OBJECTIVE: The majority of cases of hepatocellular carcinoma have been reported in individuals with cirrhosis due to chronic viral hepatitis and alcoholism, but recently, the prevalence has become increasingly related to nonalcoholic steatohepatitis around the world. The study aimed to evaluate the clinical and histophatological characteristics of hepatocellular carcinoma in Brazilians' patients with nonalcoholic steatohepatitis at the present time. METHODS: Members of the Brazilian Society of Hepatology were invited to complete a survey regarding patients with hepatocellular carcinoma related to nonalcoholic steatohepatitis. Patients with a history of alcohol intake (>20 g/day) and other liver diseases were excluded. Hepatocellular carcinoma diagnosis was performed by liver biopsy or imaging methods according to the American Association for the Study of Liver Diseases’ 2011 guidelines. RESULTS: The survey included 110 patients with a diagnosis of hepatocellular carcinoma and nonalcoholic fatty liver disease from nine hepatology units in six Brazilian states (Bahia, Minas Gerais, Rio de Janeiro, São Paulo, Paraná and Rio Grande do Sul). The mean age was 67±11 years old, and 65.5% were male. Obesity was observed in 52.7% of the cases; diabetes, in 73.6%; dyslipidemia, in 41.0%; arterial hypertension, in 60%; and metabolic syndrome, in 57.2%. Steatohepatitis without fibrosis was observed in 3.8% of cases; steatohepatitis with fibrosis (grades 1-3), in 27%; and cirrhosis, in 61.5%. Histological diagnosis of hepatocellular carcinoma was performed in 47.2% of the patients, with hepatocellular carcinoma without cirrhosis accounting for 7.7%. In total, 58 patients with cirrhosis had their diagnosis by ultrasound confirmed by computed tomography or magnetic resonance imaging. Of these, 55% had 1 nodule; 17%, 2 nodules; and 28%, ≥3 nodules. CONCLUSIONS: Nonalcoholic steatohepatitis is a relevant risk factor associated with hepatocellular carcinoma in patients with and without cirrhosis in Brazil. In this survey, hepatocellular carcinoma was observed in elevated numbers of patients with steatohepatitis without cirrhosis.

Background:Tolerance and response to antiviral HCV treatment is poor in advanced fibrosis. The aim of this study was to assess SVR rate and its predictive factors in HCV advanced fibrosis patients treated in real life with full dose PEG-IFN plus RBV and to evaluate the adverse events related to treatment.Methods:A multicentric, retrospective study was conducted at six university hospitals. METAVIR F3 and F4 HCV monoinfected patients who were treated with PEG-IFN and RBV had their data analyzed. A stepwise logistic regression analysis was performed to identify the variables independently related to SVR. Adverse events were recorded during treatment.Results:308 patients were included, 75% genotype 1 and 23% genotype 3. METAVIR F3 was present in 39% and F4 in 61% of patients. The median Child Pugh score for F4 patients was 5 (5–9). The global SVR rate was 34%, 11% were relapsers and 55% were nonresponders. SVR rates were similar between patients treated with PEG-IFN alfa 2a or alfa 2b (p = 0.24). SVR rates according to Child–Pugh score were 26% (Child A) and 18% (Child B). The independent factors related to SVR in F4 patients were genotype 3, RVR and fewer Child Pugh score points. Treatment interruption occurred in 31% patients and death occurred in 1.9%, all with liver cirrhosis.Conclusion:Treatment of HCV in patients with advanced fibrosis should not be postponed. However, a very careful evaluation of cirrhotic patients must be performed before treatment is indicated and careful monitoring is required during treatment.

RACIONAL: A hepatocarcinogênese é um processo no qual as alterações genéticas e epigenéticas são bem conhecidas em modelos animais, mas carece de estudos no homem. OBJETIVOS: Analisar a freqüência das oncoproteínas p21ras, c-myc e p53 no carcinoma hepatocelular e no fígado não-neoplásico. Verificar ainda a associação destas oncoproteínas com os padrões e graus histológicos, assim como com as infecções pelos vírus das hepatites B e C. MÉTODOS: Foi analisada por método imunoistoquímico a detecção das oncoproteínas p21ras, c-myc e p53 em 47 casos de carcinoma hepatocelular e no tecido não-neoplásico circunjacente ao tumor (40 casos). RESULTADOS: As oncoproteínas p21ras, c-myc e p53 foram detectadas, respectivamente, em 44,7%, 53,2% e 36,2% dos casos de carcinoma hepatocelular. A imunorreatividade do p21ras e c-myc mostrou uma associação significativa. Contudo, não houve associação significativa entre a detecção do p21ras, c-myc e p53 com os diferentes graus e padrões histológicos, nem tampouco com as infecções pelos vírus das hepatites B e C. A mesma associação significativa entre o p21ras e c-myc foi encontrada no tecido não-neoplásico dos casos de cirrose em relação aos que não apresentaram cirrose, enquanto que o p53 foi negativo em todos os casos. CONCLUSÕES: A imunorreatividade das oncoproteínas p21ras, c-myc e p53 corrobora evidências prévias de sua detecção no carcinoma hepatocelular, o que sugere poder haver participação destas proteínas na hepatocarcinogênese humana. A significativa associação entre as proteínas p21ras, c-myc e p53 no carcinoma hepatocelular e na cirrose pode apontar uma interação entre as mesmas, sobretudo na hepatocarcinogênese pela via da cirrose.

BACKGROUND: Genetic and epigenetic alterations have been described in animal hepatocarcinogenesis models but need to be studied in human being. AIMS: To assess the immunoreactivity of p21ras, c-myc and p53 oncoproteins in hepatocellular carcinoma and non neoplastic tissue. Association of the immunoreactivity of these markers with histological grades and patterns, hepatitis B and C were additionally studied. METHODS: Detection of oncoproteins p21ras, c-myc and p53 was performed immunohistochemically in hepatocellular carcinoma (47 cases) and surrounding non neoplastic liver tissue (40 cases). RESULTS: Oncoproteins p21ras, c-myc and p53 were detected in 44,7%, 53,2% and 36,2% of the hepatocellular carcinoma cases, respectively. The p21ras and c-myc immunoreactivity has shown a significant association. However there was no association of p21ras, c-myc and p53 detection with hepatitis B and C virus infections, histological grades and patterns. The same significant association between p21ras and c-myc was observed in non-neoplastic tissue with cirrhosis when compared with tissue without it. The p53 immunoreactivity was negative in all non-neoplastic liver tissue samples. CONCLUSIONS: The immunoreactivity detection of p21ras, c-myc and p53 corroborates previous evidence of their detection in hepatocellular carcinoma that suggest the participation of these proteins in human hepatocarcinogenesis. The significant association between p21ras and c-myc oncoproteins in hepatocellular carcinoma and in cirrhosis can point to an interaction between them mainly, in hepatocarcinogenesis that occurs through cirrhosis.

Os pacientes com lúpus eritematoso sistêmico (LES) apresentam fatores de risco para a aquisição de hepatite C, como hospitalizações e hemotransfusões, e compartilham com os pacientes infectados pelo vírus da hepatite C (HCV) várias manifestações clínico-laboratoriais relacionadas a auto-imunidade. OBJETIVOS: O objetivo do presente estudo é determinar a prevalência de hepatite C em uma população com LES acompanhada no ambulatório de programas especiais - Colagenoses - do Hospital Universitário Clementino Fraga Filho (HUCFF-UFRJ). MÉTODOS: Foi realizado um estudo de corte-transversal, incluindo os primeiros 91 pacientes com o diagnóstico de LES provável ou definitivo procedentes do referido ambulatório, no período de abril a setembro de 1997. Todos os doentes foram avaliados, sob o ponto de vista clínico e laboratorial, para determinação de atividade de doença lúpica. Foram realizados o teste de triagem UBI HCV EIA 4.0 e o teste suplementar INNO-LIA HCV AbIII nos 91 pacientes selecionados e , em 32 pacientes escolhidos ao acaso e nos pacientes reativos aos testes imunossorológicos foi realizada a pesquisa do RNA-HCV pelo método da reação de polimerização em cadeia (PCR). RESULTADOS: Observou-se um aumento significativo da prevalência de anti-HCV na amostra, quando comparada à população de doadores de sangue do HUCFF (6,6% versus 1,39% com o teste EIA, valor p=0,02 e intervalo de confiança 95%=5,5 a 13,8), contudo , considerando-se resultados obtidos com os testes confirmatórios imunoblot e PCR aplicados em série ( prevalência de HCV de 2,2%, com intervalo de confiança 95%=0,2 a 7,7) , a prevalência de HCV em pacientes com LES não parece mais alta que em doadores de sangue. CONCLUSÕES: A prevalência de hepatite C na amostra estudada utilizando-se um teste de triagem (EIA) foi significativamente maior do que a de uma população de doadores de sangue (6,6% versus 1,39%). Porém, aplicando-se em série os testes confirmatórios INNO-LIA<FONT FACE=Symbol>â</FONT> e PCR ( prevalência de hepatite C de 2,2%) parece não haver evidências de que pacientes com LES tenham maior risco de adquirir o HCV do que a população em geral, embora a prevalência tende a ser maior que a população de doadores de sangue. Em pacientes com diagnóstico provável de LES deve-se avaliar o custo/benefício de se investigar HCV e crioglobulinemia mista essencial (CME).

BACKGROUND: Patients with systemic lupus erythematosus (SLE) are at risk for the acquisition of hepatitis C, owing to frequent hospitalization and hemotransfusion. Many clinical and laboratory manifestations related to auto-imunity are shared between Lupus and HCV infected patients. OBJECTIVE: To determine the prevalence of hepatitis C in the population with SLE monitored in the out-patient service of the special programs in - Collagenoses - of the University Hospital Clementino Fraga Filho (HUCFF-UFRJ). METHODS: A Cross sectional study was performed, including 91 patients with the diagnosis of probable or definitive SLE (with 3 or more of the 11 diagnostic criteria for SLE used by the American College of Rheumatology - ACR) proceeding from the mentioned center between April / 97 to September / 97. Patients were evaluated on clinical and laboratory basis to determine activity of lupus disease (SLEDAI). All of patients were tested with UBI HCV EIA 4.0 assay and INNO-LIA HCV AbIII confirmatory assay. PCR was performed on all EIA positive INNO-LIA HCV AbIII assay positive patients besides 32 patients negatives in both serological assays. RESULTS: A significative increase in HCV prevalence among SLE patients was observed when compared with a control group of blood donors at HUCFF-UFRJ (6.6 and 1.39%, respectively; p=0,02 and confidence interval of 95%=5.5-13.8 ). However, if confirmative assays (INNO-LIA HCV ABIII and PCR ) are used, this difference can not be observed any more HCV prevalence of 2.2% with confidence interval of 95% = 0.2-7.7 ). CONCLUSIONS: HCV prevalence using ELISA assay for screening showed a significant difference between SLE patients and a blood donors control group ( 6.6 and 1.39% respectively). However, if confirmatory assays are subsequently applied, no difference in HCV prevalence among both groups can be observed. Patients with a possible diagnosis of SLE should have a cost/benefit analisys of testing for HCV.