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Adeboyejo K, Grosche VR, José DP, Ferreira GM, Shimizu JF, King BJ, Tarr AW, Soares MMCN, Ball JK, McClure CP, Jardim ACG. Simultaneous determination of HCV genotype and NS5B resistance associated substitutions using dried serum spots from São Paulo state, Brazil. Access Microbiol 2022; 4:000326. [PMID: 35693474 PMCID: PMC9175972 DOI: 10.1099/acmi.0.000326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 12/30/2021] [Indexed: 11/26/2022] Open
Abstract
Hepatitis C virus (HCV) is responsible for more than 180 million infections worldwide, and about 80 % of infections are reported in Low and Middle-income countries (LMICs). Therapy is based on the administration of interferon (INF), ribavirin (RBV) or more recently Direct-Acting Antivirals (DAAs). However, amino acid substitutions associated with resistance (RAS) have been extensively described and can contribute to treatment failure, and diagnosis of RAS requires considerable infrastructure, not always locally available. Dried serum spots (DSS) sampling is an alternative specimen collection method, which embeds drops of serum onto filter paper to be transported by posting to a centralized laboratory. Here, we assessed feasibility of genotypic analysis of HCV from DSS in a cohort of 80 patients from São Paulo state Brazil. HCV RNA was detected on DSS specimens in 83 % of samples of HCV infected patients. HCV genotypes 1a, 1b, 2a, 2c and 3a were determined using the sequence of the palm domain of NS5B region, and RAS C316N/Y, Q309R and V321I were identified in HCV 1b samples. Concerning therapy outcome, 75 % of the patients who used INF +RBV as a previous protocol of treatment did not respond to DAAs, and 25 % were end-of-treatment responders. It suggests that therapy with INF plus RBV may contribute for non-response to a second therapeutic protocol with DAAs. One patient that presented RAS (V321I) was classified as non-responder, and combination of RAS C316N and Q309R does not necessarily imply in resistance to treatment in this cohort of patients. Data presented herein highlights the relevance of studying circulating variants for a better understanding of HCV variability and resistance to the therapy. Furthermore, the feasibility of carrying out genotyping and RAS phenotyping analysis by using DSS card for the potential of informing future treatment interventions could be relevant to overcome the limitations of processing samples in several location worldwide, especially in LMICs.
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Affiliation(s)
- Kazeem Adeboyejo
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Victória Riquena Grosche
- Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil.,Institute of Bioscience, Language and Exact Sciences, São Paulo State University, São José do Rio Preto, São Paulo, Brazil
| | | | - Giulia Magalhães Ferreira
- Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Jacqueline Farinha Shimizu
- Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil.,Institute of Bioscience, Language and Exact Sciences, São Paulo State University, São José do Rio Preto, São Paulo, Brazil
| | - Barnabas J King
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,School of Life Sciences, University of Nottingham, Nottingham, UK.,MRC/EPSRC Nottingham Molecular Pathology Node, University of Nottingham, Nottingham, UK
| | - Alexander W Tarr
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,School of Life Sciences, University of Nottingham, Nottingham, UK.,MRC/EPSRC Nottingham Molecular Pathology Node, University of Nottingham, Nottingham, UK
| | | | - Jonathan K Ball
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,School of Life Sciences, University of Nottingham, Nottingham, UK.,MRC/EPSRC Nottingham Molecular Pathology Node, University of Nottingham, Nottingham, UK
| | - C Patrick McClure
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,School of Life Sciences, University of Nottingham, Nottingham, UK.,MRC/EPSRC Nottingham Molecular Pathology Node, University of Nottingham, Nottingham, UK
| | - Ana Carolina Gomes Jardim
- Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil.,Institute of Bioscience, Language and Exact Sciences, São Paulo State University, São José do Rio Preto, São Paulo, Brazil
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Jindal N, Goyal LD, Singh C. Sociodemographic features associated with Hepatitis C Virus (HCV) in pregnant females: A tertiary care centre study from Malwa region of Punjab (North India). J Family Med Prim Care 2021; 10:2679-2683. [PMID: 34568154 PMCID: PMC8415663 DOI: 10.4103/jfmpc.jfmpc_2372_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 12/12/2022] Open
Abstract
Background Hepatitis C virus (HCV) infection is high in state of Punjab, however very few studies have been done till date. We all know that pregnant females are a most important section of our community and are usually screened for HCV, HIV, and Hepatitis B at time of presentation. HCV is capable of causing chronic infections and having long-term implications on a person's health. Vertical transmission of HCV can be one of the major route of transmission of this virus to the neonate and there have been various sociodemographic factors like age, literacy, socioeconomic status, occupational status, associated with the disease causation and transmission. Methods All pregnant females attending Obstetrics and gynecology department of our institute were included in study. All the sociodemographic characters and socioeconomic records were retrieved and analyzed. Results In our study also a lower socioeconomic status, illiteracy have been significantly associated with the HCV-positive group, thus emphasizing the role of education so as to impart education to the masses as regard to mode of transmission and its effects on the disease. Higher age of conceiving is also significant associated with the increased maternal risk. Conclusions The more involvement of health care officials and even persons not related to health care set up is required who can educate masses so as to protect the community.
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Affiliation(s)
- Neerja Jindal
- Department of Microbiology, GGS Medical College and Hospital, Faridkot, Punjab, India
| | - Lajya D Goyal
- Department of Obstetrics and Gynaecology, AIIMS, Bathinda, Punjab, India
| | - Charu Singh
- Department of Microbiology, IMS BHU, Varanasi, Uttar Pradesh, India
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Pereira FM, Santos FLN, de Almeida MDCC, Carreiro RP, Silva LK, Galvão-Castro B, Rios Grassi MF. Seroprevalence and Spatial Distribution of Hepatitis C Virus in Bahia, Brazil. Am J Trop Med Hyg 2021; 105:991-998. [PMID: 34424863 PMCID: PMC8592152 DOI: 10.4269/ajtmh.20-1615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 06/06/2021] [Indexed: 12/13/2022] Open
Abstract
In Salvador, which is the capital of the Brazilian state of Bahia, it has been estimated that 1.5% of the general population is infected with hepatitis C virus (HCV); however, the circulation of HCV throughout the state remains unknown. The present retrospective study aimed to determine anti-HCV seroprevalence and describe the geographic distribution of hepatitis C in Bahia. Data from HCV serological tests submitted to the Bahia Central Laboratory of Public Health between 2004 and 2013 were analyzed. Serology for HCV was performed using the AxSYM anti-HCV enzymatic microparticle immunoassay and chemiluminescence immunoassay. A subgroup of samples with detectable HCV-RNA was genotyped using the linear array hepatitis C virus genotyping assay. A total of 247,837 samples were analyzed. The median age of the studied population was 31 years (interquartile range, 25-44 years), and the female:male ratio was 3.9:1. The global seroprevalence of HCV in Bahia was estimated to be 1.3% (3,230/247,837), corresponding to an infection rate of 21.2/100,000 inhabitants. The seroprevalence of HCV was higher among males and increased with age. The presence of anti-HCV antibodies was detected throughout all mesoregions of Bahia, and the municipality with the highest infection rate was Ipiaú (112.04 cases/100,000 inhabitants). Genotypes 1 and 3 were found to be the most prevalent, followed by genotypes 2, 4, and 5. Our results provide evidence of the widespread distribution of previous HCV infection throughout the state of Bahia.
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Affiliation(s)
- Felicidade Mota Pereira
- Advanced Public Health Laboratory, Gonçalo Moniz Institute, Fiocruz-BA, Salvador, Bahia, Brazil
- Gonçalo Moniz Public Health Central Laboratory, Salvador, Bahia, Brazil
| | | | | | - Roberto Perez Carreiro
- Center for Integration of Data and Health Knowledge, Gonçalo Moniz Institute, Fiocruz-BA, Salvador, Bahia, Brazil
| | | | - Bernardo Galvão-Castro
- Advanced Public Health Laboratory, Gonçalo Moniz Institute, Fiocruz-BA, Salvador, Bahia, Brazil
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Maria Fernanda Rios Grassi
- Advanced Public Health Laboratory, Gonçalo Moniz Institute, Fiocruz-BA, Salvador, Bahia, Brazil
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
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Evaluation of a strategy for identification of hepatitis C virus carriers in outpatient and emergency units: contribution to the microelimination of hepatitis C in Brazil. Braz J Infect Dis 2021; 25:101546. [PMID: 33636108 PMCID: PMC9392148 DOI: 10.1016/j.bjid.2021.101546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/06/2021] [Accepted: 01/19/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Hepatitis C virus (HCV) infection continues to be an important public health problem worldwide. Despite the availability of drugs that promote the cure of infection in more than 95% of cases, the identification of HCV carriers remains a major challenge. Objective To evaluate a strategy for identifying HCV carriers based on combined criteria: screening in emergency units and specialty outpatient clinics of a tertiary hospital and among older adults (≥45 years), both suggested as efficient in epidemiological studies. Methods A cross-sectional, analytical and descriptive study was conducted on individuals of both sexes, aged 45 years and older, attending the emergency department and specialty outpatient clinics of a University Hospital in São Paulo, Brazil, from January 2016 to June 2018. After giving formal consent, the patients were submitted to a standardized interview and rapid testing for the identification of HCV antibodies (SD BIOLINE® anti-HCV). Results A total of 606 adult patients (62% women and 37% men) were evaluated. The mean age was 62 ± 10 years. Four positive tests were identified, with confirmation by conventional serology and HCV-RNA determination. Thus, the prevalence of HCV identified in the sample was 0.66%. All patients had a history of risk factors for infection. Conclusion The strategies of birth-cohort testing and screening in emergency medical services for the identification of HCV carries, both suggested in the literature as efficient for the diagnosis of hepatitis C, resulted in a low rate of HCV infection. These findings highlight the magnitude of the challenge of identifying asymptomatic HCV carriers in Brazil.
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Distribution of Human T-Lymphotropic Virus (HTLV) and Hepatitis C Co-infection in Bahia, Brazil. PLoS One 2020; 15:e0223087. [PMID: 32692782 PMCID: PMC7373273 DOI: 10.1371/journal.pone.0223087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 06/29/2020] [Indexed: 02/07/2023] Open
Abstract
Both Human T-lymphotropic virus type 1 (HTLV-1) and hepatitis C virus (HCV) are endemic in Brazil. In Salvador, the capital of the state of Bahia, 2% and 1.5% of the general population is infected with HTLV-1 or HCV. This study aimed to estimate the prevalence and the distribution of HTLV/HCV coinfection in Bahia. This cross-sectional study was conducted at the Central Laboratory of Public Health for the state of Bahia (LACEN-BA). All samples in the LACEN database submitted to serological testing for anti-HCV (chemiluminescence) and anti-HTLV-1/2 (chemiluminescence/ELISA and Western blot) from 2004 to 2013 were included. Infection rate was expressed as the number of infected individuals per 100,000 inhabitants in a given municipality; municipalities were grouped by microregion for further analysis. A total of 120,192 samples originating from 358 of the 417 municipalities in Bahia (85.8%) were evaluated. The overall HCV coinfection rate in HTLV-positive was 14.31% [2.8 (ranging from 0.4 to 8.0) per 100,000 inhabitants.] Twenty-one (5%) of the municipalities reported at least one case of HTLV/HCV coinfection. Most cases (87%) were concentrated in three microregions (Salvador: 79%, Ilhéus/Itabuna: 5%, Porto Seguro: 3%). Coinfection occurred more frequently in males (51%) with a mean age of 59 [(IQR): 46–59] years. HTLV/HCV coinfection in the state of Bahia was more frequently found among males living in the microregions of Salvador, Ilhéus/Itabuna and Porto Seguro, all of which are known to be endemic for HTLV infection.
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Melo LVL, Silva MABD, Perdoná GDSC, Nascimento MMP, Secaf M, Monteiro RA, Martinelli ADLC, Passos ADC. Epidemiological study of hepatitis B and C in a municipality with rural characteristics: Cássia dos Coqueiros, State of São Paulo, Brazil. Rev Soc Bras Med Trop 2016; 48:674-81. [PMID: 26676491 DOI: 10.1590/0037-8682-0222-2015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 10/27/2015] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Hepatitis B and C viral infections remain an important cause of global morbidity and mortality. Studies have been conducted in population groups of large cities, leaving gaps in the knowledge regarding the situation in small municipalities. We aimed to measure the prevalence of hepatitis B and C markers and presence of infection-associated factors. METHODS All inhabitants of Cássia dos Coqueiros aged ≥18 years who agreed to participate in the research were included. We collected blood as well as information via a questionnaire between March 2011 and December 2013. Univariate and multivariate analyses were conducted. RESULTS Among the 1,001 participants, 41 (4.1%) participants had a serological profile of hepatitis B viral exposure, and only one (0.1%) participant was considered a virus carrier. The frequency of isolated antibody to hepatitis B virus surface antigen (anti-HBs) markers was 17.8% for the overall population. In the multivariate analysis, hepatitis B virus (HBV) infection was associated with age, birth outside the State of São Paulo, history of hepatitis, ≥2 sexual partners in the last 6 months, and tattoos. Four (0.4%) participants had a serological profile of hepatitis C viral exposure. However, after confirmation using viral ribonucleic acid (RNA) evaluation, only one (0.1%) individual remained positive. CONCLUSIONS The positivity rates for hepatitis B and C were low, despite greater sexual freedom and the recent emergence of illicit drugs, as observed by the health personnel working in Cássia dos Coqueiros.
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Affiliation(s)
- Laura Valdiane Luz Melo
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Marcondes Alves Barbosa da Silva
- Instituto de Ciências Exatas e Naturais, Curso de Medicina, Universidade Federal de Mato Grosso, Rondonópolis, Mato Grosso, Brazil
| | - Gleici da Silva Castro Perdoná
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Marie Secaf
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Rosane Aparecida Monteiro
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ana de Lourdes Candolo Martinelli
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Afonso Dinis Costa Passos
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
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Nishiya AS, Almeida-Neto CD, Romano CM, Alencar CS, Ferreira SC, Di-Lorenzo-Oliveira C, Levi JE, Salles NA, Mendrone-Junior A, Sabino EC. Phylogenetic analysis of the emergence of main hepatitis C virus subtypes in São Paulo, Brazil. Braz J Infect Dis 2015; 19:473-8. [PMID: 26296325 PMCID: PMC9427527 DOI: 10.1016/j.bjid.2015.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 04/10/2015] [Accepted: 06/14/2015] [Indexed: 01/04/2023] Open
Abstract
Background It is recognized that hepatitis C virus subtypes (1a, 1b, 2a, 2b, 2c and 3a) originated in Africa and Asia and spread worldwide exponentially during the Second World War (1940) through the transfusion of contaminated blood products, invasive medical and dental procedures, and intravenous drug use. The entry of hepatitis C virus subtypes into different regions occurred at distinct times, presenting exponential growth rates of larger or smaller spread. Our study estimated the growth and spread of the most prevalent subtypes currently circulating in São Paulo. Methods A total of 465 non-structural region 5B sequences of hepatitis C virus covering a 14-year time-span were used to reconstruct the population history and estimate the population dynamics and Time to Most Recent Common Ancestor of genotypes using the Bayesian Markov Chain Monte Carlo approach implemented in BEAST (Bayesian evolutionary analysis by sampling tree software/program). Results Evolutionary analysis demonstrated that the different hepatitis C virus subtypes had distinct growth patterns. The introduction of hepatitis C virus-1a and -3a were estimated to be circa 1979 and 1967, respectively, whereas hepatitis C virus-1b appears to have a more ancient entry, circa 1923. Hepatitis C virus-1b phylogenies suggest that different lineages circulate in São Paulo, and four well-supported groups (i.e., G1, G2, G3 and G4) were identified. Hepatitis C virus-1a presented the highest growth rate (r = 0.4), but its spread became less marked after the 2000s. Hepatitis C virus-3a grew exponentially until the 1990s and had an intermediate growth rate (r = 0.32). An evident exponential growth (r = 0.26) was found for hepatitis C virus-1b between 1980 and the mid-1990s. Conclusions After an initial period of exponential growth, the expansion of the three main subtypes began to decrease. Hepatitis C virus-1b presented inflated genetic diversity, and its transmission may have been sustained by different generations and transmission routes other than blood transfusion. Hepatitis C virus-1a and -3a showed no group stratification, most likely due to their recent entry.
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Affiliation(s)
- Anna Shoko Nishiya
- Fundação Pró-Sangue/Hemocentro de São Paulo, São Paulo, SP, Brazil; Infectious Diseases Division (DIPA), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - César de Almeida-Neto
- Fundação Pró-Sangue/Hemocentro de São Paulo, São Paulo, SP, Brazil; Discipline of Medical Science, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Camila Malta Romano
- Laboratory of Virology, Department of Infectious and Parasitic Diseases, Instituto de Medicina Tropical de São Paulo, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Cecília Salete Alencar
- Infectious Diseases Division (DIPA), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Lim 03 Medical Research Laboratory, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Suzete Cleusa Ferreira
- Fundação Pró-Sangue/Hemocentro de São Paulo, São Paulo, SP, Brazil; Infectious Diseases Division (DIPA), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | | | | | | | - Ester Cerdeira Sabino
- Infectious Diseases Division (DIPA), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Infectious Disease, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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Pereira FM, Zarife MAS, Reis EAG, G Reis M. Indeterminate RIBA results were associated with the absence of hepatitis C virus RNA (HCV-RNA) in blood donors. Rev Soc Bras Med Trop 2014; 47:12-7. [PMID: 24603731 DOI: 10.1590/0037-8682-0222-2013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 01/31/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Hepatitis C virus (HCV) infection is diagnosed by the presence of antibodies and is supplemented by confirmatory testing methods, such as recombinant immunoblot assay (RIBA) and HCV-RNA detection. This study aimed to evaluate the efficacy of RIBA testing to diagnose HCV infection in blood donors positive for anti-HCV antibodies. METHODS A total of 102 subjects positive for anti-HCV determined by enzyme-linked immunosorbent assay (ELISA) at the Hematology and Hemotherapy Foundation of Bahia (HEMOBA) were later assessed with new samples using the Abbott Architect anti-HCV test (Abbott Diagnostics, Wiesbaden, Germany), the RIBA III test (Chiron RIBA HCV 3.0 SIA, Chiron Corp., Emeryville, CA, USA), the polymerase chain reaction (PCR; COBAS® AMPLICOR HCV Roche Diagnostics Corp., Indianapolis, IN, USA) and line probe assay (LiPA - Siemens, Tarrytown, NY, USA) genotyping for HCV diagnosis. RESULTS Of these new samples, 38.2% (39/102) were positive, 57.8% (59/102) were negative and 3.9% (4/102) were indeterminate for anti-HCV; HCV-RNA was detected in 22.5% (23/102) of the samples. RIBA results were positive in 58.1% (25/43), negative in 9.3% (4/43) and indeterminate in 32.6% (14/43) of the samples. The prevailing genotypes were 1 (78.3%, 18/23), 3 (17.4%, 4/23) and 2 (4.3%, 1/23). All 14 samples with indeterminate RIBA results had undetectable viral loads (detection limit ≤50 IU/mL). Of these samples, 71.4% (10/14) were reevaluated six months later. Eighty percent (8/10) of these samples remained indeterminate by RIBA, and 20% (2/10) were negative. CONCLUSIONS In this study, individuals with indeterminate RIBA results had no detectable HCV-RNA.
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Affiliation(s)
- Felicidade Mota Pereira
- Laboratório Central de Saúde Pública do Estado da Bahia, Secretaria da Saúde, SalvadorBA, Laboratório Central de Saúde Pública do Estado da Bahia, Secretaria da Saúde, Salvador, BA
| | - Maria Alice Sant'ana Zarife
- Laboratório Central de Saúde Pública do Estado da Bahia, Secretaria da Saúde, SalvadorBA, Laboratório Central de Saúde Pública do Estado da Bahia, Secretaria da Saúde, Salvador, BA
| | - Eliana Almeida Gomes Reis
- Laboratório de Patologia e Biologia Molecular, Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, SalvadorBA, Laboratório de Patologia e Biologia Molecular, Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA
| | - Mitermayer G Reis
- Laboratório de Patologia e Biologia Molecular, Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, SalvadorBA, Laboratório de Patologia e Biologia Molecular, Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA
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Bruggmann P, Berg T, Øvrehus ALH, Moreno C, Brandão Mello CE, Roudot-Thoraval F, Marinho RT, Sherman M, Ryder SD, Sperl J, Akarca U, Balık I, Bihl F, Bilodeau M, Blasco AJ, Buti M, Calinas F, Calleja JL, Cheinquer H, Christensen PB, Clausen M, Coelho HSM, Cornberg M, Cramp ME, Dore GJ, Doss W, Duberg AS, El-Sayed MH, Ergör G, Esmat G, Estes C, Falconer K, Félix J, Ferraz MLG, Ferreira PR, Frankova S, García-Samaniego J, Gerstoft J, Giria JA, Gonçales FL, Gower E, Gschwantler M, Guimarães Pessôa M, Hézode C, Hofer H, Husa P, Idilman R, Kåberg M, Kaita KDE, Kautz A, Kaymakoglu S, Krajden M, Krarup H, Laleman W, Lavanchy D, Lázaro P, Marotta P, Mauss S, Mendes Correa MC, Müllhaupt B, Myers RP, Negro F, Nemecek V, Örmeci N, Parkes J, Peltekian KM, Ramji A, Razavi H, Reis N, Roberts SK, Rosenberg WM, Sarmento-Castro R, Sarrazin C, Semela D, Shiha GE, Sievert W, Stärkel P, Stauber RE, Thompson AJ, Urbanek P, van Thiel I, Van Vlierberghe H, Vandijck D, Vogel W, Waked I, Wedemeyer H, Weis N, Wiegand J, Yosry A, Zekry A, Van Damme P, Aleman S, Hindman SJ. Historical epidemiology of hepatitis C virus (HCV) in selected countries. J Viral Hepat 2014; 21 Suppl 1:5-33. [PMID: 24713004 DOI: 10.1111/jvh.12247] [Citation(s) in RCA: 179] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Chronic infection with hepatitis C virus (HCV) is a leading indicator for liver disease. New treatment options are becoming available, and there is a need to characterize the epidemiology and disease burden of HCV. Data for prevalence, viremia, genotype, diagnosis and treatment were obtained through literature searches and expert consensus for 16 countries. For some countries, data from centralized registries were used to estimate diagnosis and treatment rates. Data for the number of liver transplants and the proportion attributable to HCV were obtained from centralized databases. Viremic prevalence estimates varied widely between countries, ranging from 0.3% in Austria, England and Germany to 8.5% in Egypt. The largest viremic populations were in Egypt, with 6,358,000 cases in 2008 and Brazil with 2,106,000 cases in 2007. The age distribution of cases differed between countries. In most countries, prevalence rates were higher among males, reflecting higher rates of injection drug use. Diagnosis, treatment and transplant levels also differed considerably between countries. Reliable estimates characterizing HCV-infected populations are critical for addressing HCV-related morbidity and mortality. There is a need to quantify the burden of chronic HCV infection at the national level.
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Affiliation(s)
- P Bruggmann
- Arud Centres for Addiction Medicine, Zurich, Switzerland
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Thong VD, Akkarathamrongsin S, Poovorawan K, Tangkijvanich P, Poovorawan Y. Hepatitis C virus genotype 6: virology, epidemiology, genetic variation and clinical implication. World J Gastroenterol 2014; 20:2927-40. [PMID: 24659883 PMCID: PMC3961978 DOI: 10.3748/wjg.v20.i11.2927] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 01/06/2014] [Accepted: 01/19/2014] [Indexed: 02/07/2023] Open
Abstract
Hepatitis C virus (HCV) is a serious public health problem affecting 170 million carriers worldwide. It is a leading cause of chronic hepatitis, cirrhosis, and liver cancer and is the primary cause for liver transplantation worldwide. HCV genotype 6 (HCV-6) is restricted to South China, South-East Asia, and it is also occasionally found in migrant patients from endemic countries. HCV-6 has considerable genetic diversity with 23 subtypes (a to w). Although direct sequencing followed by phylogenetic analysis is the gold standard for HCV-6 genotyping and subtyping, there are also now rapid genotyping tests available such as the reverse hybridization line probe assay (INNO-LiPA II; Innogenetics, Zwijnaarde, Belgium). HCV-6 patients present with similar clinical manifestations as patients infected with other genotypes. Based on current evidence, the optimal treatment duration of HCV-6 with pegylated interferon/ribavirin should be 48 wk, although a shortened treatment duration of 24 wk could be sufficient in patients with low pretreatment viral load who achieve rapid virological response. In addition, the development of direct-acting antiviral agents is ongoing, and they give high response rate when combined with standard therapy. Herein, we review the epidemiology, classification, diagnosis and treatment as it pertain to HCV-6.
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Nishiya AS, de Almeida-Neto C, Ferreira SC, Alencar CS, Di-Lorenzo-Oliveira C, Levi JE, Salles NA, Mendrone A, Sabino EC. HCV genotypes, characterization of mutations conferring drug resistance to protease inhibitors, and risk factors among blood donors in São Paulo, Brazil. PLoS One 2014; 9:e86413. [PMID: 24466079 PMCID: PMC3897703 DOI: 10.1371/journal.pone.0086413] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 12/11/2013] [Indexed: 12/18/2022] Open
Abstract
Background Hepatitis C virus (HCV) infection is a global health problem estimated to affect almost 200 million people worldwide. The aim of this study is to analyze the subtypes and existence of variants resistant to protease inhibitors and their association with potential HCV risk factors among blood donors in Brazil. Methods Repeat anti-HCV reactive blood donors are systematically asked to return for retest, notification, and counseling in which they are interviewed for risk factors for transfusion-transmitted diseases. We analyzed 202 donors who returned for counseling from 2007 to 2010 and presented enzyme immunoassay- and immunoblot-reactive results. The HCV genotypes and resistance mutation analyses were determined by the direct sequencing of the NS5b and NS3 regions, respectively. The HCV viral load was determined using an in-house real-time PCR assay targeting the 5′-NCR. Results HCV subtypes 1b, 1a, and 3a were found in 45.5%, 32.0%, and 18.0% of the donors, respectively. The mean viral load of genotype 1 was significantly higher than that of the genotype 3 isolates. Subtype 1a was more frequent among young donors and 3a was more frequent among older donors. Protease inhibitor-resistant variants were detected in 12.8% of the sequenced samples belonging to genotype 1, and a higher frequency was observed among subtype 1a (20%) in comparison to 1b (8%). There was no difference in the prevalence of HCV risk factors among the genotypes or drug-resistant variants. Conclusions We found a predominance of subtype 1b, with an increase in the frequency of subtype 1a, in young subjects. Mutations conferring resistance to NS3 inhibitors were frequent in treatment-naïve blood donors, particularly those infected with subtype 1a. These variants were detected in the major viral population of HCV quasispecies, have replicative capacities comparable to nonresistant strains, and could be important for predicting the response to antiviral triple therapy.
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Affiliation(s)
- Anna S. Nishiya
- Fundação Pró-Sangue/Hemocentro de São Paulo, São Paulo, Brazil
- Infectious Diseases Division (DIPA), Federal University of São Paulo, São Paulo, Brazil
- * E-mail:
| | - Cesar de Almeida-Neto
- Fundação Pró-Sangue/Hemocentro de São Paulo, São Paulo, Brazil
- Discipline of Medical Science, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Suzete C. Ferreira
- Fundação Pró-Sangue/Hemocentro de São Paulo, São Paulo, Brazil
- Infectious Diseases Division (DIPA), Federal University of São Paulo, São Paulo, Brazil
| | - Cecília S. Alencar
- Infectious Diseases Division (DIPA), Federal University of São Paulo, São Paulo, Brazil
- LIM 03 Lab. Medice Laboratory, Department of Pathology, HCFMUSP, São Paulo, Brazil
| | | | - José E. Levi
- Fundação Pró-Sangue/Hemocentro de São Paulo, São Paulo, Brazil
| | - Nanci A. Salles
- Fundação Pró-Sangue/Hemocentro de São Paulo, São Paulo, Brazil
| | | | - Ester C. Sabino
- Infectious Diseases Division (DIPA), Federal University of São Paulo, São Paulo, Brazil
- Department of Infectious Disease, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
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Falquetto TC, Endringer DC, Andrade TUD, Lenz D. Hepatitis C in prisoners and non-prisoners in Colatina, Espírito Santo, Brazil. BRAZ J PHARM SCI 2013. [DOI: 10.1590/s1984-82502013000400013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of the present work was to compare hepatitis C prevalence, genotypes, and risk factors between prisoners and non-prisoners in the city of Colatina, Espírito Santo, Brazil. This cross-sectional study involved approximately 1,600 residents and 730 prisoners, all of whom were living in Colatina. The percentage of individuals who tested positive for anti-HCV was 0.1% (2/1,600) in the non-prisoner group and 1.0% (7/730) in the prisoner group, confirming a higher risk of hepatitis C in the latter group. The percentage of subjects who progressed to HCV-RNA negative was 11.1% (1/9), confirming the high probability of evolution to chronicity. Genotype 1 was the most predominant genotype found. Factors associated with increased risk of hepatitis C were being male, being institutionalized, having an income of less than three minimum wages, having low educational attainment, and using injected drugs. Alcohol use, pain in the liver, migraine, and reported history of hepatitis were markedly associated with hepatitis C. The prison population tested positive for anti-HCV at a higher rate than the non-prison population.
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Rodrigues Neto J, Cubas MR, Kusma SZ, Olandoski M. Prevalence of hepatitis C in adult users of the public health service of São José dos Pinhais--Paraná. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2013; 15:627-38. [PMID: 23090309 DOI: 10.1590/s1415-790x2012000300016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 05/18/2012] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES We aimed to investigate the prevalence of Hepatitis C in adult users of the Public Health Services of São José dos Pinhais - Paraná. METHODS We performed an epidemiological survey with a probabilistic sample of 5,017 volunteers who answered a questionnaire and were submitted to an anti-HCV quick test. Data were organized using Epi-info 3.5.1. The association between the presence of the disease and the factors of interest in the study were evaluated by the Chi-square test. We used a Logistic Regression Adjusted Model for risk factor analysis and the Wald test for decision making on the importance of the risk factors. RESULTS The absolute frequency of positive anti-HCV was 13, with a prevalence of 0.30%, (IC = 0.12% - 0.40%). A higher probability of the disease was reported in males (p = 0.008) and in single, separated and widowed subjects (p = 0.045); in subjects with prior HCV symptoms (p < 0.001) and a previous blood transfusion (p < 0.001); and with the presence of a tattoo (p = 0.033). Drug abuse, blood transfusion and age > 40 years increased the risk for disease, regardless of sex, age and marital status. CONCLUSION We found a low prevalence of Hepatitis C, albeit expected for Southern Brazil. Our results did not differ from other studies as to contamination risks. The study may contribute to highlight the importance of Hepatitis C, the need to implement strategies to cope with it, and stimulate better understanding of Hepatitis C.
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Lampe E, Lewis-Ximenez L, Espírito-Santo MP, Delvaux NM, Pereira SA, Peres-da-Silva A, Martins RMB, Soares MA, Santos AF, Vidal LL, Germano FN, de Martinez AMB, Basso R, Pinho JRR, Malta FM, Gomes-Gouvêa M, Moliterno RA, Bertolini DA, Fujishima MAT, Bello G. Genetic diversity of HCV in Brazil. Antivir Ther 2013; 18:435-44. [PMID: 23792792 DOI: 10.3851/imp2606] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Many studies have documented the molecular epidemiological scenario of HCV within individual Brazilian states, but we still have an incomplete understanding of the dispersion dynamics of the virus in different regions throughout the country. METHODS A total of 676 HCV NS5B gene sequences of subtypes 1a (n=321), 1b (n=170) and 3a (n=185), isolated from seven different Brazilian states covering four out of five regions were analysed in the present study. We also analysed 22 HCV NS5B gene sequences of minor genetic variants including genotype 2 (n=13), genotype 4 (n=6) and subtype 5a (n=3). Brazilian HCV sequences were aligned with sequences of non-Brazilian origin and subjected to maximum likelihood phylogenetic analyses. RESULTS These analyses revealed that the Brazilian HCV epidemic resulted from multiple introductions and autochthonous transmission of subtypes 1a, 1b, 3a and genotypes 2, 4 and 5. Brazilian HCV subtype 1a epidemic is dominated by the dissemination of one major clade; while Brazilian HCV subtypes 1b and 3a epidemics are characterized by concurrent dissemination of several independent HCV lineages. Some HCV Brazilian lineages of subtypes 1a, 1b, 2b and 3a were successful in becoming established and disseminated through several regions in the country. Despite significant phylogenetic intermixing of Brazilian sequences, the distribution of HCV strains from different states across lineages was not completely homogeneous. CONCLUSIONS These results demonstrate the existence of multiple introductions and local propagation of both prevalent and uncommon HCV genetic variants in Brazil and identify some major Brazilian HCV clades with nationwide dissemination. This study also suggests that the observed HCV diversity in Brazil has been shaped by both frequent viral migration among regions and in situ viral dissemination.
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Affiliation(s)
- Elisabeth Lampe
- Laboratório de Hepatites Virais, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil.
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de Almeida-Neto C, Sabino EC, Liu J, Blatyta PF, Mendrone-Junior A, Salles NA, Leão SC, Wright DJ, Basques FV, Ferreira JE, Busch MP, Murphy EL. Prevalence of serologic markers for hepatitis B and C viruses in Brazilian blood donors and incidence and residual risk of transfusion transmission of hepatitis C virus. Transfusion 2013; 53:827-34. [PMID: 22882510 PMCID: PMC3499633 DOI: 10.1111/j.1537-2995.2012.03840.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND We evaluate the current prevalence of serologic markers for hepatitis B virus (HBV) and hepatitis C virus (HCV) in blood donors and estimated HCV incidence and residual transfusion-transmitted risk at three large Brazilian blood centers. STUDY DESIGN AND METHODS Data on whole blood and platelet donations were collected from January through December 2007, analyzed by center; donor type; age; sex; donation status; and serologic results for hepatitis B surface antigen (HBsAg), antibody to hepatitis B core antigen (anti-HBc), and anti-HCV. HBV and HCV prevalence rates were calculated for all first-time donations. HCV incidence was derived including interdonation intervals that preceded first repeat donations given during the study, and HCV residual risk was estimated for transfusions derived from repeat donors. RESULTS There were 307,354 donations in 2007. Overall prevalence of concordant HBsAg and anti-HBc reactivity was 289 per 100,000 donations and of anti-HCV confirmed reactivity 191 per 100,000 donations. There were significant associations between older age and hepatitis markers, especially for HCV. HCV incidence was 3.11 (95% confidence interval, 0.77-7.03) per 100,000 person-years, and residual risk of HCV window-phase infections was estimated at 5.0 per million units transfused. CONCLUSION Improvement in donor selection, socioeconomic conditions, and preventive measures, implemented over time, may have helped to decrease prevalence of HBV and HCV, relative to previous reports. Incidence and residual risk of HCV are also diminishing. Ongoing monitoring of HBV and HCV markers among Brazilian blood donors should help guide improved recruitment procedures, donor selection, laboratory screening, and counseling strategies.
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Carmo RA, Campos LN, Melo APS, Guimarães MDC. Hepatitis C among patients with mental illness in Brazil: an analysis of associated factors. Gen Hosp Psychiatry 2013; 35:129-33. [PMID: 23260338 DOI: 10.1016/j.genhosppsych.2012.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 11/09/2012] [Accepted: 11/09/2012] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The objective was to assess factors associated with previous exposure to hepatitis C virus (HCV) infection among Brazilian adults in mental health centers. METHOD A cross-sectional national multicenter study of 2087 psychiatric patients randomly selected from 26 public mental health services was conducted between 2005 and 2007 in Brazil. An interview was conducted for obtaining sociodemographic, clinical and behavioral data. Psychiatric diagnoses were obtained from medical charts. Serology testing was conducted using anti-HCV. The magnitude of the associations was estimated by the prevalence rate ratio under Poisson distribution. Multivariate analysis for previous HCV exposure was carried out by weighted Poisson regression. RESULTS The weighted prevalence of previous HCV exposure was 2.53% (95% confidence interval: 2.22-2.83). Factors associated with previous exposure to HCV infection included male gender; age ≥ 40 years; history of sexually transmitted infections; current tobacco use; lifetime injecting drug use; exchange of money/drugs for sex; and main psychiatric diagnoses of psychoses and bipolar disorders, substance use disorders or dementia. CONCLUSIONS Our results indicate a high prevalence of previous exposure to HCV in this population of Brazilian psychiatric patients. Most factors statistically associated with HCV were demographic or behavioral related, indicating a potential high-vulnerability profile. Screening for HCV in high-risk patients should be routine practices in these mental health services in Brazil.
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Affiliation(s)
- Ricardo Andrade Carmo
- Infectious Diseases Reference Center CTR-DIP Orestes Diniz, Municipal Health Division/Federal University of Minas Gerais, Belo Horizonte, Brazil.
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Hernandez D, Zhou N, Ueland J, Monikowski A, McPhee F. Natural prevalence of NS5A polymorphisms in subjects infected with hepatitis C virus genotype 3 and their effects on the antiviral activity of NS5A inhibitors. J Clin Virol 2013; 57:13-8. [PMID: 23384816 DOI: 10.1016/j.jcv.2012.12.020] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 12/01/2012] [Accepted: 12/13/2012] [Indexed: 12/25/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) NS5A replication complex inhibitors (RCIs) have been shown to exhibit picomolar antiviral activity against genotype 1 (GT1) in vitro. This has translated into rapid and robust declines in HCV RNA in GT1 patients. Less is known about the susceptibility of other genotypes such as GT3 to inhibition by NS5A RCIs. OBJECTIVES To detect and phenotype naturally occurring HCVGT3 NS5A polymorphisms against two NS5A RCIs (daclatasvir [DCV] and GS-5885) currently in clinical development. STUDY DESIGN The NS5A region from 96 HCV GT3 treatment-naive patients spanning North America, Europe and Australia was determined. RESULTS Phylogenetic analysis revealed a broad distribution with no significant geographic clustering. GT1 DCV resistance-associated variants (RAVs) were observed in GT3 subjects; variants (and their frequencies) included 28M/V (1%), 30A/K/S/T/V (10%), 31L/M (1%), E92A (1%) and Y93H (8.3%). A consensus sequence was used to generate a JFH1/3a-NS5A hybrid replicon and employed to assess susceptibility to NS5A RCIs. Against JFH1/3a-NS5A, DCV was more potent (EC(50) = 0.52 nM) than GS-5885 (EC(50) = 141 nM). DCV sensitivity was increased against JFH1/3a-NS5A-M28V (EC50 = 0.006 nM), A30V (EC(50) = 0.012 nM), and E92A (EC(50) = 0.004 nM) while the NS5A-A30K and -Y93H variants exhibited reduced sensitivity to DCV (EC50 values of 23 nM and 1120 nM, respectively) and to GS-5885 (EC50 values of 1770 nM and 4300 nM, respectively). CONCLUSIONS Substitutions conferring resistance to NS5A RCIs pre-existed in treatment-naive patients infected with HCV GT3. The effectiveness of these NS5A RCIs to exert efficacy in the clinic may depend on which inhibitor is used in combination with other antivirals.
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Affiliation(s)
- Dennis Hernandez
- Bristol-Myers Squibb, 5 Research Parkway, Wallingford, CT 06492, USA.
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Pereira LMMB, Martelli CMT, Moreira RC, Merchan-Hamman E, Stein AT, Cardoso RMA, Figueiredo GM, Montarroyos UR, Braga C, Turchi MD, Coral G, Crespo D, Lima MLC, Alencar LCA, Costa M, dos Santos AA, Ximenes RAA. Prevalence and risk factors of Hepatitis C virus infection in Brazil, 2005 through 2009: a cross-sectional study. BMC Infect Dis 2013; 13:60. [PMID: 23374914 PMCID: PMC3574834 DOI: 10.1186/1471-2334-13-60] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 01/11/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hepatitis C chronic liver disease is a major cause of liver transplant in developed countries. This article reports the first nationwide population-based survey conducted to estimate the seroprevalence of HCV antibodies and associated risk factors in the urban population of Brazil. METHODS The cross sectional study was conducted in all Brazilian macro-regions from 2005 to 2009, as a stratified multistage cluster sample of 19,503 inhabitants aged between 10 and 69 years, representing individuals living in all 26 State capitals and the Federal District. Hepatitis C antibodies were detected by a third-generation enzyme immunoassay. Seropositive individuals were retested by Polymerase Chain Reaction and genotyped. Adjusted prevalence was estimated by macro-regions. Potential risk factors associated with HCV infection were assessed by calculating the crude and adjusted odds ratios, 95% confidence intervals (95% CI) and p values. Population attributable risk was estimated for multiple factors using a case-control approach. RESULTS The overall weighted prevalence of hepatitis C antibodies was 1.38% (95% CI: 1.12%-1.64%). Prevalence of infection increased in older groups but was similar for both sexes. The multivariate model showed the following to be predictors of HCV infection: age, injected drug use (OR = 6.65), sniffed drug use (OR = 2.59), hospitalization (OR = 1.90), groups socially deprived by the lack of sewage disposal (OR = 2.53), and injection with glass syringe (OR = 1.52, with a borderline p value). The genotypes 1 (subtypes 1a, 1b), 2b and 3a were identified. The estimated population attributable risk for the ensemble of risk factors was 40%. Approximately 1.3 million individuals would be expected to be anti-HCV-positive in the country. CONCLUSIONS The large estimated absolute numbers of infected individuals reveals the burden of the disease in the near future, giving rise to costs for the health care system and society at large. The known risk factors explain less than 50% of the infected cases, limiting the prevention strategies. Our findings regarding risk behaviors associated with HCV infection showed that there is still room for improving strategies for reducing transmission among drug users and nosocomial infection, as well as a need for specific prevention and control strategies targeting individuals living in poverty.
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Affiliation(s)
- Leila MMB Pereira
- Universidade de Pernambuco, Faculdade de Ciências Médicas de Pernambuco, Hospital Universitário Oswaldo Cruz, Rua Arnóbio Marques, 310, Santo Amaro, CEP: 50100-130, Recife, PE, Brazil
- Instituto do Fígado de Pernambuco, Rua Aluísio Azevedo, 209, Santo Amaro, 50.100-130, Recife, PE, Brazil
| | - Celina MT Martelli
- Universidade Federal de Goiás, Instituto de Patologia Tropical e Saúde Publica, Departamento de Saúde Coletiva, Rua Delenda Rezende de Mello, s/n, sala 405, Setor Universitário, CEP: 74605050, Goiânia, GO, Brazil
- Universidade Federal de Pernambuco, Departamento de Medicina Tropical, Av. Prof. Moraes Rego, s/n, Cidade Universitária, CEP: 50670-420, Recife, PE, Brazil
| | - Regina C Moreira
- Instituto Adolfo Lutz, Av. Dr. Arnaldo, nº 355, Cerqueira Cézar, CEP: 01246-902, Capital, SP, Brazil
| | - Edgar Merchan-Hamman
- Universidade de Brasília, Faculdade de Ciências da Saúde, Departamento de Saúde Coletiva. DSC - Faculdade de Saúde, Campus Universitário Darcy Ribeiro – Asa Norte, CEP: 70910-900, Brasília, DF, Brazil
| | - Airton T Stein
- Fundação Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245, Bom Fim, CEP: 90050-170, Porto Alegre, RS, Brazil
| | - Regina Maria A Cardoso
- Departamento de Epidemiologia, Universidade de São Paulo, Faculdade de Saúde Pública, Avenida Dr. Arnaldo 715, Cerqueira Cesar, 01246-904, São Paulo, SP, Brazil
| | - Gerusa M Figueiredo
- Departamento de Epidemiologia, Universidade de São Paulo, Faculdade de Saúde Pública, Avenida Dr. Arnaldo 715, Cerqueira Cesar, 01246-904, São Paulo, SP, Brazil
| | - Ulisses R Montarroyos
- Universidade de Pernambuco, Faculdade de Ciências Médicas de Pernambuco, Hospital Universitário Oswaldo Cruz, Rua Arnóbio Marques, 310, Santo Amaro, CEP: 50100-130, Recife, PE, Brazil
- Universidade Federal de Pernambuco, Departamento de Medicina Tropical, Av. Prof. Moraes Rego, s/n, Cidade Universitária, CEP: 50670-420, Recife, PE, Brazil
| | - Cynthia Braga
- Fundação Oswaldo Cruz, Centro de Pesquisas Aggeu Magalhães, Av Moraes Rego, s/n, Cidade Universitária, CEP: 50000-230, Recife, PE, Brazil
| | - Marília D Turchi
- Universidade Federal de Goiás, Instituto de Patologia Tropical e Saúde Publica, Departamento de Saúde Coletiva, Rua Delenda Rezende de Mello, s/n, sala 405, Setor Universitário, CEP: 74605050, Goiânia, GO, Brazil
| | - Gabriela Coral
- Fundação Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245, Bom Fim, CEP: 90050-170, Porto Alegre, RS, Brazil
| | - Deborah Crespo
- Secretaria de Saúde Pública do Estado do Pará, Av. Conselheiro Furtado, 1597, CEP 66040-100, Belém, PA, Brazil
| | - Maria Luiza C Lima
- Fundação Oswaldo Cruz, Centro de Pesquisas Aggeu Magalhães, Av Moraes Rego, s/n, Cidade Universitária, CEP: 50000-230, Recife, PE, Brazil
- Universidade Federal de Pernambuco, Departamento de Medicina Preventiva e Social, Av. Prof. Moraes Rego, s/n, Cidade Universitária, CEP: 50670-420, Recife, PE, Brazil
| | - Luis Claudio A Alencar
- Universidade de Pernambuco, Faculdade de Ciências Médicas de Pernambuco, Hospital Universitário Oswaldo Cruz, Rua Arnóbio Marques, 310, Santo Amaro, CEP: 50100-130, Recife, PE, Brazil
| | - Marcelo Costa
- Hospital de Base do DF, Area Especial, Asa Sul, CEP:70.335-900, Brasília, DF, Brazil
| | - Alex A dos Santos
- Instituto Bioestatístico –IBCT, Rua Bernal do Couto, 1311, Umarizal, CEP: 67150-050, Belem, PA, Brazil
| | - Ricardo AA Ximenes
- Universidade de Pernambuco, Faculdade de Ciências Médicas de Pernambuco, Hospital Universitário Oswaldo Cruz, Rua Arnóbio Marques, 310, Santo Amaro, CEP: 50100-130, Recife, PE, Brazil
- Universidade Federal de Pernambuco, Departamento de Medicina Tropical, Av. Prof. Moraes Rego, s/n, Cidade Universitária, CEP: 50670-420, Recife, PE, Brazil
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Distribution of hepatitis c virus (hcv) genotypes in patients with chronic infection from Rondônia, Brazil. Virol J 2011; 8:165. [PMID: 21486472 PMCID: PMC3082223 DOI: 10.1186/1743-422x-8-165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 04/12/2011] [Indexed: 02/05/2023] Open
Abstract
Background Hepatitis C virus (HCV) is an important human pathogen affecting around 3% of the human population. In Brazil, it is estimated that there are approximately 2 to 3 million HCV chronic carriers. There are few reports of HCV prevalence in Rondônia State (RO), but it was estimated in 9.7% from 1999 to 2005. The aim of this study was to characterize HCV genotypes in 58 chronic HCV infected patients from Porto Velho, Rondônia (RO), Brazil. Methods A fragment of 380 bp of NS5B region was amplified by nested PCR for genotyping analysis. Viral sequences were characterized by phylogenetic analysis using reference sequences obtained from the GenBank (n = 173). Sequences were aligned using Muscle software and edited in the SE-AL software. Phylogenetic analyses were conducted using Bayesian Markov chain Monte Carlo simulation (MCMC) to obtain the MCC tree using BEAST v.1.5.3. Results From 58 anti-HCV positive samples, 22 were positive to the NS5B fragment and successfully sequenced. Genotype 1b was the most prevalent in this population (50%), followed by 1a (27.2%), 2b (13.6%) and 3a (9.0%). Conclusions This study is the first report of HCV genotypes from Rondônia State and subtype 1b was found to be the most prevalent. This subtype is mostly found among people who have a previous history of blood transfusion but more detailed studies with a larger number of patients are necessary to understand the HCV dynamics in the population of Rondônia State, Brazil.
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Lampe E, Espirito-Santo MP, Martins RM, Bello G. Epidemic history of Hepatitis C virus in Brazil. INFECTION GENETICS AND EVOLUTION 2010; 10:886-95. [DOI: 10.1016/j.meegid.2010.05.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 05/15/2010] [Accepted: 05/18/2010] [Indexed: 02/07/2023]
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Ximenes RADA, Pereira LMB, Martelli CMT, Merchán-Hamann E, Stein AT, Figueiredo GM, Braga MC, Montarroyos UR, Brasil LM, Turchi MD, Fonseca JCFD, Lima MLCD, Alencar LCAD, Costa M, Coral G, Moreira RC, Cardoso MRA. Methodology of a nationwide cross-sectional survey of prevalence and epidemiological patterns of hepatitis A, B and C infection in Brazil. CAD SAUDE PUBLICA 2010; 26:1693-704. [DOI: 10.1590/s0102-311x2010000900003] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Accepted: 06/10/2010] [Indexed: 08/30/2023] Open
Abstract
A population-based survey to provide information on the prevalence of hepatitis viral infection and the pattern of risk factors was carried out in the urban population of all Brazilian state capitals and the Federal District, between 2005 and 2009. This paper describes the design and methodology of the study which involved a population aged 5 to 19 for hepatitis A and 10 to 69 for hepatitis B and C. Interviews and blood samples were obtained through household visits. The sample was selected using stratified multi-stage cluster sampling and was drawn with equal probability from each domain of study (region and age-group). Nationwide, 19,280 households and ~31,000 residents were selected. The study is large enough to detect prevalence of viral infection around 0.1% and risk factor assessments within each region. The methodology seems to be a viable way of differentiating between distinct epidemiological patterns of hepatitis A, B and C. These data will be of value for the evaluation of vaccination policies and for the design of control program strategies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gabriela Coral
- Fundação Universidade Federal de Ciências da Saúde de Porto Alegre, Brasil
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Freitas NR, Teles SA, Matos MA, Lopes CL, Reis NR, Espírito-Santo MP, Lampe E, Martins RM. Hepatitis C virus infection in Brazilian long-distance truck drivers. Virol J 2010; 7:205. [PMID: 20799961 PMCID: PMC2939560 DOI: 10.1186/1743-422x-7-205] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 08/27/2010] [Indexed: 02/05/2023] Open
Abstract
Hepatitis C virus (HCV) infection is a global public health problem. Long-distance truck drivers live apart from their family for long periods of time, a lifestyle that favors at-risk behaviors such as unprotected sex with multiple partners and illicit drug use. As data concerning HCV infection in this population are still rare, this paper aims to investigate the prevalence, genotypes/subtypes, and the factors associated with HCV infection in long-distance truck drivers in Brazil. A cross-sectional survey was carried out with 641 Brazilian long-truck drivers who were recruited at a major truck stop located at kilometer 1,296 of the BR-153 highway, which is considered to be one of the longest roads in Brazil. All individuals were interviewed, and their serum samples were tested for the presence of antibodies to HCV (anti-HCV) by ELISA and immunoblot. Anti-HCV positive samples were tested for HCV RNA by PCR amplification of the 5' NC and NS5B regions and were genotyped using the LiPA assay and nucleotide sequencing, respectively. Factors associated with HCV infection were identified with logistic regression. The prevalence of HCV infection was 1.4% (95% CI: 0.7-2.8). History of blood transfusion, sharing of personal hygiene tools, illicit drug use and HBV status were factors independently associated with HCV infection in the study population. HCV RNA was detected in 8/9 anti-HCV positive samples, in which genotypes 1 (n = 3), 2 (n = 2), and 3 (n = 3) were determined by LiPA. Using phylogenetic tree analysis of the NS5B region, subtypes 1a (n = 1), 1b (n = 2), 2b (n = 2) and 3a (n = 3) were identified. These data show that the prevalence of HCV infection among Brazilian truck drivers was similar to that observed for the general population. History of blood transfusion, sharing of personal hygiene tools, illicit drug use and HBV status were predictors of HCV infection. The HCV genotypes/subtypes identified in the study population are consistent with those circulating in Brazil.
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Affiliation(s)
- Nara R Freitas
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás (UFG), Goiás, Brazil.
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Silva MBS, Andrade TM, Silva LK, Rodart IF, Lopes GB, Carmo TM, Zarife MAS, Dourado I, Reis MG. Prevalence and genotypes of hepatitis C virus among injecting drug users from Salvador-BA, Brazil. Mem Inst Oswaldo Cruz 2010; 105:299-303. [PMID: 20512243 DOI: 10.1590/s0074-02762010000300009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Accepted: 03/12/2010] [Indexed: 11/22/2022] Open
Abstract
Hepatitis C virus (HCV) is the major infectious disease agent among injecting drug users (IDUs), with seroprevalence ranging from 50-90%. In this paper, serological and virological parameters were investigated among 194 IDUs, 94 ex-IDUs and 95 non-IDUs that were sampled by the "snowball" technique in three localities renowned for both intense drug use and trafficking activities in Salvador, Brazil. The majority of the participants were male, but sex and mean age differed significantly between IDUs/ex-IDUs and non-IDUs (p < 0.05). Anti-HCV screening revealed that 35.6%, 29.8% and 5.3% of samples from IDUs, ex-IDUs and non-IDUs, respectively, were seropositive. HCV-RNA detection confirmed that the prevalence of infection was 29.4%, 21.3% and 5.3% for IDUs, ex-IDUs and non-IDUs, respectively. Genotyping analysis among IDUs/ex-IDUs determined that 76.9% were infected with genotype 1, 18.5% with genotype 3 and 4.6% with a mixed genotype; this result differed significantly from non-IDUs, where genotype 3 was the most frequent (60%), followed by genotype 1 (20%) and a mixed genotype (20%). We report a significantly higher prevalence of HCV infection in IDUs/ex-IDUs compared to the control group (p < 0.001). Although the sample size of our study was small, the differences in HCV genotype distribution reported herein for IDUs/ex-IDUs and non-IDUs warrant further investigation.
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Costa ZB, Machado GC, Avelino MM, Filho CG, Filho JVM, Minuzzi AL, Turchi MD, Stefani MMA, de Souza WV, Martelli CMT. Prevalence and risk factors for Hepatitis C and HIV-1 infections among pregnant women in Central Brazil. BMC Infect Dis 2009; 9:116. [PMID: 19635135 PMCID: PMC2726149 DOI: 10.1186/1471-2334-9-116] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Accepted: 07/27/2009] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Hepatitis C (HCV) and human immunodeficiency virus (HIV) infections are a major burden to public health worldwide. Routine antenatal HIV-1 screening to prevent maternal-infant transmission is universally recommended. Our objectives were to evaluate the prevalence of and potential risk factors for HCV and HIV infection among pregnant women who attended prenatal care under the coverage of public health in Central Brazil. METHODS Screening and counselling for HIV and HCV infections was offered free of charge to all pregnant women attending antenatal clinic (ANC) in the public health system, in Goiania city (~1.1 million inhabitants) during 2004-2005. Initial screening was performed on a dried blood spot collected onto standard filter paper; positive or indeterminate results were confirmed by a second blood sample. HCV infection was defined as a positive or indeterminate sample (EIA test) and confirmed HCV-RNA technique. HIV infection was defined according to standard criteria. Factors associated with HIV and HCV infections were identified with logistic regression. The number needed to screen (NNS) to prevent one case of infant HIV infection was calculated using the Monte Carlo simulation method. RESULTS A total of 28,561 pregnant women were screened for HCV and HIV-1 in ANC. Mean maternal age was 23.9 years (SD = 5.6), with 45% of the women experiencing their first pregnancy. Prevalence of HCV infection was 0.15% (95% CI 0.11%-0.20%), and the risk increased with age (p < 0.01). The prevalence of anti-HIV infection was 0.09% (95% CI 0.06%-0.14%). Black women had a 4.9-fold (95% CI 1.42-16.95) greater risk of HIV-1 infection compared to non-black women. NNS to prevent one case of infant HIV infection ranged from 4,141 to 13,928. CONCLUSION The prevalence of HIV and HCV infections were low among pregnant women, with high acceptability rates in the opt-in strategy in primary care. Older maternal age was a risk factor for HCV and antenatal HCV testing does not fulfill the requirements for screening recommendation. The finding of higher risk of HIV-1 infection among black women despite being in consonance with the HIV-1 ethnic pattern in some American regions cannot be ruled out to be a surrogate marker of socio-economic condition.
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Affiliation(s)
- Zelma B Costa
- Faculty of Medicine, Federal University of Goiás, Goiás, Brazil
| | | | | | - Clidenor Gomes Filho
- Health State Secretariat, Goiás, Brazil, Associação de Pais e Amigos dos Excepcionais de Goiania – APAE, Goiás, Brazil
| | - Jose V Macedo Filho
- Health State Secretariat, Goiás, Brazil, Associação de Pais e Amigos dos Excepcionais de Goiania – APAE, Goiás, Brazil
| | - Ana L Minuzzi
- Health State Secretariat, Goiás, Brazil, Associação de Pais e Amigos dos Excepcionais de Goiania – APAE, Goiás, Brazil
| | - Marilia D Turchi
- Institute of Tropical Medicine and Public Health, Federal University of Goiás, Goiás, Brazil
| | - Mariane MA Stefani
- Institute of Tropical Medicine and Public Health, Federal University of Goiás, Goiás, Brazil
| | | | - Celina MT Martelli
- Institute of Tropical Medicine and Public Health, Federal University of Goiás, Goiás, Brazil
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Gonzaga RMS, Rodart IF, Reis MG, Ramalho Neto CE, Silva DW. Distribution of Hepatitis C virus (HCV) genotypes in seropositive patients in the state of Alagoas, Brazil. Braz J Microbiol 2008; 39:644-7. [PMID: 24031281 PMCID: PMC3768450 DOI: 10.1590/s1517-83822008000400008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Revised: 02/25/2008] [Accepted: 11/02/2008] [Indexed: 12/03/2022] Open
Abstract
We determined the frequency of hepatitis C virus (HCV) genotypes in anti-HCV seropositive patients in the state of Alagoas, Brazil, by means of nested-reverse transcription-polymerase chain reaction (RT-nested-PCR) followed by restriction fragment length polymorphism (RFLP) of amplified fragments of the 5´NCR. The nested-PCR with genotype-specific primers from the core region was carried out when detection was not possible by the first approach. Detectable HCV-RNA was present in 115 (74.7%) of 154 serum samples. Genotype 1 was the most frequent (77.4%), against 20.9% of genotype 3 and 0.8% of genotype 2. Subtype 1b was predominant (65.2%), followed by subtypes 1a (8.7%), and 3a (6.1%). Coinfection (1a/3a) was detected in 0.8% of the samples. Indeed, there was no significant differences in the prevalence of genotype 1 compared to what has been obtained from anti-HCV seropositive patients from other locations in Brazil. Here we report for the first time the genotype 2 in the state of Alagoas.
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Affiliation(s)
- Rosa Maria S. Gonzaga
- Laboratório de Genética Molecular, Genômica e Proteômica, Universidade Federal de Alagoas, Maceió, AL, Brasil
| | - Itatiana F. Rodart
- Laboratório de Patologia e Biologia Molecular, Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brasil
| | - Mitermayer Galvão Reis
- Laboratório de Patologia e Biologia Molecular, Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brasil
| | - Cícero Eduardo Ramalho Neto
- Laboratório de Genética Molecular, Genômica e Proteômica, Universidade Federal de Alagoas, Maceió, AL, Brasil
| | - Denise Wanderlei Silva
- Laboratório de Microbiologia Molecular, Setor de Microbiologia, Parasitologia e Patologia, Instituto de Ciências Biológicas e da Saúde, Universidade Federal de Alagoas, Maceió, AL, Brasil
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Zarife MASA, de Oliveira ECP, Romeu JMSL, dos Reis MG. [Detection of genotype 4 of the hepatitis C virus in Salvador, BA]. Rev Soc Bras Med Trop 2007; 39:567-9. [PMID: 17308705 DOI: 10.1590/s0037-86822006000600012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Accepted: 12/05/2006] [Indexed: 12/09/2022] Open
Abstract
The first detected case of genotype 4 of the hepatitis C virus (HCV) in Salvador, Bahia, is described. RT-PCR tests were used to detect HCV-RNA, and LIPA was used for genotyping. Genotype 4 responds poorly to treatment, and it is therefore important to actively search for people who have been in contact with it.
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