RESUMEN
PURPOSE: Universal anti-hepatitis B vaccination of infants and of 12-year-old children became mandatory in Italy in 1991. The purpose of this study was to evaluate the persistence of anti-hepatitis B surface (HBs) antibodies several years after a primary course of vaccination. METHODS: In 2010, anti-HBs titers were measured in all subjects aged between 5 and 25 years residing in a southern Italian town. Individuals with an anti-hepatitis B antibody concentration of 10 IU/ml or more were considered to be protected. RESULTS: Of the 671 subjects evaluated, 149 (30%) lacked protective antibodies. Fifty-three (29.4%) of the subjects had been vaccinated ≤10 years earlier and 96 (30.3%) more than 10 years earlier (P = not significant). Subjects vaccinated in infancy were more likely to lack protective anti-HBs antibodies than subjects vaccinated at 12 years of age, regardless of the years elapsed since immunization. CONCLUSIONS: Most subjects maintained protective antibodies for a considerable number of years after vaccination. Vaccination in adolescence results in more prolonged immunogenicity than vaccination in infancy.
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Anticuerpos contra la Hepatitis B/sangre , Vacunas contra Hepatitis B/inmunología , Hepatitis B/inmunología , Adolescente , Adulto , Niño , Preescolar , Ensayo de Inmunoadsorción Enzimática , Femenino , Hepatitis B/prevención & control , Antígenos del Núcleo de la Hepatitis B/sangre , Antígenos del Núcleo de la Hepatitis B/inmunología , Antígenos de Superficie de la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/inmunología , Vacunas contra Hepatitis B/administración & dosificación , Virus de la Hepatitis B/aislamiento & purificación , Humanos , Italia , Masculino , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVE: We report elevated serum alanine aminotransferase (ALT) levels during pegylated interferon (PEG-IFN)-alpha-2a in a patient with chronic HCV without other clinical manifestations. CASE SUMMARY: A 38-year-old man presented for HCV infection evaluation. Serum aspartate aminotransferase (AST) and ALT levels were 43 and 116 U/l, respectively; RT-PCR blood analysis revealed HCV-RNA infection. PEG-IFN-alpha-2b plus ribavirin treatment induced both a rapid virologic response and a normalization of transaminase plasma levels. During follow-up, an increase in transaminase and HCV-RNA values prompted us to start a new antiviral treatment with PEG-IFN-alpha-2a plus ribavirin. Four months later, after the follow-up, a new blood test documented both a HCV-RNA titer <50 U/ml and an increase in ALT and AST plasma levels. Immunostaining of the liver biopsy showed an accumulation of PEG-IFN-alpha-2a. PEG-IFN-alpha-2a elimination and the addition of recombinant IFN-alpha-2a induced normalization of the plasma transaminase levels in about 2 months. CONCLUSION: We postulate PEG-IFN-alpha-2a treatment because both the molecular weight and the distribution volume of the PEG-IFN may accumulate in the liver resulting in an increase of plasma transaminase levels. In contrast, during PEG-IFN-alpha-2b treatment, we did not document any increase in plasma transaminase values probably because of the lower molecular weight of the PEG.
Asunto(s)
Alanina Transaminasa/sangre , Hepatitis C Crónica/tratamiento farmacológico , Interferón-alfa/efectos adversos , Interferón-alfa/uso terapéutico , Polietilenglicoles/efectos adversos , Adulto , Antivirales/efectos adversos , Antivirales/farmacología , Antivirales/uso terapéutico , Aspartato Aminotransferasas/sangre , Quimioterapia Combinada , Regulación Enzimológica de la Expresión Génica/efectos de los fármacos , Hepacivirus , Hepatitis C Crónica/enzimología , Humanos , Interferón alfa-2 , Interferón-alfa/farmacología , Hígado/efectos de los fármacos , Masculino , Polietilenglicoles/farmacología , Polietilenglicoles/uso terapéutico , Proteínas Recombinantes , Ribavirina/uso terapéuticoRESUMEN
BACKGROUND: Psychological adverse effects in intravenous drug users represent a challenge in the management of anti-HCV therapy. AIMS: To evaluate the depressive symptoms during the first weeks of anti-HCV therapy and to assess their impact on the early virological response and discontinuation of therapy. SUBJECTS: A prospective cohort study of HCV-infected drug addicts on a detoxification program at the onset of therapy with peg-interferon and ribavirin. METHODS: A self-report screening of depression (Center for Epidemiological Studies-Depression Scale) and a questionnaire investigating treatment adherence and the presence of side effects were prospectively administered. RESULTS: The mean baseline Center for Epidemiological Studies-Depression Scale score of the 43 subjects studied was 17.3. This value did not worsen significantly after 4 and 12 weeks of therapy. A higher depressive score at baseline neither significantly affected the early virological response, nor the early treatment discontinuation. Conversely, a higher symptoms score (HR 1.33; 95% CI, 1.02-1.71) was associated with a greater probability of early treatment discontinuation. CONCLUSIONS: A depressive attitude should not be considered a contraindication to the treatment of HCV-infected drug addicts on the detoxification program in which they are monitored by a multidisciplinary team. Effective management of side effects could increase the treatment adherence during the first weeks of therapy and increase the possibility of an early virological response.
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Depresión/epidemiología , Hepatitis C Crónica/epidemiología , Cooperación del Paciente , Abuso de Sustancias por Vía Intravenosa/epidemiología , Abuso de Sustancias por Vía Intravenosa/psicología , Adulto , Antivirales/uso terapéutico , Comorbilidad , Femenino , Humanos , Interferón alfa-2 , Interferón-alfa/uso terapéutico , Masculino , Polietilenglicoles/uso terapéutico , Estudios Prospectivos , Proteínas Recombinantes , Ribavirina/uso terapéutico , Abuso de Sustancias por Vía Intravenosa/tratamiento farmacológicoRESUMEN
We determined whether triple therapy comprising amantadine (AMA), ribavirin (RBV) and either peginterferon (PEG-IFN) alpha-2a or conventional IFN alpha-2a would improve sustained virological response (SVR) rates over dual therapy with IFN alpha-2a and RBV in patients with chronic HCV infection. A total of 362 treatment-naïve patients were randomized to 48 weeks of treatment with: PEG-IFN alpha-2a 180 microg/week (group A) or IFN alpha-2a 3 MU tiw (groups B and C). All patients received RBV 1000 or 1200 mg/day and those in groups A and B received AMA 200 mg/day. SVR was defined as an undetectable HCV RNA after 24 weeks of untreated follow-up. At the end of therapy, 74.4% (95% CI 0.66-0.82) of patients in group A were HCV RNA-negative compared with 42.5% (95% CI 0.33-0.50) of those in group B (P = 0.0001) and 48.8% (95% CI 0.40-0.56) of those in group C. SVR was achieved in a significantly greater proportion of patients in group A compared with groups B and C: 65.3% (95% CI 0.53-0.56), 33.3% (95% CI 0.25-0.41) and 44.6% (95% CI 0.36-0.53; P = 0.0001) respectively. In patients with genotype 1, SVR rates were 55.2, 22.8 and 28.8% with the three regimens respectively. Factors independently associated with SVR were HCV genotype 2 or 3, therapy with PEG-IFN, female gender and age. In treatment-naive patients with chronic hepatitis C, triple therapy with PEG-IFN alpha-2a, RBV and AMA produces higher SVR than dual or triple therapy with conventional IFN alpha-2a.
Asunto(s)
Amantadina/administración & dosificación , Hepacivirus/efectos de los fármacos , Hepatitis C Crónica/tratamiento farmacológico , Interferón-alfa/administración & dosificación , Polietilenglicoles/administración & dosificación , Ribavirina/administración & dosificación , Adolescente , Adulto , Anciano , Amantadina/efectos adversos , Biopsia con Aguja , Distribución de Chi-Cuadrado , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Hepatitis C Crónica/diagnóstico , Humanos , Inmunohistoquímica , Interferón alfa-2 , Interferón-alfa/efectos adversos , Masculino , Persona de Mediana Edad , Polietilenglicoles/efectos adversos , Probabilidad , Estudios Prospectivos , Proteínas Recombinantes , Ribavirina/efectos adversos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Método Simple Ciego , Estadísticas no Paramétricas , Resultado del Tratamiento , Carga ViralRESUMEN
The significance of non-organ specific antibodies (NOSAs) in HCV-related chronic hepatitis is largely unclear. In this study we evaluated the prevalence of NOSAs in a non-selected population of HCV-infected subjects. One hundred and seventy anti-HCV positive and 192 anti-HCV negative sex and age-matched subjects (median age 64 years, range 7-91 years, female 68%) enrolled from the general population of a small Italian town were evaluated for NOSAs by indirect immunofluorescence on rat tissue sections and HEp-2 cells, and by counterimmunoelectrophoresis with thymus and spleen extracts as the antigen source. One hundred and sixty-three (96%) HCV-infected subjects had normal ALT serum levels and no evidence of liver disease. NOSAs were found in 31 out of 170 (18%) anti-HCV positive subjects and in 20 out of 192 (10%) controls (P = NS), with similar median titre (1:40) and range (1:40 to 1:160). Neither liver/kidney microsomal antibody type 1 nor antiactin reactivity were detected. No significant association between NOSAs and HCV genotypes was observed. In the general population, HCV-infected subjects and healthy controls have a similar prevalence of NOSAs. Without continuous liver damage HCV infection is unlikely to induce the appearance of NOSAs.
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Autoanticuerpos/sangre , Hepatitis C Crónica/inmunología , Adolescente , Adulto , Anciano , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Niño , Femenino , Técnica del Anticuerpo Fluorescente Indirecta , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estadísticas no ParamétricasRESUMEN
The characteristics of genotype 4 subtype variability of HCV isolates circulating in Italy were studied. The viral isolates were identified from 736 HCV-RNA positive sera originated from seroepidemiological studies undertaken in 4 different regions of North, South Italy and Sardinia. 24 out of 28 genotype 4 isolates (86%) were classified by phylogenetic analysis of E1 genome region (915-1128) as belonging to subtype 4d (Neighbour Joining Method). Three isolates classified as subtype 4a were detected in haemophilic patients, possibly related to infections from blood products. One isolate classified as a new subtype derived from an Eritrean patient subjected to haemodialysis. Very high genome homogeneity (mean 4.3%) was shown by genetic comparisons (DNA dist programs Phylip Package) for all the 4d isolates relative to the studies performed in Veneto, Calabria and Sardinia and originated from subjects from the general population and outpatients (19 subtype 4d isolates out of 24). In the 3 studies different prevalence rates of HCV genotype 4 (3.1%, 1. 3%, 14% respectively) were found. In contrast a considerable degree of heterogeneity, both intragroup and with the other groups (mean 8. 2% and 8.7%, respectively) was observed among subtype 4d isolates identified in the patients of a haemodialysis centre in Apulia region. In conclusion the subtype 4d of genotype 4 was highly prevalent and endemic in Italy. An elevated level of viral heterogeneity was observed in one study carried out in a region of Southern Italy. This can be related to a longer period of past endemicity of this genotype and to a high level of exposure to reinfections in particular categories of patients such as haemodialysis patients.
Asunto(s)
Hepacivirus/clasificación , Filogenia , ARN Viral/genética , Genotipo , Hepacivirus/genética , Hepacivirus/aislamiento & purificación , Humanos , Italia , Datos de Secuencia Molecular , ARN Viral/sangre , Diálisis Renal , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Análisis de Secuencia de ADNRESUMEN
Vertical transmission is an uncommon route of hepatitis C virus (HCV) infection. Little is known about the way of virus spread between relatives. Furthermore, the nucleotide sequence variability studies that can be used for the definition of cases of HCV transmission still need accurate standardization. In this study, we analyzed the HCV positive sera from subjects belonging to one family. Five out of seven individuals were positive both for anti-HCV and HCV-RNA. The epidemiological data, in our knowledge, excluded the possible risk of parenteral exposure to HCV for the members of the family. The genetic relatedness of the viruses infecting the members of this family was demonstrated by the phylogenetic analysis of sequences from E1 genome region. The analysis included the calculation of the genetic divergence specific index, based on the ratio of synonymous/non-synonymous mutations. By the analysis of this genome region, we demonstrated the occurrence of HCV transmission among family members. In 2 cases out of 3, Mother-to-Infant transmission was demonstrated that involved three generations of the family. Transmission by sexual route was absent. A method of sequence analysis of E1 HCV genome region is proposed as molecular approach for the definition of transmission cases of HCV.
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Hepacivirus/genética , Hepatitis C/virología , Transmisión Vertical de Enfermedad Infecciosa , Proteínas del Envoltorio Viral/genética , Secuencia de Aminoácidos , Secuencia de Bases , ADN Viral , Femenino , Hepacivirus/clasificación , Hepatitis C/transmisión , Humanos , Masculino , Datos de Secuencia Molecular , Linaje , Homología de Secuencia de Aminoácido , Homología de Secuencia de Ácido NucleicoRESUMEN
Hepatitis C virus (HCV) affects millions of individuals worldwide. In most cases, HCV infection progresses to chronic liver disease and, subsequently, to liver cirrhosis and hepatocellular carcinoma. HCV is transmitted by the parenteral route, for example by transfusion of blood or blood products, injection during drug abuse, etc., and by the inapparent parenteral route (penetration of the virus through difficult-to-identify microlesions present on the skin or mucosae), for example, sexual exposure or household exposure to infected contacts, etc. The cost of chronic hepatitis C and its sequelae is high in both financial and human terms. At present, only anti-HCV screening of blood/organ/tissue donors and universal precautions for the prevention of blood-borne infections are recommended for HCV prevention. Before the discovery of the main aetiological agent of non-A, non-B hepatitis (HCV), several randomised controlled clinical trials demonstrated that standard intramuscular immunoglobulin exerted a preventive effect on post-transfusional and sexual and /or horizontal transmission of non-A, non-B hepatitis. When serological tests for HCV infection became available, bimonthly inoculation of standard unscreened intramuscular immunoglobulin (prepared from plasma pools containing about 2% of anti-HCV-positive units) was demonstrated to significantly prevent sexually transmitted HCV infection. The immunoglobulin used contained high titres of anti-HCV neutralising antibodies (anti-E2 neutralisation of binding assay), whereas currently available commercial screened immunoglobulin (prepared from anti-HCV-negative blood units) did not. This finding suggested that anti-HCV neutralising antibodies are concentrated only in anti-HCV-positive units (which are currently discarded). Thus, anti-HCV hyperimmune globulin (HCIg) can be produced only from anti-HCV-positive units. The neutralising titre can be increased by the exclusive use of units with higher titres of neutralising antibodies. Unlike other hyperimmune globulins, which are produced from a limited number of selected donors, HCIg should be produced from a large number of units so as to contain neutralising antibodies to the different HCV strains. HCIg will have a number of advantages: (i) it is easy to produce and inexpensive; (ii) it has a long half-life, allowing infrequent administration; (iii) new additional viral inactivation procedures have been introduced to eradicate transmission of infection, and (iv) it may be possible to neutralise all the emerging HCV strains. HCIg could be used in all individuals at risk of HCV infection (sexual partners, haemodialysis patients, etc), in preventing reinfection of transplanted livers, and perhaps also in the treatment of chronic hepatitis C, alone or associated with other drugs.
RESUMEN
A revision of the polymerase chain reaction (PCR) core procedure was performed for genotyping hepatitis C virus (HCV) in 139 patients from Italy. This procedure, developed prior to the identification of new genotypes, may be inadequate in several geographical areas. We proposed a new typing mixture in which primers for types 2c and 4, that are reported to be circulating in Italy, were added and a primer for type 2b was substituted. Using the modified procedure, 139 HCV-positive patients were analysed. The HCV genotype was identified in 96.4% of the cases. We observed double infections and unclassified genotypes in 5 (3.6%) and 5 (3.6%) patients, respectively. The classification of isolates into genotypes and subtypes 2b, 2c and 4 was confirmed by sequence analysis. Furthermore, the efficiency and accuracy of the modified core procedure were evaluated by parallel testing of 107 out of 139 samples using the line probe assay, and demonstrated a 98.9% degree of concordance. The results demonstrated the specificity of the selected primers for type 2c, 2b and 4 and confirmed the circulation of types 2c and 4 in Italy. In conclusion, the proposed modified PCR procedure is the only primer-specific PCR genotyping method available for identification of the 2c and 4 genotypes reported to be circulated in Italy and other European countries.
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Hepacivirus/clasificación , Hepacivirus/genética , Hepatitis C/virología , Reacción en Cadena de la Polimerasa/métodos , Proteínas del Núcleo Viral/genética , Regiones no Traducidas 5'/genética , Adulto , Secuencia de Bases , Cartilla de ADN , Femenino , Genotipo , Hepacivirus/aislamiento & purificación , Hepatitis C/epidemiología , Humanos , Italia/epidemiología , Masculino , Datos de Secuencia Molecular , Estudios Retrospectivos , Análisis de Secuencia de ADN , Especificidad de la EspecieRESUMEN
To evaluate risk factors associated with intrafamiliar transmission of hepatitis C virus (HCV), 113 hepatitis C virus index subjects with chronic HCV infection and their 267 family contacts were studied from January 1994 to October 1995. Overall, 16 family contacts (6%) were positive for anti-HCV by ELISA II generation. The prevalence was 11.3% in spouses and 2.9% in other relatives (odds ratios: 4.2; 95% CI: 1.4-12.6). Spouses who had been married to the index cases longer than 20 years had a 7.5-fold risk (95% CI: 1.0-336.3) of HCV seropositivity as compared to those married less than 20 years. In univariate analysis HCV seropositivity was associated with surgical intervention, use of glass syringes and hospitalization. The results of multivariate logistic analysis showed that any parenteral exposure (odds ratios: 3.8; 95% CI: 1.2-12.8) and sexual contact with an anti-HCV index case (odds ratios: 3.0; 95% CI: 1.0-9.4) were both independent predictors of HCV seropositivity among household contacts of HCV positive index cases. These findings indicate that sexual contact and any parenteral exposure both play an independent role in the spread of HCV infection in the family setting.
Asunto(s)
Anticuerpos Antivirales/sangre , Salud de la Familia , Hepacivirus/aislamiento & purificación , Hepatitis C/transmisión , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Niño , Preescolar , Intervalos de Confianza , Ensayo de Inmunoadsorción Enzimática , Femenino , Encuestas Epidemiológicas , Hepatitis C/virología , Humanos , Transmisión Vertical de Enfermedad Infecciosa , Italia/epidemiología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Prevalencia , Factores de TiempoRESUMEN
The sexual transmission of hepatitis C virus (HCV) has long been debated. The prevalence of infected at-risk partners varies from 0% to 30%. In a prospective study, the risk of infection was quantified in steady heterosexual partners and the prophylactic effect of normal human polyvalent immune serum globulin (ISG) was evaluated. A total of 899 at-risk partners of HCV-infected patients were enrolled in a single-blind randomized controlled trial and assigned to receive every 2 month 4 mL of intramuscular ISG from unscreened donors (450 partners) or placebo (499 partners). Seven partners developed acute HCV infection (increased aminotransferase levels and appearance of HCV-RNA): six of the placebo group (incidence density [ID] 12.00/1,000 person year; 95% confidence interval [CI] 3.0 to 21.61), and only one of the ISG-treated group (ID 1.98/1,000 person year; 95% CI 0 to 5.86). The risk of infection was significantly higher in controls versus treated individuals (p = 0.03). Six couples had genotype 1b (85%), and one couple had genotype 1a; HCV sequence homology strongly supported sexual transmission. Our trial demonstrates that HCV infection can be sexually transmitted and quantifies the risk of sexual transmission: for every year of at-risk sexual relationship, almost 1% of the partners became infected. Intramuscular ISG is safe and well tolerated. Unlike ISG from screened donors, ISG from donors unscreened for anti-HCV contains high titers of anti-gpE1/gpE2 neutralizing antibodies and high neutralizing activity. Anti-HCV hyperimmune globulin could be prepared from anti-HCV-positive blood units and could be used to protect sexual partners and in other at-risk situations of exposure to HCV infection.
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Hepatitis C/prevención & control , Hepatitis C/transmisión , Inmunoglobulinas/uso terapéutico , Enfermedades Virales de Transmisión Sexual/prevención & control , Adulto , Femenino , Hepatitis C/epidemiología , Heterosexualidad , Humanos , Incidencia , Inyecciones Intramusculares , Italia/epidemiología , Masculino , Prevalencia , Estudios Prospectivos , Enfermedades Virales de Transmisión Sexual/epidemiología , Resultado del TratamientoRESUMEN
In 1996 the prevalence, risk factors, and genotype distribution of hepatitis C virus (HCV) infection were assessed in the general population of a town in southern Italy. The sample was selected from the census by a systematic 1:4 sampling procedure. The participation rate was 96.6%. Among the 1,352 subjects enrolled, 195 (14.4%) tested reactive to antibody to HCV (anti-HCV) with enzyme immunoassay (EIA 3). When further tested with recombinant immunoblot assay (RIBA 3), 170 subjects (87.2%) tested positive, 23 subjects (11.8%) had indeterminate results, and 2 subjects (1%) tested negative. Thus, the overall anti-HCV EIA-positive RIBA-confirmed prevalence was 12.6% (170 of 1,352 subjects) and increased from 1.3% in subjects younger than 30 years to 33.1% in those > or =60 years of age. This latter age group accounted for 72.3% of all anti-HCV-positive subjects. Females tested positive more frequently than males (14.1% vs. 10.5%; P < .05). Alanine transaminase (ALT) concentrations were abnormal in only 4.1% (7/170) of anti-HCV EIA-positive RIBA-confirmed subjects. This suggests that ALT screening is not useful in the detection of anti-HCV-positive subjects in a general population. The results of multiple logistic regression analysis showed that an age of less than 45 years, the use of glass syringes, and dental therapy were all independent predictors of anti-HCV positivity. HCV RNA was detected by polymerase chain reaction in 75.9% of the 195 anti-HCV EIA-positive subjects: in 84.7% (144/170) of the RIBA-confirmed subjects; in 17.4% (4/23) tested as RIBA indeterminate; and in neither of the two subjects who tested RIBA negative. HCV type 1b was detected in 75 subjects (50.7%), type 2b in 1 subject (0.7%), type 2c in 66 subjects (44.6%), type 3a in 4 subjects (2.7%), and type 4 in two subjects (1.3%). These figures differ from those of Italian patients with chronic liver disease in whom genotype 2 is more rare. None of the individuals was infected with more than one genotype. The distribution of the two most common HCV viral types (1b and 2c) was not statistically different in terms of mean age, sex, or risk factors and suggests that they may have had a parallel spread in this community. These findings provide one of the highest overall anti-HCV prevalence rates in a general population with a likely cohort effect, i.e., decreased risk of infection along generations. These observations may indicate an epidemic or focus of hepatitis C that occurred several years earlier. The majority of anti-HCV-positive subjects in the oldest age group and with no clinical evidence suggests that HCV infection is a very prolonged and indolent disease.
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Hepatitis C/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Alanina Transaminasa/sangre , Niño , Femenino , Genotipo , Hepacivirus/clasificación , Anticuerpos contra la Hepatitis C/sangre , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , ARN Viral/análisis , Factores de RiesgoRESUMEN
OBJECTIVE: To estimate the risk of sexual transmission of hepatitis C and to assess the value of prophylaxis with periodic intramuscular immune serum globulin administration. METHODS: Of 1102 steady heterosexual partners of patients with antibodies to the hepatitis C virus (HCV), 899 were enrolled in a single-blind, randomized, controlled trial. All the partners tested negative for antibodies to HCV and had normal baseline serum aminotransferase concentrations. The partners were assigned to receive 4 mL of 16% polyvalent immune serum globulin prepared from unscreened donors every 2 months (n = 450) or a placebo (n = 449). Tests for HCV infection were performed every 4 months. RESULTS: Eight hundred eighty-four partners completed the study. Seven partners became infected with HCV: 6 in the control group (incidence density, 12.00 per 1000 person-years; 95% confidence interval, 3.0 21.61) and 1 in the immune serum globulin group (incidence density, 1.98 per 1000 person-years; 95% confidence interval, 0-5.86). The risk of infection was significantly higher for partners in the control group (P = .03): for each year approximately 1% of the partners became infected. Sequence homology studies strongly suggest the sexual transmission of HCV. All immune serum globulin lots used had high enzyme-linked immunosorbent assay titers of neutralizing antibodies to HCV envelope glycoproteins and high neutralization titers in the neutralization of binding assay. CONCLUSIONS: Hepatitis C can be sexually transmitted. Immune serum globulin prepared from unscreened donors significantly reduced the risk. The treatment was safe and well tolerated. Because only immune serum globulin from unscreened donors (and not from those screened for HCV) contain anti-HCV neutralizing antibodies, hyperimmune anti-HCV immune serum globulin should be prepared from blood testing positive for antibodies to HCV, which is currently discarded.
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Hepatitis C/prevención & control , Hepatitis C/transmisión , Inmunización Pasiva , Enfermedades Virales de Transmisión Sexual/prevención & control , Adulto , Ensayo de Inmunoadsorción Enzimática , Femenino , Glicoproteínas/inmunología , Hepacivirus/genética , Hepatitis C/genética , Hepatitis C/inmunología , Anticuerpos contra la Hepatitis C/sangre , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Riesgo , Enfermedades Virales de Transmisión Sexual/inmunología , Método Simple Ciego , Resultado del Tratamiento , Proteínas del Envoltorio Viral/inmunologíaRESUMEN
BACKGROUND: The level of endemicity and modes of transmission of hepatitis B virus infection may change over time. AIMS: To assess prevalence of and risk factors for hepatitis B infection in the general population. SUBJECTS: A total of 1352 subjects residing in a Southern Italian town in the year 1996. METHODS: Subjects were selected from the census by a systematic 1:4 random sampling procedure. Hepatitis B surface antigen and antibodies to hepatitis B core antigen were detected by ELISA. The association (Odds Ratio) linking hepatitis B seropositivity to potential risk factors was estimated by univariate and multivariate analysis. RESULTS: The participation rate was 96.6%. The overall prevalence of hepatitis B surface antigen and antibodies to hepatitis B core antigen were 0.8% and 21.5%, respectively. Hepatitis B surface antigen prevalence was 0.2% in subjects younger than 30 years, peaked to 2.5% in the age-group 40-49 years, and decreased to 0.3% in those 60 years and older. Antibodies to hepatitis B core antigen positivity linearly increased from 6.2% in subjects < 30 years of age to 37.1% in those 60 years or older (p < 0.01). The results of multiple logistic regression analysis showed that age > 45 years (Odds Ratio = 1.9; Confidence Intervals 95% = 1.2-3.0), use of glass syringes (Odds Ratio = 2.2; Confidence Intervals 95% = 1.5-3.4), surgical intervention (Odds Ratios = 1.8; Confidence Intervals: 95% = 1.3-2.6), and positivity for antibodies to hepatitis C virus infection (Odds Ratios = 2.6; Confidence Intervals 95% = 1.5-4.3) were all independent predictors of the likelihood of hepatitis B positivity. CONCLUSIONS: Given that a significant proportion of the general population undergoes surgical intervention, the association found between hepatitis B positivity and this exposure highlights the importance of further developing efficient procedures for the sterilization of instruments as well as the use of disposable materials to control the spread of infection.
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Hepatitis B/epidemiología , Adulto , Anticuerpos contra la Hepatitis B/análisis , Antígenos del Núcleo de la Hepatitis B/inmunología , Antígenos de Superficie de la Hepatitis B/análisis , Humanos , Italia/epidemiología , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Estudios SeroepidemiológicosRESUMEN
Pseudouridine is a modified nucleoside derived from RNA catabolism; the concentration of this nucleoside is elevated in body fluids of both tumour-bearing and human immunodeficiency virus (HIV) infected patients. We used an HPLC procedure to evaluate the serum pseudouridine concentration in patients with chronic hepatitis C in an attempt to determine whether the nucleoside serum concentration was related to the response to alpha-interferon treatment. We found that: a) pseudouridine serum concentration was increased significantly in 76% (29/39) of patients with chronic hepatitis C at the time of diagnosis and before any therapeutic treatment; b) pseudouridine excretion was higher in patients affected by chronic hepatitis C with cirrhosis; c) there was a positive correlation between response to therapy and pseudouridine serum concentration in patients undergoing treatment with alpha-interferon; d) during one year of alpha-interferon treatment, the pseudouridine serum concentration remained within the normal range in responder patients. These results indicate that serum pseudouridine might be useful as a valuable biochemical marker with which to monitor chronic hepatitis C patients treated with alpha-interferon.
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Hepatitis C/terapia , Interferón-alfa/uso terapéutico , Seudouridina/análisis , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Enfermedad Crónica , Monitoreo de Drogas , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The present work describes the distribution of HCV genotypes in Calabria. The data presented suggest that, in the sample of population investigated, genotype 1b is the most prevalent followed by the 2b and the 2a.. In addition it is important to note that in Calabria the prevalence of genotype 1b is strikingly high in respect to the other Italian pullulation. An Association between HCV type 1b and the more severe clinical course of the liver disease has been reported. Although the data presented indicate that in Calabria most of the subjects enrolled in the study are infected by a virulent HCV strain, no association has been found with more severe clinical manifestations.
Asunto(s)
Hepacivirus/genética , Hepatitis C/epidemiología , Hepatitis Crónica/epidemiología , ARN Viral/química , Adulto , Factores de Edad , Anciano , Femenino , Hepacivirus/aislamiento & purificación , Hepatitis C/virología , Hepatitis Crónica/virología , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Fenotipo , Reacción en Cadena de la Polimerasa , Prevalencia , Factores de RiesgoAsunto(s)
Relación CD4-CD8 , Hepatitis C/terapia , Hepatitis Crónica/terapia , Interferón-alfa/uso terapéutico , Adulto , Anciano , Femenino , Hepatitis C/inmunología , Hepatitis Crónica/inmunología , Humanos , Interferón alfa-2 , Masculino , Persona de Mediana Edad , Pronóstico , Proteínas Recombinantes , Subgrupos de Linfocitos T/inmunologíaRESUMEN
The purpose of this study was to analyze the relationship between intravenous (i.v) drug use practices and the prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) in 146 heterosexual male i.v. drug users (IVDUs) attending a methadone-maintainance treatment program in Catanzaro, Southern Italy. One hundred and forty-six heterosexual male IVDUs attending a methadone-maintainance treatment program in Catanzaro were interviewed in order to obtain the following information: age, number of drug injections (calculated by multiplying the mean number of daily injections by 365 and then by the number of years of injections), number of injection equipment-sharing partners in the last year, number of sexual partners in the last year and possible IV cocaine use. Their sera were studied for the presence of antibodies to HIV, HBV and HCV by commercial enzyme-linked-immuno-sorbent assays run in duplicate. HIV positive samples were confirmed by Western Blot assay. Sixteen per cent of IVDUs were anti-HIV positive, 40% were anti-HBc positive and 68% were anti-HCV positive. Twenty-three per cent were seronegative and 12% were seropositive for all 3 viral markers. Multiple logistic analysis of HIV, HBV and HCV seropositivities in relation to age, number of drug injections, i.v. cocaine use and presence of injection equipment-sharing partners in the last year, showed that: a) older age (more than 27 years) was significantly associated with all 3 viral infections (mainly with HIV); b) i.v. cocaine use was associated with HBV, but even more with HIV; c) injection equipment-sharing partners in the last year was directly associated with HCV and inversely with HIV. No significant association was observed with the number of drug injections and the number of sexual partners. In conclusion, this study: a) demonstrates a difference of prevalence for HIV, HBV and HCV serum markers in this group of IVDUs from Catanzaro, Southern Italy; b) underlines the importance of i.v. cocaine use in the spreading of HIV; c) emphasizes the need of preventive strategies.