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Olmedo DB, Precioso PM, Lugdero-Correia A, Silva GD, Santos AMGD, Pôrto LC. Exposure source prevalence is associated with gender in hepatitis C virus patients from Rio de Janeiro, Brazil. Mem Inst Oswaldo Cruz 2017; 112:632-639. [PMID: 28902289 PMCID: PMC5572449 DOI: 10.1590/0074-02760160553] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 04/17/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is a worldwide public health problem. A characterisation of the differences in exposure sources among genders will enable improvements in surveillance actions. METHODS Exposure data were obtained for 1180 confirmed HCV cases Brazil's mandatory reporting to epidemiological surveillance, which was directed by a reference laboratory in Rio de Janeiro, Brazil. The Chi-square test (χ2) was used to assess the associations between exposure sources and gender. The prevalence ratio (PR) was calculated for exposures that showed an association. RESULTS The results showed 57.7% cases were female, and associations with snorting drugs, sexual activity, surgery, aesthetic procedures, blood transfusions, and educational level were observed (p < 0.001). Men showed 2.53 (1.33-3.57), 4.83 (3.54-6.59), and 2.18 (1.33-3.57) times more exposure to sniffing drugs, risky sex and higher levels of education, respectively, than women. Women demonstrated 4.46 (3.21-6.21), 1.94 (1.43-2.63), and 3.10 (2.09-4.61) times more exposure to surgery, aesthetic procedures, and blood transfusions, respectively, than men. CONCLUSION Our results showed differences in risk behaviours associated with gender among HCV carriers. These data are likely to significantly influence clinical practice regarding the adoption of specific approaches for counselling and control policies to prevent the emergence of new cases and break the chain of transmission of the virus.
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Affiliation(s)
- Daniele Blasquez Olmedo
- Universidade do Estado do Rio de Janeiro, Laboratório de Histocompatibilidade e Criopreservação, Rio de Janeiro, RJ, Brasil
| | - Patrícia Marraccini Precioso
- Universidade do Estado do Rio de Janeiro, Laboratório de Histocompatibilidade e Criopreservação, Rio de Janeiro, RJ, Brasil
| | - António Lugdero-Correia
- Universidade do Estado do Rio de Janeiro, Laboratório de Histocompatibilidade e Criopreservação, Rio de Janeiro, RJ, Brasil
| | - Guida da Silva
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | - Luís Cristóvão Pôrto
- Universidade do Estado do Rio de Janeiro, Laboratório de Histocompatibilidade e Criopreservação, Rio de Janeiro, RJ, Brasil
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Mesquita F, Santos ME, Benzaken A, Corrêa RG, Cattapan E, Sereno LS, Naveira MCM. The Brazilian comprehensive response to hepatitis C: from strategic thinking to access to interferon-free therapy. BMC Public Health 2016; 16:1132. [PMID: 27806712 PMCID: PMC5094040 DOI: 10.1186/s12889-016-3784-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 10/19/2016] [Indexed: 11/21/2022] Open
Abstract
Background Hepatitis C affects over 185 million people around the world. This silent disease is responsible for up to 700,000 deaths per year. Despite the scientific revolution in diagnosis and treatment, hepatitis C control remains a huge challenge due to the cost of effective medications. In response to the global outcry of hepatitis epidemic and the need to improve the nation’s public health response, the Ministry of Health of Brazil revolutionized hepatitis C treatment by incorporating highly effective drugs that can be accessed through sustainable and universal means. Discussion This paper describes the unique process of implementing evidence-informed policy to respond to hepatitis C epidemic through the update of hepatitis C treatment in Brazil based on the estimate of disease prevalence, current international guidelines, and the cost-effectiveness impact in the Brazilian Unified Health System. Through a debate of an experience report, the authors underlie the strategic plan implemented according to the situation analysis that emphasized the need to improve its current response over a relatively short-term period. The comprehensive response is detailed comprising three main objectives: improve treatment outcomes by evaluating and incorporating new and effective medications at a sustainable price; elaborate on clinical guidelines to treat hepatitis C patients; and develop awareness and diagnosis campaigns targeted at the population of interest. In this scenario, Brazil was able to obtain an unprecedented discount for a high-medium income country; provided treatment to more than 7000 individuals in the last 2 months of 2015; and expects to treat 38,000 new patients in 2016. Summary The remarkable process applied in Brazil was developed according to epidemiological data and scientific evidence, and it was motivated by the engagement of the country in the Sustainable Development Goals, which may inspire other developing countries to identify ways to achieve these goals by 2030.
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Affiliation(s)
- Fabio Mesquita
- Department of STI, AIDS and Viral Hepatitis, Secretariat of Health Surveillance, Ministry of Health, Setor Administrativo Federal Sul 02-Bloco F-Ed. Premium Torre I, Brasília, 70070-600, Federal District, Brazil
| | - Melina Erica Santos
- Department of STI, AIDS and Viral Hepatitis, Secretariat of Health Surveillance, Ministry of Health, Setor Administrativo Federal Sul 02-Bloco F-Ed. Premium Torre I, Brasília, 70070-600, Federal District, Brazil
| | - Adele Benzaken
- Department of STI, AIDS and Viral Hepatitis, Secretariat of Health Surveillance, Ministry of Health, Setor Administrativo Federal Sul 02-Bloco F-Ed. Premium Torre I, Brasília, 70070-600, Federal District, Brazil
| | - Renato Girade Corrêa
- Department of STI, AIDS and Viral Hepatitis, Secretariat of Health Surveillance, Ministry of Health, Setor Administrativo Federal Sul 02-Bloco F-Ed. Premium Torre I, Brasília, 70070-600, Federal District, Brazil
| | - Elisa Cattapan
- Department of STI, AIDS and Viral Hepatitis, Secretariat of Health Surveillance, Ministry of Health, Setor Administrativo Federal Sul 02-Bloco F-Ed. Premium Torre I, Brasília, 70070-600, Federal District, Brazil
| | - Leandro Soares Sereno
- Pan American Health Organization, World Health Organization, Avenida das Nações-Setor de Embaixadas Norte, Lote 19, Brasília, 70312-970, Federal District, Brazil
| | - Marcelo Contardo Moscoso Naveira
- Department of STI, AIDS and Viral Hepatitis, Secretariat of Health Surveillance, Ministry of Health, Setor Administrativo Federal Sul 02-Bloco F-Ed. Premium Torre I, Brasília, 70070-600, Federal District, Brazil.
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Pessoa LS, Vidal LL, Costa ECBD, Abreu CM, Cunha RDD, Valadão ALC, Santos AFD, Tanuri A. Development of a rapid phenotypic test for HCV protease inhibitors with potential use in clinical decisions. Genet Mol Biol 2016; 39:358-64. [PMID: 27575432 PMCID: PMC5004841 DOI: 10.1590/1678-4685-gmb-2016-0022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/25/2016] [Indexed: 11/24/2022] Open
Abstract
Approximately 185 million people worldwide are chronically infected with hepatitis C
virus (HCV). The first-wave of approved NS3 protease inhibitors (PIs) were Telaprevir
and Boceprevir, which are currently discontinued. Simeprevir is a second-wave PI
incorporated into the Brazilian hepatitis C treatment protocol. Drug resistance plays
a key role in patients' treatment regimen. Here, we developed a simple phenotypic
assay to evaluate the impact of resistance mutations in HCV NS3 protease to PIs,
using a protein expression vector containing wild type NS3 protease domain and NS4A
co-factor. We analyzed the impact of five resistance mutations (T54A, V36M, V158I,
V170I and T54S+V170I) against Telaprevir, Boceprevir and Simeprevir. Protein
purifications were performed with low cost methodology, and enzymatic inhibition
assays were measured by FRET. We obtained recombinant proteases with detectable
activity, and IC50 and fold change values for the evaluated PIs were
determined. The variant T54A showed the highest reduction of susceptibility for the
PIs, while the other four variants exhibited lower levels of reduced susceptibility.
Interestingly, V170I showed 3.2-fold change for Simeprevir, a new evidence about this
variant. These results emphasize the importance of enzymatic assays in phenotypic
tests to determine which therapeutic regimen should be implemented.
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Affiliation(s)
- Luciana Santos Pessoa
- Laboratório de Virologia Molecular, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Luãnna Liebscher Vidal
- Laboratório de Virologia Humana, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | - Celina Monteiro Abreu
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rodrigo Delvecchio da Cunha
- Laboratório de Virologia Molecular, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Ana Luiza Chaves Valadão
- Laboratório de Virologia Molecular, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - André Felipe Dos Santos
- Laboratório de Virologia Humana, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Amilcar Tanuri
- Laboratório de Virologia Molecular, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Hanus JS, Ceretta LB, Simões PW, Tuon L. Incidence of hepatitis C in Brazil. Rev Soc Bras Med Trop 2016; 48:665-73. [PMID: 26676490 DOI: 10.1590/0037-8682-0230-2015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/22/2015] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Hepatitis C is a public health problem of global dimensions, affecting approximately 200 million people worldwide. The main objective of this study was to estimate the incidence rate of hepatitis C in Brazil during the period between 2001 and 2012. METHODS An epidemiological, temporal, and descriptive study was performed using data from the Information System for Reportable Diseases. RESULTS Between 2001 and 2012, a total of 151,056 hepatitis C cases were recorded, accounting for 30.3% of all hepatitis notifications in Brazil. The average gross coefficient for the analysis period was 6.7 new cases per 100,000 inhabitants. The regions with the highest rates were the Southeast region (8.7 new cases/100,000 inhabitants) and the South (13.9 new cases/100,000 inhabitants). There was a predominance of men with respect to the incidence rate (8.0 new cases/100,000 inhabitants) compared to women (5.5 new cases/100,000 inhabitants). Injection drug use was the most common source of infection, and members of the white race, residents of urban areas, and those aged 60 to 64 years had the highest incidences. CONCLUSIONS Over the last 10 years, the incidence of hepatitis C in Brazil has increased, mainly in the South and Southeast. The adoption of fast, accurate diagnostic methods, together with epidemiological awareness, can facilitate early intervention measures for adequate control of the disease.
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Affiliation(s)
- Juliét Silveira Hanus
- Programa de Residência Multiprofissional em Saúde Coletiva, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Santa Catarina, Brazil
| | - Luciane Bisognin Ceretta
- Programa de Residência Multiprofissional em Saúde Coletiva, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Santa Catarina, Brazil
| | - Priscyla Waleska Simões
- Programa de Residência Multiprofissional em Saúde Coletiva, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Santa Catarina, Brazil
| | - Lisiane Tuon
- Programa de Residência Multiprofissional em Saúde Coletiva, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Santa Catarina, Brazil
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Olmedo DB, Cader SA, Porto LC. IFN-λ gene polymorphisms as predictive factors in chronic hepatitis C treatment-naive patients without access to protease inhibitors. J Med Virol 2015; 87:1702-15. [PMID: 25970604 DOI: 10.1002/jmv.24227] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2015] [Indexed: 12/16/2022]
Abstract
The single nucleotides polymorphisms analyses in the regions near the IL28B gene in patients chronically infected with genotype 1 hepatitis C virus (HCV) are an important predictive factor for sustained virological response (SVR). The aim was to assess the predictive value of the polymorphisms of the IL28B/IFNL3 gene in patients chronically infected with genotype 1 for the viral clearance obtained after initial treatment including admixed populations. A systematic review was conducted, using a meta-analysis in the PubMed, Embase, LILACS, and SCIELO using MesH and DECS in 42 studies. The parameters were IL28B polymorphisms, rs12979860, rs8099917, and rs12980275, SVR ratio, and OR (odds ratio). OR and confidence Interval of 95% (95%CI), were calculated by fixed or random effects models. Heterogeneity, sensitivity analysis, and publication bias were also performed. Significant differences were noted between carriers groups with the major versus minor allele at rs12979860 CC versus CT/TT-genotype (OR = 4.18; 95%CI = 3.37-5.17), rs8099917 TT versus TG/GG-genotype (OR = 4.07; 95%CI = 2.94-5.63), and rs12980275 AA versus AA/AG-genotype (OR = 5.34; 95%CI = 1.60-17.82). There was selection bias in the rs8099917 analysis (Egger's regression P = 0.049), which reversed after performing a sensitivity analysis (P = 0.510). The incorporation of SNP analyses in IL28B/IFNL3 gene during the diagnosis process in Brazil should be used as a complementary tool to determine the appropriate treatment for HCV genotype 1. Here, we confirm that the rs12979860 CC, rs8099917 TT, and rs12980275 AA genotype-carriers have favorable responses to standard therapy, including two studies with Brazilian population, and this information should be considered.
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Affiliation(s)
- Daniele Blasquez Olmedo
- Histocompatibility and Cryopreservation Laboratory, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Samária Ali Cader
- Histocompatibility and Cryopreservation Laboratory, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Luís Cristóvão Porto
- Histocompatibility and Cryopreservation Laboratory, Rio de Janeiro State University, Rio de Janeiro, Brazil
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