Prevalência de obesidade e distúrbios metabólicos em ambulatório de hepatite C e prevalência de hepatite C e distúrbios metabólicos em ambulatório de obesidade no hospital universitário de Salvador (Bahia)

Abstract

Introduction: Chronic infection with hepatitis C virus (HCV) can lead to cirrhosis, hepatocellular carcinoma, and the development of diabetes mellitus (DM). Obesity increases the risk for the development of hepatic steatosis and DM. Objectives: 1- To evaluate the prevalence of obesity and metabolic disorders in patients with HCV; 2- To study the prevalence of hepatitis C and metabolic disorders in the patients of the obesity outpatient clinic, in the University Hospital Complex Professor Edgard Santos (Complex HUPES); 3- To analyze the metabolic scores of fibrosis and hepatic steatosis. Methodology: cross-sectional study, with patients followed in the hepatitis C outpatient clinic and in the obesity outpatient clinic. In the hepatitis C outpatient clinic was evaluated: obesity; fasting glycemia; glycated hemoglobin; liver enzymes; prothrombin time; Fibroscan; APRI, eLIFT, FIB-4, RNL, RPL, NFS, HSI and FLI scores; body mass index (BMI); comorbidities and exposure to risk factors for hepatitis C. In the obesity outpatient clinic was evaluated the prevalence of HCV and the other variables mentioned above. Results: Obesity outpatient clinic: were evaluated 45 patients, prevalence of hepatitis C was 6.7% (n = 3); these 3 cases had mild liver fibrosis and genotype 1b, had no DM or metabolic syndrome (MS), and only 1 had hepatic steatosis. The prevalences of metabolic disorders were: DM: 40% (n = 18); MS: 54.5%; hepatic steatosis (by the HSI and FLI indexes): between 61% -73%. This sample had age: 50.5 (+ 12.5) years; women: 84%; browns: 66.7%; and married: 59.1%. Among obese patients with DM, 72.2% were able to maintain glycated hemoglobin (A1C) <7%; 77.8% had MS and 50% -67% had hepatic steatosis (according to the HSI and FLI indixes). The second sample had 184 HCV carriers from the hepatology outpatient clinic. The prevalence of obesity in this sample was 20.2% (n = 22). The prevalences of metabolic disorders were: DM: 22.3%; SM: 8.1%; hepatic steatosis: 28.1%; steatohepatitis: 7%. This sample had age 56.7 (+9.9) years; men: 50.5%; blacks: 35.6%; degree of mild hepatic fibrosis (F0-F2): 56.3%. Genotypic profile: 1a (53.5%), 1b (30.2%), 1 (6.4%), 2 (0.6%), 3 (8.1%) and 3a. Among diabetics with HCV, 54.5% can not maintain A1C <7%; of those 14.6% (n = 6) had obesity, 26.8% had MS and 39% had hepatic steatosis. Regarding the scores analyzed, APRI and NFS indexes have high sensitivity (> 90%) for the identification of mild fibrosis, and eLIFT for the identification of advanced fibrosis. Conclusion: there is a high prevalence of hepatitis C in patients with obesity (6.7%) when compared to the prevalence expected for the general population of Salvador, which is 1.5%. The prevalence of obesity in patients with HCV (20.2%) is similar to that expected for the general population of Salvador (19.9%). Diabetes and MS were more frequent in the obese group, but this group showed generally glycated hemoglobin levels at desirable levels. However, most diabetic patients with HCV can not maintain glycated hemoglobin at desirable levels.