Alessandra Mendonça de Alme
Abstract
Background: Hepatitis C is the principal cause of chronic liver disease. In Brazil, statistics show that 2.5 million individuals are infected with HTLV-I, representing in absolute terms the largest number of individuals in the world infected by this virus. Data from the literature suggest that HTLV infection exerts a detrimental effect on cell immune response, exacerbates the progression of hepatitis C and negatively affects treatment response in HCV co-infected patients. The objective of this study is to describe epidemiological, clinical and laboratory characteristics of a group of patients co-infected with both hepatitis C virus (HCV) and human T-cell lymphotropic virus (HTLV) and another with HCV monoinfected patients. Methods: Anti-HTLV I/II ELISA was performed in HCV-RNA-positive patients of Gaffrée and Guinle Teaching Hospital (HUGG) Outpatient Hepatology Department, followed by Western blot and/or PCR for confirmation. Groups of co and monoinfected individuals were submitted to epidemiological analysis and to clinical and laboratory evaluation: hematological, biochemical, HCV genotype, HCV viral load and liver fibrosis score. Statistical analysis was performed using the SPSS statistical software program, version 16.0. For comparison between the groups of study, p-values and their respective 95% confidence intervals were calculated using the Fisher´s exact test or Mann-Whitney´s test. Results: The seroprevalence of HCV/HTLV co-infection was 7.4% (95%CI: 4.5-11.6%; n=16/215). A control group of 83 HCV monoinfected individuals was constituted. Most participants in the two groups were male, white and symptomless. Intravenous drug abuse was more common in co-infected than in monoinfected individuals (33.3% versus 10.8%; p=0.037). Advanced liver fibrosis (Metavir fibrosis score ≥ 2) was more common in monoinfected patients (59.3% versus 10%; p=0.005), as were elevated levels of ALT (p=0.030), AST (p=0.015) and GGT (p=0.055). Conclusions: Contrary to the literature, this study found no clinical, biochemical or histological differences between HCV/HTLV coinfected patients compared to HCV monoinfected patients.