Davide Pulvirenti

Controlled clinical trial to assess the response of recent heroin abusers with Chronic hepatitis C virus infection to treatment with interferon alpha-n2b

BACKGROUND Chronic infection with hepatitis C virus (HCV) is the most common infectious disease among heroin abusers, but it is recommended that specific treatment with interferon be delayed until at least 6 to 12 months after the end of drug addiction. OBJECTIVE We investigated the response of heroin abusers to interferon treatment shortly after the end of detoxification treatment with methadone. METHODS We studied 2 homogeneous groups of white Italian patients with chronic HCV infection: former male heroin abusers and males without a history of drug addiction. Tumor necrosis factor, interleukin-1beta, interleukin-2, activated monocytes, anti-HCV antibodies, HCV RNA, and alanine aminotransferase levels were assessed. Standard treatment was initiated with 5 MU interferon alpha-n2b administered subcutaneously once daily for 8 weeks. Patients with negative HCV-RNA findings at the end of 8 weeks received further treatment with 5 MU TIW subcutaneously for an additional 48 weeks. RESULTS Thirty of 47 patients in group A (former heroin abusers) and 30 of 30 patients in group B (controls) completed the study. Heroin abusers presented a significantly enhanced response to treatment compared with the controls. After 8 weeks, HCV-RNA test results were negative in 27 of 30 patients in group A (90.0%) and in 25 of 30 in group B (83.3%) (P = NS). Onset of relapse occurred significantly later in heroin abusers (mean [SD], 53 [3] weeks) than in controls (26 [2] weeks) (P < 0.05). Cytokine levels and activated CD11 antigen-expressing monocytes were significantly (P < 0.001) higher in heroin abusers than controls. CONCLUSION Heroin abusers with chronic HCV infection were successfully treated with interferon alpha-n2b soon after the end of detoxification treatment.

Psychiatric Symptoms Induced by Antiviral Therapy in Chronic Hepatitis C

AbstractBackground and objective: Interferon-α treatment is associated with a large number of adverse effects. Depressive symptoms are not unexpected, and potentially dangerous psychiatric adverse effects can induce life-threatening conditions. We compared the incidence of depressive symptoms in patients with chronic hepatitis C during treatment with pegylated interferon-α-2a (IFNα-2a) and pegylated interferon-α-2b (IFNα-2b). Patients and design: We randomly divided 186 subjects with chronic hepatitis C into two treatment groups: group A, treated with IFNα-2a, and group B, treated with IFNα-2b. Treatment was continued for up to 48 weeks. Liver biopsy and hepatitis C virus RNA assay were carried out in all patients. Depressive symptoms and the prevalence of psychiatric adverse effects during treatment with IFN were evaluated using the Hamilton Depression Rating Scale, the Zung Self-Rating Depression Scale, and the Structured Clinical Interview for Diagnostic and Statistic Manual-IV axis disorders. Results: At baseline 53% of subjects in group A and 57% of subjects in group B presented with depressive symptoms; at 12 weeks we found a high incidence of depressive symptoms in both groups (group A 61% and group B 65%) and three cases of life-threatening psychiatric symptoms (i.e. psychosis and delirium requiring discontinuation of antiviral therapy and admission to a psychiatric unit) in group A. Conclusions: Long-term administration of IFN can be associated with serious psychiatric adverse effects. It is very important that psychiatric symptoms are diagnosed early in IFN treatment so to improve treatment compliance and prevent fatal and/or life-threatening adverse events, as were documented in some subjects treated with IFNα-2a in our study.

Can ultrasonographic findings of perihepatic lymphadenopathy promote investigations to detect possible presence of virus C infection in non-symptomatic subjects?

PURPOSE: Only early detection of non-symptomatic patients is able to arrest the diffusion of the non-symptomatic HCV infection and lead to prompt treatment. Our aim was to attempt to correlate the presence of perihepatic lymph nodes and hepatitis C infection and to assess whether ultrasonography can have a role to promote specific investigations for pre-clinical diagnosis of virus C infection. METHOD: We performed a controlled study on a cohort of 7974 subjects from a town of 27000 inhabitants on the eastern coast of Sicily. Serologic hepatitis A, B and C markers, alanine aminotransferase levels and abdominal ultrasound examination according to size and number of peri-hepatic lymph nodes were performed on blind basis. RESULTS: One or more pathological lymph nodes were present in 684/7974 subjects. Haematochemical tests revealed the presence of anti-HCV positivity in 528/684 subjects with pathological lymph nodes and in 8/7290 subjects without pathological lymph nodes, there being a significant difference (P<0.0001) between the two groups. CONCLUSION: Our results confirm the association between perihepatic lymph nodes and virus C infection. Correct diagnostic assessment of this datum could lead not only to early diagnosis by specific blood test for HCV and consequent prompt aimed treatment, but could pave the way for efficacious territorial prevention and detection of an elevated percentage of likely non-symptomatic carriers.

A case of progression from type II cryoglobulinaemia to Waldenstrom's macroglobulinaemia in a patient with chronic hepatitis C.

Hepatitis C infection is associated with B-cell lymphoproliferative disorders, including mixed cryoglobulinaemia and B-cell lymphoma. A direct pathogenetic role of this infection in lymphomagenesis has been suggested but the molecular basis for viral induced B-cell proliferation is still unknown. We report an unusual case of a patient affected by chronic hepatitis C who presented severe type II cryoglobulinaemia and subsequently lymphoplasmacytoid lymphoma consistent with Waldenstrom’s macroglobulinaemia and type I cryoglobulinaemia. In this patient antiviral treatment induced beneficial effects.

Verrucous Psoriasis in a Patient with Chronic C Hepatitis Treated with Interferon

There are about 150 million hepatitis C virus week) had been administered for 1 year. This treat(HCV) carriers worldwide, and in industrialised nament had normalised transaminase levels and tions HCV is the cause of 70% of cases of chronic viraemia for about 2 years. HCV RNA follow-up hepatitis.[1] Interferon (IFN)-α, administered either performed about 3 months prior to observation in alone or in association with ribavirin for 6–12 our department revealed relapse (elevated transmonths, has for some time been used to manage aminase levels and viraemia), and further IFNα HCV as it is able to normalise transaminase concenpegylate treatment (80 μg/week subcutaneously) trations and reduce viraemia. However, interferon had been initiated. After 60 days of IFN treatment, treatment is by no means free of side effects, and HCV RNA was negative, but psoriatic onycholysis exacerbation of a latent, or existing psoriasis, which progressively involved the patient’s toeand fingercan at times develop rapidly into a severe condition, nails. has been reported in the literature with its use.[2-4] Physical examination in our department revealed Whether the HCV or IFN is the initiator or exacerdiffuse hyperkeratosis with erythematous-desquabating factor of the psoriatic disease remains to be mative plaques measuring between 1 and 5cm, some established in these cases. of which were aligned along scratch lines (figure 1). We report a case of a man with chronic HCV Lesions were also observed in the major skin folds, receiving IFN treatment where common psoriasis rapidly developed into verrucous psoriasis and an ichthyosis hystrix-like form of psoriasis after 15 days’ of treatment.