Incidence of lymphoma in HIV-HCV-infected patients. Modifications in function of the anti-hepatitis C virus therapy.

The change in the incidence of lymphomas in function of the presence or absence of sustained virological response after anti-hepatitis C therapy in a cohort of human immunodeficiency (HIV)-hepatitis C (HCV) viruses coinfected patients was analyzed. A prospective cohort of 755 HIV-HCV coinfected patients who received their first anti-HCV therapy, based on interferon + ribavirin schemas, was evaluated. Incidence and histologic types of lymphomas were analyzed in two periods: (1) before administration of anti-HCV therapy and (2) after anti-HCV therapy. The association between lymphoma incidence and demographic, HIV- (minimum CD4+ cell count and CD4+ cell count at diagnosis of lymphoma, antiretroviral therapy, maximal HIV load and HIV load at diagnosis of lymphoma) and HCV-related variables (HCV load, genotype, sustained viral response to anti-HCV therapy) were analyzed. A total of 13 lymphomas [incidence rate (95% confidence interval), 0.72 (0.33-1.11) × 1000 person-years, time from HIV diagnosis to lymphoma diagnosis (median, interquartile range), 15 (11-19) years] were diagnosed. Nine of them were non-Hodgkin and four Hodgkin lymphomas. The median CD4+ T cell count at diagnosis of lymphoma was 457/mm3, with only two cases with values lower than 200/mm3. The incidence rate of non-Hodgkin lymphomas was similar pre- and post-anti HCV therapy [0.33 (0.00-0.65) vs 0.68 (0.08-1.26) × 1000 person-years, respectively, p > 0.05]. Patients with sustained virologic HCV response showed similar incidence rate of lymphomas than that of those without anti-HCV response. In conclusion, anti-HCV therapy does not modify the incidence rate of lymphomas in HIV-HCV coinfected patients.

Encefalopatía hepática crónica en paciente con cirrosis biliar primaria / Chronic hepatic encephalopathy in a patient with primary biliary cirrhosis

La encefalopatía hepática crónica o persistente es una complicación que aparece en el 1% de los pacientes con hepatopatía crónica. Presentamos un nuevo caso en una paciente afectada de cirrosis biliar primaria.Mujer de 69 años con cirrosis biliar primaria en estadio IV. Consulta por cuadro progresivo de 6 meses de evolución de fallos mnésicos, temblor y cierta torpeza para caminar. La exploración reveló un tinte subictérico, amnesia reciente, temblor fino distal en miembros superiores bilateral e hiperreflexia generalizada con aumento del área reflexógena.El hemograma mostró discreta pancitopenia, hipertransaminasemia, patrón de colestasis, alargamiento del tiempo de tromboplastina e hipocolinesterasemia. Tras descartar la enfermedad de Wilson se practicó una resonancia magnética craneal en secuencia T1 que mostró hiperintensidad en globo pálido bilateral, que junto a la clínica son compatibles con el diagnóstico.Las hepatopatías crónicas pueden ocasionar una encefalopatía hepática crónica. Los especialistas en digestivo deben conocer esta entidad(AU)

Chronic or persistent hepatic encephalopathy is a complication that develops in 1% of patients with chronic liver disease. We report a new case of this complication in a patient with primary biliary cirrhosis.A 69-year-old woman with stage IV primary biliary cirrhosis presented with a 6-month history of progressive memory deficits, tremors and somewhat clumsy gait. Examination revealed sub-jaundiced skin tone, short-term memory deficits, fine distal bilateral tremor in the upper extremities and generalized hyperreflexia with spread of the reflexogenic zone.The hemogram showed mild pancytopenia, hypertransaminasemia, cholestatic pattern, lengthened thromboplastin time and hypocholinesterasemia. Wilson's disease was excluded and a cranial magnetic resonance imaging scan showed a bilateral hyperintense globus pallidus on T1-weighted sequences, which, together with the symptoms, were compatible with the diagnosis.Chronic liver diseases may cause chronic hepatic encephalopathy. Gastroenterologists should be familiar with this entity(AU)

[Chronic hepatic encephalopathy in a patient with primary biliary cirrhosis]. / Encefalopatía hepática crónica en paciente con cirrosis biliar primaria.

Chronic or persistent hepatic encephalopathy is a complication that develops in 1% of patients with chronic liver disease. We report a new case of this complication in a patient with primary biliary cirrhosis. A 69-year-old woman with stage IV primary biliary cirrhosis presented with a 6-month history of progressive memory deficits, tremors and somewhat clumsy gait. Examination revealed sub-jaundiced skin tone, short-term memory deficits, fine distal bilateral tremor in the upper extremities and generalized hyperreflexia with spread of the reflexogenic zone. The hemogram showed mild pancytopenia, hypertransaminasemia, cholestatic pattern, lengthened thromboplastin time and hypocholinesterasemia. Wilson's disease was excluded and a cranial magnetic resonance imaging scan showed a bilateral hyperintense globus pallidus on T1-weighted sequences, which, together with the symptoms, were compatible with the diagnosis. Chronic liver diseases may cause chronic hepatic encephalopathy. Gastroenterologists should be familiar with this entity.