Estudo dos genótipos dos vírus das hepatites B e Delta no Maranhão

• Ano de defesa: 2011
• Autor(a) principal: Fonseca, Lena Maria Barros
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: UNIVERSIDADE FEDERAL DO MARANHÃO
• Palavras-chave em Português: Biotecnologia; Genótipo; Hepatite B
• Link de acesso: https://siduece.uece.br/siduece/trabalhoAcademicoPublico.jsf?id=71026

<span class="markedContent" id="page18R_mcid0"><span style="left: calc(var(--scale-factor)*85.09px); top: calc(var(--scale-factor)*124.82px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.03644);" role="presentation" dir="ltr">O vírus da hepatite B (HBV) é um vírus DNA que se replica via transcrição reversa de um </span><span style="left: calc(var(--scale-factor)*85.09px); top: calc(var(--scale-factor)*143.77px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.06277);" role="presentation" dir="ltr">RNA intermediário, o que confere uma alta variabilidade ao seu genoma. A diversidade </span><span style="left: calc(var(--scale-factor)*85.08px); top: calc(var(--scale-factor)*162.74px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.00793);" role="presentation" dir="ltr">genética do HBV possibilitou a sua classificação em genótipos (A-J). Os genótipos parecem</span> <span style="left: calc(var(--scale-factor)*85.08px); top: calc(var(--scale-factor)*181.70px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.04511);" role="presentation" dir="ltr">ter associação com a evolução da doença e com a resposta ao tratamento. No Brasil, os </span><span style="left: calc(var(--scale-factor)*85.08px); top: calc(var(--scale-factor)*200.66px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.00405);" role="presentation" dir="ltr">poucos estudos publicados mostram maior frequência dos genótipos A, D e F. A co-infecção </span><span style="left: calc(var(--scale-factor)*85.09px); top: calc(var(--scale-factor)*219.74px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.04041);" role="presentation" dir="ltr">com o vírus da hepatite Delta (HDV) também pode modificar a evolução da infecção pelo</span> <span style="left: calc(var(--scale-factor)*85.09px); top: calc(var(--scale-factor)*238.69px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.0613);" role="presentation" dir="ltr">HBV. Esta pesquisa teve como objetivo, estudar os vírus das hepatites B (HBV) e Delta </span><span style="left: calc(var(--scale-factor)*85.09px); top: calc(var(--scale-factor)*257.65px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.05888);" role="presentation" dir="ltr">(HDV) relacionando os genótipos e subgenótipos, entre portadores crônicos do HBV do</span> <span style="left: calc(var(--scale-factor)*85.09px); top: calc(var(--scale-factor)*276.60px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.05982);" role="presentation" dir="ltr">Estado do Maranhão. Foi realizado um estudo transversal com inclusão consecutiva de </span><span style="left: calc(var(--scale-factor)*85.09px); top: calc(var(--scale-factor)*295.56px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.03272);" role="presentation" dir="ltr">portadores crônicos do HBV provenientes de várias regiões do estado entre 2008 e 2010. </span><span style="left: calc(var(--scale-factor)*85.09px); top: calc(var(--scale-factor)*314.52px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.01309);" role="presentation" dir="ltr">Foram coletadas amostras de sangue para realização de exames sorológicos e virológicos.</span> <span style="left: calc(var(--scale-factor)*85.09px); top: calc(var(--scale-factor)*333.47px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.996075);" role="presentation" dir="ltr">As</span><span style="left: calc(var(--scale-factor)*97.93px); top: calc(var(--scale-factor)*333.47px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*104.65px); top: calc(var(--scale-factor)*333.47px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.04133);" role="presentation" dir="ltr">sorologias foram</span><span style="left: calc(var(--scale-factor)*189.66px); top: calc(var(--scale-factor)*333.47px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*196.43px); top: calc(var(--scale-factor)*333.47px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.990879);" role="presentation" dir="ltr">realizadas</span><span style="left: calc(var(--scale-factor)*246.32px); top: calc(var(--scale-factor)*333.47px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*253.04px); top: calc(var(--scale-factor)*333.47px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.99663);" role="presentation" dir="ltr">por</span><span style="left: calc(var(--scale-factor)*268.95px); top: calc(var(--scale-factor)*333.47px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*275.72px); top: calc(var(--scale-factor)*333.47px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.997841);" role="presentation" dir="ltr">testes</span><span style="left: calc(var(--scale-factor)*305.12px); top: calc(var(--scale-factor)*333.47px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*311.84px); top: calc(var(--scale-factor)*333.47px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.997166);" role="presentation" dir="ltr">de</span><span style="left: calc(var(--scale-factor)*324.10px); top: calc(var(--scale-factor)*333.47px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*330.68px); top: calc(var(--scale-factor)*333.47px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.996989);" role="presentation" dir="ltr">Enzyme-Linked</span><span style="left: calc(var(--scale-factor)*406.58px); top: calc(var(--scale-factor)*333.47px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*413.28px); top: calc(var(--scale-factor)*333.47px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.996608);" role="presentation" dir="ltr">Immunoabsorbent</span><span style="left: calc(var(--scale-factor)*501.99px); top: calc(var(--scale-factor)*333.47px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*508.77px); top: calc(var(--scale-factor)*333.47px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.993047);" role="presentation" dir="ltr">Assay </span><span style="left: calc(var(--scale-factor)*85.09px); top: calc(var(--scale-factor)*352.43px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.00299);" role="presentation" dir="ltr">(ELISA), a quantificação do HBV-DNA por</span><span style="left: calc(var(--scale-factor)*291.31px); top: calc(var(--scale-factor)*352.43px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*294.61px); top: calc(var(--scale-factor)*352.43px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.998058);" role="presentation" dir="ltr">Polymerase Chain Reaction</span><span style="left: calc(var(--scale-factor)*431.24px); top: calc(var(--scale-factor)*352.43px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*434.41px); top: calc(var(--scale-factor)*352.43px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.00013);" role="presentation" dir="ltr">(PCR em tempo real)</span><br role="presentation"/><span style="left: calc(var(--scale-factor)*85.09px); top: calc(var(--scale-factor)*371.38px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.00818);" role="presentation" dir="ltr">(limite de detecção de 50 UI/ml) e a determinação dos genótipos e subgenótipos do HBV foi</span> <span style="left: calc(var(--scale-factor)*85.09px); top: calc(var(--scale-factor)*390.46px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.07693);" role="presentation" dir="ltr">feita por análise filogenética de um fragmento de 1300 nucleotídeos dos genes S e da </span><span style="left: calc(var(--scale-factor)*85.09px); top: calc(var(--scale-factor)*409.42px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.03072);" role="presentation" dir="ltr">polimerase. Os genótipos do HDV foram caracterizados através de análise filogenética da</span> <span style="left: calc(var(--scale-factor)*85.09px); top: calc(var(--scale-factor)*428.26px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.01249);" role="presentation" dir="ltr">sequência codificadora do HDVAg</span><span style="left: calc(var(--scale-factor)*254.78px); top: calc(var(--scale-factor)*428.26px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr">.</span><span style="left: calc(var(--scale-factor)*257.84px); top: calc(var(--scale-factor)*428.26px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*261.62px); top: calc(var(--scale-factor)*428.26px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.01766);" role="presentation" dir="ltr">Foram estudados 133 portadores crônicos do HBV, 126 </span><span style="left: calc(var(--scale-factor)*85.10px); top: calc(var(--scale-factor)*447.34px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.99837);" role="presentation" dir="ltr">(95%) apresentaram carga viral detectável. Foi possível determinar os genótipos do HBV em </span><span style="left: calc(var(--scale-factor)*85.10px); top: calc(var(--scale-factor)*466.29px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.00977);" role="presentation" dir="ltr">119 (89,5%) das amostras, sendo o genótipo A o mais prevalente (67%), todos subgenótipo</span> <span style="left: calc(var(--scale-factor)*85.10px); top: calc(var(--scale-factor)*485.25px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.995884);" role="presentation" dir="ltr">A1,</span><span style="left: calc(var(--scale-factor)*101.61px); top: calc(var(--scale-factor)*485.25px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*109.22px); top: calc(var(--scale-factor)*485.25px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.995326);" role="presentation" dir="ltr">seguido</span><span style="left: calc(var(--scale-factor)*147.74px); top: calc(var(--scale-factor)*485.25px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*155.28px); top: calc(var(--scale-factor)*485.25px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.997166);" role="presentation" dir="ltr">do</span><span style="left: calc(var(--scale-factor)*167.54px); top: calc(var(--scale-factor)*485.25px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*174.96px); top: calc(var(--scale-factor)*485.25px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.993754);" role="presentation" dir="ltr">genótipo</span><span style="left: calc(var(--scale-factor)*217.07px); top: calc(var(--scale-factor)*485.25px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*224.61px); top: calc(var(--scale-factor)*485.25px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr">D</span><span style="left: calc(var(--scale-factor)*232.59px); top: calc(var(--scale-factor)*485.25px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*240.09px); top: calc(var(--scale-factor)*485.25px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.998066);" role="presentation" dir="ltr">em</span><span style="left: calc(var(--scale-factor)*255.41px); top: calc(var(--scale-factor)*485.25px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*262.89px); top: calc(var(--scale-factor)*485.25px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.997279);" role="presentation" dir="ltr">28%</span><span style="left: calc(var(--scale-factor)*284.94px); top: calc(var(--scale-factor)*485.25px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*292.40px); top: calc(var(--scale-factor)*485.25px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.01387);" role="presentation" dir="ltr">(33/119).</span><span style="left: calc(var(--scale-factor)*336.37px); top: calc(var(--scale-factor)*485.25px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*343.99px); top: calc(var(--scale-factor)*485.25px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.996455);" role="presentation" dir="ltr">Entre</span><span style="left: calc(var(--scale-factor)*370.29px); top: calc(var(--scale-factor)*485.25px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*377.71px); top: calc(var(--scale-factor)*485.25px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.995253);" role="presentation" dir="ltr">estes</span><span style="left: calc(var(--scale-factor)*403.98px); top: calc(var(--scale-factor)*485.25px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*411.54px); top: calc(var(--scale-factor)*485.25px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.991965);" role="presentation" dir="ltr">últimos,</span><span style="left: calc(var(--scale-factor)*449.28px); top: calc(var(--scale-factor)*485.25px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*456.90px); top: calc(var(--scale-factor)*485.25px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.997166);" role="presentation" dir="ltr">29</span><span style="left: calc(var(--scale-factor)*469.15px); top: calc(var(--scale-factor)*485.25px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*476.57px); top: calc(var(--scale-factor)*485.25px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.999294);" role="presentation" dir="ltr">(24%)</span><span style="left: calc(var(--scale-factor)*506.00px); top: calc(var(--scale-factor)*485.25px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*513.61px); top: calc(var(--scale-factor)*485.25px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.994742);" role="presentation" dir="ltr">eram </span><span style="left: calc(var(--scale-factor)*85.10px); top: calc(var(--scale-factor)*504.21px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.0785);" role="presentation" dir="ltr">subgenótipo D4, 3 (2,5%) D3 e 1 (0,5%) D2. O restante dos pacientes, 6 (5%), tinham</span><br role="presentation"/><span style="left: calc(var(--scale-factor)*85.10px); top: calc(var(--scale-factor)*523.16px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.00274);" role="presentation" dir="ltr">genótipo F, subgenótipo F2. A prevalência do anti-HDV foi de 3,75% (5/133), destes 3 (60%)</span> <span style="left: calc(var(--scale-factor)*85.10px); top: calc(var(--scale-factor)*542.12px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.02527);" role="presentation" dir="ltr">apresentaram HDV-RNA positivo.</span><span style="left: calc(var(--scale-factor)*253.74px); top: calc(var(--scale-factor)*542.12px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*264.23px); top: calc(var(--scale-factor)*542.12px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.05742);" role="presentation" dir="ltr">Os genótipos do HDV encontrados foram HDV-3 (um </span><span style="left: calc(var(--scale-factor)*85.09px); top: calc(var(--scale-factor)*561.19px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.04761);" role="presentation" dir="ltr">paciente) e HDV-8 (dois pacientes). Houve frequência inesperada do subgenótipo D4 do</span> <span style="left: calc(var(--scale-factor)*85.09px); top: calc(var(--scale-factor)*580.15px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.08449);" role="presentation" dir="ltr">HBV, de origem africana, sendo a primeira descrição do HDV-8 em população de não </span><span style="left: calc(var(--scale-factor)*85.09px); top: calc(var(--scale-factor)*599.11px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.02005);" role="presentation" dir="ltr">nativos africanos. É possível que estes genótipos do HBV e HDV tenham sido introduzidos </span><span style="left: calc(var(--scale-factor)*85.09px); top: calc(var(--scale-factor)*618.06px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.03031);" role="presentation" dir="ltr">no Brasil através do tráfico negreiro a partir de países da África ocidental entre os séculos</span> <span style="left: calc(var(--scale-factor)*85.09px); top: calc(var(--scale-factor)*637.02px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.04084);" role="presentation" dir="ltr">XVI e XVIII. Este estudo identificou entre os portadores crônicos do HBV no Maranhão, a </span><span style="left: calc(var(--scale-factor)*85.09px); top: calc(var(--scale-factor)*655.97px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.00386);" role="presentation" dir="ltr">existência de 3 genótipos (A, D e F) e seus respectivos subgenótipos (A1, D2, D3, D4, F2a),</span><br role="presentation"/><span style="left: calc(var(--scale-factor)*85.09px); top: calc(var(--scale-factor)*674.93px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.06351);" role="presentation" dir="ltr">além da co-infecção HBV/HDV e os genótipos HDV-3 e HDV – 8, sendo este inédito no</span> <span style="left: calc(var(--scale-factor)*85.09px); top: calc(var(--scale-factor)*693.88px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.995502);" role="presentation" dir="ltr">Brasil.</span><span style="left: calc(var(--scale-factor)*115.63px); top: calc(var(--scale-factor)*693.88px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*125.04px); top: calc(var(--scale-factor)*693.88px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.999215);" role="presentation" dir="ltr">Estes</span><span style="left: calc(var(--scale-factor)*152.64px); top: calc(var(--scale-factor)*693.88px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*161.89px); top: calc(var(--scale-factor)*693.88px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.995688);" role="presentation" dir="ltr">resultados</span><span style="left: calc(var(--scale-factor)*212.63px); top: calc(var(--scale-factor)*693.88px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*221.99px); top: calc(var(--scale-factor)*693.88px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.99465);" role="presentation" dir="ltr">indicam</span><span style="left: calc(var(--scale-factor)*259.84px); top: calc(var(--scale-factor)*693.88px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*269.25px); top: calc(var(--scale-factor)*693.88px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr">a</span><span style="left: calc(var(--scale-factor)*275.39px); top: calc(var(--scale-factor)*693.88px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*284.73px); top: calc(var(--scale-factor)*693.88px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.99407);" role="presentation" dir="ltr">necessidade</span><span style="left: calc(var(--scale-factor)*346.40px); top: calc(var(--scale-factor)*693.88px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*355.74px); top: calc(var(--scale-factor)*693.88px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.997166);" role="presentation" dir="ltr">de</span><span style="left: calc(var(--scale-factor)*367.99px); top: calc(var(--scale-factor)*693.88px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*377.33px); top: calc(var(--scale-factor)*693.88px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.998429);" role="presentation" dir="ltr">estudos</span><span style="left: calc(var(--scale-factor)*415.96px); top: calc(var(--scale-factor)*693.88px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*425.32px); top: calc(var(--scale-factor)*693.88px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.991244);" role="presentation" dir="ltr">adicionais,</span><span style="left: calc(var(--scale-factor)*477.06px); top: calc(var(--scale-factor)*693.88px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*486.49px); top: calc(var(--scale-factor)*693.88px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.990122);" role="presentation" dir="ltr">clínicos</span><span style="left: calc(var(--scale-factor)*522.96px); top: calc(var(--scale-factor)*693.88px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr"> </span><span style="left: calc(var(--scale-factor)*532.32px); top: calc(var(--scale-factor)*693.88px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif;" role="presentation" dir="ltr">e </span><span style="left: calc(var(--scale-factor)*85.09px); top: calc(var(--scale-factor)*712.84px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.05724);" role="presentation" dir="ltr">epidemiológicos para investigar a presença e apresentação destas infecções em outras</span> <span style="left: calc(var(--scale-factor)*85.09px); top: calc(var(--scale-factor)*731.92px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(0.996248);" role="presentation" dir="ltr">regiões do Brasil.</span> <span style="left: calc(var(--scale-factor)*85.09px); top: calc(var(--scale-factor)*763.35px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.03685);" role="presentation" dir="ltr">Palavra Chave</span><span style="left: calc(var(--scale-factor)*160.19px); top: calc(var(--scale-factor)*763.35px); font-size: calc(var(--scale-factor)*11.04px); font-family: sans-serif; transform: scaleX(1.004);" role="presentation" dir="ltr">: Hepatite B. Hepatite Delta. HBV. HDV. Genótipos. Brasil. <br/></span></span>