Hepatite C em pacientes hemofílicos: perfil imunológico e caracterização dos diferentes genótipos virais

Abstract

The hemophiliac patients were already victims of infections transmitted by the blood, mainly through sanguine transfusions. The hepatitis C is one of the infections that the hemophiliacs are subject, especially those that received combined of coagulation factors before the nineties (period in which this virus still had not been identified). The HCV is responsible for increase of the mortality and the cases of hepatocellular carcinoma. The objective of this study was to esteem the seroprevalence of HCV, to associate the immune response and to relationship between the genotype and viral load in the hemophiliac patients assisted in the Fundação de Hematologia e Hemoterapia do Amazonas - HEMOAM. Seventy eight hemophiliac patients were assisted at Fundação HEMOAM in the period of January to December of 2008. All the participants are male and they presented age between 2 and 52 years. None of the studied patients presented reactivity in the serologic exams for HIV, HTLV, Chaga’s disease or Syphilis. However, 30,8% presented reactivity for antibodies anti-HCV and 19,2% for anti-HBC. The concentrations of the transaminases (AST and ALT) of the patients anti-HCV reagents were larger compared with those which presented the anti-HCV -. ALT still showed significant correlation with the viral load of HCV in those patients. In the evaluation of the cellular immunological response, we can verify an increase of the lymphocytes TCD8+ in the hemophiliac’s anti-HCV +. However, the activated leukocytes CD69+ didn't present significant differences among the groups. The analysis of the seric cytokines shows an increase of IL-4 and IFN -γ in the hemophiliac’s anti-HCV+ . However, when we compared these cytokines with the viral load of HCV in those patients, only the IL-4 it presented correlation. The IL-10 concentrations presented correlation with the viral load of HCV, indicating that this increase is related with the viral proliferation of HCV in those patients, in spite of they have not presented difference among the studied groups. We can end of this study saying that the hemophiliacs chances contract infections transmitted by the blood decreased after 1990. The hemophiliacs infected by HCV present a clinical picture of chronic hepatitis C and the increase of the transaminases related with the viral load of HCV. In those patients indicate the need to submit these patient ones to a treatment. The highest concentrations of IFN-γ in the hemophiliacs with anti-HCV+ were not shown efficient in the resolution of the infection.