useful in prediction of infection as its concentration remains low in patients without infection whereas if an infection appears its levels raise markedly. In addition, in patients with documented infections CRP was useful as a marker of therapeutic response and follow-up, with marked decreases in patients with good outcome and remaining elevated in those with poor prognosis, as well as the recognition of different patterns of evolution. In summary, daily CRP measurement was helpful in critical ill patients along the entire Intensive Care Unit stay, both in the presence and in the absence of infection. As a result, daily CRP measurement can assure a better and more rational use of antibiotics and consequently contribute to a decrease in the antibiotic toxicity and demand, reducing the risks of emergence of resistant strains aas well as costs. Provided that patients admitted to an Intensive Care Unit presented the same clinical diagnosis as those admitted to the wards but with higher severity, one can speculate that CRP is also a potentially good marker of infection in these of patients.

Liver fibrosis progression in HIV/hepatitis C virus coinfected patients with normal aminotransferases levels

INTRODUCTION: Approximately 30% of hepatitis C virus (HCV) monoinfected patients present persistently normal alanine aminotransferase (ALT) levels. Most of these patients have a slow progression of liver fibrosis. Studies have demonstrated the rate of liver fibrosis progression in hepatitis C virus-human immunodeficiency virus (HCV-HIV) coinfected patients is faster than in patients infected only by HCV. Few studies have evaluated the histological features of chronic hepatitis C in HIV-infected patients with normal ALT levels. METHODS: HCV-HIV coinfected patients (HCV-RNA and anti-HIV positive) with known time of HCV infection (intravenous drugs users) were selected. Patients with hepatitis B surface antigen (HBsAg) positive or hepatitis C treatment before liver biopsy were excluded. Patients were considered to have a normal ALT levels if they had at least 3 normal determinations in the previous 6 months prior to liver biopsy. All patients were submitted to liver biopsy and METAVIR scale was used. RESULTS: Of 50 studied patients 40 (80%) were males. All patients were treated with antiretroviral therapy. The ALT levels were normal in 13 (26%) patients. HCV-HIV co-infected patients with normal ALT levels had presented means of the liver fibrosis stages (0.77��0.44 versus 1.86��1.38; p<0.001) periportal inflammatory activity (0.62��0.77 versus 2.24��1.35; p<0.001) and liver fibrosis progression rate (0.058��0.043 fibrosis unit/year versus 0.118��0.102 fibrosis unit/year) significantly lower as compared to those with elevated ALT. CONCLUSIONS: HCV-HIV coinfected patients with persistently normal ALTs showed slower progression of liver fibrosis. In these patients the development of liver cirrhosis is improbable.

Quality of life of patients with hepatitis C

INTRODUCTION: Self-report on the quality of life (QOL) is increasingly studied in the evaluation of various diseases, especially in chronic ones. However, there are few data in the literature focusing the QOL of patients living with chronic hepatitis C. The objective of this study was to evaluate the QOL in patients with hepatitis C assessed by the World Health Organization Quality of Life Assessment (WHOQOL)-bref scale. METHODS: One hundred and eight hepatitis C patients attending the Outpatient Healthcare Medical Specialties in Tubar��o, State of Santa Catarina, Brazil, were contacted from May 2010 to February 2011. Patients answered the WHOQOL-bref scale and a questionnaire about their treatment and risk factors to hepatitis C virus (VHC) infection. RESULTS: Although most of patients with chronic hepatitis C considered their QoL good or very good (58.1%), 47 (44.8%) patients were poorly or very poorly satisfied with their health. About the WHOQOL answers, the environment domain had the highest score (25.15 + 5.77), while the lowest score was the social relationships domain (9.19 + 2.5). There was statistically significant association between household income and quality of life in all domains (p<0.001) and statistically significant association between education and the physical, psychological and social domains of quality of life (p<0.05). CONCLUSIONS: Based on the answers given in WHOQOL-bref, patients with chronic hepatitis C have a generally poor QOL, especially in social relationship domain. Household income and educational level were factors that interfered significantly with patients' QOL assessment.

Transplanta����o hep��tica no C. H. Porto

RESUMO - Contexto: a actividade de transplanta����o hep��tica envolve um n��mero consider��vel de profissionais multidisciplinares e, possui uma aloca����o de verbas importante do ponto de vista do administrador hospitalar. Estudar e analisar a actividade de transplanta����o hep��tica no Centro Hospitalar do Porto (CHP), �� por isso, objecto do trabalho. Objectivos: Efectuar uma an��lise custo/proveito do processo de transplanta����o hep��tica para o CHP nos anos de 2010, 2011 e 2012 e, caracterizar a popula����o em estudo com o maior n��mero de vari��veis poss��vel. Metodologia: Seleccionou-se para an��lise os pacientes com o Grupo de Diagn��stico Homog��neo (GDH) 480 que realizaram transplante hep��tico entre 1 de Janeiro de 2010 at�� 30 de Junho de 2012 de modo a quantificar os custos e proveitos dos 161 pacientes desde a fase pr��-transplante, passando pelo internamento at�� aos 6 meses ap��s a alta hospitalar da fase p��s-transplante. Na an��lise de custos da fase pr��-transplante consideraram-se os custos com recursos humanos (RH) m��dicos das consultas e o custo com meios complementares de diagn��stico e terap��utica (MCDT���s). Na fase de internamento considerou-se os custos relativos �� cirurgia (RH e material de consumo clinico e farmacol��gico) e di��rias de internamento. Para a fase p��s-transplante contabilizou-se os custos relativos a RH m��dicos das consultas, o custo com MCDT���s e f��rmacos. O apuramento de proveitos decorreu do contrato programa da institui����o, da Portaria 839-A/2009 de 31 de Julho para o c��lculo pelo peso relativo do transplante hep��tico, pelo Despacho n�� 19964/2008 de 28 de Julho para a comparticipa����o dos f��rmacos. Considerou-se ainda o incentivo �� transplanta����o pelos Despachos n��6155/2006, de 15 de Mar��o e n�� 10485/2011, de 19 de Agosto. Resultados: Da an��lise global dos 161 GDH���s o verificado foi um custo total para o CHP de 7.505.518,89euro (um custo m��dio de 46.618,13euro por paciente). Quanto aos proveitos utilizando o contrato programa do CHP bem como os Despachos relativos ao incentivo �� transplanta����o e �� comparticipa����o de f��rmacos, existiu proveitos de 7.089.462,77euro (proveito m��dio de 44.033,93euro). Se o c��lculo dos proveitos de internamento fosse pelo peso relativo do transplante hep��tico os proveitos seriam de 21.834.655,50euro (proveito m��dio de 135.618,98euro).

Secondary bronchiolitis obliterans organizing pneumonia during treatment of chronic hepatitis C: role of pegylated interferon alfa-2a

The treatment of chronic hepatitis C has frequent side effects such as cytopenias and neuropsychiatric symptoms. However, pulmonary toxicity associated with interferon is rarely described. This paper describes the clinical case of a 67-year-old female patient with chronic hepatitis C who presented an acute onset of dry cough, dyspnoea, and fever 36 weeks after the use of pegylated interferon alfa-2a and ribavirin. The lung biopsy confirmed the diagnosis of a bronchiolitis obliterans organizing pneumonia (BOOP). Corticotherapy was initiated, with clinical and radiological improvement. This paper aims to advise physicians to this occasional, though severe, adverse event related to hepatitis C virus (HCV) treatment.

Galen on Mental Disorders

Este trabalho aborda a conceito de desordem ps��quica na obra de Galeno (129-216). A primeira parte enquadra o pensamento de Galeno na vis��o da Filosofia e Medicina em vigor no in��cio do s��c. II d.C. De seguida descrevo a concep����o Hipocr��tica de epilepsia, e a abordagem que Plat��o desenvolve no Timeu e Fedro acerca da loucura, para de seguida abordar a concep����o de doen��a em Galeno, onde s��o analisados os conceitos de nos��ma, diathesis, pathos e energeia. Ap��s este excurso descrevo o ponto de vista de Galeno acerca da controv��rsia sobre a localiza����o da parte dirigente da alma (h��gemonikon) que se dividia entre defensores do encefalocentrismo (Plat��o, Hip��crates e Her��filo) e do cardiocentrismo (Arist��teles e os Est��icos). De modo a aprofundar a compreens��o de Galeno acerca deste tema descrevo o trabalho anat��mico-fisiol��gico desenvolvido pelos m��dicos Alexandrinos Erasistrato e Her��filo, activos no sec. III a. C., que descobriram, atrav��s de disseca����o de animais e muito provavelmente de humanos, o papel dos nervos e tend��es nas atividades cognitivas e sens��rio-motoras. Esta foi uma descoberta central para a argumenta����o de Galeno acerca da interac����o mente-corpo assim como para a descri����o das desordens ps��quicas. Posteriormente apresento a metodologia de Galeno no que concerne ao processo de diagn��stico e etiologia, essencial para se compreender como �� poss��vel aceder a ���entidades��� n��o vis��veis, como o h��gemonikon e as suas diferentes faculdades: ���imagina����o���, mem��ria e racioc��nio. Por fim, analiso alguns casos cl��nicos de pacientes afectados por desordens do h��gemonikon, a saber: phrenitis, mania e melancolia. Os principais textos objecto de an��lise s��o: Acerca dos Lugares Afectados, Acerca das Teses de Hip��crates e Plat��o e Que as Faculdades da Alma Seguem as Disposi����es do Corpo. Todavia, outros textos de Galeno ser��o convocados consoante a necessidade de analisar os conceitos que me proponho compreender, entre eles Acerca do M��todo Terap��utico e Acerca da Utilidade das Partes.

Hepatitis C and cutaneous alterations

While most of those infected with hepatitis C virus (HCV) are asymptomatic or only develop liver manifestations, a significant percentage evolves with autoimmune and lymphoproliferative disorders, resulting in a clinical condition called HCV syndrome. This work involving case studies of six patients with hepatitis C and varied skin manifestation aimed to report skin lesions occurring with HCV infection and its treatment. Skin manifestations in hepatitis C have been based on epidemiological studies. This justifies the need for studies that correlate HCV infection and its treatment with skin manifestations.

Evaluation of the therapeutic response of hepatitis C in coinfected patients (HIV/HCV): a study of cases from a hospital for chronic liver diseases in the Eastern Brazilian Amazon

INTRODUCTION: The aim of this study was to evaluate the therapeutic response of hepatitis C in patients coinfected with human immunodeficiency virus (HIV-1). METHODS: A retrospective study of 20 patients coinfected with HIV-1/HCV who were treated in the outpatient liver clinic at the Sacred House of Mercy Foundation Hospital of Par&#225; (Funda&#231;&#227;o Santa Casa de Miseric&#243;rdia do Par&#225; - FSCMPA) from April 2004 to June 2009. Patients were treated with 180&#181;g PEG interferon-&#945;2a in combination with ribavirin (1,000 to 1,250mg/day) for 48 weeks. The end point was the sustained virological response (SVR) rate (HCV RNA negative 24 weeks after completing treatment). RESULTS: The mean age of the patients was 40&#177;9.5 years, of which 89% (n=17) were male, and the HCV genotypes were genotype 1 (55%, n=11/20), genotype 2 (10%, n=2/20) and genotype 3 (35%, n=7/20). The mean CD4+ lymphocyte count was 507.8, and the liver fibrosis stages were (METAVIR) F1 (25%), F2 (55%), F3 (10%) and F4 (10%). The early virological response (EVR) was 60%, the end-of-treatment virological response (EOTVR) was 45% and the SVR was 45%. CONCLUSIONS: The median HCV viral load was high, and in 85% of cases in which highly active antiretroviral therapy (HAART) was used, none of the patients with F3-F4 fibrosis responded to treatment. Of the twenty patients treated, 45% achieved SVR and 45% achieved EOTVR. Studies that include cases from a wider region are needed to better evaluate these findings.

Epidemiology of the viral hepatitis B and C in female prisoners of Metropolitan Regional Prison Complex in the State of Goi��s, Central Brazil

INTRODUCTION: Little information regarding hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among Brazilian female prisoners exists. This study investigated the prevalence and risk factors associated with HBV and HCV infections and identified viral genotypes among female prisoners in Goi&#225;s, Central Brazil. METHODS: Women incarcerated in the largest prison in the State of Goi&#225;s were invited to participate in the study. All female prisoners were interviewed and tested for the detection of hepatitis B surface antigen (HBsAg), antibodies against HBsAg (anti-HBs), against hepatitis B core antigen (anti-HBc), and antibody against HCV (anti-HCV) by ELISA. HBsAg and anti-HCV positive samples were tested for HBV DNA and HCV RNA and genotyped, respectively. RESULTS: Participants (n=148; 98.6%) completed the study with an overall HBV prevalence of 18.9%. Age >30 years, a low education level, sex with a sexually transmitted diseases carrier, and a male sexual partner serving in the same penitentiary were associated with HBV infections. Only 24% of the women were anti-HBs positive suggesting previous HBV vaccination. Nine female prisoners (6.1%) were anti-HCV positive. Age >40 years, injecting drug use and length of incarceration were statistically associated with anti-HCV antibodies. Five samples were HCV RNA positive and classified as genotypes 1 (subtypes 1a; n=3 and 1b; n=1) and 3 (subtype 3a; n=1). The HBsAg-reactive sample was HBV DNA positive and genotype A. CONCLUSIONS: These findings highlight the necessity of public policies to control hepatitis B and C infections and emphasize the importance of hepatitis B vaccination in prison environments.