Camelia Sultana

Serum iron markers in patients with chronic hepatitis C infection.

Background Patients with chronic hepatitis C (CHC) often have elevated serum iron markers, which may worsen liver injury. Objectives The aim of this study was to investigate the possible correlations between iron metabolism serum markers, HCV viral load, and liver disease severity in treatment-naive patients with chronic hepatitis C infection. Patients and Methods Eighty five patients with untreated hepatitis C chronic infection were investigated. Results Twenty one patients (24.7%) had elevated serum iron levels, and 29 subjects (34.1%) had severe liver fibrosis. Significantly elevated levels of serum iron (P < 0.05) and ferritin (P < 0.001), associated with lower levels of TIBC (P < 0.05) were detected in patients with severe fibrosis compared to no/mild fibrosis. Severe necroinflammatory activity was also significantly correlated with serum iron (P < 0.001), TIBC (P < 0.05), and ferritin levels (P < 0.001). Using multiple linear regression analysis, serum levels of ferritin and transferrin were the independent variables selected as being good predictors for advanced fibrosis and severe necroinflammatory activity. No significant correlations were detected between HCV viral load and iron markers. Conclusions This study revealed that serum iron markers (especially ferritin and transferrin) might be used as surrogate markers for both liver fibrosis and necroinflammatory activity.Patients with chronic hepatitis C (CHC) often have elevated serum iron markers, which may worsen liver injury.

HEPATITIS C VIRUS GENOTYPES IN INJECTING DRUG USERS FROM ROMANIA.

Due to the increasing number of infections related to injecting drug use, both the pattern of hepatitis C virus (HCV) transmission, and the circulating genotypes in Europe have changed. As there are little available data in this respect for Romania, the aim of our study was a preliminary analysis of the distribution of HCV genotypes circulating among injecting drug users (IDUs). Of the 45 IDUs evaluated (86.7% men, mean age − 27.6 ± 3.7 years, mean age at first drug use − 17.5 ± 3.9 years), 88.9% presented anti-HCV antibodies, with higher rates in those with an injecting history of more than 10 years; 57.8% of the subjects had detectable HCV viral load. Only 6.7% had markers of chronic hepatitis B infection, and none had anti-HIV antibodies. While HCV subtype 1b is still prevalent (in 50% of the viraemic subjects), other subtypes begin to emerge, especially in younger patients (1a — in 23.1%, 4 — in 11.5%, 3a — in 7.7% of the cases). These data indicate the possibility of major shifts in the distribution of the dominant subtype, underlining the need for close surveillance of HCV infections in IDUs, who can act as a bridging group toward the general population.

Optimizing donor selection in order to establish a cord blood banking facility: maternal and obstetric factors impact

In this study, we analyzed the obstetric factors affecting total nucleated cells (TNC) content of cord blood units to establish the criteria for umbilical cord blood (UCB) donor selection in our geographic area.UCB was collected from normal uncomplicated pregnancies. In every case, following data were recorded: (1) gestation length; (2) type of delivery (cesarean or vaginal); and (3) newborn characteristics: weight and sex. For each sample, TNC content, percentage and number of CD34+ cells, and viability were analyzed.The results showed that TNC content increases with cord blood volume, gestational length and newborn weight. The mean blood volume and the mean TNC per unit were 42.37 ± 13.5 ml and 55.49 ± 19.4 × 107, respectively. Stepwise regression analysis revealed a positive and significant correlation (r= 0.89) between these two variables. Meanwhile the CD34+ cell content remains unchanged in deliveries at 32–40 weeks of gestation. The mean CD34+ percentage obtained was 0.37 ± 0.06, and the total number of CD34+ cells was 4.827 ± 0.8204 × 104 / mL UCB.Concluding, the maternal and obstetric factors have a significant impact on UCB cell quantity and quality. The main criteria for UCB collection and storage resulted to be: a gestational age higher than 36–40 weeks and newborn weight > 3200g; gestation number ≤ 2 and placental weight > 700g can be added to the standard criteria to improve the bank efficiency. Our results have also become helpful in evaluating stored UCB units to establish the adequacy for clinical transplant utilization.

Predictors of Chronic Hepatitis C Evolution in HIV Co-Infected Patients From Romania

Background Due to a recent alarming increase in the number of HIV-HCV co-infected patients in Romania. Objectives A cross sectional study was conducted to assess the baseline predictors of liver disease evolution. Patients and Methods 83 HIV-HCV co-infected patients, untreated for HCV infection, were evaluated for viral replication, liver fibrosis (estimated by a noninvasive marker - FIB4), and plasma levels of IP-10 (interferon-gamma inducible protein 10) - a cytokine associated with an unfavorable outcome of HCV infection. Results The median value for HCV viral load was high (6.3 log10 IU/mL), 98.8% of the patients were infected with HCV genotype 1. Although 53% of the patients received antiretroviral therapy (cART), only 31.8% of these achieved undetectable HIV levels. HCV viral load was significantly higher in patients with AIDS (6.4 vs. 6.1 log10IU/mL; P = 0.04), and in those naïve for cART (6.5 vs. 5.9 log10 IU/mL; P = 0.04). Severe fibrosis was directly correlated with immunosupression (56% vs. 17.4%, P = 0.03), HCV replication (6.1 vs. 4.9 log10IU/mL P = 0.008), and IP-10 median values (312 vs. 139 pg/ml, P=0.008). A serum IP-10 level higher than 400 pg/mL was significantly associated with FIB-4 median values (4.09 vs. 1.7, P = 0.004), HCV viral load (6.4 vs. 6.1 log10 IU/mL, P = 0.02) and ALT level (206.8 vs. 112.4 IU/L, P = 0.05). Conclusions An important part of the HIV-HCV co-infected patients had negative baseline predictors for the evolution of HCV infection; their therapeutical management must be conducted with special attention towards adherence and potential overlapping drug toxicities. High concentrations of plasma IP-10 are reliable markers for the severity of liver disease.

HCV non-1b genotypes in injecting drug users from Romania

INTRODUCTION Chronic hepatitis C cases diagnosed in Romania were mostly related to unsafe parenteral treatments and blood transfusions; HCV genotype 1b was prevalent. During the last decade, an increasing number of HCV infections was reported among people who inject drugs (PWID). The aim of the current study was to test if this epidemiological shift triggered a diversification of the circulating viral strains. METHODOLOGY HCV genotypes were determined by reverse hybridization in 130 HCV-infected PWID (87.7% males; mean age 27.9 ± 6.7 years, injecting drugs for 8.1 ± 4.8 years). RESULTS HIV-HCV co-infection was diagnosed in 80.8% of the subjects and 26.9% were HIV-HCV-HBV triple infected. Active HCV viral replication was present in 104 PWID (80%), more frequently in those HIV-co-infected (91.4% vs. 52% in HCV mono-infected, and 77.148.5% in HIV-HCV-HBV triple-infected, p = 0.0001). Non-1b genotypes were prevalent (54.8%), with subtype 1a the most commonly detected (24%), followed by genotypes 3a (14.4%) and 4 (7.7%). Mixed infections with genotypes 1a and 1b were found in nine subjects (8.7%). There was no difference in the genotypes frequencies based on HIV or HBV co-infection status, length of drug usage, or associated risk factors (tattoos, piercing, detention). CONCLUSION The continuous surveillance of HCV genotypes in PWID from Romania will add valuable information to the overall European epidemiological picture, with important therapeutic implications.

Are HIV, HBV and HCV Voluntary Counseling and Testing Programs Needed in Balkans?

In Romania, as in other Balkan countries with a similar epidemiological background, there is a significant community demand for integrated health programs. Implementation of voluntary counseling and testing can complete the overall regional epidemiological picture and concurrently raise awareness about the importance of early detection of infections.

Analysis of transmitted drug resistance, resistance mutations and future antiretroviral efficacy in HIV-1 subtype F infected-patients prior to therapy

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK

Development of drug resistance among HIV-1 F1 sub-type patients with treatment failure

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK

HIV lamivudine resistance mutations in HBV co-infected Romanian patients

Purpose of the study Previous studies of our team have shown that Romanian teenagers horizontally infected with HIV in early childhood, have a high prevalence of HBV co-infection (78.3% being anti-HBc positive vs. 21.8% of age-matched HIVnegative controls). Our aim was to investigate the frequency of mutations and variables potentially associated with an increased risk of liver disease evolution in HIV/ HBV co-infected individuals receiving 2NRTI + 1PI boosted with ritonavir.