Implicações clínicas e imunobiológicas da co-infecção HIV e vírus da hepatite C em uma população atendida na fundação de medicina tropical do Amazonas

Abstract

The global epidemic of AIDS began in 1981, the United States, and after the introduction of antiretroviral drugs to patients infected with HIV / AIDS have been given a higher survival emerged a new challenge, co-infection with the hepatitis C virus (HCV), which is already the leading cause of death in these individuals. The HCV was discovered in 1989 and its main route of transmission, parenteral, is common to HIV, thus increasing the prevalence of co-infection HIV / HCV and are currently more than 30% of those infected by HIV also infected by HCV. There are few studies on co-infection HIV / HCV in the Amazon and this study provides an opportunity to evaluate the association of these viruses. The work is a description of a number of cases and is intended to study the clinical implications and immunobiologicals of co-infection HIV / HCV in a population of patients in the Tropical Medicine Foundation of Amazonas (FMTAM), in the period 2000 to 2007. This study found a prevalence of patients co-infected HIV / HCV of 4.42% (n = 70), with an average annual growth of 3.6%. Of these 72.9% were male, 47.1% were aged 30 | - 40. Of these 80% had completed the first grade, 50% received up to a minimum wage and 55.7% were natural in the city of Manaus where 94.3% from the capital too. Of the patients studied, 68.6% were heterosexuals and 84.3% of patients there was sexual promiscuity as a risk factor. During the study period 34.3% of the patients died. Co-infected individuals, only 25.7% (n = 18/70) to attend the clinic for viral hepatitis FMTAM for collection of biological material. In these patients (n = 18) the mean AST was 61.5 ± 61 U / L, ALT of 62.2 ± 37 U / L and the AST / ALT was 0.88 ± 0.33 U / L. As for lipids 38.9% had total cholesterol> 200mg/dl, 83.3% had HDL ≤ 40 mg / dL, 77.8% had triglycerides> 150 mg / dL and 33.3% had glucose> 110 mg / dL . Included 83.3% of patients used HAART scheme whereby 100% of these were using the protease inhibitor regimen. In applying the FIB-4 score in predicting fibrosis found that 77.8% with a cutoff point was <1.45 and 22.2% with a cutoff> 3.25. As for CD4 + T cells 72.2% had <500 cls/mm3 with a median of 271 cls/mm3, on the T CD8 + 88.9% had ≥ 215 cls/mm3 with a median of 794.5 cls/mm3. The ratio CD4 + / CD8 + was 0.32 cls/mm3. As the viral load of HIV and HCV there was a median of 16,911 copies / mL and 543,209 copies / mL, respectively. In this population 88.9% had the genotype 1 of HCV and 94.4% had a sub-type B HIV. Of these, 83.3% had Child-Pugh A and 61.1% who had normal liver on ultrasound. When the dose cytokines IL4, IL6, IL8, IL10, IL12 and IFN-γ in these patients found that only the IL6 (p = <0.001) showed statistical significance especially when correlated to the logarithm of the HCV viral load (0.031). The results found in this study, despite the low prevalence, have annual growth of co-infection due to improvement in the research of hepatitis C in patients with HIV. These results contribute to a better understanding of the clinical, epidemiological and immunological profile of patients co-infected in the north, because these data may lead to greater understanding of the interaction of these two viruses resulted in early diagnosis and consequent reduction of deaths.