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1.
Infection ; 40(2): 173-9, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22095532

RESUMEN

BACKGROUND: Pegylated interferon (PEG-IFN) and ribavirin is the most effective treatment for chronic hepatitis C virus (HCV) hepatitis, but the rate of sustained virological response (SVR) remains approximately 50%, and 15-20% of all treated patients have a virological relapse after completing the treatment. Studies on the SVR have failed to discriminate between non-responders and relapsers. AIMS: To identify the risk factors for relapse among patients with an end-of-treatment response (ETR). METHODS: We retrospectively analyzed 281 patients consecutively treated with PEG-IFN and ribavirin with a follow-up period of at least 24 weeks. The baseline details collected on each patient included demographic data, histological features, and biochemical profiles. RESULTS: Forty-six patients (16.4%) relapsed during the first 6 months of follow-up after discontinuing the therapy. Relapser patients were significantly older, had more steatosis, fibrosis, and showed significantly lower rapid virological response (RVR) rates compared with SVR patients. By logistic regression analysis, only the absence of RVR was found to be significantly associated with relapses in both subgroups of patients with genotypes 1 and 4 (p < 0.004) and those with genotypes 2 and 3 (p < 0.006). Severe fibrosis was also predictive of relapsing disease, but only for genotypes 2 and 3 patients (p < 0.003). During the treatment, serum HCV-RNA decreased more rapidly in patients with SVR compared to non-responder and relapser patients (p < 0.001). Interestingly, relapser patients exhibited an intermediate serum HCV-RNA decay during the first 4 weeks of therapy. CONCLUSION: Among HCV patients treated with PEG-IFN and ribavirin, the absence of RVR was the most important independent predictor of relapse, independent of the HCV genotype. In the subgroup of genotypes 2 and 3 patients, the severity of fibrosis was also an important factor associated with the relapse rate.


Asunto(s)
Antivirales/uso terapéutico , Hepacivirus/aislamiento & purificación , Hepatitis C Crónica/tratamiento farmacológico , Interferón-alfa/uso terapéutico , Polietilenglicoles/uso terapéutico , Ribavirina/uso terapéutico , Adulto , Análisis de Varianza , Quimioterapia Combinada , Femenino , Genotipo , Hepacivirus/fisiología , Hepatitis C Crónica/genética , Hepatitis C Crónica/virología , Humanos , Interferón alfa-2 , Modelos Logísticos , Masculino , Persona de Mediana Edad , ARN Viral/genética , Proteínas Recombinantes/uso terapéutico , Estudios Retrospectivos , Factores de Riesgo , Prevención Secundaria , Factores de Tiempo , Carga Viral
3.
Hepatology ; 32(4 Pt 1): 824-7, 2000 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-11003629

RESUMEN

Hepatitis delta virus (HDV) was responsible for a high proportion of cases of acute and chronic liver disease in Southern Europe during the 1970s. Some data suggest that by the 1990s HDV circulation had substantially declined. We have assessed the prevalence of HDV infection and its clinical impact in 834 Italian hepatitis B surface antigen (HBsAg) carriers in 1997. Anti-HDV antibodies were sought in all consecutive chronic HBsAg carriers observed in 14 referral liver units throughout Italy. Risk factors for anti-HDV positivity were evaluated. Anti-HDV antibodies were found in 69 of 834 (8.3%) HBsAg-positive patients. Cohabitation with an anti-HDV-positive subject, intravenous drug addiction, residence in the South of the country, and the presence of cirrhosis were independently associated with the presence of anti-HDV antibodies. The overall prevalence of anti-HDV antibodies was lower than those observed in 2 multicenter surveys performed in 1987 and 1992 (23% and 14%, respectively). By 1997, the percentage of anti-HDV-positive subjects had sharply decreased in the 30 to 50 years age group, whereas it was almost unchanged in subjects over 50 years of age. The highest prevalence of anti-HDV antibodies (11.7%) was found in patients with cirrhosis. This prevalence was as high as 40% in the 1987 study. The circulation of HDV sharply decreased in Italy, by 1.5% per year, from 1987 to 1997. This decrease resulted mainly from the reduction in chronic HDV infections in the young, for whom high morbidity and mortality rates were recorded in the past. The results anticipate the almost complete control of HDV infection in the near future.


Asunto(s)
Hepatitis D/epidemiología , Hepatitis Crónica/epidemiología , Adulto , Factores de Edad , Anciano , Femenino , Anticuerpos Antihepatitis/sangre , Antígenos de Superficie de la Hepatitis B/análisis , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Tiempo
4.
Cancer ; 85(10): 2132-7, 1999 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-10326690

RESUMEN

BACKGROUND: Cirrhosis of viral etiology due to hepatitis B virus (HBV) or hepatitis C virus (HCV) infection is a risk factor for hepatocellular carcinoma (HCC). The current study evaluated the rate of incidence of HCC in patients with compensated cirrhosis of viral etiology. METHODS: Two hundred fifty-nine cirrhotic patients (66 hepatitis B surface antigen [HBsAg] positive, 166 HCV positive, and 27 HBsAg/HCV positive) were longitudinally examined every 6 months by serum alpha-fetoprotein test and liver ultrasonography. The rates of incidence of HCC were calculated by the person-years method. The Kaplan-Meier method was used to estimate the cumulative probability of HCC development. Differences in survival time were evaluated by a log rank test. Independent predictors of HCC development were estimated by Cox proportional hazard regression analysis. RESULTS: During a mean follow-up of 64.5 months, HCC developed in 51 (19.7%) patients: in 34 of 166 HCV positive subjects (20.5%) (mean follow-up, 66.3 months), in 6 of 66 of those HBsAg positive (9.1%) (mean follow-up, 55.06 months), and in 11 of 27 of those with dual HBsAg/HCV infection (40.7%) (mean follow-up, 76.4 months). The rate of incidence of HCC per 100 person-years of follow-up was 3.7 in HCV positive subjects, 2.0 in those HBsAg positive, and 6.4 in those with dual infection. Cumulative HCC appearance rates in HBsAg positive, HCV positive, and HBsAg/HCV positive subgroups were 10%, 21%, and 23% at 5 years, 16%, 28%, and 45% at 10 years, and 16%, 40%, and 55% at 13 years, respectively. Multivariate analysis indicated that age >50 years (hazard risk [HR], 4.5; 95% confidence interval [CI] = 2.1-9.4), male gender (HR, 2.8; 95% CI = 1.1-5.3), and HBsAg/HCV coinfection (HR, 2.3; 95% CI = 1.1-4.6) were independent predictors of HCC development. CONCLUSIONS: These findings confirm that male gender and more advanced age (>50 years) are risk factors for HCC in patients with cirrhosis. Furthermore, the data indicate that subjects with dual HBsAg/HCV infection are at highest risk for HCC. Surveillance programs for early detection of HCC should focus especially on these patients.


Asunto(s)
Carcinoma Hepatocelular/epidemiología , Hepatitis B/complicaciones , Hepatitis C/complicaciones , Cirrosis Hepática/virología , Neoplasias Hepáticas/epidemiología , Medición de Riesgo , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Carcinoma Hepatocelular/etiología , Carcinoma Hepatocelular/virología , Femenino , Humanos , Incidencia , Cirrosis Hepática/complicaciones , Neoplasias Hepáticas/etiología , Neoplasias Hepáticas/virología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Factores Sexuales
5.
Aliment Pharmacol Ther ; 12(7): 653-6, 1998 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-9701529

RESUMEN

RATIONALE: Because of its antifibrotic and anti-inflammatory effects, colchicine has been proposed as a treatment for liver disease. Early in vitro studies have demonstrated that colchicine blocks mitosis in the metaphase and inhibits DNA synthesis. AIM: A pilot study of hepatitis B virus (HBV)-related/HBV-DNA+ve chronic liver disease. PATIENTS: Nine biopsy-proven chronic hepatitis patients (three with cirrhosis) entered the study. Two of them were HBeAg+ve and seven were antiHBe+. All patients were HBV-DNA+ve/antiHBc IgM+ve (index values of anti-HBc IgM ranged from 0.370 to 1.200). All of them had a major contraindication to interferon therapy or refused antiviral treatment. The known persistence of positive HBsAg ranged from 2 to 21 years. METHODS: After informed consent, the patients received 1 mg colchicine a day orally for 5 days-a-week over 6 months. Testing for liver enzymes and viral markers was performed at the baseline and after 3 and 6 months. RESULTS: None of the patients experienced side-effects during the treatment. The two HBeAg+ve patients seroconverted to anti-HBe with a normalization of AST/ALT during therapy. Among the seven antiHBe+ve patients, four had a complete normalization of transaminases (one patient cleared the HBsAg with seroconversion to anti-HBs). Six of the nine patients were HBV-DNA-ve at the end of therapy and were still negative after 12 months of follow-up. CONCLUSION: These preliminary results suggest that colchicine might have an antiviral activity in HBV-DNA+ve chronic liver disease, and it could be regarded as an alternative therapy to interferon.


Asunto(s)
Colchicina/uso terapéutico , ADN Viral/efectos de los fármacos , Supresores de la Gota/uso terapéutico , Virus de la Hepatitis B/efectos de los fármacos , Hepatitis B Crónica/tratamiento farmacológico , Administración Oral , Adulto , Anciano , ADN Viral/aislamiento & purificación , Femenino , Virus de la Hepatitis B/genética , Virus de la Hepatitis B/aislamiento & purificación , Hepatitis B Crónica/enzimología , Humanos , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Proyectos Piloto
6.
J Viral Hepat ; 5(1): 61-6, 1998 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-9493518

RESUMEN

Chronic hepatitis B infection with the hepatitis B e antigen (HBeAg)-negative variant is associated with a severe clinical course and a low response rate to interferon (IFN). In an attempt to improve the chances of sustained response to interferon we designed a pilot study, using titres of IgM antibodies to hepatitis B core antigen (HBcAb IgM) to guide treatment initiation. Eighteen adults who were HBeAg-negative with biopsy-proven chronic active hepatitis (seven with cirrhosis) entered the study. They were followed-up bimonthly with routine liver function tests, and HBcAb IgM titres were also determined. Treatment (lymphoblastoid IFN 5 million units (MU) m(-2) three times weekly for 6 months) was started when the HBcAb IgM titre was increasing. Fifteen (83.3%) patients had normal alanine aminotransferase (ALT) levels and undetectable HBV DNA at the end of treatment. HBcAb IgM decreased in all responders. We observed a relapse in four patients (three with cirrhosis), in the first year after treatment, with an increase in ALT, HBV DNA and titre of HBcAb IgM. Eleven patients (61.1%) had a sustained response and eight of these 11 patients were followed-up for more than 18 months; two responders cleared hepatitis B surface antigen (HBsAg). Hence, the rate of sustained response to IFN in HBeAb-positive patients with chronic hepatitis is improved if treatment is started when HBcAb IgM levels are increasing.


Asunto(s)
Antivirales/uso terapéutico , Monitoreo de Drogas/métodos , Hepatitis B Crónica/tratamiento farmacológico , Hepatitis B Crónica/inmunología , Interferón-alfa/uso terapéutico , Adolescente , Adulto , Alanina Transaminasa/análisis , Alanina Transaminasa/metabolismo , Antivirales/administración & dosificación , Biopsia , ADN Viral/análisis , Femenino , Estudios de Seguimiento , Anticuerpos contra la Hepatitis B/análisis , Anticuerpos contra la Hepatitis B/inmunología , Antígenos de la Hepatitis B/análisis , Antígenos de la Hepatitis B/inmunología , Antígenos del Núcleo de la Hepatitis B/análisis , Antígenos del Núcleo de la Hepatitis B/inmunología , Antígenos e de la Hepatitis B/análisis , Antígenos e de la Hepatitis B/inmunología , Virus de la Hepatitis B/genética , Virus de la Hepatitis B/inmunología , Virus de la Hepatitis B/aislamiento & purificación , Humanos , Inmunoglobulina M/análisis , Inmunoglobulina M/inmunología , Interferón-alfa/administración & dosificación , Hígado/patología , Hígado/virología , Cirrosis Hepática/complicaciones , Cirrosis Hepática/virología , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Retrospectivos
7.
Psychol Rep ; 69(3 Pt 2): 1115-8, 1991 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-1669962

RESUMEN

Short-forms of Wechsler intelligence tests have abounded in the literature and have been recommended for use as screening instruments in clinical and research settings. Clinicians who administer short-forms as screening devices are concerned with the accuracy of the resulting IQ estimate. LoBello recently recommended that subtest scatter might serve as an indicator that the resulting short-form IQ does not accurately estimate the IQ based on the entire scale. In this study, the data from 69 children who had taken the WPPSI-R were used to estimate the correlation for the differences between Full Scale WPPSI-R IQs on the complete test and on the short-form (four subtests) and the differences between the subtests with the highest and lowest scaled scores. The Pearson r of .02 indicates that subtest scatter is not related to the accuracy of the short-form IQ and will not reliably alert clinicians to the need to administer the entire battery.


Asunto(s)
Discapacidad Intelectual/diagnóstico , Escalas de Wechsler/estadística & datos numéricos , Niño , Preescolar , Femenino , Humanos , Discapacidad Intelectual/clasificación , Masculino , Psicometría , Escalas de Wechsler/normas
8.
Psychol Rep ; 66(3 Pt 1): 867-70, 1990 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-2377705

RESUMEN

Subjects self-identified as occasional blood donors or nondonors completed a survey to estimate differences in attitudes about donating blood. Subjects who had never donated blood were more likely than occasional donors to doubt that the blood supply was free of the AIDS virus, more likely to worry about contracting AIDS through blood transfusions or blood donations, and more likely to have an aversion to venipuncture procedures. No differences were observed between groups on fear of having an AIDS test, current worry about having the AIDS virus, or belief that AIDS can be contracted from transfused blood. Implications for increasing blood donations during the AIDS crisis are discussed.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/psicología , Actitud Frente a la Salud , Donantes de Sangre/psicología , Síndrome de Inmunodeficiencia Adquirida/transmisión , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo
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