Antonio Macor

Long-Term Follow-Up of Previous Hepatitis C Virus Positive Nonresponders to Interferon Monotherapy Successfully Retreated with Combination Therapy: Are They Really Cured?

OBJECTIVES:To evaluate whether in chronic hepatitis C-positive patients who failed to respond to interferon (IFN) monotherapy a sustained response obtained with retreatment using the combination therapy of IFN + ribavirin can be safely considered to reflect eradication of the infection.METHODS:Prospective follow-up of a cohort of 97 patients who responded to retreatment with different regimens of IFN + ribavirin after failing to respond to a first IFN monotherapy course. The patients were followed throughout 7 yr of follow-up with determinations of HCV viremia every 6 months.RESULTS:At the end of the follow-up, 11 patients (11.3%) showed a viremic reappearance. HCV late relapse rates were 0%, 13%, 20%, and 12% in patients retreated, respectively, with 3 MU IFN + ribavirin for 12 months (Group 1), 5 MU IFN + ribavirin for 12 months (Group 2), 3 MU IFN + ribavirin for 6 months (Group 3), and 5 MU IFN + ribavirin for 6 months (Group 4) (Group 2 vs Group 3, p = 0.005).The virologic relapses occurred within 2 yr from therapy withdrawal. Among patients with genotype 1 and 4, the long-term response was significantly higher in Group 2 than in Group 3 (15% vs 3%, p = 0.03). In patients with genotype 2 and 3, the long-term virological response was not affected by the different regimens.CONCLUSIONS:Nonresponders to IFN monotherapy who achieve a sustained virologic response after retreatment with IFN + ribavirin stand a discrete risk of HCV reactivation within 2 yr after therapy.

Clinical and microscopical features of small-intestinal microsporidiosis in patients with AIDS.

SummaryIntestinal microsporidiosis byEnterocytozoon bieneusi is an increasingly recognized infection in AIDS patients. We report eight cases of microsporidiosis. All patients were severely immunodepressed. Clinical features were highly variable. Patients were followed up for a mean period of 7.8 months. All patients had persistent infection during the follow-up and spore excretion remained constant. Two patients became asymptomatic during the follow-up. None of the patients presented clinical and echographic signs of biliary involvement. Treatment with albendazole, metronidazole or paromomycin failed to produce a durable clinical response or to eradicate the organism. Cases were identified by stool examination and additionally investigated with light and electron microscopy. It was found that light microscopy was a sensitive method, while electron microscopy was less sensitive but allowed the definition of the infecting species. The modified trichrome stain was a satisfactory method for diagnosis on fecal smears. The calcofluor stain and the combination of DAPI with calcofluor was a rapid and simple staining method for screening.ZusammenfassungBei AIDS-Patienten werden mit zunehmender Häufigkeit Fälle von intestinaler Mikrosporidiose durchEnterocytozoon bineusi beobachtet. Wir berichten über 11 Mikrospordiosefälle. Bei allen Patienten bestand eine schwere Immundefizienz. Die klinische Symptomatik war sehr variabel. Die Patienten wurden im Mittel 7,8 Monate lang beobachtet. Alle Patienten hatten während der Beobachtungszeit eine persistierende Infektion und die Exkretion der Sporen blieb konstant. Zwei Patienten wurden während der Beobachtungszeit asymptomatisch. Bei keinem der Patienten bestanden klinische oder sonographische Zeichen für eine Beteiligung der Gallenwege. Die Therapie mit Albendazol, Metronidazol oder Paromomycin führte nicht zu einer bleibenden klinischen Besserung oder Erregereradikation. Die Diagnostik erfolgte durch Stuhluntersuchung unter Anwendung von Licht- und Elektronenmikroskopie. Die Lichtmikroskopie erwies sich als empfindliche Methode. Die Elektronenmikroskopie war weniger empfindlich, erlaubte jedoch die Spezifizierung des Erregers. Eine modifizierte Trichrom-Färbemethode war für die Beurteilung von Stuhlausstrichen brauchbar. Die Calcofluor-Färbung und die Kombination von DAPI mit Calcofluor erlaubte eine rasche und einfache Beurteilung für das Screening.

A randomised 4-arm multicentre study of interferon alfa-2b plus ribavirin in the treatment of patients with chronic hepatitis C not responding to interferon alone

GIORGIO SARACCO,1 ALESSIA CIANCIO,1 ALDA OLIVERO,1 ANTONINA SMEDILE,1 LUIGI ROFFI,2 GUIDO CROCE,3 COSIMO COLLETTA,4 GIUSEPPE CARITI,5 MASSIMO ANDREONI,6 ALBERTO BIGLINO,7 GUIDO CALLERI,8 GIOVANNI MAGGI,9 GIAN FRANCO TAPPERO,10 PIER GIULIO ORSI,11 NATALIA TERRENI,12 ANTONIO MACOR,13 ANGELO DI NAPOLI,14 ENRICO RINALDI,15 GIOVANNINO CICCONE,16 AND MARIO RIZZETTO1 FOR THE NORTH WEST ITALIAN HEPATOLOGIC GROUP