Hepatite B crônica e esquistossomose mansoni: uma associação deletéria

Abstract

BACKGROUND: Chronic hepatitis B (CHB) and schistosomiasis are prevalent in several countries, but the impact of this association is unknown. We aimed to investigate the prevalence and the morbidity of this coinfection. METHODS: 406 adults with CHB (HBsAg positive > 6 months) were included in a cross-sectional study. CHB was classified as replicative (HBVDNA 2,000 IU/ml) HBeAg-positive or -negative, and inactive or low replicative (HBVDNA < 2,000 IU/ml). Schistosomiasis was classified as hepatosplenic (HSS) or non-HSS. Liver biopsies were scored by METAVIR. Multivariate analysis estimated the risk of severe fibrosis (METAVIR F3-4). RESULTS: 263/406 (64.8%) were male, median age 45 years (IQR 35-54). 235/406 (57.9%) had replicative CHB (66.4% HBeAg-negative, 33.6% -positive). 128 (31.5%) had cirrhosis. Schistosomiasis was confirmed in 124/406 (30.5%), being 81.5% male, median age 47 years (IQR 39.5-54). 86/124 (69.4%) had HSS. 61.3% and 38.7% coinfected had replicative and inactive CHB, respectively. Patients with CHB replicative and HSS had more advanced fibrosis and severe inflammation as compared to patients without HSS (80.8% vs. 43.6% for METAVIR F3-F4, p<0.01; 64.0% vs. 39.8% for METAVIR A2-A3, p<0.01). In patients with replicative CHB, age > 50 years (OR=1.10; 95% CI 1.06-1.14, p<0.001), male gender (OR=2.61, 95% CI 1.12-6.09, p=0.03), HSS (OR=4.56, 95% CI 2.10-9.91, p<0.001) and alcoholism (OR=2.46, 95% CI 1.16-5.19, p=0.02) were independently associated with cirrhosis. CONCLUSIONS: The association between replicative CHB and HSS is a risk factor for severe liver fibrosis, which can result in deleterious outcomes for patients from endemic areas.