published_or_final_version / Medicine / Master / Master of Medical Sciences

Objetivo : Determinar los factores de riesgo asociados a la transmisión del virus de la Hepatitis B (VHB) en el Centro Médico Naval durante el período de estudio. Material y métodos : Estudio de casos y controles. Se evaluaron los pacientes hospitalizados en la Sala de Enfermedades Transmisibles con el diagnóstico de Síndrome ictérico mas hipertransaminasemia ( TGO y/o TGP > 500 u/l ). Los factores de riesgo reportados entre los sujetos infectados con el VHB (B+); fueron comparados con los sujetos no infectados (B-), mediante el análisis bivariado y multivariado. Resultados : Un total de 74 sujetos fueron evaluados serológicamente para VHB, de los cuales 37 fueron positivos ( 35 infección aguda y 2 infección no aguda ). Los sujetos B+ fueron en su mayoría de sexo masculino y tuvieron como factor de riesgo mas significativo una hospitalización previa ( OR:13.33 ). Además se describen los cuadros clínicos y exámenes de laboratorio encontrados en ambos grupos. Conclusión : La fuerte asociación encontrada entre hepatitis B y hospitalización previa, sugiere que la transmisión horizontal nosocomial tiene un rol protagónico en la transmisión del VHB en el Centro Médico Naval.

Se realizó un estudio retrospectivo de casos y controles para evaluar los factores predictivos de eficacia del tratamiento combinado con interferón pegilado alfa (Peg IFN) y ribavirina (RBV) contra la hepatitis C crónica en un hospital de Lima Perú, años 2006-2011. Se incluyó 34 casos consecutivos de sujetos con Respuesta Virológica Sostenida (RVS) y 36 controles temporales sin RVS, entre quienes se determinó 16 variables epidemiológicas, clínicas y de tratamiento. Se utilizó el análisis univariado de regresión logística a través del programa estadístico Epi Info. Los hallazgos fueron: ninguno de los factores epidemiológicos, como edad, género, procedencia e ingesta alcohólica se relacionó con la RVS; de los factores clínicos evaluados, como: IMC, score Child-Pugh, índice MELD, transaminasemia y grado de fibrosis, solo el estadío Child A (OR=9,45; p<0,05) se relacionó con RVS; y de los factores de tratamiento, la carga viral ≤ 600 mil UI/mL (OR=2,68; p<0,05), la Respuesta Virológica Rápida (RVR; OR=58,4; p<0,01), y la Respuesta Virológica Precoz (RVP; OR=14,5; p<0,05) se asociaron con la RVS. En conclusión, los factores predictores de la RVS en los pacientes con terapia para VHC fueron: la enfermedad hepática compensada (Child-Pugh A), la RVP, y sobretodo, la RVR. Palabras Claves: Hepatitis C crónica (HCC), Virus de hepatitis C (VHC), Respuesta Virológica Sostenida (RVS). / --- We performed a retrospective study of cases and controls to assess predictors of efficacy of combination therapy with pegylated interferon alpha (Peg IFN-) and ribavirin (RBV) for hepatitis C infection in a hospital in Lima Peru, years 2006 2011. It included 34 consecutive cases of patients with Sustained Virological Response (SVR) and 36 controls without SVR, among whom was determined 16 variables epidemiological, clinical and treatment. We used univariate logistic regression analysis through statistical program Epi Info. The findings were: none of the epidemiological factors such as age, gender, origin and alcohol intake, were associated with SVR; clinical factors evaluated, as: BMI, Child-Pugh score, MELD index, transaminasemia and degree of fibrosis; only stage Child A (OR = 9,45; p <0.05) was associated with SVR, and treatment factors, the load viral ≤ 600 000 IU/mL (OR = 2,68; p <0.05), Rapid Virological Response (RVR; OR = 58.4; p <0.01), and Early Virological Response (EVR; OR = 14,5 ; p <0.05) were associated with SVR. In conclusion, predictors of SVR in patients with HCV therapy were: the compensated liver disease (Child-Pugh A), the RVP, and above all, the RVR. Keywords: Hepatitis C Chronic (HCC), Hepatitis C Virus (HCV), Sustained Virological Response (SVR).

El objetivo del presente trabajo fue determinar la seroprevalencia del virus de la hepatitis C (VHC) y de la B (VHB) en donadores militares y civiles que acudieron al Banco de Sangre del Hospital Naval así como los factores de riesgo asociados. Se trata de un estudio transversal, descriptivo y retrospectivo, cuyos datos epidemiológicos y resultados del tamizaje general se obtuvieron de los Libros de registros del Banco de Sangre e Historias Clínicas en el caso de los donantes militares, en el período comprendido de Enero de 1999 hasta Abril de 2004. El Test de MUREX HBsAg Versión 3 y Hepanostika Anti-HBc UniForm fueron empleados para Hepatis B, mientras que para el virus de la Hepatitis C se utilizó el Test de Elisa de tercera generación. Un total de 7009 donantes fueron registrados entre 1999 y 2004. Se incluyeron en el presente estudio 320, aquellos que presentaban anticuerpos contra el virus C (anti-VHC) y, para el virus de la hepatitis B: Antígeno de superficie (AgSupHBV) y/o Antígeno Core-IgG. Los datos recolectados fueron procesados y analizados en el paquete estadístico SPSS versión 10 para Windows: Prueba de Ji cuadrado o Prueba de Fisher. RESULTADOS: La prevalencia de portadores de VHC y VHB fue de 0.74% y 0.34%, respectivamente. La mayor población de infectados se encuentra entre los 18 y 30 años y corresponde al personal de la sanidad naval para la Hepatitis B y de Infantería de Marina para la Hepatitis C. No se pudo encontrar factores de riesgo relacionados en ninguna de las dos etiologias debido a una tasa de negación del 96,4% del total de donantes. CONCLUSIONES: Los resultados demuestran una baja prevalencia de infección por virus de hepatitis B, pero elevada para la hepatitis C de acuerdo a los reportes nacionales e internacionales. La pobre o nula asociación entre los factores de riesgo y la enfermedad por hepatitis B y C, que estaría en relación a la limitada efectividad y poca utilidad de la AEC. Se hace necesario que el escrutinio, a través de la encuesta de predonación, sea mas completo, diseñando un cuestionario capaz de detectar más factores de riesgo, probablemente determinanates en la transmisión de los virus de la hepatitis B y C. / The aim of the present work was to determine the seroprevalence of the virus of the hepatitis C (VHC) and of the hepatitis B (VHB) in military and civil donors who came to the Bank of Blood of the Navy Hospital as well as the associate factors of risk. It is a question of a transverse, descriptive and retrospective study realized in the Bank of Blood, which information epidemiological and proved from the general tamizaje was obtained of the Books of records of the Bank of Blood and Clinical Histories in case of the military donors, in the included period of January, 1999 until April, 2004. Murex’s Test HBsAg Version 3 and Hepanostika Anti-HBc UniForm were used for Hepatitis B, whereas for the virus of the Hepatitis C there was in use Elisa's Test of third generation. A whole of 7009 donors was registered between 1999 and 2004.Were included in the present study 320, those who were presenting antibodies against the virus C (anti-VHC) and for the virus of hepatitis B: Surface antigen (HBsAg) and/or Antigen Core-IgG. The information was gathered, percentages were obtained and the results were analyzed by means of SPSS 10 Windows version Statistics Program: chi-square or Fisher’s Tests. RESULTS: The prevalence of carriers of VHC and VHB was 0.74% and 0.34%, respectively. The principal infection people are between 18 to 30 years old, and belong to health navy personal for HBV infection and Marine Infantry for HCV infection. It couldn’t find risks factors in relation to the two etiologists, due a negative rate of 96,4%. CONCLUSIONS: The results suggest a low prevalence of infection for VHB but high for VHC infection in the studied population as it are indicate in the national and international reports. The poor or useless association between de risks factors and the illness it could be in relation to a limited effective and a poor utility of de Confidential Autoexclusion Exam. It’s necessary that this exam must be complete and have the property to identify more risks factors on the transmission of HBV and HCV. / Tesis de segunda especialidad

Although Australian epidemiology of HBV and HCV has been well described for populations groups at higher risk, but the information available for groups generally considered to be lower risk is much more limited. An understanding of the prevalence of these infections and their risk factors in antenatal women is important to guide testing policy and practice. A study was therefore conducted of the epidemiology of hepatitis B and hepatitis C infection in women. In addition, women were asked about their experience with antenatal testing. A total of 516 women participated in the survey, of these 479 (95%) women had been tested for HCV antibodies .The prevalence of HCV antibodies was 4% overall, and 2% among women who were unaware of their HCV status prior to their antenatal test. A history of injecting drug use and residing with a HCV positive person were significantly associated with HCV infection in multivariate analyses. HBV testing was conducted in 468 (99.6%) of women, and the overall prevalence was 2%. Risk factors identified were birthplace in countries of South East Asia. Women were asked about their perception of antenatal testing and pre-test information. Nearly a third (143, 30.5%) of women who had been tested for HCV infection either said that they did not know whether they had been tested, or said that they had declined testing. The corresponding proportion for HBV infection was 28.8% (135). Over 65% and 66% of women said that had not received any information about testing for HCV and HBV respectively. The finding that virtually all antenatal women were being tested for HCV was in contrast to government and non-government organisation policies of ???selective??? screening in place during the study period. Of concern was the substantial proportion of women who were tested despite reporting that they had declined their clinician???s offer to test for HCV and HBV, and the large number of women who reported an absence of pre-test information. Women who said they had received information reported the delivery and quality of information varied according to the antenatal clinician group, but perceived the overall quality as poor.

Objetivo : Determinar los factores de riesgo asociados a la transmisión del virus de la Hepatitis B (VHB) en el Centro Médico Naval durante el período de estudio. Material y métodos : Estudio de casos y controles. Se evaluaron los pacientes hospitalizados en la Sala de Enfermedades Transmisibles con el diagnóstico de Síndrome ictérico mas hipertransaminasemia ( TGO y/o TGP > 500 u/l ). Los factores de riesgo reportados entre los sujetos infectados con el VHB (B+); fueron comparados con los sujetos no infectados (B-), mediante el análisis bivariado y multivariado. Resultados : Un total de 74 sujetos fueron evaluados serológicamente para VHB, de los cuales 37 fueron positivos ( 35 infección aguda y 2 infección no aguda ). Los sujetos B+ fueron en su mayoría de sexo masculino y tuvieron como factor de riesgo mas significativo una hospitalización previa ( OR:13.33 ). Además se describen los cuadros clínicos y exámenes de laboratorio encontrados en ambos grupos. Conclusión : La fuerte asociación encontrada entre hepatitis B y hospitalización previa, sugiere que la transmisión horizontal nosocomial tiene un rol protagónico en la transmisión del VHB en el Centro Médico Naval.

El objetivo del presente trabajo fue determinar la seroprevalencia del virus de la hepatitis C (VHC) y de la B (VHB) en donadores militares y civiles que acudieron al Banco de Sangre del Hospital Naval así como los factores de riesgo asociados. Se trata de un estudio transversal, descriptivo y retrospectivo, cuyos datos epidemiológicos y resultados del tamizaje general se obtuvieron de los Libros de registros del Banco de Sangre e Historias Clínicas en el caso de los donantes militares, en el período comprendido de Enero de 1999 hasta Abril de 2004. El Test de MUREX HBsAg Versión 3 y Hepanostika Anti-HBc UniForm fueron empleados para Hepatis B, mientras que para el virus de la Hepatitis C se utilizó el Test de Elisa de tercera generación. Un total de 7009 donantes fueron registrados entre 1999 y 2004. Se incluyeron en el presente estudio 320, aquellos que presentaban anticuerpos contra el virus C (anti-VHC) y, para el virus de la hepatitis B: Antígeno de superficie (AgSupHBV) y/o Antígeno Core-IgG. Los datos recolectados fueron procesados y analizados en el paquete estadístico SPSS versión 10 para Windows: Prueba de Ji cuadrado o Prueba de Fisher. RESULTADOS: La prevalencia de portadores de VHC y VHB fue de 0.74% y 0.34%, respectivamente. La mayor población de infectados se encuentra entre los 18 y 30 años y corresponde al personal de la sanidad naval para la Hepatitis B y de Infantería de Marina para la Hepatitis C. No se pudo encontrar factores de riesgo relacionados en ninguna de las dos etiologias debido a una tasa de negación del 96,4% del total de donantes. CONCLUSIONES: Los resultados demuestran una baja prevalencia de infección por virus de hepatitis B, pero elevada para la hepatitis C de acuerdo a los reportes nacionales e internacionales. La pobre o nula asociación entre los factores de riesgo y la enfermedad por hepatitis B y C, que estaría en relación a la limitada efectividad y poca utilidad de la AEC. Se hace necesario que el escrutinio, a través de la encuesta de predonación, sea mas completo, diseñando un cuestionario capaz de detectar más factores de riesgo, probablemente determinanates en la transmisión de los virus de la hepatitis B y C. / The aim of the present work was to determine the seroprevalence of the virus of the hepatitis C (VHC) and of the hepatitis B (VHB) in military and civil donors who came to the Bank of Blood of the Navy Hospital as well as the associate factors of risk. It is a question of a transverse, descriptive and retrospective study realized in the Bank of Blood, which information epidemiological and proved from the general tamizaje was obtained of the Books of records of the Bank of Blood and Clinical Histories in case of the military donors, in the included period of January, 1999 until April, 2004. Murex’s Test HBsAg Version 3 and Hepanostika Anti-HBc UniForm were used for Hepatitis B, whereas for the virus of the Hepatitis C there was in use Elisa's Test of third generation. A whole of 7009 donors was registered between 1999 and 2004.Were included in the present study 320, those who were presenting antibodies against the virus C (anti-VHC) and for the virus of hepatitis B: Surface antigen (HBsAg) and/or Antigen Core-IgG. The information was gathered, percentages were obtained and the results were analyzed by means of SPSS 10 Windows version Statistics Program: chi-square or Fisher’s Tests. RESULTS: The prevalence of carriers of VHC and VHB was 0.74% and 0.34%, respectively. The principal infection people are between 18 to 30 years old, and belong to health navy personal for HBV infection and Marine Infantry for HCV infection. It couldn’t find risks factors in relation to the two etiologists, due a negative rate of 96,4%. CONCLUSIONS: The results suggest a low prevalence of infection for VHB but high for VHC infection in the studied population as it are indicate in the national and international reports. The poor or useless association between de risks factors and the illness it could be in relation to a limited effective and a poor utility of de Confidential Autoexclusion Exam. It’s necessary that this exam must be complete and have the property to identify more risks factors on the transmission of HBV and HCV.

Diss. (sammanfattning) Örebro : Örebro universitet, 2009. / Härtill 4 uppsatser.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

The cost effectiveness of using novel HCV treatment option, telaprevir and boceprevir, should depend on patients’ respond to conventional PEG-INFα and ribavirin therapy. The study of pharmacogenomics, interleukin-28B (IL-28B) polymorphisms, accompanied with the information of HCV genotypes are suggested to have the strongest predictive value of treatment outcomes and prognosis of disease in individuals infected with HCV who are undergoing conventional PEG-INFα and ribavirin therapy. It is extremely valuable in HCV/HIV co-infected patients as these groups of patients require a complex treatment regimen and demonstrate poor sustained viral response (SVR) rate. The development of a fast and promising IL-28B genotyping assay is urgently needed. A total of 47 blood samples randomly selected from HCV and HIV co-infected patients were used in this investigation. The aims of this study are to evaluate and compare the performance of newly developed IL-28B HybProbe real-time PCR assay using LightCycler® system against Sanger Sequencing method in determining IL-28B polymorphisms on rs12979860 and rs8099917 and to estimate the prevalence of IL-28B polymorphisms among HCV/HIV co-infected patients in Hong Kong. In addition, the genotypic distribution of HCV among the same patient group is identified by using in-house Sanger Sequencing method. It was found that the newly developed IL-28B real-time HybProbe assay resulted in 100% concordance with the traditionally used Sanger Sequencing method. The allele frequencies of C and T were 96% and 4% in rs12979860 and T and G were 97% and 3% in rs8099917 respectively. The CC and TT wild type are predominating in rs12979860 and rs8099917 with frequencies of 93.62% and 95.74% respectively. The most favorable compound genotype CC/TT with both homozygous wild types on both SNPs was the most predominant type with a high prevalence of 93.61%. Among all the samples, 50% samples were found to be HCV genotype 1, 41.18% were genotype 6 and 8.82% were genotype 3. A simple and efficient IL-28B real-time HybProbe assay was developed in this study and proved to show excellent performance on IL-28B genotyping although further optimization is suggested before it can be applied in the clinical setting. The favourable wild type genotypes of rs12979860 and rs8099917 accounted for the most predominant genotypes which is similar to other findings obtained from an Asian population. A comparatively high prevalence of HCV genotype 6 was found in the HCV/HIV co-infected group. Future study with the information of treatment outcomes (HCV viral load) can further evaluate the predictive value of IL-28B polymorphisms on SVR in different HCV genotypes. / published_or_final_version / Medical Sciences / Master / Master of Medical Sciences