Spontaneous Cure of Acute Hepatitis C.

The statistics proved that approximately 25% of the patients with acute HCV present with jaundice, and only 10-20% develop gastrointestinal symptoms. We present the case of a 58 year-old woman, with prior antecedents of arterial hypertension and diabetes mellitus since 25 years old, hypercholesterolemia and hypertriglyceridemia, psoriasis, epilepsy and depressive syndrome. She clinically presents asthenia, anorexia, itching, jaundice and choluria. The objective examination showed an orientated patient, without flapping, hemorrhagic dyscrasia or signs of chronic hepatic disease, with icteric mucosa and skin, abdominal pain, with hepatomegaly and splenomegaly. The laboratory tests have been compatible with acute hepatitis with colestatic pattern: AST/ALT 969/798 UI/ml, FA 796 UI/ml, GGT 2476 UI/ml, BT/BD 7.39/6.10, INR 0.9. The abdominal echography showed: hepatomegaly, regular borders, hepatic steatosis, splenomegaly without ascitic fluid. The viral serological tests revealed protection for hepatitis A ( IgM neg/IgG pos), negative for HVB infection (AgHBs neg, anti-HBc neg), negative for HVE and other viruses (CMV Herpes virus, Epstein Barr, HIV), positive antibodies for HCV and positive RNA VHC (164200 UI/ml), HCV genotype 3a, IL-28B CT, negative autoimmunity. The previous HCV tests were negative, sustaining the recent infection. We assumed an acute hepatitis C. The patient was symptomatically treated with hydroxyzine for the skin itch, with vitamin K for INR correction and she was closely monitored. She had good clinical and laboratorial evolution and she was discharged after one week, maintaining hepatology consultation. She spontaneously cleared HCV infection after 3 months, maintaining negative RNA VHC 6 months after infection. The patient has cured the HCV infection with no need for antiviral treatment.

Historical epidemiology of hepatitis C virus (HCV) in selected countries.

Chronic infection with hepatitis C virus (HCV) is a leading indicator for liver disease. New treatment options are becoming available, and there is a need to characterize the epidemiology and disease burden of HCV. Data for prevalence, viremia, genotype, diagnosis and treatment were obtained through literature searches and expert consensus for 16 countries. For some countries, data from centralized registries were used to estimate diagnosis and treatment rates. Data for the number of liver transplants and the proportion attributable to HCV were obtained from centralized databases. Viremic prevalence estimates varied widely between countries, ranging from 0.3% in Austria, England and Germany to 8.5% in Egypt. The largest viremic populations were in Egypt, with 6,358,000 cases in 2008 and Brazil with 2,106,000 cases in 2007. The age distribution of cases differed between countries. In most countries, prevalence rates were higher among males, reflecting higher rates of injection drug use. Diagnosis, treatment and transplant levels also differed considerably between countries. Reliable estimates characterizing HCV-infected populations are critical for addressing HCV-related morbidity and mortality. There is a need to quantify the burden of chronic HCV infection at the national level.

Intermediate hepatocellular carcinoma: current treatments and future perspectives.

Current guidelines recommend transarterial chemoembolization (TACE) as the standard treatment of Barcelona-Clinic Liver Cancer (BCLC)-B patients. However, the long-term survival outcomes of patients managed with this technique do not appear fully satisfactory; in addition, intermediate-stage hepatocellular carcinoma (HCC) includes a heterogeneous population of patients with varying tumour burdens, liver function and disease aetiology. Therefore, not all patients with intermediate-stage HCC may derive similar benefit from TACE, and some patients may benefit from other treatment options, which are currently approved or being explored. These include different TACE modalities, such as selective TACE or drug-eluting beads TACE and radioembolization. The introduction of sorafenib in the therapeutic armamentarium for HCC has provided a new therapeutic option for the treatment of BCLC-B patients who are unsuitable to TACE or in whom TACE resulted in unacceptable toxicity. In addition, clinical trials aimed at investigating the potential role of this molecule in the treatment of patients with intermediate-stage HCC within combination therapeutic regimens are ongoing. This narrative review will present and discuss the most recent evidence on the locoregional or medical treatment with sorafenib in patients with intermediate-stage HCC.

Effects of interferon and ribavirin combination therapy on CD4+ proliferation, lymphocyte activation, and Th1 and Th2 cytokine profiles in chronic hepatitis C.

We studied the relationship between immunological markers such as CD4+ proliferation, cytokines profile and lymphocyte activation markers in patients with chronic hepatitis C, having different responses to interferon (IFN) and ribavirin (RBV) treatment. A prospective study of 20 patients was conducted, six had received IFN-alpha-2b alone and 14 IFN in combination with RBV. The proliferative immune responses of peripheral blood mononuclear cells to hepatitis C virus peptides and the lymphocyte activation markers (CD25+, CD38+ and CD69+) were assessed before treatment, at 1 week, and 1, 3 and 6 months of treatment. Cytokines interleukin (IL)-2, IFN-gamma, IL-4 and IL-10 were determined in supernatants before onset of treatment and at 1 and 6 months thereafter. Stimulation indices (SI) were higher in the sustained responders (SR), in comparison with those with no response (NR), before treatment (5.2 +/- 3.7 to 3.3 +/- 1.9, P = 0.028) and also at 6 months (7.8 +/- 1.9 to 4.1 +/- 1.2, P = 0.021). Patients with SR also had high SI to NS3 when compared with those with transitory response or no response (NR) (4.9 +/- 2.5 and 3.3 +/- 1.1, P = 0.033). At 1 month, SR had higher supernatant IL-2 than those with NR (133.8 +/- 119.2 to 56.0 +/- 89.3 pg/mL, P = 0.023) and lower levels of IL-10 (13.8 +/- 10.1 and 167.1 +/- 272.0 pg/mL, P = 0.023) in response to NS3. Combination therapy induced a higher percentage of the lymphocyte activation markers CD69+ and CD38+. In conclusion, we found that SR is associated with higher CD4+ proliferation particularly in response to the NS3 region, promoting a T-helper (Th)1/Th0 profile of cytokines, and that combination therapy induced a higher percentage of lymphocyte activation than therapy with IFN alone.

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in health care workers (HCWs): guidelines for prevention of transmission of HBV and HCV from HCW to patients.

The transmission of viral hepatitis from health care workers (HCW) to patients is of worldwide concern. Since the introduction of serologic testing in the 1970s there have been over 45 reports of hepatitis B virus (HBV) transmission from HCW to patients, which have resulted in more than 400 infected patients. In addition there are six published reports of transmissions of hepatitis C virus (HCV) from HCW to patients resulting in the infection of 14 patients. Additional HCV cases are known of in the US and UK, but unpublished. At present the guidelines for preventing HCW to patient transmission of viral hepatitis vary greatly between countries. It was our aim to reach a Europe-wide consensus on this issue. In order to do this, experts in blood-borne infection, from 16 countries, were questioned on their national protocols. The replies given by participating countries formed the basis of a discussion document. This paper was then discussed at a meeting with each of the participating countries in order to reach a Europe-wide consensus on the identification of infected HCWs, protection of susceptible HCWs, management and treatment options for the infected HCW. The results of that process are discussed and recommendations formed. The guidelines produced aim to reduce the risk of transmission from infected HCWs to patients. The document is designed to complement existing guidelines or form the basis for the development of new guidelines. This guidance is applicable to all HCWs who perform EPP, whether newly appointed or already in post.

Oropharyngeal pemphigus in a patient with chronic hepatitis C during interferon alpha-2a therapy.

There are a few reports in the literature concerning pemphigus induced by interferon given for hepatitis C. We present the case of a 28-year-old woman with post-transfusional chronic hepatitis C who developed ulcers and vesicles on her tongue, cheeks, posterior oropharynx and vocal cords 5 months after beginning treatment with recombinant interferon alpha-2a. The direct and indirect immunofluorescence was diagnostic of pemphigus vulgaris. The drug was promptly withdrawn; the patient was medicated with prednisolone and azathioprine and recovered only 3 months later. Although there are several publications describing the occurrence of other autoimmune diseases in patients receiving interferon alpha therapy, this is the first report of a pemphigus induced by interferon in hepatitis C patients involving oropharyngeal and laryngeal mucosae without cutaneous involvement.

Hepatitis B vaccination in hospital personnel and medical students.

We determined the prevalence of hepatitis B markers and the compliance to hepatitis B vaccination in a University Hospital of Santa Maria, Lisbon. The program was begun in 1989 for all hospital personnel and students of the medical school. The screening included 2,360 health care workers and 1,153 students; 57% (2,360/4,103) of hospital personnel and 41% (1,153/2,779) of medical students appeared for vaccination. The prevalence of hepatitis B markers was 16.8% (397/2,360) for hospital personnel and 5.5% (64/1,153) for students, the chronic carrier appearing in 0.95% (22/2,360) of hospital personnel and 0.3% (4/1.153) of students. The departments with the highest prevalence were the Biochemical Laboratory (64%, 7/11), Surgery (42%, 13/31), Pulmonary (39%, 9/23), Emergency (29%, 7/24), Hematology Laboratory (29%, 7/24), and Orthopedics (29%, 10/35). The prevalence was higher in students in the last 3 years of medical school than those in the first 3 years (12.2% [22/181] vs. 7.2% [8/110], p = NS). Adverse effects to vaccination occurred in 14.5%, with local pain the most frequent in 8.6%. The serologic efficacy was 95% (1,044/ 1,097). A nonresponse was observed in male workers, 13% (26/200) compared with 5% (45/897) for females (p < 0.05). Older employees also showed higher nonresponse: The average age of workers with anti-HBs of 0 IU/l was 52.3 years and those with anti-HBs of more than 100 IU/l was 38.4 years (p < 0.02). Hepatitis B vaccination is safe and effective. Our study shows the need for a more aggressive approach to the vaccination of health care workers because a significant percentage of them are not protected.

[Vaccine against hepatitis B. Eight years of experience]. / Vacinação contra a hepatite B. Oito anos de experiência.

Hepatitis B virus infection is one of the world's major health problems and health care workers are especially at risk, leading to the need for a high priority vaccination program. Such a program was begun in 1989 in S. Maria Hospital and included all hospital personnel and students of the Faculty of Medicine. The screening included 2360 health care workers and 1153 students. Fifty-five percent of hospital health care workers and 41% of the students participated in the vaccination program. The overall prevalence of hepatitis B markers was 16.8%, for hospital personnel, the chronic carrier being 0.95%, and for the students, 5.5% and 0.3% respectively. The highest prevalence was observed in the Biochemical Laboratory--64% (7/11), Surgery--42% (13/31), Pneumology--39% (9/23), Emergency Department--29% (7/24), Hematology Laboratory--29% (7/24) and Orthopedics--29% (10/35). The prevalence was also higher in students in the last three years of Medical School compared to those in the first three years, 12.2% vs 7.2%, p = NS. Local pain has been the most frequent complaint in 8.6% of vaccinees. The control with the quantification of anti-HBs in the 7th month has shown a serological efficacy of about 95%. A non-response was observed in male workers, 13% compared to 5% for females, p < 0.05. Older employees also showed higher non-response: the average age of workers with anti-HBs of 0 U/L was 52.3 years, and those with anti-HBs of more than 100 U/L was 38.4 years, p < 0.02. Hepatitis B vaccine is a safe and effective preventative measure that has been widely used for years. Our study shows the need for a more aggressive approach to the vaccination of health care workers because a significant percentage of them in our country are not protected.

The changing epidemiological pattern of hepatitis A in Lisbon, Portugal.

OBJECTIVE: To evaluate the prevalence of anti-hepatitis A virus (HAV) in an urban population, in order to assess the changing epidemiological pattern of hepatitis A. SUBJECTS: We studied 325 health care workers from Santa Maria Hospital and 201 students of the Medical School of Lisbon. RESULTS: The prevalence of anti-HAV was lower in the younger age groups: 29% in the first 3 years of Faculty compared to 46% in the last 3 years, P < 0.001. The overall prevalence for students was 35%, whereas in health care workers of less than 30 years it was 65%, P < 0.001. These findings show a declining prevalence of anti-HAV, particularly in younger age groups, when compared with the results obtained in 1983, which showed a prevalence of 85%. CONCLUSION: The epidemiological pattern of hepatitis A in Lisbon, Portugal, is changing in some urban groups, with prevalences approaching those of more developed countries.