MARIO GUIMARAES PESSOA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
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conferenceObject EFFECTIVENESS OF THE IMPLEMENTATION OF A RE-LINKAGE TO CARE STRATEGY IN PATIENTS WITH HEPATITIS C WHO WERE LOST OF FOLLOW-UP(2021) MENDIZABAL, Manuel; THOMPSON, Marcos Andres; RIDRUEJO, Ezequiel; BALLERGA, Esteban Gonzalez; VELASCO, Jose Antonio Velarde Ruiz; PALAZZO, Ana; MEZZANO, Gabriel; ESPINOSA, Linda Elsa Munoz; PESSOA, Mario; REYES, Eira Cerda; SOZA, Alejandro; RUIZ, Sandro; GOMEZ-ALDANA, Andres Jose; GERONA, Solange; FUSTER, Francisco; ANDERS, Margarita; VALDIVIA, Flor De Maria Beltran; PONIACHIK, Jaime; SCHINONI, Maria Isabel; HERNANDEZ, Nelia; MONTES, Pedro; GIRALA, Marcos; CASTILLO, Lida; CASTILLO-BARRADAS, Mauricio; CHAVEZ, Rocio; CABRERA, Cecilia; TENORIO, Laura; ZEVALLOS, Katherine; GARAVITO, Jorge; BRUTTI, Julia; TAGLE, Martin; NARRO, Graciela Castro; POZO, Emilia Vera; PERAZZO, Rosalia; TORO, Luis Guillermo; VARON, Adriana; FERREIRO, Melina; LAZCANO, Monserrat; MURGA, Maria Dolores; GOMEZ, Fernando; HERNANDEZ, Larissa; MOUTINHO, Bruna Damasio; GANDARA-CALDERON, Julian; VARGAS, Jose Ignacio; SIMIAN, Daniela; SILVA, Marcelo- Hepatitis E virus infection increases the risk of diabetes and severity of liver disease in patients with chronic hepatitis C virus infection(2021) ZITELLI, Patricia Momoyo Yoshimura; GOMES-GOUVEA, Michele; MAZO, Daniel F.; SINGER, Julio da Motta; OLIVEIRA, Claudia P. M. S.; FARIAS, Alberto Queiroz; PINHO, Joao Renato; TANIGAWA, Ryan Yukimatsu; ALVES, Venancio Avancini Ferreira; CARRILHO, Flair Jose; PESSOA, Mario GuimaraesOBJECTIVES: Co-infection with hepatitis A or B viruses may aggravate liver injury in patients infected with hepatitis C virus (HCV). However, few studies have assessed co-infection with hepatitis E virus (HEV) and HCV. Therefore, this study aimed to assess the prevalence and impact of HEV infection among Brazilian patients with chronic HCV infection. METHODS: This observational study included adult patients with chronic HCV infection who were naive to antiviral therapy from January 2013 to March 2016. A total of 181 patients were enrolled, and HEV serology and PCR were performed for all patients. RESULTS: Seropositivity for anti-HEV IgG was detected in 22 (12.0%) patients and anti-HEV immunoglobulin M in 3 (1.6%). HEV RNA showed inconclusive results in nine (4.9%) patients and was undetectable in the remaining patients. HEV serology positive patients had more severe liver disease, characterized by liver fibrosis >= 3 versus <= 2 (p<0.001), Aspartate Aminotransferase-to-Platelet Ratio Index of >= 1.45 (p=0.003), and Fibrosis-4 score of >= 3.25 (p=0.001). Additionally, the odds of HEV-positive patients developing diabetes mellitus were 3.65 (95% CI 1.40-9.52) times the corresponding odds of HEV-negative patients. A case-control-based histological analysis (n=11 HEV-HCV-positive patients and n=22 HCV-positive patients) showed no significant differences between the groups. CONCLUSIONS: This prevalence is higher than that reported in previous studies of the general population in Brazil. Thus, HEV infection may influence the severity of liver disease and may represent an additional risk of developing diabetes mellitus in patients with HCV infection.
- The role of PNPLA3 and TM6SF2 polymorphisms on liver fibrosis and metabolic abnormalities in Brazilian patients with chronic hepatitis C(2021) OLIVEIRA, Arthur Ivan N.; MALTA, Fernanda M.; ZITELLI, Patricia Momoyo Y.; SALLES, Ana Paula M.; GOMES-GOUVEA, Michele S.; NASTRI, Ana Catharina S.; PINHO, Joao Renato R.; CARRILHO, Flair J.; OLIVEIRA, Claudia P.; MENDES-CORREA, Maria Cassia; PESSOA, Mario G.; MAZO, Daniel F.BackgroundDespite the growing body of knowledge about TM6SF2 and PNPLA3 polymorphisms in non-alcoholic fatty liver disease, their influence in the spectrum of HCV liver disease is not yet fully defined. Besides that, admixed populations, such as Brazilians, were not included in most of the studies.MethodsThis cross-sectional study enrolled 365 treatment-naive patients with HCV and 134 healthy individuals. TM6SF2 (rs58542926 c.499C>T) and PNPLA3 (rs738409 c.444C>G) polymorphisms were evaluated regarding their association with clinical and laboratory data, histological liver steatosis and fibrosis, and with components of the metabolic syndrome.ResultsIn HCV subjects, the frequencies of TM6SF2 CC and CT+TT were 89% and 11%, while PNPLA3 frequencies of CC and CG+GG were 51.4% and 48.6%. In the univariate logistic regression analysis, the TM6SF2 CT+TT genotype in HCV was associated with significant liver fibrosis (p=0.047; OR 1.953; 95% CI 1.009-3.788). In comparison to the CT+TT genotype, the TM6SF2 CC genotype in HCV was associated with older age (p=0.002), higher frequency of arterial hypertension (p=0.032), obesity (p=0.030), metabolic syndrome (p=0.014) and lower total cholesterol levels (p=0.036). The PNPLA3 GG subjects had lower body mass index than CG/ CC individuals (p=0.047). None of the polymorphisms, or their combinations, was independently associated with hepatic steatosis or fibrosis. On the other hand, older age, lower serum levels of total cholesterol, and higher serum levels of alanine aminotransferase and alkaline phosphatase were associated with liver fibrosis in the multivariate logistic regression analysis.ConclusionIn this evaluation of an admixed HCV population, neither TM6SF2 nor PNPLA3 polymorphisms were independently associated with hepatic steatosis or fibrosis. Other factors seem more influential than these specific polymorphisms in isolation. More studies are warranted to clarify the role of the TM6SF2 and PNPLA3 polymorphisms in Brazilians with HCV.
- The Latin American Association for the Study of the Liver (ALEH) position statement on the redefinition of fatty liver disease(2021) MENDEZ-SANCHEZ, Nahum; ARRESE, Marco; GADANO, Adrian; OLIVEIRA, Claudia P.; FASSIO, Eduardo; ARAB, Juan Pablo; CHAVEZ-TAPIA, Norberto C.; DIRCHWOLF, Melisa; TORRE, Aldo; RIDRUEJO, Ezequiel; PINCHEMEL-COTRIM, Helma; FERNANDEZ, Marlen Ivon Castellanos; URIBE, Misael; GIRALA, Marcos; DIAZ-FERRER, Javier; RESTREPO, Juan C.; PADILLA-MACHACA, Martin; DAGHER, Lucy; GATICA, Manuel; OLAECHEA, Blanca; PESSOA, Mario G.; SILVA, MarceloThe Latin American Association for the Study of the Liver (Asociacion latinoamericana para el Estudio del Higado; ALEH) represents liver professionals in Latin America with the mission of promoting liver health and quality patient care by advancing the science and practice of hepatology and contributing to the development of a regional health policy framework. Fatty liver disease associated with metabolic dysfunction is of specific concern in the ALEH region, where its prevalence is one of the highest globally, second only to the Middle East. A recent consensus from an international panel recommended a new definition of fatty liver disease associated with metabolic dysfunction, including a shift in name from non-alcoholic fatty liver disease (NAFLD) to metabolic-associated fatty liver disease (MAFLD), and adoption of a set of positive criteria to diagnose the disease, independent of alcohol intake or other liver diseases. Given, the importance of this proposal, ALEH invited leading members of regional nations to come to a consensus on it from a local perspective. We reached a consensus to endorse the proposal that the disease should be renamed as MAFLD and that the disease should be diagnosed by the proposed simple and easily applicable criteria. We expect that this change in nosology will result in improvements in disease awareness and in advances in scientific, economic, public health, political, and regulatory aspects of the disease.
- Early liver function improvement following successful treatment of chronic hepatitis C in patients with decompensated cirrhosis: a real-life study(2021) LOURENCO, Mariana Sandoval; ZITELLI, Patricia Momoyo Y.; CUNHA-SILVA, Marlone; OLIVEIRA, Arthur Ivan N.; LIMA, Roque Gabriel Rezende de; OLIVEIRA, Souza Evandro de; OLIVEIRA, Claudia P.; SEVA-PEREIRA, Tiago; CARRILHO, Flair J.; PESSOA, Mario G.; MAZO, Daniel F.OBJECTIVES: Despite higher rates of sustained virologic response (SVR), important concerns remain when patients with decompensated cirrhosis due to hepatitis C virus (HCV) are treated with direct-acting antiviral agents (DAA). Questions include efficacy, safety, and the magnitude of liver function improvement. Here, we aimed to evaluate HCV treatment data in this specific population in Brazil. METHODS: We included 85 patients with decompensated cirrhosis submitted to HCV therapy with DAA followed at two academic tertiary centers in the southeastern region of Brazil. RESULTS: Seventy-nine patients (92.9%) were Child-Pugh (CP) score B, and six (7.1%) were CP score C. The mean MELD score was 12.86. The most common treatment was sofosbuvir plus daclatasvir +/- ribavirin for 24 weeks. The overall intention-to-treat (ITT) SVR rate was 87.4% (74/85) and modified-ITT 96.1% (74/77). ITT SVR was associated with lower baseline INR values (p.=0.029). Adverse events (AE) occurred in 57.9% (44/76) of patients. Serious AE were reported in 12.8% (10/78), and were related to the presence of hepatic encephalopathy (p.=0.027). SVR was associated with improvement in CP (p<0.0001) and MELD scores (p.=0.021). Among baseline CP score B patients with SVR, 46% (29/63) regressed to CP score A. Ascites was independently associated with no improvement in liver function in patients who achieved SVR (p.=0.001; OR:39.285; 95% CI:4.301-258.832). CONCLUSIONS: Patients with decompensated HCV cirrhosis showed a high SVR rate with interferon-free therapy. Early liver function improvement occurred after successful HCV eradication. However, long-term follow-up of these patients after SVR remains strongly advised.
- Efficacy and safety of glecaprevir/pibrentasvir in treatment-naive adults with chronic hepatitis C virus genotypes 1-6 in Brazil(2021) PERIBANEZ-GONZALEZA, Mario; CHEINQUER, Hugo; RODRIGUES, Lino; LIMA, Maria Patelli; ALVARES-DA-SILVA, Mario Reis; MADRUGA, Jose; PARISE, Edison Roberto; PESSOA, Mario Guimaraes; FURTADO, Juvencio; VILLANOVA, Marcia; FERREIRA, Adalgisa; MAZZOLENI, Felipe; NASCIMENTO, Ecio; SILVA, Giovanni Faria; FREDRICK, Linda; KRISHNAN, Preethi; BURROUGHS, Margaret; REUTER, TaniaIntroduction and objectives: Glecaprevir/pibrentasvir is a highly effective and well tolerated treatment for hepatitis C infection. Brazilian patients were not included in the original development studies for glecaprevir/pibrentasvir. This study aimed to assess safety and efficacy of glecaprevir/pibrentasvir in treatment-naive Brazilian adults without cirrhosis or with compensated cirrhosis. Patients and methods: EXPEDITION-3 was a Phase 3, open-label, multicenter study in treatment-naive Brazilian adults with hepatitis C infection genotype 1-6. Patients without cirrhosis (F2 or F3) or with compensated cirrhosis (F4) received 8 or 12 weeks of glecaprevir/pibrentasvir, respectively. The primary efficacy endpoint was the rate of sustained virologic response at post-treatment Week 12. Secondary endpoints were on-treatment virologic failure and relapse rates. Baseline polymorphisms were assessed in NS3 and NS5A. Adverse events and laboratory abnormalities were monitored. Results: 100 patients were enrolled, 75 received 8 weeks of treatment and 25 received 12 weeks; all patients completed treatment. Overall sustained virologic response at post-treatment Week 12 rate was high (98.0%; 98/100; 95% confidence interval: 93.0-99.4) and remained high regardless of baseline viral or host factors, including demographics, hepatitis C virus RNA levels, polymorphisms in NS3 and/or NS5A, genotype, and relevant comorbidities. 55% of patients reported >= 1 adverse event, the most common being headache (18.0%). Four patients reported serious adverse events; none were considered drug related or led to study drug discontinuation. No hepatic decompensations were observed. Conclusions: Glecaprevir/pibrentasvir was effective and well tolerated in treatment-nave Brazilian patients with hepatitis C infection without cirrhosis and with compensated cirrhosis. (C) 2020 Published by Elsevier Espafia, S.L.U. on behalf of Fundacion Clinica Medica Sur, A.C. This is an open access article under the CC BY-NC-ND license.
- The impact of hepatitis E infection on hepatic fibrosis in liver transplanted patients for hepatitis C infection(2021) MORAES, Adriano Claudio Pereira de; GOUVEA, Michele Gomes; FERREIRA, Ariana Carolina; PINHO, Joao Renato Rebello; MELLO, Evandro Sobroza de; D'ALBUQUERQUE, Luiz Augusto Carneiro; TERRABUIO, Debora; ABDALA, Edson; CARRILHO, Flair Jose; PESSOA, Mario GuimaraesHepatitis E Virus (HEV) is an infection known worldwide for its asymptomatic and self-limited course in most cases. Some cases progressing to chronicity have been described in immunosuppressed patients, especially in recipients of solid organ transplants. We evaluated laboratory parameters of HEV infection (HEV RNA, anti-HEV IgM and anti-HEV IgG) through enzyme-linked immunosorbent assay (Elisa), confirmed by immunoblotting, in a cohort of 294 patients who received liver transplants at the HCFMUSP (Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo). Laboratory and demographic data were collected from the entirety of the transplanted population. Hepatic biopsies of 122 patients transplanted due liver failure secondary to hepatitis C (HCV), with or without serological or molecular markers of HEV, were analyzed according to METAVIR score. Out of 24 (8.2%) patients tested positive for anti-HEV IgG, six (2%) were positive for anti-HEV IgM and 17 (5.8%) for HEV RNA. Of the patients transplanted because of HCV infection, 95 (77.8%) had received treatment including ribavirin for at least six months before blood sample collection. Among patients transplanted due to HCV cirrhosis who tested positive for anti-HEV IgG, only three (37.5%) showed fibrosis beyond stage 2, while five (41.7%) of the HEV RNA-positive patients had liver fibrosis beyond stage 2. Overall, the prevalence of HEV in the post-hepatic transplant scenario appears to be low, and, at least histologically, seemingly not harmful. We conclude that, although some studies reported a risk of HEV chronification, patients who had their livers transplanted due to HCV and showed serological or molecular markers of HEV did not have higher levels of fibrosis compared to patients who showed no indications of HEV infection at the time of the analysis. (C) 2021 Sociedade Brasileira de Infectologia.
conferenceObject RESPONSE TO URSODEOXYCHOLIC ACID SHOULD BE ASSESSED EARLIER TO ALLOW ADD-ON SECOND-LINE THERAPY IN PATIENTS WITH PRIMARY BILIARY CHOLANGITIS UNRESPONSIVE TO INITIAL TREATMENT(2021) CANCADO, Guilherme Grossi Lopes; BITTENCOURT, Paulo L.; BRAGA, Michelle Harriz; FERRAZ, Maria Gomes; VILLELA-NOGUEIRA, Cristiane Alves; TERRABUIO, Debora Raquel Benedita; CANCADO, Eduardo Luiz Rachid; NARDELLI, Mateus Jorge; FARIA, Luciana Costa; GOMES, Nathalia Mota De Faria; OLIVEIRA, Elze Maria G.; ROTMAN, Vivian; OLIVEIRA, Maria Beatriz; CUNHA, Simone Muniz Carvalho Fernandes Da; CUNHA-SILVA, Marlone; MENDES, Liliana; IVANTES, Claudia Alexandra Pontes; CODES, Liana; BORGES, Valeria Ferreira De Almeida E.; PACE, Fabio Heleno De Lima; PESSOA, Mario Guimaraes; SIGNORELLI, Izabelle Venturini; CORAL, Gabriela Perdomo; LEVY, Cynthia; COUTO, Claudia AlvesconferenceObject NON-INVASIVE ASSESSMENT ON HEPATIC FIBROSIS BEFORE AND AFTER HCV CURE AND CORRELATION WITH CLINICAL OUTCOMES(2021) RAGAZZO, Taisa Grotta; GARCIA-TSAO, Guadalupe; MAZO, Daniel; OLIVEIRA, Claudia P. M. S.; ZITELI, Patricia; SINGER, Julio Da Motta; CARRILHO, Flair J.; PESSOA, Mario