Interferon and amantadine in combination as initial treatment for chronic hepatitis C patients.

BACKGROUND/AIMS: To evaluate the efficacy and tolerance of amantadine in combination with interferon in the treatment of chronic hepatitis C. METHODS: Multi-centre trial including 180 chronic hepatitis C patients without cirrhosis, randomly enrolled to receive interferon 6 MU every other day for 6 months followed by 3 MU for further 6 months (group A, 90 patients), or the same schedule plus amantadine 200 mg/day (group B, 90 patients). Primary end-point was a sustained virological and biochemical response, secondary end-points were on-treatment (third month) and end-of-treatment response rates. RESULTS: The two groups had similar demographic, biochemical and virological characteristics. A sustained response after 6 months follow-up was observed in 17% of group A and 24% of group B patients (P not significant), an end-of-treatment response was observed in 37% in group A and 47% in group B (P not significant), an on-treatment response was observed in 46% in group A and 61% in group B patients (P < 0.05). No major side effects due to amantadine administration were observed. CONCLUSIONS: Adding amantadine to interferon did not improve the sustained treatment efficacy. However, the rate of early response at the third month of therapy was significantly higher in the combination therapy group.

Natural beta interferon in acute type-C hepatitis patients: a randomized controlled trial.

AIM OF THE STUDY: A multicentre randomized controlled trial to assess whether a short course of beta-interferon could reduce the rate of chronic evolution of acute hepatitis C, in line with recent observations, was started in Northern Italy in 1991. METHODS: Forty acute hepatitis C patients were randomized to receive natural beta interferon 3,000,000 international units intramuscularly three times a week for 4 weeks or symptomatic drugs, and were followed up for a median period of 22.5 months. RESULTS: The chronicity rate was 75% (15/20 patients) in the interferon-treated group, and 80% (16/20) in the untreated group. No difference in the duration of the acute phase of hepatitis was observed. Hepatitis C virus ribonucleic acid was determined in 21 cases and was positive in 19 cases at baseline and in 15/17 chronic and 1/4 non chronic cases at the end of follow-up. Side effects of therapy (flu-like syndrome in 40% of cases) were mild and short-lasting. No aminotransferase flare-ups were observed during treatment. CONCLUSIONS: Beta interferon at the suggested regimen is well tolerated but does not seem to significantly influence the natural course of acute hepatitis C.

[Complete response to IFN in a case of typical HBV cirrhosis]. / Risposta completa all'IFN in un caso di cirrosi da HBV "tipico".

A rare case of "wild-type" HBV cirrhosis (CHIL A/HBeAG+/HBV-DNA+) with complete response to IFN treatment after 3 successive series based on different types of IFN is reported. In this patient, HBeAg and HBV-DNA negativization after the second treatment with r-alpha-2b-IFN was observed and after the third treatment with lymphoblastoid-IFN HBcAb,-IgM negativization simultaneously with ALT persistent normalization. Over one year after the interruption of the last treatment, HBV clearance with HBsAg elimination and HBsAb, seroconversion was observed. The effectiveness of IFN was histologically confirmed with decrease of the piecemeal necrosis in the liver and presence of light fibrosis whereas the results of 3 previous histological evaluations showed: 1) CPH (1985); 2) CAH lightly active with initial signs of cirrhotic evolution (1988); 3) CAH with presence of nodular cirrhosis in the liver (1991). In particularly selected cases the possibility of a favourable response to the series of IFN treatment is stresses even in more advanced chronic "wild" HBV forms in which there is not evidence of mutants in the viral population.

[A case of herpetic meningoencephalitis. Serological and imaging diagnosis]. / Su di un caso di meningoencefalite herpetica. Diagnostica sierologica e per immagini.

The paper reports a case of HSVE observed in a 46-year-old patient with a negative anamnesis for previous HSV infection and with no objective signs of herpetic muco-cutaneous infection at time of hospitalisation. Due to the impossibility of carrying out bioptic and cultural tests, the diagnosis was based on the increased levels of specific anti-HSV1 antibodies in the liquor; these findings were compared to those found in serum, taking into account the increased antibody titres and in particular the ratio between the level of liquor and serum albumin and that of specific antibodies in both liquor and serum. The diagnostic importance of cerebral CT was confirmed by the early revelation of morphostructural alterations during the acute phase. RMN also allowed a more detailed imaging diagnosis to be made. From a therapeutic point of view, the paper confirms the value of acyclovir treatment.

[A case of pericarditis in acute brucellosis]. / Su di un caso di pericardite in corso di brucellosi acuta.

A case of brucellosis pericarditis in a patient affected with acute brucellosis hospitalized in the Infectious Disease Department of Asti Hospital is described. During the hospitalization, the patient revealed (in addition to the classical symptoms and signs), a modest shooting pain in the chest and typical electrocardiographic alterations confirmed by an echocardiography that revealed slight pericardial effusion at both front and rear, subsequently and by steroid and specific antibiotic therapies. The real possibility of finding this complication, considered so rare in the literature, in cardiovascular brucellosis is pointed out as is the capacity of modern echocardiographic research to confirm and reinforce diagnosis and consequently also the description of modest pericardial effusions with unclear symptoms and electrocardiographic signs that were once practically ignored when the pericardial involvement often escaped a clinical identification, being concealed by the most important signs of the primary infection.

[A case of Plasmodium vivax malaria]. / Considerazioni su di un caso di malaria da Plasmodium vivax.

A case of malaria caused by Plasmodium vivax is reported in order to underline the importance of correct pharmacological prophylaxis and meticulous anamnestic and epidemiological investigations.

[A case of adenovirus-induced hepatitis]. / Su di un caso di epatite da adenovirus.

A case of acute adenovirus-induced hepatitis is reported. The diagnosis was based on the increase in adenovirus antibodies and the absence of markers for HBV, HAV and other minor hepatitis viruses on a double serum sample. NANB hepatitis was excluded on the basis of the patient's history, epidemiological data and clinical course.