Cribado, diagnóstico y tratamiento de la hepatitis por virus C en la práctica clínica / Screening, diagnosis and treatment of chronic hepatitis C in clinical practice

La hepatitis crónica por el virus de la hepatitis C (HCV) es un problema de salud mundial. En el mundo, 170 millones de personas están infectadas. En Latinoamérica la prevalencia se estima entre 1.0 y 2.3% y en Argentina es en promedio 1.0 a 1.5%. La eficacia del tratamiento de esta enfermedad ha mejorado sustancialmente en los últimos 2 a 3 años. Con los nuevos antivirales de acción directa (AAD) disponibles actualmente, pueden lograrse tasas de respuesta viral sostenida (RVS) mayores al 90-95% prácticamente con pocos efectos adversos. Para poder acceder a estos tratamientos con una alta tasa de curación, y así lograr reducir la carga de la enfermedad en la salud pública, es necesario aumentar el número de pacientes diagnosticados y que estos accedan a un cuidado adecuado. El rol de los médicos de atención primaria es fundamental: deben sospechar la infección, diagnosticarla y complementar su atención con la derivación al especialista. El trabajo conjunto de generalistas y especialistas optimizará el manejo de los recursos disponibles, permitiendo que cada vez más personas infectadas con el HCV sean diagnosticadas y tratadas adecuadamente.

Chronic hepatitis C (HCV) is a global health problem. Worldwide, 170 million people are chronically infected. In Latin America its prevalence is estimated between 1.0 and 2.3%, and in Argentina between 1.0 and 1.5%. Treatment efficacy has considerably improved in the last 2 or 3 years. Sustained virological response (SVR) rates around 90-95% can be achieved with the new direct acting antiviral agents (DAAs) currently available, with few side effects. It is necessary to increase the number of diagnosed patients, linking them to adequate management and treatment. Raising treatment rates will increase the percentage of cured patients, reducing the burden of disease. Primary care physicians´ role is essential to achieve this goal. They must identify persons at risk, diagnose them and work with specialists to continue their medical care. Team working of generalists and specialists will permit that more HCV infected people can access to adequate care and treatment.

Baja prevalencia de anticuerpos antifosfolípidos autoinmunes en enfermedades hepáticas / Low prevalence of autoimmune antiphospholipid antibodies in hepatic diseases

Antiphospholipid antibodies (aPL) have been associated with different diseases. They are defined as a large family of immunoglobulins (Ig) of either alloantibodies or autoantibodies. The autoimmune antibodies are associated with venous and/or arterial thrombosis, thrombocytopenia and recurrent fetal loss in the so-called antiphospholipid syndrome or in systemic lupus erythematosus. These antibodies are directed against proteins or phospholipid-protein complexes. On the contrary, antiphospholipid antibodies (alloantibodies) which are found in infectious diseases sera (syphilis, HIV, and other viral diseases), disappear with illness remission and are directed to phospholipids alone (particularly cardiolipin) and are not associated with thrombosis or recurrent fetal loss. However, the role and type of aPL found during hepatic diseases is still unclear. To investigate the prevalence of autoimmune aPL (IgG and IgM) during different hepatic diseases, we have studied 128 patients with hepatitis C virus, hepatitis B virus and hepatic autoimmune diseases without treatment as well as 40 healthy control subjects. We have used a specific ELISA kit, that uses a mixture of phospholipid instead of cardiolipin alone, and allows a better detection of aPL of the autoimmune type. Our results show that autoimmune aPL are not significantly increased in viral hepatic diseases (2%) or autoimmune diseases of the liver (3%) when compared to the control group (0%).

Análisis de la expresión de los antígenos del virus de la hepatitis B por las células mononucleares / Analysis the expresion of the antigens of hepatitis B virus of mononuclear cells

En este trabajo se estudió la expresión de los antígenos de superficie (HBsAg) y core (HBcAg) del virus de la hepatitis B (HBV) por las células mononucleares de pacientes infectados. La expresión del HBsAg fue analizada por inmunofluorescencia con anticuerpos monoclonales, en un total de 110 pacientes con enfermedad hepática viral. Todos los 33 pacientes con hepatitis crónica activa (HCA) y 33/52 pacientes con hepatitis B aguda, expresaron HBsAg en las células mononucleares. En este grupo la expresión abarcó a todos los pacientes, cuando el estudio se efectuó dos meses después del inicio de la enfermedad. Resultados negativos se obtuvieron en 30 controles normales, 16 HCA noA noB, 5 hepatitis A y 4 hepatitis B recuperadas. En un grupo de pacientes agudos y crónicos se estudió, también, la expresión del HBcAg, la que se observó en 1/3 de los pacientes infectados. Todos los casos de HCA positivos para HBcAg fueron, también, HBeAg(+) en suero. Los resultados fueron confirmados por estudios de dot blot sobre nitrocelulosa de los lisiados celulares

Prevalencia de infeccion por el VIH-1 en enfermos de hepatitis virica con antecedente de toxicomania por inyeccion / HIV-1 Infection in intravenous drug abusers with clinical manifestations of hepatitis

A serologic study of hepatitis and HIV infections among intravenous drug abusers with hepatitis was conducted at the "Francisco J. Muniz" Infectious Diseases Hospital in Buenos Aires Argentina. The population studies consisted of 99 hospital patients who were intravenous drug abusers presenting a clinical and humoral picture of hepatitis, all of whom received care at the hospital between December 1986 and September 1987. The median age of the study subjects were males, including four whose sexual orientation was homosexual/bisexual. All the study subjects were intravenous cocaine addicts, and some were intravenous users of other drugs as well. Serologic test for hepatitis A and B markers, for the delta agent, and for HIV-1 indicated that 87 of the 99 subjects had hepatitis B virus infections. Sixty-two (including five coinfected with the deltal agent) have acute cases and 25 (including four coinfected with the delta agent) had chronic cases. Two of the subjects had acute cases of hepatitis A, and the 10 remaining subjects had non A non B hepatitis. Forty-seven of the study subjects were also found to be infected with HIV-1, the prevalence of HIV-1 infection being about the same in males and females. Only 10 of these subjects had traveled outside the county (to Bolivia or Brazil), and so in most cases it appears that the HIV-12 infection was acquired in Argentina. This 47 percent prevalence is