A prospective and randomized study using ribavirin as monotherapy for the treatment of naïve patients with chronic hepatitis C.

In order to evaluate the response to ribavirin in previously untreated patients with chronic hepatitic C, 39 patients were selected for a double-blind prospective and randomized trial, and divided into two groups: ribavirin-group (19 patients) and placebo-group (20 patients). Ribavirin was administered orally for 24 weeks (600 mg/day, followed by 1,000 mg/day and 1,200 mg/day each one for 8 weeks). After 3 months of drug administration, the patients were evaluated by measuring biochemical, virologic and histologic responses. After this phase, ribavirin was offered to the patients who had received placebo (second phase). The results showed that the patients who received ribavirin showed a higher reduction in serum alanine aminotransferase (ALT) activity than patients in the placebo group. Among the patients in the ribavirin-group, a complete biochemical response (ALT levels normalized) was observed in 3 patients (16%), and a partial response (reduction greater than 50% of the initial value of ALT activity) in 4 (21%). In the 20 patients in the placebo group, only 1 showed a partial response (5%). In the second phase of the study, among 16 patients who received ribavirin, 4 (25%) showed a complete and 5 (31%) a partial biochemical response. HCV-RNA did not become negative in any patient during the two phases. A reduction in the score of portal and lobular activity was observed in patients who received ribavirin, but statistical analysis did not identify differences. This study showed that ribavirin alone induces a biochemical response (ALT reduction) in some patients with chronic hepatitis C, which may be associated with a reduction in hepatic inflammatory activity reduction, but the changes are not sufficient to recommend initial monotherapy with ribavirin.

alpha-Interferon therapy for HBV-related glomerulonephritis.

We report a case of a patient with hepatitis B virus (HBV)-related membranous glomerulonephritis (MGN) who showed improvement after interferon-alpha (IFN-alpha) therapy. A 35-year-old man with nephrotic syndrome and HBV antigens received a 24-week course of IFN-alpha. At the end of therapy there was an elevation in the level of plasma aminotransferase and an increase in proteinuria, which were followed by antigen/antibody seroconversion. This "flare-up" before seroconversion suggests an increase in disease activity in the liver and kidney, demonstrating in vivo HBV involvement in MGN.

Epidemiology of acute hepatitis B in a university hospital in São Paulo, Brazil: retrospective study of two five-year periods.

CONTEXT: HBV infection is endemic in Brazil and acute HBV infection is still a common disease. OBJECTIVE: To analyze incidence, risk factors and evolution of acute HBV infection. SETTING: University Hospital. PATIENTS: 357 patients with acute HBV infection, comparing two periods: 1985-1989 vs. 1990-1994. RESULTS: The overall incidence declined from 50 new cases/year in 1985-89 (30% of all cases) to 25 new cases/year in 1990-94 (8% of all cases). Transmission among male homosexuals (3.9% of cases in 85-89) declined to 1.3% in 90-94 (p > 0.05). Amongst health care workers (HCW) it declined from 8.2% to 2.0% (p = 0.02). Conversely, heterosexual transmission increased from 4.8% to 10.1% (p = 0.06). Chronification of HBV infection following the acute episode was observed in 1.7%. Fulminant hepatic failure was seen in 3.4%. However, 27.2% of patients were lost to follow-up before normalization of the biochemical tests. CONCLUSIONS: The different patterns of risk factors observed is probably related to measures for preventing AIDS and to HCW vaccination programs. Chronification following acute episodes was not a common event.

[Identification of molecular nexus between infection and premature rupture of membranes]. / Identificación de nexos moleculares entre infección y ruptura prematura de membranas.

The tumoral necrosis factor alfa (TNF-alpha) has been characterized as a signal contained in chorioamniotic membrane with premature rupture of membrane complicated with infection, inducing enzymes that degrade extracellular matrix components in fetal membranes. This cytocine is normally produced of immune system cells as a response to contact with infectious agents, and its identification is a direct molecular nexus between inflammatory response and development of premature rupture of membranes.

[Evaluation of the immunological response to hepatitis B vaccine in health care professionals]. / Avaliação da resposta imunológica à vacina contra hepatite B em profissionais da área de saúde.

Clinical trials have shown the safety and efficacy of Hepatitis B (HB) vaccination, but it is well known that host and immunization factors can affect the response to HB vaccine. In order to assess the importance of some of these factors we evaluated the immune response of 86 health care workers who received three doses of H-B-Vax intramuscularly (deltoid), at days 0, 30 and 180. Serum samples were taken after each dose and anti-HBs antibodies were determined by quantitative radioimmunoassay. The results showed that males had a diminished immune response to the first dose of HB vaccine (31.7% x 53.3%, p < 0.05) and had geometric mean titers (GMT) of anti-HBs lower than females at the end of the vaccination program (2109.4 x 2453.8, p > 0.05). Smokers had a lower rate of seroconversion after the first dose (29.7% x 53.1%, p < 0.05) and reached lower GMT (2015.2 x 2453.8, p > 0.05) than non-smokers. There were no statistically significant differences between individuals younger or older than 35 years old, in either immunological response of level of anti-HBs.

Surto de hepatite aguda pelo vírus A: avaliaçäo epidemiológica, clínica e laboratorial / Outbreak of acute hepatitis by virus A: epidemiologic, clinical and laboratory evaluation

Os autores analisam as características epidemiológicas, clínicas e sorológicas de um surto de hepatite aguda ocorrido na cidade de Valparaiso, SP. O agente etiológico foi identificado como sendo o vírus A da hepatite e a doença incidiu sobretudo em crianças, com cerca de 80% dos casos abaixo de 10 anos de idade. Foram analisadas amostras de soro de 37 comunicante dos casos índices, sendo constatada evidência de infecçäo aguda pelo vírus A em 9/37 (24,3%) dos comunicantes, que se apresentavam totalmente assintomáticos, evidenciando a alta incidência de formas anictéricas e assintomáticas da doença

Infecçäo pelo vírus B da hepatite: um risco para o profissional da área de patologia clínica / Hepatitis B virus infection: a risk clinical pathology workers

Os autores estudaram 252 indivíduos que trabalham em laboratório de análises clínicas, com o objetivo de verificar a prevalência da infecçäo pelo vírus da hepatite B (VHB) entre os mesmos, comparando-os com um grupo controle de 261 indivíduos. Observou-se que 22,6 por cento dos funcionários do laboratório mostravam evidência de contato prévio com o VHB e 4,0 por cento apresentavam HBsAg positivo, caracterizando o estado de portadores crônicos do vírus. Estas cifras diferiram significativamente (p<0,05) daquelas observadas no grupo controle, caracterizando o grupo estudado como de risco para a infecçäo pelo VHB. Aos indivíduos suscetíveis (77, 4 por cento), foi oferecida a vacina contra o VHB, em esquema de três doses, cujo índice de aceitaçäo foi de 87,2 por cento

Hepatite pelo vírus A em adulto: ocorrência de formas prolongadas e polifásicas da doença / Hepatitis A in adults: occurrence of prolonged and polyphasic forms of the disease

Os autores estudaram a ocorrência de formas prolongadas e/ou polifásicas da infecçao, em 84 pacientes adultos com diagnóstico de hepatite aguda pelo vírus A. Foram prolongada de doença (duraçao superior a quatro meses) foi observada em 8/84 (9,5 por cento) dos pacientes. Padrao polifásico foi observado em 12/84 (14,3 por cento) dos casos. Observou-se ainda que indivíduos com mais de 18 anos tiveram tendência a demorar mais tempo para normalizar as transaminases, quando comparados com pacientes entre 12 e 18 anos, o mesmo ocorrendo com homens, quando comparados às mulheres. Entretanto, em todos os casos observou-se normalizaçao do quadro, em períodos que chegaram a ser tao longos quanto nove a dez meses de evoluçao.