Feasibility of vaccination in preventing secondary cases of hepatitis A virus infection.

Although the secondary transmission of hepatitis A virus (HAV) infection is preventable through vaccination, it is not known whether the vaccination of household contacts is feasible. To this end, we conducted a prospective cohort study among the household contacts, 40 years of age or less, of all persons infected with primary HAV infection (index cases) and admitted to eight hospitals in southern Italy within 7 days of onset. Household contacts were vaccinated, and serum samples were taken at vaccination and after 14 and 45 days. Secondary cases were defined as those with IgM seroconversion occurring at least two weeks after enrollment. Coprimary cases were those assumed to have had the same exposure as the index case. Susceptible cases were those who were negative for both IgG and IgM. A total of 495 household contacts participated (acceptance rate of 65%); 65% were vaccinated within 4 days of admission of the index case and 95% within 7 days. At enrollment, 196 (39.6%) household contacts were immune (IgG-positive serum). During follow-up, 19 (3.8%) were IgM-positive: 13 (2.6%) were coprimary cases and 6 (1.2%; 95% CI: 0.2-3.2) secondary cases (5 identified at 14 days from vaccination and 1 at 45 days). Of the 241 susceptible cases, 192 (79.7%) had developed IgG antibodies at 14 days and only 3 (1.2%) did not develop IgG antibodies at 45 days. The 65% acceptance rate and the finding that 95% of the participating household contacts were vaccinated within 7 days of the index case's hospitalization indicate that timely vaccination is indeed feasible. The necessity of returning for the collection of blood samples probably decreased the acceptance rate.

Pilot study of a short course of ribavirin and alpha interferon in the treatment of chronic active hepatitis C not responding to alpha-interferon alone.

Chronic active hepatitis due to HCV represents a severe progressive disorder of the liver, At present, Interferon seems to be the most efficacious treatment available, however, only 20-25% of the patients treated achieve complete remission. The efficacy has, therefore, been evaluated of Ribavirin, a nucleoside analogue active both on DNA and RNA viruses, in the treatment of non responders to a previous course of interferon. Twenty patients were randomly assigned to two groups: A) received the association R (800 mg/day for 2 months)+interferon (9 Mu/week for 6 months); B) received IFN (9 Mu/week for 6 months). All patients completed the study without important side effects. Four patients in group A presented reduced ALT and loss of viraemia during treatment with Ribavirin. Only one patient in group B had reduced indices of cell lysis and was negative for HCV-RNA during the course of the study. However, viremia and an increase of ALT values were observed in all of these subjects once treatment was interrupted. The results emerging from this study indicate that Ribavirin therapy, at the dose and duration of treatment employed, is not sufficient to change the natural course of events of chronic active hepatitis from HCV.

Ultrasound monitoring of alcholic liver steatosis during glutathione (GSH) treatment.

In addition to clinical and laboratory alterations, the ultrasound picture in patients with liver steatosis may be quite clearly and closely connected to the histological aspects of this disease. Moreover, these patients have been found to have a reduced hepatocytic and plasmatic glutathione (GSH) level and consequently a reduced liver detoxicating capacity. The aim of this study was to evaluate the therapeutic action of exogenous GSH and its positive modifying role, not only in hepatic function indices (transaminase - GT), but also in the ultrasound picture, in a group of alcholic subjects suffering from carying levels of hepatic steatosis.

Sexual transmission of hepatitis C virus infection.

The role of sexual transmission in the diffusion of HCV infection, was studied through the seroprevalence of anti-HCV antibodies in the heterosexual habitual partners of 83 anti-HCV positive subjects. The index cases were represented by 10 dialysed subjects, 31 patients with chronic liver disease and 42 healthy carriers. Seroprevalence of anti-HCV positivity reported in partners was 8.43%, with a higher rate in cohabitants of patients with chronic liver disease (16.12% vs 4.76% of carriers); no case was found among partners of dialysed subjects Laboratory and ultrasonograph signs of chronic hepatitis were reported in 3 cases (3.61%). Control on 70% of the cohabitants' relatives, was negative for HCV infections. These data suggest a possible sexual transmission of HCV infection, even if its prevalence resulted modest, undoubtedly lower than in other disease sexually transmitted.

[Glutathione in the treatment of chronic fatty liver diseases]. / Il glutatione nella terapia delle epatopatie croniche steatosiche.

In chronic steatosic liver disease, alcohol or non-alcohol related or HBV, HCV, HDV associated, a reduction in hepatic glutathione and, consequently, in the detoxifying effects of hepatocytes is observed. Intravenous administration of high dose glutathione in patients with chronic steatosic liver disease has shown that glutathione significantly improves the rate of some hepatic tests (bilirubin, GOT, GPT, GT) even several months after treatment interruption. Further confirmation of the efficacy of GSH treatment is provided by the reduction of malondialdehyde, a marker of hepatic cell damage. The optimal results obtained in patients receiving 1800 mg/die/i.v. advocate the use of this high dosage.

Treatment with ribavirin+alpha interferon in HCV chronic active hepatitis non-responders to interferon alone: preliminary results.

Alpha interferon (IFN-alpha) represents the best therapy for HCV active chronic hepatitis, but only 25% of treated patients achieve a complete recovery. Several attempts have been made to increase this percentage. The objective of our study is to verify whether the combination ribavirin (R)+ IFN-alpha can lead to positive results in non-responders to treatment with IFN-alpha alone. The preliminary results for 5 subjects, all non-responders to IFN, treated with R+ IFN for 60 days and then IFN alone for 4 months more show that during the R+IFN treatment, 2 subjects presented a reduction in transaminase; a month after the suspension of R, ALT returned to pre-treatment values. The results are preliminary but we can say that this combination in the proposed doses and times in these subjects, cannot be considered adequate to modify the natural course of this disease.

HCV infections in dialysis patients.

HCV is seen as an emergent problem in Dialysis Units; in fact, the patients of these centers are at high risk for blood-transmitted infections, through coming microepidemies. For this reason and using the same method, we have studied the prevalence of anti-HCV and virus-derived hepatitis in a dialytic population of 105 patients. The prevalence of anti-HCV was 25.71%.