Giuseppe Giusti

Pathogenic factors in cirrhosis with and without hepatocellular carcinoma: A multicenter italian study

We designed a multicenter cross‐sectional study to evaluate the role of alcohol abuse, the hepatitis viruses and other pathogenic factors in cirrhosis and hepatocellular carcinoma. A total of 1,829 consecutive cirrhosis patients, with or without HCC, was enrolled over 6 mo in 21 centers throughout Italy. The etiological categories and diagnostic criteria were preestablished. The median age of the patients was 59 yr (range, 13 to 85 yr); 63.6% of the patients were graded as Child class A, 23.4% as Child class B and 13% as Child class C. Hepatitis C virus antibodies were found in 72.1% of cases (47.7% alone, 21.2% with alcohol abuse, 3.2% with hepatitis B virus); HBsAg was present in 13.8% (4.2% alone, 3.2% with hepatitis D virus, 3.2% with hepatitis C virus, 3% with alcohol abuse), alcohol abuse with no concomitant viral infection was recorded in 8.7%, primary biliary cirrhosis was found in 1.8%, other causes were found in 1.4% and cryptogenic cirrhosis was only present in 5.3%. Hepatocellular carcinoma was detected in 11.9% of patients (217 cases). The presence of hepatocellular carcinoma was more frequent in males than females (14.7% vs. 7.3%; p < 0.001) and increased with worsening Child class (8.3% in Child class A, 16.9% in Child class B, 19.9% in Child class C, p < 0.001). The highest prevalences of hepatocellular carcinoma were observed in hepatitis B virus infection, with or without alcohol abuse (20% and 16%, respectively) and in hepatitis C virus cirrhosis, with or without alcohol abuse (16% and 10.3%, p < 0.005). Our data indicate chronic viral infection to be responsible for most cirrhosis and hepatocellular carcinoma in Italy. This finding may aid development of guidelines for prevention programs. (Hepatology 1994;20:1225–1230).

Decrease in HDV endemicity in Italy.

BACKGROUND/AIMS To evaluate a possible variation in hepatitis D virus endemicity in Italy, the data from a multicentre study concerning HBsAg chronic carriers first observed in 31 liver units during 1992 were compared with the corresponding figures from a similar study performed in 1987. METHODS/RESULTS In both studies the methodology for the recruitment of cases was the same. The overall anti-HD prevalence in 1992 was 14.4%, a significantly lower rate than that observed in 1987 (23.4%, p < 0.01). The decrease significantly (p < 0.01) affected both males and females; it occurred in all geographical areas, although to a greater extent in northern regions. It was evident in subjects below 50 years of age, but not in subjects older than 50. A significant reduction in the anti-HD prevalence was seen in all forms of chronic hepatitis. CONCLUSIONS These findings indicate a lower level of hepatitis D virus endemicity in Italy, probably as a consequence of the reported decreased pool of HBsAg chronic carriers, the reduced size of families, the improved socio-economic conditions and changes in intravenous drug abuser behaviour. All these factors may have affected the strength of hepatitis D virus infection which has greatly reduced the spread of the virus.

The epidemiology of hepatitis delta infection in Italy

Abstract The epidemiology of HDV infection in Italy was assessed in a retrospective study involving 1556 HBsAg chronic carriers on their first presentation at one of the 35 Liver Units in 1987. Total anti-HD was detected in 23.4% of HBsAg carriers and was significantly more frequent in southern than in northern Italy (26.6% vs. 19.1%, p p p

Hepatitis C virus infection in households of anti-HCV chronic carriers in Italy: A multicentre case-control study

To test the hypothesis that households of anti-HCV positive subjects might be at increased risk of HCV infection, a case-control study was carried out comparing 518 family members of 205 anti-HCV positive subjects (index carriers) with 281 family members of 100 anti-HCV negative subjects (index controls), consecutively observed in ten gastroenterology units in different Italian regions. The index carriers were age and sex matched to the index controls and their households were similar with respect to the main sociodemographic characteristics. Anti-HCV antibodies were found in 6.9% (36/518) of household members of index carriers and in 3.2% (9/281) of household members of index controls (p<0.05). The results of multiple logistic regression analysis showed that being over 50 years of age was the sole independent predictor for a household contact of the likelihood of being anti-HCV positive (O.R. 3.6; C.I. 95%=1.5−8.2). Being in the household of an anti-HCV index carrier was marginally associated to anti-HCV positivity (O.R. 2.0; C.I. 95%=0.9−4.6). No association was found for sex, area of residence, family size, lowest level of schooling, or any type of family relationship. These findings are not in compliance with the statement that household contacts of HCV carriers are at increased risk of HCV infection. The 3.2% anti-HCV prevalence rate observed among household contacts of anti-HCV negative index controls may suggest that the true anti-HCV prevalence in the general population in Italy is nearly 2.5 times as high as the 1.3% found in Italian blood donors.SummaryTo test the hypothesis that households of anti-HCV positive subjects might be at increased risk of HCV infection, a case-control study was carried out comparing 518 family members of 205 anti-HCV positive subjects (index carriers) with 281 family members of 100 anti-HCV negative subjects (index controls), consecutively observed in ten gastroenterology units in different Italian regions. The index carriers were age and sex matched to the index controls and their households were similar with respect to the main sociodemographic characteristics. Anti-HCV antibodies were found in 6.9% (36/518) of household members of index carriers and in 3.2% (9/281) of household members of index controls (p<0.05). The results of multiple logistic regression analysis showed that being over 50 years of age was the sole independent predictor for a household contact of the likelihood of being anti-HCV positive (O.R. 3.6; C.I. 95%=1.5−8.2). Being in the household of an anti-HCV index carrier was marginally associated to anti-HCV positivity (O.R. 2.0; C.I. 95%=0.9−4.6). No association was found for sex, area of residence, family size, lowest level of schooling, or any type of family relationship. These findings are not in compliance with the statement that household contacts of HCV carriers are at increased risk of HCV infection. The 3.2% anti-HCV prevalence rate observed among household contacts of anti-HCV negative index controls may suggest that the true anti-HCV prevalence in the general population in Italy is nearly 2.5 times as high as the 1.3% found in Italian blood donors.

Surgical procedures as a major risk factor for chronic hepatitis C virus infection in Italy: Evidence from a case-control study

OBJECTIVES The study was carried out to evaluate the risk factors associated with chronic hepatitis C virus (HCV) infection. METHODS This case-control study used multiple logistic regression analysis to determine risk factors associated with HCV infection. Study participants were followed at 10 liver or gastroenterologic units and included 294 subjects with chronic HCV infection and 295 age and sex matched anti-HCV-negative controls. RESULTS The use of glass syringes and surgical procedures was reported by as many as 77.6% and 73.8% of cases, respectively; blood transfusion was recorded in nearly a quarter of cases; 10.2% of cases, but none of the controls, reported past or current intravenous drug use. Multiple logistic regression analysis showed that blood transfusion, being the sexual partner of an intravenous drug user, and surgery all were independent predictors of the likelihood of HCV infection. CONCLUSIONS These findings indicate that, besides the well-known sources of infection, such as blood transfusion and intravenous drug use, surgical procedures may play an important role in the spread of HCV infection in Italy. Given that a large proportion of the general population undergoes surgery, a rational and relatively inexpensive policy for the prevention of HCV infection must focus on implementing efficient procedures for the sterilization of instruments and the use of disposable materials in surgical units.

Mucocutaneous diseases in drug addicts with or without HIV infection. A case-control study

SummaryA case-control study was performed to evaluate the prevalence of mucocutaneous diseases in 106 male drug addicts (age 21–38 years) with or without HIV infection. A mucocutaneous disease was recorded in ten out of 64 HIV-negative and in 20 of 42 HIV-positive patients (OR=4.9; p<0.01). Some mucocutaneous diseases were present in similar proportions in both groups (i. e. fungal skin lesions), while others were typically present only in HIV-positive patients. Stratification for possible confounding factors, such as years of drug addiction and number of sexual partners, confirmed that HIV infection is the main risk factor for mucocutaneous disease. Stratification according to the number of CD4-positive cells showed that the more advanced the HIV disease, the more frequently mucocutaneous disease was present (p=0.02). The study demonstrates that many, but not all, mucocutaneous diseases are associated with HIV infection.ZusammenfassungZur Bestimmung der Prävalenz von mukokutanen Krankheiten wurde bei 106 männlichen Drogenabhängigen (Alter 21 bis 38 Jahre) mit oder ohne HIV-Infektion eine Fall-Kontroll-Studie durchgeführt. Bei zehn der 64 HIV-negativen und 20 der 42 HIV-positiven Patienten wurde eine mukokutane Krankheit gefunden (OR=4,9; p<0,01). Einige mukokutane Krankheiten wiesen in beiden Gruppen ein ähnliches Vorkommen auf (zum Beispiel Pilzinfektionen der Haut), andere fanden sich typischerweise nur bei HIV-Infizierten. Eine Stratifikation nach möglichen Einflußfaktoren wie Jahr der beginnenden Drogenabhängigkeit und Zahl der sexuellen Partner bestätigte, daß die HIV-Infektion der Hauptrisikofaktor für mukokutane Erkrankungen ist. Die Stratifikation nach der Zahl CD4-positiver Zellen zeigte, daß sich mit fortschreitender HIV-Krankheit zunehmend mukokutane Erkrankungen einstellen (p=0,02). Die Studie ließ erkennen, daß viele, aber nicht alle mukokutanen Erkrankungen mit der HIV-Infektion assoziiert sind.A case-control study was performed to evaluate the prevalence of mucocutaneous diseases in 106 male drug addicts (age 21–38 years) with or without HIV infection. A mucocutaneous disease was recorded in ten out of 64 HIV-negative and in 20 of 42 HIV-positive patients (OR=4.9; p<0.01). Some mucocutaneous diseases were present in similar proportions in both groups (i. e. fungal skin lesions), while others were typically present only in HIV-positive patients. Stratification for possible confounding factors, such as years of drug addiction and number of sexual partners, confirmed that HIV infection is the main risk factor for mucocutaneous disease. Stratification according to the number of CD4-positive cells showed that the more advanced the HIV disease, the more frequently mucocutaneous disease was present (p=0.02). The study demonstrates that many, but not all, mucocutaneous diseases are associated with HIV infection. Zur Bestimmung der Prävalenz von mukokutanen Krankheiten wurde bei 106 männlichen Drogenabhängigen (Alter 21 bis 38 Jahre) mit oder ohne HIV-Infektion eine Fall-Kontroll-Studie durchgeführt. Bei zehn der 64 HIV-negativen und 20 der 42 HIV-positiven Patienten wurde eine mukokutane Krankheit gefunden (OR=4,9; p<0,01). Einige mukokutane Krankheiten wiesen in beiden Gruppen ein ähnliches Vorkommen auf (zum Beispiel Pilzinfektionen der Haut), andere fanden sich typischerweise nur bei HIV-Infizierten. Eine Stratifikation nach möglichen Einflußfaktoren wie Jahr der beginnenden Drogenabhängigkeit und Zahl der sexuellen Partner bestätigte, daß die HIV-Infektion der Hauptrisikofaktor für mukokutane Erkrankungen ist. Die Stratifikation nach der Zahl CD4-positiver Zellen zeigte, daß sich mit fortschreitender HIV-Krankheit zunehmend mukokutane Erkrankungen einstellen (p=0,02). Die Studie ließ erkennen, daß viele, aber nicht alle mukokutanen Erkrankungen mit der HIV-Infektion assoziiert sind.

Doctors in the Kitchen

The use of raw or hurriedly steamed shellfish is recognized as a vehicle for the transmission of typhoid fever and Type A viral hepatitis.1 Steaming contaminated clams for five minutes or less is n...

Nucleoside Phosphates in Liver of Mice During Experimental MHV-3 Virus Hepatitis.

Summary The concentration of nucleoside phosphates was determined in the liver of mice at various intervals after experimental infection with MHV-3 virus. During the first phase of active viral multiplication, occurring between 12 and 24 hours after inoculation of virus, there was no change in concentration of the nucleoside phosphates. A significant decrease only in nucleoside triphos-phates was first found at 36 hours after inoculation when hepatic necrosis is only initial. This decrease became more marked at 48 and 72 hours at which time there also appeared a statistically significant decrease in nucleoside di- and mono-phosphates.