ABSTRACT
BACKGROUND: TT virus (TTV) is a recently discovered human DNA virus with worldwide distribution, but with no clear disease association. The possibility of an enhanced TTV virulence in patients with immunodeficiencies has not yet been investigated but is of particular interest because other viruses have been demonstrated to cause severe and rapid liver disease in such patients. Here we analysed the characteristics of TTV infection in a large cohort of patients with primary hypogammaglobulinaemia (PHG) and whether TTV has a role in the frequently observed cryptogenic liver disease in these patients. METHODS: 83 Norwegian patients with PHG (serum immunoglobulin G < 2 g/L), receiving substitution treatment with immunoglobulins, were followed regularly for median 10.2 years (range 2-30). TTV DNA was sought in serum samples and three immunoglobulin preparations by polymerase chain reaction; TTV DNA quantitation, DNA sequencing and phylogenetic analysis were performed in selected samples. RESULTS: TTV DNA was detected in 27 of 83 (32.5%) patients and was not associated with a particular type of PHG. The prevalence of TTV infection was dependent on intravenous immunoglobulin administration, duration of therapy and patient's age. TTV DNA was found in two of three currently used immunoglobulin preparations. In the longitudinal study, whether TTV was cleared or newly acquired had no impact on liver function tests and no particular TTV strain was found in patients with more severe liver disease. CONCLUSIONS: TTV infection is common in patients with PHG. Treatment with immunoglobulins has a role in the transmission of TTV in these patients. However, we found no evidence of TTV-induced liver disease in this group of immunocompromised patients.
Subject(s)
Agammaglobulinemia/virology , DNA Virus Infections/immunology , Hepatitis, Viral, Human/virology , Immunocompromised Host , Torque teno virus , Adult , Agammaglobulinemia/immunology , Cohort Studies , DNA Virus Infections/epidemiology , DNA Virus Infections/transmission , DNA, Viral/isolation & purification , Female , Follow-Up Studies , Hepatitis, Viral, Human/immunology , Humans , Immunoglobulins, Intravenous/therapeutic use , Male , Prevalence , Time Factors , Torque teno virus/isolation & purificationABSTRACT
BACKGROUND: A newly described DNA virus, named transfusion-transmitted virus (TTV), was recently detected with high prevalence in Japanese patients with fulminant hepatitis and chronic liver disease of unknown aetiology. We investigated the presence of this virus in patients with liver disease in the UK to find out whether TTV infection is associated with liver damage. METHODS: We used semi-nested PCR to amplify TTV DNA from serum samples from 126 adults, of whom 72 were patients with a range of chronic liver diseases, 24 had spontaneous resolution of infection with hepatitis C virus (HCV), and 30 were normal controls. Direct DNA sequencing and phylogenetic analysis were used to characterise the TTV isolates. FINDINGS: We detected TTV DNA in 18 (25%) of the 72 patients with chronic liver disease, which was not different from the 10% prevalence in normal controls (p=0.15). The rate of TTV DNA was similar among patients with various liver diseases. The majority of TTV-positive cases had no biochemical or histological evidence of significant liver damage. TTV DNA sequencing of nine isolates showed the same genotypic groups as in Japan: three patients were infected with genotype 1, which showed 4% nucleotide divergence, and six patients were infected with genotype 2 with 15-27% divergence. INTERPRETATION: The high prevalence of active TTV infection in the general population, both in the UK and in Japan, and the lack of significant liver damage, suggest that TTV, similar to hepatitis G virus (HGV), may be an example of a human virus with no clear disease association.
Subject(s)
DNA Viruses/isolation & purification , Hepatitis, Viral, Human/virology , Liver Diseases/virology , Transfusion Reaction , Adult , Case-Control Studies , DNA Viruses/genetics , Female , Genome, Viral , Hepatitis, Viral, Human/epidemiology , Hepatitis, Viral, Human/transmission , Humans , Japan/epidemiology , Liver Diseases/epidemiology , Male , Polymerase Chain Reaction , Prevalence , United Kingdom/epidemiologyABSTRACT
22 patients with panic disorder (diagnosis according to ICD-10) were treated with alprazolam (monotherapy) in a dose of 1-2,5 mg/daily during 6 weeks. Disappearance of panic attacks was observed in 59% of cases while in 27% of patients they arose more rarely. The drug's antipanic action was revealed during second week of treatment. The side-effects were typical for benzodiazepine preparations. No one patient refused of drug administration in connection with side-effects development. Prognostically unfavourable signs were found: the high frequency of panic attacks, the presence of atypical marked permanent symptoms in attack structure, as well as the steady vegetative disturbances presence.
