Astrid Scalori

HCV genotypes in Northern Italy: a survey of 1368 histologically proven chronic hepatitis C patients

BACKGROUND/AIMS Hepatitis C virus (HCV) easily undergoes genomic changes, thus accounting for the presence of different genotypes, with different geographic distributions and different outcomes of chronic hepatitis. Type 1b is frequently found in advanced diseases; however, since this genotype is the most prevalent in older patients, the association with advanced age and severity of the disease is confounding. The aim of this study was to assess changes in the prevalence of HCV genotypes by surveying a large population of chronic hepatitis C patients in Northern Italy, and to assess if the high prevalence of genotype 1b in older patients with advanced diseases simply reflects the duration of HCV infection, rather than intrinsic biological properties of HCV. METHODS We studied 1368 HCV-RNA positive patients, with histologically proven chronic hepatitis. Drug addiction, blood transfusions and sporadically acquired infections represented the risk factors. RESULTS Genotype 1b, the most prevalent isolate, and genotype 2a were associated with older age, cirrhosis, sporadically-acquired infections and blood transfusion, while types 1a, 3a, and 4 were associated with younger age, chronic persistent hepatitis and drug addiction. Patients with a history of transfusions were divided into four groups depending on the period of transfusion. The prevalence of genotype 1b decreased with time. Type 3a appeared only after 1979. CONCLUSION The severity of chronic hepatitis C could be related more to the duration of the infection rather than to the intrinsic pathogenicity of HCV genotypes.

Depression during interferon therapy for chronic viral hepatitis : early identification of patients at risk by means of a computerized test

Objectives At the doses used for the treatment of chronic viral hepatitis, interferon (IFN)‐related side‐effects are usually modest, even though in some cases they require the interruption of therapy. Neuropsychiatric disturbances that range from modest depression and irritability to forms of manic‐depressive psychosis and attempted or successful suicides are among the most important sideeffects. The aim of our study was to determine whether the Minnesota Multiphasic Personality Inventory (MMPI) is a sensitive and reliable test for the early identification of patients at risk of depression before IFN therapy is commenced, and whether it could be useful for the monitoring of these patients during treatment. Methods We prospectively studied 67 patients with chronic active liver diseases, consecutively enrolled in open studies and treated with r‐IFN&agr;2. Before starting therapy and after 3 months of treatment, all patients underwent a clinical neurological evaluation and MMPI. Results At baseline, the correlation between the clinical evaluation and the score of the depression scale of the MMPI was statistically significant (P < 0.0001). Nine of 14 (64.3%) patients with a baseline score ⩾ 60/100 showed a depressive mood after 3 months of therapy. Five of 44 patients (11.3%) with a baseline score < 60/100 showed a depression of medium level after 3 months of treatment. This difference was highly significant (P < 0.0001). Conclusions According to our results, the MMPI is a reliable and sensitive test for the early identification of patients at risk of depression before and during IFN therapy for chronic viral liver diseases. Eur J Gastroenterol Hepatol 12:505‐509

Outcome of liver disease in a large cohort of histologically proven chronic hepatitis C : Influence of HCV genotype

Objective To assess the influence of hepatitis C virus (HCV) genotypes on the clinical outcome of liver disease, we analysed 2307 patients. Results The most frequently represented genotypes were 1b (40%) and 2 (28.1%). Patients with these genotypes had a median age higher than patients with other genotypes (P < 0.01). The overall survival of subjects with genotype 1b was poorer than the survival of patients with other genotypes (P < 0.01). Liver cirrhosis was found in 280 patients (12.1%), and type 1b was the most represented isolate among them (P < 0.01). Sixty-two patients (22%) developed hepatocellular carcinoma (HCC) during a follow-up of 1481.8 cumulative years (estimated crude incidence rate, 4.1 cases per 100 person-years for all cirrhotics; 5.9 cases for genotype 1a; 4.5 cases for genotype 1b; and 2.8 cases for genotypes non-1). Considering the whole population of 2307 patients, only genotype 1b was associated significantly with both cirrhosis and the development of HCC. One hundred and nineteen cirrhotic patients underwent treatment with interferon in uncontrolled studies. Interferon therapy was associated with both better survival (P < 0.01) and a lower cumulative hazard for HCC (P < 0.01). Conclusions Genotype 1b was associated with a poorer prognosis, probably because it leads to cirrhosis and consequently to HCC development. However, our data did not confirm genotype 1b as an independent risk factor for HCC in liver cirrhosis, which plays a major role in carcinogenesis. Interferon should be considered as a useful strategy in cirrhosis for improvement of survival and reduction of HCC risk.

Risk factors for focal nodular hyperplasia of the liver: an Italian case-control study

OBJECTIVES:Risk factors for focal nodular hyperplasia (FNH) of the liver are largely unknown, except for a possible role of female hormones. We evaluated the role of tobacco smoking and some lifestyle and dietary factors in its etiology.METHODS:A hospital-based case-control study was conducted in Italy between January, 1999 and February, 2000 on 28 patients with histologically confirmed FNH of the liver and 115 controls in the hospital for acute, nonneoplastic, non-liver related diseases. Odds ratios (OR) and 95% confidence intervals (CI) were computed using multiple logistic regression equations.RESULTS:Compared to those who never smoked the multivariate ORs were 1.9 (95% CI = 0.6–6.0) in ex-smokers and 3.5 (95% CI = 1.2–9.7) in current smokers, and the risk increased with number of cigarettes smoked to 8.0 (95% CI = 1.7–37.4) for ≥20 cigarettes/day. Intake of whole-grain foods was inversely related to risk, with an OR of 0.3 (95% CI = 0.1–0.7) in consumers versus nonconsumers. No significant association was observed with education, alcohol drinking, and selected indicator foods.CONCLUSIONS:This study indicates that cigarette smoking is an indicator of elevated risk for FNH of the liver, whereas whole grain and, possibly, vegetable intake seems to be a favorable indicator.

HCV Genotypes and Breakthrough in Patients Treated With Recombinant Alpha Interferon

have positive immunohistochemical stains for somatostatin. With rare exception (6), these carcinoids appear to be pure somatostatinomas, especially when associated with psammoma bodies on histological sectioning. We have reported a similar case (7). It would be of interest to know whether the authors performed immunohistochemical stains for somatostatin on tissue from their patient reported herein or others from their institution reported elsewhere (3).