Avaliação de abordagens estratégicas para enfrentamento da hepatite viral C: diagnóstico e vigilância

Abstract

Hepatitis C virus infection (HCV) is the leading cause of chronic liver disease worldwide. The confrontation of the disease is achieved through actions with different approaches. In this sense, the development of studies to assist in the diagnostic strategy and actions that support surveillance are essential to improving its knowledge and control. The aim of this thesis was to evaluate two strategic approaches focused on the diagnosis and surveillance in HCV infection. A systematic review with meta-analysis was performed to obtain the best clinical evidence of single nucleotide polymorphisms (SNPs) in the proximal regions the IL28B gene as sustained virologic response (SVR) predictorin patients with genotype 1 (G1), presented by the odds ratio (OR). At the same time, a routine with interviews and notification of HCV suspected cases in Pathology Service of Policlínica Piquet Carneiro was structured and then a case series study was realized to compare exposure sources between gender, using the prevalence ratio (PR). The results of the first study showed differences among patients of major versus minor alleles: rs12980275, AA x AA / AG (OR 5.34, 95% CI 1.60 to 17.82); rs8099917, TT x TG / GG (OR 3.99, 95% CI 2.99 to 5.32) and rs12979860, CC x CT / TT (OR 4.11, 95% CI 3.37- 5.02). A routine of interviews was implemented and allowed the continued reporting of HCV-cases to public surveillance system, and the low incompleteness of epidemiological data (<2.0%) allowed the realization of the second study. HCV cases (n=1,180) were analysed and higher prevalences of exposure to inhaled drugs, sexual risk, and higher education in men when compared to women, with RP 2.53 (1.33 to 3.57), 4.83 (3.54 to 6.59), and 2.18 (1.33 to 3.57), respectively, were observed. Higher prevalences of surgeries exposure, other exposures and blood transfusion exposure were observed in women when compared to men, with RP 4.46 (3.21 to 6.21), 1.94 (1.43 to 2.63), and 3.10 (2.09 to 4.61), respectively. The use of SNPs in IL28B analysis may be useful for diagnosis and treatment choice by G1 carriers when based in interferon (IFN). The support to surveillance activities are possible in clinical laboratories and can be strategic to improve knowledge of HCV cases in countries. And approaches in different strategies can be incorporated into the diagnostic policy, prevention and control, contributing to the eradication of the disease.