Treatment cost of ulcerative colitis is apheresis with Adacolumn cost-effective?

BACKGROUND: Scarce data are available in Europe on the cost of treatment for ulcerative colitis (UC). AIM: To assess the cost of illness of moderate-to-severe UC in two scenarios: traditional treatment versus alternative treatment incorporating granulocyte, monocyte adsorption - apheresis (GMA-Apheresis; Adacolumn). To determine the relative cost-effectiveness of both options in steroid-dependent patients. METHODS: One-year cost-of-illness and cost-effectiveness analysis from the third-payer perspective using a decision tree model was carried out. Probabilities of each event were derived from the literature and an expert panel. Direct medical costs were obtained from official sources (euro2004). Effectiveness was measured by the proportion of patients achieving clinical remission. RESULTS: The average annual cost per patient treated with traditional treatment was estimated to be euro6740; with GMA-Apheresis, the cost was estimated to be euro6959. In steroid-dependent patients, the average annual cost was euro6059 and euro11,436, respectively. The proportion of patients achieving clinical remission with GMA-Apheresis was 22.5% higher. As second- and third-line therapy, a new course of corticosteroids and surgery was avoided in 18.5 and 4% of patients, respectively. CONCLUSIONS: Incorporating GMA-Apheresis (Adacolumn) in the therapeutic management of moderate-to-severe UC patients is cost-effective and implies savings related to the reduction of adverse effects derived from corticosteroid use and to the decreased number of surgical interventions.

Manejo diagnóstico de las pacientes con osteoporosis atendidas en consultas de Atención Primaria en España / Diagnostic management of patients with osteoporosis seen in primary health care medical centers in Spain

OBJETIVOS. Conocer los criterios clínicos que se utilizan en Atención Primaria para el diagnóstico de la osteoporosis en mujeres posmenopáusicas y conocer las características clínicas y sociodemográficas de las pacientes susceptibles de recibir tratamiento. DISEÑO. Estudio multicéntrico descriptivo. EMPLAZAMIENTO. Centros de Atención Primaria de toda la geografía española. PARTICIPANTES. Mujeres posmenopáusicas de 50 años o más con diagnóstico clínico de osteoporosis. MEDICIONES PRINCIPALES. Datos sociodemográficos y clínicos, factores de riesgo para la osteoporosis y métodos utilizados para su diagnóstico. RESULTADOS. Participaron 745 mujeres con una edad media de 62 años (rango 50-86). El factor de riesgo más frecuente fue tener antecedentes familiares de osteoporosis (48,6%), seguido de menopausia precoz (30,7%). Los criterios diagnósticos más frecuentes fueron la combinación de la historia clínica, los factores de riesgo de osteoporosis y la radiología convencional (20,3%). En el 32% de las pacientes se utilizó la densitometría ósea (DMO) sola o en combinación con otras exploraciones. Las diferencias en la utilización de DMO según grupos de edad no fueron significativas (¾61 años: 28,9% frente a > 61 años: 35,6%; p > 0,06). CONCLUSIONES. El diagnóstico de la osteoporosis en Atención Primaria en nuestro medio es principalmente un diagnóstico clínico que tiene en cuenta los factores de riesgo de la enfermedad. Se utiliza también la radiología convencional y en menor proporción la DMO. De acuerdo a las recomendaciones actuales, sería necesario aumentar el uso de la DMO en Atención Primaria en España para el manejo de la enfermedad

OBJECTIVES. Know the clinical criteria used in primary health care for the diagnosis of osteoporosis in postmenopausal women and know the clinical and sociodemographic characteristics of the patients who can receive treatment. DESIGN. Multicenter, descriptive study. SITE. Primary Health Care Center of all the Spanish territory. PARTICIPANTS. Postmenopausal women of 50 years or older with clinical diagnosis of osteoporosis. PRINCIPAL MEASUREMENTS. Sociodemographic and clinical data, risk factors for osteoporosis and methods used for the diagnosis. RESULTS. A total of 745 women with a mean age of 62 years (range 50-86) participated. The most frequent risk factor was a family background of osteoporosis (48.6%), followed by early menopause (30.7%). The most frequent diagnostic criteria were the combination of clinical history, risk factors of osteoporosis and conventional X-ray (20.3%). Densitometry was used alone or in combination with other examinations in 32% of the patients. The differences in the use of densitometry according to age groups were not significant (¾ 61 years: 28.9% versus > 61 years: 35.6%; p > 0.06). CONCLUSIONS. Diagnosis of osteoporosis in Primary Health Care in our setting is mainly a clinical diagnosis that takes the risk factors of the disease into account. Conventional X-ray and, to a lesser degree, densitometry are also used. In accordance with the current recommendations, it would be necessary to increase the use of the densitometry in primary health care in Spain for management of the treatment

Asthma control in Spain. Do season and treatment pattern matter? The ESCASE study.

The aim of this study was to assess the degree of asthma control according to GINA criteria during two different seasons in Spain. An multicenter, longitudinal, epidemiological study with the participation of a sample of physicians in Spain was conducted. Consecutive asthma patients, 18 years of age and older, seeking primary and specialist care were included in the study. Patients were seen during the winter and spring 2004 and were asked about asthma control according to GINA control criteria (daytime and nighttime symptoms, asthma exacerbations, limitations of physical activity, and visits to the emergency department) during the 4 weeks prior to the visit. Control was defined according to daytime and nighttime symptoms. A total of 614 patients participated in the study. The proportion of patients reporting daytime symptoms "every day" or "most days" during the winter versus spring was 40.1% vs. 23% (P<0.01); 26.9% vs. 14.1% presented symptoms at night (P<0.01); 11.5% vs. 8.3% had severe exacerbations; 33.5% vs. 35.7% presented symptoms accompanying exercise, and 9.4% vs. 4.3% (P<0.01) had required emergency visits. The number of patients with inadequate control was slightly higher in winter than in spring (74.4% vs. 71%) (P<0.01). The most commonly prescribed treatment was ICS plus LABAs for both periods. Asthma is poorly controlled in Spain and strategies are needed to improve management of this illness.

Documento de consenso en el uso de la granulocitoaféresis en pacientes con enfermedad inflamatoria intestinal / Consensus document on the use of granulocytapheresis in patients with inflammatory bowel disease

No disponible

Does an educational leaflet improve self-reported adherence to therapy in osteoporosis? The OPTIMA study.

INTRODUCTION: Adherence to treatment in osteoporosis remains poor. The aim of this study was to evaluate the effects of an educational leaflet on adherence to medication and to assess the association between adherence and health-related quality of life (HRQOL). METHODS: A naturalistic, observational, multi-center, prospective study of 12 months' follow-up was performed. Consecutive post-menopausal women aged 50 years to 86 years starting treatment with raloxifene according to daily practice were enrolled from 126 primary care offices in Spain. The women were assigned to two study groups. Group A received an educational leaflet with general information about osteoporosis; group B followed current practice. To assess adherence to medication and HRQOL, the Morisky test and the EuroQoL questionnaire were administered. A total of 745 post-menopausal women (group A, n=366; group B n=379), with a mean age of 62 years, were included. RESULTS: Most patients in both study groups showed high adherence to raloxifene at the 3-month visit: 56.3% vs 62.7% for groups A and B, respectively; this proportion at the 12-month visit was 47.4% (P=0.15) and 52.5% (P=0.02), respectively. At baseline, "pain/discomfort" was the dimension showing the highest percentage of women reporting problems: 86.4% vs 83.2% in groups A and B, respectively (P=0.22). HRQOL improved in both groups throughout the study, with an overall mean increment in the EuroQoL visual analog scale (EQ VAS) of 9.2 at 12 months (P<0.01). Correlations between adherence and HRQOL were weak. After receiving an educational leaflet, young post-menopausal women suffering osteoporosis did not show improvement in adherence to therapy. HRQOL improved at 12-month follow-up under treatment. CONCLUSION: No consistent correlation between adherence and HRQOL was found.

Long-term follow-up of chronic hepatitis C in patients diagnosed at a tertiary-care center.

BACKGROUND/AIMS: The natural history of chronic hepatitis C (HCV) is not completely understood. This study was aimed to evaluate the long-term outcome of the disease over a prolonged period of time and to identify factors associated with progression. METHODS: One hundred and sixteen patients with non-cirrhotic chronic non-A, non-B hepatitis consecutively diagnosed at a tertiary hospital between 1971 and 1977 were followed until December 1998 or until death. Patients with significant alcohol intake were excluded from the study. Variables obtained at the time of diagnosis, including epidemiological, clinical, laboratory, and histological data were recorded to determine risk factors associated with the development of liver cirrhosis and hepatic decompensation. RESULTS: Based on complete follow-up data, the development of liver cirrhosis and hepatic decompensation was evaluated in 94 and 114 of the 116 patients, respectively. Thirty-seven (39.3%) of 94 patients developed liver cirrhosis; an aspartate aminotransferase (AST) value higher than 70 IU/L was associated with development of cirrhosis (odds ratio (OR) 4.22, 95% CI 1.3-13.8). Hepatic decompensation occurred in 12 (10.5%) of 114 patients, its cumulative probability being 2.8% at 10 years, 5.2% at 15 years and 19.8% at 20 years. The only factor independently associated to the development of hepatic decompensation was the presence of fibrosis (stage 2 or 3) in the initial liver biopsy (OR 4.1, IC 95% 1.22-13.9). Liver-related death occurred only in seven (6%) of 114 patients. In comparison with the 116 patients diagnosed in the 1970's, patients with chronic hepatitis C diagnosed in 1999 were younger, more often asymptomatic, had lower AST and alanine aminotransferase (ALT) values and had significantly lower grade and stage histological scores. CONCLUSIONS: In summary, chronic hepatitis C had a high rate of progression to liver cirrhosis over a prolonged follow-up. However, this might be related to the fact that two decades ago the diagnosis was made at a significantly more advanced stage of the disease. Patients at high risk of progression can be identified by biochemical and histological variables at the time of diagnosis.

Criteria used by general practitioners in prescribing prokinetic or antisecretory drugs in patients with functional dyspepsia.

OBJECTIVE: To analyze the clinical factors considered by general practitioners for the prescription of prokinetic or antisecretory drugs in patients with functional dyspepsia (FD), and to assess therapeutic outcomes and factors predicting effectiveness. DESIGN: Multicentric, prospective and observational study. PATIENTS: 1,021 patients with FD were included. One hundred and thirty-two (132) were excluded from the analysis because they were taking ASA or NSAID. Patients were classified according to their predominant symptoms as reflux, ulcer, dysmotility or non-specific. At the physician discretion, treatment with alkali drugs was prescribed to 38 patients, prokinetic drugs to 574, antisecretory drugs to 123 and a combined therapy to 154. One month later, patient self-perception of symptomatic improvement was evaluated in patients treated with prokinetic drugs and antisecretory drugs. RESULTS: 85% of the patients reported symptomatic improvement after one month of treatment. Patients with non-specific FD had lower improvement rates regardless of the drug used (prokinetic or antisecretory) (77%) compared to all the other types (p = 0.03). Prescription of prokinetics was associated to female gender (OR: 0.43; 95% CI: 0.28-0.66) and early satiety (OR: 2.5; 95% CI: 1.6-4.1). A longer symptomatic evolution (OR 0.92: 95% CI: 0.88-0.97) was the only independent predictive factor of a poor response to prokinetic drugs. CONCLUSIONS: Among patients with FD attended by general practitioners, female gender and early satiety symptom were associated to the prescription of prokinetic drugs. Early symptomatic effectiveness rates for prokinetic or antisecretory drugs alike were high (85%). Patients with non-specific dyspepsia or long symptomatic evolution showed less favorable symptomatic response to prokinetic drugs.

Criterios de los médicos de atención primaria para la indicación de tratamiento con procinéticos o antisecretores en pacientes con dispepsia funcional / Criteria used by ge neral practitioners in prescribing prokinetic or antisecretory drugs in patients with functional dyspepsia

Objetivo: analizar los factores clínicos que valoran los médicos de atención primaria para la prescripción de procinéticos o antisecretores en pacientes con dispepsia funcional (DF) y evaluar los resultados terapéuticos y factores predictivos de efectividad. Diseño: estudio multicéntrico, prospectivo y observacional. Pacientes: se incluyeron 1.021 pacientes con DF, se excluyeron 132 porque tomaban AAS o AINE. Se clasificaron según sintomatología predominante en tipo reflujo, ulceroso, dismotilidad e inespecífica. A criterio del facultativo se prescribió tratamiento con alcalinos en 38 pacientes, procinéticos en 574, antisecretores en 123 o mixto en 154. Al mes se evaluó la percepción de mejoría sintomática de los pacientes tratados con procinéticos y antisecretores. Resultados: se produjo mejoría sintomática en un 85 por ciento de pacientes al mes de tratamiento. Los pacientes con DF tipo inespecífico, tanto con procinéticos como con antisecretores, tuvieron menores tasas de mejoría (77 por ciento) que el resto de subtipos (p = 0,03). La prescripción de procinéticos se relacionó con el sexo femenino (OR: 0,43; IC 95 por ciento: 0,28-0,66) y el síntoma saciedad precoz (OR: 2,5; IC 95 por ciento: 1,6-4,1). Una evolución sintomática más larga (OR 0,92: IC 95 por ciento: 0,88-0,97) fue el único predictor independiente de peor respuesta a procinéticos. Conclusiones: en los pacientes con DF atendidos por médicos de Atención Primaria, el sexo femenino y el síntoma de saciedad precoz se relacionaron con la prescripción de procinéticos. Las tasas de eficacia sintomática precoz con procinéticos o antisecretores fueron altas (85 por ciento). Los pacientes con dispepsia del tipo inespecífico o sintomatología de larga evolución presentaron respuesta terapéutica menos favorable a procinéticos (AU)

Pre-treatment with prednisolone does not improve the efficacy of subsequent alpha interferon therapy in chronic hepatitis C.

BACKGROUND/AIMS: Alpha interferon administration is quite disappointing as a single therapy in chronic hepatitis C. A brief course of corticosteroid therapy might increase the effectiveness of subsequent alpha interferon administration, but data on this issue are controversial. METHODS: One hundred and fifty-six consecutive patients with chronic hepatitis C were randomly assigned to be treated blind with tapering doses of oral prednisolone or placebo for 4 weeks. Two weeks after cessation of therapy, patients received alpha interferon (3 MU t.i.w.) for 48 weeks and were followed for 24 additional weeks. Response was defined by the presence of normal alanine aminotransferase (ALT) and negative HCV-RNA in serum. RESULTS: ALT activity decreased during prednisolone administration and rebounded upon withdrawal in 38% of the patients treated with this drug. Significant changes in serum bilirubin were not observed. HCV-RNA serum concentration tended to increase during prednisolone administration and to decrease upon withdrawal. ALT and HCV-RNA did not change during administration of placebo. At the end of interferon administration, 33% of patients treated with prednisolone and 25% of those treated with placebo presented biochemical and virological response. At the end of post-treatment follow-up, response was maintained in 12% and 13% of patients treated with prednisolone or placebo respectively. Response was not related to ALT or HCV-RNA changes observed during the pre-interferon phase of the study. No adverse events related to prednisolone administration were observed. CONCLUSIONS: Prednisolone administration and withdrawal induced a rebound in ALT activity and a decrease in HCV-RNA serum concentration in about one third of the patients with chronic hepatitis C. However, these changes did not enhance the effectiveness of subsequent alpha interferon therapy.

Genetic evolution of GB virus C/hepatitis G virus (GBV-C/HGV) under interferon pressure.

The epidemiology and clinical features of chronic GBV-C/HGV infection have largely been explored, but there is little information about the mechanisms enabling GBV-C/HGV to cause persistent infection. Since analysis of the genomic variation of GBV-C/HGV under interferon pressure might provide some insight into this issue, we analyzed the nucleotide sequence variation of the 5'NC and NS3 regions in GBV-C/HGV isolates obtained sequentially from seven patients co-infected with HCV and treated with interferon. A reduction of GBV-C/HGV-RNA serum level below the detection limit of the RT-PCR assay was observed during treatment in all patients, but upon interferon withdrawal, viral RNA remained undetectable in only two patients. Among the five patients who did not clear GBV-C/HGV-RNA, viral strains emerging after treatment were identical to those present at baseline in three cases. In a further case, in whom GBV-C/HGV-RNA re-emerged during therapy (breakthrough episode), several mutations appeared in relapse samples. In the remaining patient, with a mixed infection before therapy, only one of the two GBV-C/HGV strains present at baseline was detected upon treatment withdrawal. These data raise the possibility that positive selection may act over GBV-C/HGV genome during interferon therapy, and contribute to persistence of infection with this virus.

Prevalence and route of transmission of infection with a novel DNA virus (TTV), hepatitis C virus, and hepatitis G virus in patients infected with HIV.

OBJECTIVES: To evaluate the prevalence, route of transmission and clinical significance that current co-infection with TT virus (TTV), hepatitis C virus (HCV), and hepatitis G virus (HGV) have in HIV-1-infected patients. DESIGN: Presence of TTV, HCV, and HGV was analyzed in plasma samples from 160 HIV-1-infected patients with parenteral (38 intravenous drug users [IVDUs] and 41 patients with hemophilia) or sexual (39 homosexuals and 42 heterosexuals) risk of exposure, and in 168 volunteer blood donors. Alanine aminotransferase (ALT) levels and CD4+ counts were also analyzed. METHODS: HCV and HGV RNA were detected by specific reverse transcriptase (RT) nested polymerase chain reaction (PCR) and TTV DNA by specific heminested PCR. RESULTS: TTV DNA was detected in 39% of the patients and in 14% of the volunteer blood donors. HCV and HGV infections were detected in 42% and in 14% of the patients, and in 0% and 3% of the blood donors, respectively. Prevalences of TTV and HCV infection were higher among patients with parenteral (62% and 68%) than in those with sexual (17% and 16%) risk of exposure. A higher prevalence of TTV infection (but not of HCV or HGV infection) was observed among patients with hemophilia (76%) than IVDUs (47%), and among homosexuals (26%) than among heterosexuals (10%). Abnormal ALT levels were related with the presence of HCV infection, independently of the detection of TTV DNA. TTV infection did not seem to alter the levels of CD4+ T cells. CONCLUSIONS: Prevalence of current TTV infection is high among HIV-infected patients with parenteral risk of exposure, but TTV is also transmitted through sexual routes; detection of TTV does not seem to influence the clinical or immune status of HIV-infected patients.

Infection with a novel human DNA virus (TTV) has no pathogenic significance in patients with liver diseases.

BACKGROUND/AIMS: A recently identified DNA virus, termed TT virus (TTV), has been associated with post-transfusional hepatitis, and a high prevalence of TTV infection in patients with acute or chronic liver disease of unknown etiology has been reported from Japan, but few data are available about TTV infection in other countries. METHODS: Using hemi-nested-PCR amplification to detect TTV-DNA sequences in serum, we investigated TTV infection in blood donors and in patients with liver diseases of varied etiology. RESULTS: The prevalence of TTV infection was 13.7% in blood donors (23/168), 18.6% in chronic hepatitis C (19/102), 28.6% in chronic hepatitis B (16/56), 29.9% in hepatocellular carcinoma (20/67), 9.1% in cryptogenic chronic liver disease (2/22) and 39.6% in fulminant hepatitis (19/48). The prevalence of TTV infection in patients with virus-induced or idiopathic fulminant hepatitis was similar. Comparison of TTV-infected and non-infected patients did not reveal significant differences concerning demographic, epidemiological or histopathological features. In patients with hepatitis C, response to interferon therapy was not related to TTV infection. Phylogenetic analysis of TTV isolates showed that at least three different types of TTV are present in Spain. CONCLUSIONS: Our data suggest that TTV infection is frequent among blood donors and patients with acute liver disease. However, pathogenic effects associated with TTV infection were not observed.

Comparative study of a modified competitive RT-PCR and Amplicor HCV monitor assays for quantitation of hepatitis C virus RNA in serum.

A modified competitive RT-PCR (mcRT-PCR) to measure HCV RNA in serum and the Amplicor HCV Monitor assay were compared. For mcRT-PCR, the RNA extracted was retrotranscribed and coamplified in one step with a known amount of a DNA internal control (IC). Digoxigenin-labeled amplified products were hybridized to specific HCV DNA and IC-DNA probes and quantified by colorimetry. HCV RNA concentration was calculated by plotting the ratio of HCV/IC ODs against a calibration curve. Multiple samples were analyzed in the same round and tedious titration of each sample with a competitor was unnecessary. The mcRT-PCR assay was linear from 6 x 10(3) to 6 x 10(7) copies/ml, whereas Amplicor was linear up to 1-2 x 10(6) copies/ml. HCV RNA was measured in samples from 75 carriers. There was agreement between both methods in type 1 infections but not in type 2 or type 3 infections, in which the values measured by Amplicor were, on average, 15 times lower than those measured by the mcRT-PCR. HCV RNA measured by Amplicor was higher in type 1 infections than in type 2 or 3 infections, but no differences were found when viral load was assessed by mcRT-PCR. The binding efficiency of the Amplicor-probe was greater for type 1 than for types 2 or 3, suggesting Amplicor underestimates the viral load in the latter types. In contrast, the mcRT-PCR is not affected by genotype-related variation of HCV. This study suggests that mcRT-PCR assay is reliable for sensitive and accurate measurement of HCV RNA over a broad range of values independently of the HCV genotype.

Relationship of the genomic complexity of hepatitis C virus with liver disease severity and response to interferon in patients with chronic HCV genotype 1b infection [correction of interferon].

In patients with chronic hepatitis C, the influence of the genetic heterogeneity of the hepatitis C virus (HCV) on the progression of liver disease and on the responsiveness to interferon therapy is a matter of controversy. In this study we evaluated the genetic complexity of HCV by single-strand conformation polymorphism (SSCP) analysis of amplicons from the hypervariable region 1 (HVR1) in 168 patients with chronic genotype 1b HCV infection, of whom 122 received a single course of interferon therapy (3 MU, three times weekly for 6 months). No correlation was observed between the degree of genetic complexity of HCV (indicated by the number of bands in the SSCP assay) and patient age, serum alanine aminotransferase activity, or serum HCV-RNA concentration, measured by competitive polymerase chain reaction. HCV genomic complexity was not related to gender nor to the presumed source of infection. The number of SSCP bands detected in serum samples from patients with chronic hepatitis, either mild (8.1 +/- 3.9), moderate (8.0 +/- 3.3), or severe (9.2 +/- 3.3), and in patients with liver cirrhosis, either compensated (8.0 +/- 2.9), decompensated (6.3 +/- 2.9), or with superimposed hepatocellular carcinoma (9.5 +/- 2.9), was similar. The number of SSCP bands detected in patients with sustained response (7.5 +/- 3. 9), transient response (8.3 +/- 2.9), or no response (8.2 +/- 3.6) to interferon administration was similar as well. These observations suggest that the genetic complexity of hypervariable region (HVR1) of HCV, as estimated by SSCP analysis, is not related to the severity of liver injury nor to the type of response to interferon therapy. Thus, information offered by SSCP analysis of HVR1 of HCV in chronic HCV genotype 1b infection does not appear to be useful in the clinical management of these patients. (HEPATOLOGY 1999;29:897-903.)

Hepatitis G virus infection in chronic liver disease.

BACKGROUND: The hepatitis G virus (HGV), a recently identified member of the Flaviviridae family, can cause chronic infection in man but the role of this agent in chronic liver disease is poorly understood. AIMS: To evaluate the prevalence and meaning of HGV infection in a large series of patients with chronic liver disease. SUBJECTS: Two hundred volunteer blood donors, 179 patients with chronic hepatitis C, 111 with chronic hepatitis B, 104 with alcoholic liver disease, 136 with hepatocellular carcinoma, and 24 with cryptogenic chronic liver disease were studied. METHODS: HGV RNA was investigated in serum samples by reverse transcription and polymerase chain reaction amplification of the 5' non-coding region of HCV and hybridisation to a specific probe. The main features of HGV RNA seropositive and seronegative patients were compared. RESULTS: The prevalence of HGV infection was 3% in blood donors, 7% in chronic hepatitis C, 8% in chronic hepatitis B, 2% in alcoholic liver disease, 4% in hepatocellular carcinoma, and 8% in cryptogenic chronic liver disease. HGV infected patients tended to be younger than non-infected patients but no differences concerning sex, possible source of infection, clinical manifestations, biochemical and virological parameters, or severity of liver lesions were found. CONCLUSIONS: The prevalence of HGV infection in chronic liver disease seems to be relatively low in our area. Infection with HGV does not seem to play a significant pathogenic role in patients with chronic liver disease related to chronic HBV or HCV infection or to increased alcohol consumption, or in those with cryptogenic chronic liver disease.

Hepatitis G virus infection in a haemodialysis unit: prevalence and clinical implications.

BACKGROUND: Hepatitis viruses have become one of the main infectious problems in patients on long-term haemodialysis. A new RNA virus, designated hepatitis G virus (HGV) has been recently identified. The pathogenic relevance of this virus is currently under investigation. The aim of this study was to analyse the prevalence and clinical implications of hepatitis G virus infection in patients on haemodialysis. METHODS: The presence of HGV-RNA was investigated in 96 patients on maintenance haemodialysis. Hepatitis viral markers (HBsAg, anti-HCV, HGV-RNA) and liver tests were assessed in all these patients, as well as the risk factors for hepatitis viruses acquisition. As a control group, 200 blood donors were tested for the presence of HGV-RNA. RESULTS: HGV-RNA was detected in 25 of 96 patients on haemodialysis (26%) and in six of 200 blood donors (3%) (P < 0.001). Thirteen of 25 HGV infected patients (52%) were coinfected with other hepatitis viruses (HBV and/or HCV). Evidences of chronic liver disease were more frequent in patients infected by HBV and/or HCV (61%) than in patients infected by HGV alone (17%) (P = 0.01). Although 80% of HGV infected patients had received blood products, the transfusion rate was not different from non HGV-infected patients. Time on haemodialysis was significantly shorter in patients infected with HGV alone (3.1 +/- 3.5 years) compared to patients infected with HBV and/or HCV (7.6 +/- 5.8 years) (P = 0.04). CONCLUSIONS: Patients on maintenance haemodialysis are at increased risk for HGV infection. HGV infection itself does not seem to be a frequent cause of chronic liver disease in these patients. Since the prevalence of HGV infection in blood donors is high, blood transfusion could be one of the main factors implicated in HGV transmission in patients on haemodialysis.

Hepatitis G virus infection in chronic hepatitis C: frequency, features and response to interferon therapy.

BACKGROUND/AIMS: The pathogenic relevance of the hepatitis G virus (HGV) and its sensitivity to interferon are currently under investigation. This study aimed to investigate the prevalence of HGV infection in patients with chronic hepatitis C and to elucidate if HGV co-infection modifies the clinical course and the response to interferon therapy in this disease. METHODS: HGV-RNA was investigated by reverse transcription-polymerase chain reaction in serum from 143 consecutive patients who received interferon alpha-2b (3 MU t.i.w.) for 24 weeks. Baseline features and response to therapy in HGV-infected and non-infected patients were compared. To assess the antiviral effect of interferon, serial quantitative measurement of HCV-RNA and HGV-RNA in serum was performed in patients co-infected with HCV and HGV. RESULTS: Eight patients (5.6%) presented HGV-RNA sequences in serum. No significant differences were found between HGV-infected and non-infected patients in relation to age, sex, source of infection, liver function tests, liver histology and HCV genotype, nor in the biochemical response to interferon, which was sustained in 12% and 15%, transient in 37% and 30% and absent in 50% and 55% of HGV-infected and non-infected patients, respectively. HGV-RNA became negative in all treated patients, but sustained viral inhibition was observed only in those with low viral load. CONCLUSIONS: The prevalence of HGV infection in HCV-infected patients is relatively low in our geographical area. HGV co-infection does not appear to modify the clinical presentation nor the response to interferon in chronic hepatitis C. HGV is sensitive to interferon, particularly if pre-treatment viral load is low.

Hepatitis G virus infection in fulminant hepatic failure.

BACKGROUND: RNA sequences of the recently identified hepatitis GB virus C (HGBV-C), also named hepatitis G virus (HGV), have been detected in patients with idiopathic fulminant hepatic failure (FHF) but the role of this agent in the disease remains controversial. AIMS: To investigate the presence and implications of HGV infection in a large series of Spanish patients with FHF. PATIENTS: Sixty eight patients with FHF, including 19 with idiopathic disease, were studied. In 28 cases, studies were performed before and after liver transplantation. For comparison 200 volunteer blood donors and 22 patients transplanted for chronic liver disease were also studied. METHODS: HGV RNA was measured in serum by reverse transcriptase polymerase chain reaction of the 5' non-coding region. RESULTS: Evidence of HGV infection was found in 3% (6/200) of blood donors and in 19% (13/68) of patients with FHF. HGV infection was more frequent in patients with hepatitis B (24%, 6/25) or hepatitis D (42%, 5/12), than in patients with idiopathic disease (11%, 2/19). Half of the patients with HGV infection used illicit intravenous drugs. Specific clinical features associated with HGV infection were not identified. A very high rate of infection with HGV was observed in patients who underwent liver transplantation, either for FHF (60%, 15/24) or chronic liver disease (45%, 9/20). CONCLUSIONS: In our geographical area, HGV infection is relatively frequent in FHF, but it does not seem to play a major role in idiopathic cases.

[Abdominal pseudotumor and Whipple's disease]. / Seudotumor abdominal y enfermedad de Whipple.

Whipple's disease is an uncommon systemic disease which most often affects the intestine but may involve any other organ. The case of a woman who consulted for weight loss, fever of unknown origin, cutaneous eruptions and increase in the abdominal perimeter is presented. The ascitic fluid showed exudate infected by E. coli suggesting spontaneous bacterial peritonitis associated with chronic liver disease. Antibiotic treatment and diuretics were administered after which abdominal exploration demonstrated the presence of a mesogastric mass. Echographic and tomographic studies were unable determine the origin of the mass with the final diagnosis being achieved by exploratory laparotomy and biopsy.