Avaliação clínica e laboratorial de pacientes portadores de hepatite C crônica em tratamento

Abstract

Chronic Hepatitis C (CHC) is a worrisome public health problem that can lead the infected patient to liver cirrhosis and hepatocellular carcinoma. Treatment of Hepatitis C virus (HCV) in Brazil in monoinfected patients is provided according to the degree of fibrosis and genotype of the virus. It is an expensive treatment and in some situations presents important side effects. The objective of this work is to evaluate the patients before and during treatment with Peginterferon and Ribavirin and is divided into three articles. The first article was a transversal study evaluated noninvasive tests (APRI, FIB-4 and GPR) in relation to liver biopsy to evaluate liver fibrosis according to the viral genotypes in 94 patients in the pre-treatment. The APRI concordance for liver biopsy for advanced fibrosis presented AUROC = 0.67 (95% CI 0.55-0.79). The GPR index represents an AUROC = 0.59 (95% CI 0.46-0.73) for advanced fibrosis, whereas the FIB-4 represents an AUROC = 0.69 (95% CI 0.58-0.80) for advanced fibrosis. No significant difference was found when compared the three tests used (p = 0.306). Moreover, when evaluated the tests in relation to the viral genotypes, we found only statistical difference for GPR (P = 0.006), with better accuracy for genotype 2-3. The second article was a Coorte Study evaluated in 136 patients the influence of sociodemographic factors on hematological parameters during the first 12 weeks of treatment. Men had higher hemoglobin levels along the treatment (p = 0.001), while older patients (p = 0.012) and non-Caucasians (p = 0.008) had lower values. Platelet levels decreased in the elderly (p = 0.007) and men (p = 0.001) along the treatment. In conclusion, social factors such as sex, age and ethnicity showed a greater impact on the hematological variables during CHC treatment. The third article was a Coorte study evaluated the association between major depression and depressive symptoms and the rs12979860 polymorphism (SNP) in the IL28B gene during the first 12 weeks of treatment in 90 patients. There was no statistically significant relationship with depression in the pre-treatment and during the treatment. However, regarding the symptoms, there was an association of the T-allele with risk for irritability (p = 0.021) and a trendy for loss of appetite (p=0.072) and agitation (p=0.060).