Josep M. Barrera

PREVALENCE OF ANTIBODIES TO HEPATITIS C VIRUS IN SPANISH PATIENTS WITH HEPATOCELLULAR CARCINOMA AND HEPATIC CIRRHOSIS

The prevalence of antibodies against hepatitis C virus (HCV) was investigated in 96 patients with hepatocellular carcinoma, 106 patients with liver cirrhosis without evidence of cancer, and 177 controls without liver disease. 75% of patients with hepatocellular carcinoma had HCV antibodies (anti-HCV), a significantly higher proportion than that observed in patients with cirrhosis (55.6%), or controls (7.3%). The prevalence of anti-HCV was significantly higher in patients with alcoholic cirrhosis and hepatocellular carcinoma (76%) than in patients with alcoholic cirrhosis alone (38.7%) whereas in patients with cryptogenic cirrhosis there was no significant difference between those with and without primary liver cell cancer (81.4% and 77.5%, respectively). These results indicate that HCV infection may have a role in the pathogenesis of hepatocellular carcinoma, even in patients with chronic liver disease apparently related to other agents such as alcohol, and that this recently identified hepatitis virus may be found in a large proportion of patients with cryptogenic cirrhosis.

Is Hepatitis C Virus Infection a Trigger of Porphyria Cutanea Tarda

The causes of liver disease, ranging from fatty changes to cirrhosis and hepatocellular carcinoma, in porphyria cutanea tarda (PCT) remain unclear. We tested 100 consecutive PCT patients for antibodies to hepatitis C virus (HCV) by enzyme-linked immunosorbent assay and a recombinant immunoblot assay. 75 (79%) patients with sporadic PCT but none of 5 with familial PCT were positive. HCV RNA was found in serum of all 18 anti-HCV-positive patients tested. There were no significant differences in the prevalence of anti-HCV between treated and untreated patients or between those with and without various HCV risk factors. The frequency of anti-HCV increased with the severity of liver histology. These findings implicate HCV in the aetiology of PCT-associated liver disease.

Hepatitis C Virus Infection in Patients with Nonalcoholic Chronic Liver Disease

STUDY OBJECTIVE To determine the prevalence and meaning of antibodies to the hepatitis C virus (HCV) in patients with nonalcoholic chronic liver diseases. DESIGN Cross-sectional study. SETTING The liver unit of a referral-based university hospital. PATIENTS Three hundred and forty-six consecutive patients, including 137 with cryptogenic chronic liver disease, 156 with chronic hepatitis B, 47 with primary biliary cirrhosis, and 8 with persistently abnormal aminotransferase serum levels and normal liver histology. Among patients with cryptogenic liver disease, 41 received blood transfusions before discovery of liver disease and 18 had circulating nonorgan-specific autoantibodies. For comparison, 1495 apparently healthy volunteer blood donors were included in the study. LABORATORY INVESTIGATIONS: The presence of anti-HCV antibodies (anti-HCV) was determined by a recently developed enzyme-linked immunoassay. MEASUREMENTS AND MAIN RESULTS In patients with cryptogenic liver disease, the prevalence of anti-HCV was 82% (95% CI, 76% to 89%), being higher (P = 0.02) in patients with histories of blood transfusion than in those with unknown sources of exposure. Antibodies to HCV were not detected in patients with antinuclear antibodies at high titer. Among patients with chronic hepatitis B, anti-HCV were found in 11% (CI, 5% to 18%) of those with hepatitis B virus (HBV)-associated DNA in serum and in 29% (CI, 17% to 43%) of those with undetectable HBV replication (P less than 0.05). The prevalence of anti-HCV in blood donors was 1.2% (CI, 1.1% to 1.3%). CONCLUSIONS Our results indicate that HCV infection probably plays an important etiologic role in cryptogenic liver disease and, in some patients, in chronic hepatitis B. Determining whether anti-HCV are present appears to be useful for differentiating viral from autoimmune chronic liver diseases.

Incidence of Non-A, Non-B Hepatitis after Screening Blood Donors for Antibodies to Hepatitis C Virus and Surrogate Markers

Abstract ▪Objective:To compare the effect of screening blood donors for antibodies to hepatitis C virus (anti-HCV) on the incidence of non-A, non-B hepatitis in recipients with that of screening bl...

Eficacia de una intervención para mejorar el cumplimiento terapéutico en las dislipemias

Objetivo Analizar la eficacia de la intervencion mediante una «llamada telefonica» en el cumplimiento terapeutico de las dislipemias Diseno Ensayo clinico controlado, aleatorizado Emplazamiento Diez consultas de 6 centros de atencion primaria Participantes Se selecciono a 126 hipercolesterolemicos diagnosticados segun criterios del Consenso espanol Intervencion Se formaron dos grupos: grupo control, formado por 63 pacientes que recibieron la intervencion habitual del medico, y grupo de intervencion, con 63 pacientes que recibieron, ademas, una «llamada telefonica» a los 15 dias y a los 2 y 4 meses Mediciones principales Se realizo el recuento de comprimidos y la determinacion de colesterol, trigliceridos, cHDL y cLDL al inicio y a los 3 y 6 meses. Se compararon los porcentajes de cumplidores (80-110%), el porcentaje medio de cumplimiento y el grado de control. Se calculo la reduccion de los riesgos absoluto y relativo, asi como el numero de individuos que es necesario intervenir para evitar un incumplimiento Resultados Finalizaron 115 individuos (91,26%).El grupo de intervencion estaba compuesto por 56 individuos y el grupo control por 59. Fue cumplidor el 77,1% (IC del 95%, 68,4–85,8), el 64,4% en el grupo control (IC del 95%, 55,3–73,5) y el 93,5% del grupo de intervencion (IC del 95%,88,8–98) (p Conclusiones La intervencion telefonica es una medida eficaz para mejorar el porcentaje de cumplidores en el tratamiento de las dislipemias

Terapia de inducción con interferón alfa-2a en la cirrosis por el virus de la hepatitis C compensada. Estudio multicéntrico aleatorizado

Fundamento Aunque el tratamiento con interferon (IFN) a las dosis estandar solo consigue unarespuesta persistente en el 5% de los pacientes con cirrosis debida al virus de la hepatitis C(CVHC), se ha planteado que podria disminuir el riesgo de complicaciones y la incidencia dehepatocarcinoma. Teniendo en cuenta los estudios cineticos del virus de la hepatitis C (VHC),la terapia de induccion con IFN podria aumentar las tasas de respuesta al tratamiento. Pacientes y metodo Cuarenta pacientes con CVHC compensada fueron distribuidos al azar pararecibir (grupo I = 19) o no (grupo II = 21) tratamiento con IFN (4,5 MU/dia durante 6 meses,seguidos de 4,5 MU/dias alternos durante 6 meses mas, solo si la ALT se habia normalizado). Resultados El tratamiento con IFN hubo de reducirse o interrumpirse por efectos adversos en11 (58%) y seis (31,5%) casos, respectivamente. La respuesta al final del tratamiento se observoen 4 pacientes del grupo I (21%), que fue persistente en dos (10,5%), y en ninguno delgrupo II (p = 0,04 y NS, respectivamente). La probabilidad global de presentar ascitis, hepatocarcinomay/o muerte o trasplante hepatico fue menor en el grupo I que en el II (el 6 frenteal 27% a los tres anos; p = 0,05). Conclusiones Aunque la terapia de induccion con IFN en la CVHC compensada se asocia a frecuentesefectos adversos e induce una respuesta persistente en una proporcion baja de pacientes,podria mejorar el pronostico a medio plazo de los pacientes.

Mother-to-Infant Transmission of Hepatitis C Virus­ A Prospective Study

Some studies and case reports suggest that mother-to-infant transmission of hepatitis C virus (HCV) is uncommon. However, the real extent of vertical and perinatal transmission of HCV is unknown. We prospectively followed-up 38 infants born to HCV seropositive mothers, and 105 infants born to both anti-HCV and anti-HIV positive mothers. The mean time of follow-up was 29 ± 16 months. Two of 38 (5.2%) infants born to anti-HCV-positive mothers were HCV-infected, while 19 of 105 (18.1%) born to both anti-HCV and anti-HIV-positive mothers were HCV-infected (P < 0.02). Furthermore, 9 of 17 (52.9%) infants who developed AIDS were also infected with HCV, but only 10 of 88 (11.4%) HIV- uninfected infants were HCV-infected (P < 0.00002).