Evaluation of hepatitis C virus serotypes and IgM anti-HCV antibodies in two groups of anti-HCV positive subjects in south-east Italy.

We investigated the relation between the presence of IgM antibodies to hepatitis C virus (HCV) and serotypes of HCV, in particular when a high level of IgM antibodies are present in patients infected with HCV serotype I and may be associated with the source, duration and evolution of infection. The study involved two anti-HCV positive groups with chronic liver disease from the same area, one of which was a group of haemodialysis patients attending the same haemodialysis centre.

Distribution of hepatitis C virus serotypes and duration of infection in HCV infected subjects from a geographical area in Southeast Italy.

Hepatitis C virus serotypes and the duration of infection HCV positive subjects from a restricted geographical area in Italy, were evaluated. HCV serotypes were determined by Murex serotyping assay. Serotypes were detected in 592 (88.0%) of 669 samples. Type 1 proved to be the most frequent (48.9%), followed by types 2 (29%), 3(4.5%) and 4 (2.1%). The transmission of HCV 3 and 4 were observed only in the past 20 years whilst those of other types were recorded during 40 or more years. The results support the view that the prevalence of different HCV types of infection in one restricted geographical area may be associated with the source and duration of infection.

Hepatitis C virus serotypes in haemodialysis patients in South-East Italy.

Hepatitis C virus (HCV) infection is highly prevalent in haemodialysis patients. To date, only a few studies involving a small number of subjects have characterized HCV-infected dialysis patients by serotyping. The spread of HCV serotypes in 114 HCV-positive dialysis patients from the same geographical area was evaluated by Murex HCV serotyping assay. Serotypes were detected in 102 subjects (89.5%), with type 1 being the most frequent (37.7%), followed by types 2 (19.3%), 4 (8.8%) and 3 (7.9%). Types 5 and 6 were the least prevalent (3.5%). Ten samples (8.8%) revealed mixed infections: type 1 was detectable in all and the co-infecting HCV types were types 2, 3 and 4 in 3, 4 and 3 cases, respectively. These results suggest that the serotyping assay as an alternative method of distinguishing the major types of HCV, also for particular risk groups and especially in laboratories that lack the specific expertise to perform genotyping methods. Age-related differences in patients with type 5 compared with those with types 3 and 6 may provide evidence of a more recent spread of these latter types.

Hepatitis C virus serotypes and sources of infection in patients with HCV-related chronic liver disease from one geographical area in southeast Italy.

Hepatitis C virus serotypes and sources of infection in HCV-positive patients from a restricted geographical area were evaluated. HCV serotypes were determined by Murex serotyping assay. Of 192 samples, serotypes were detected in 189 (98.5%): type 1 proved to be the most common (53.1%), followed by types 2 (15.2%), 3 (6.2%), 6 (5.3%), 4 (3.6%) and 5 (1.6%). Intravenous drug users were significantly younger than the rest of the patients and infected mainly with HCV type 3. Transmission of HCV 3 has only been observed over the past 20 years; other types have been transmitted for up to 40 years. These results support the view that the prevalence of the infection by different HCV types in one restricted geographical area may be associated with the source and duration of infection.

Hepatitis C virus-RNA, immunoglobulin M anti-HCV and risk factors in haemodialysis patients.

In order to evaluate hepatitis C virus-RNA (HCV-RNA), immunoglobulin M (IgM) anti-HCV and risk factors in haemodialysis patients, 180 subjects (45 HCV negative and 135 HCV positive) were studied. Sex, age, duration of dialysis, number of transfusions and ALT were also considered. HCV-RNA was determined by the Amplicor HCV test, and IgM anti-HCV by the Abbott HCV IgM EIA. These markers were present in 40% and 30.4% of anti-HCV positive subjects. The agreement between the two tests employed was 77%. The results showed a close association between HCV-RNA and IgM anti-HCV with abnormal ALT levels and between HCV-RNA and the number of transfusions. Both of these markers were different when correlated with age and time on dialysis, respectively. Therefore, IgM anti-HCV may also serve as a serological marker of HCV infection and a complementary marker of virus replication.

Ultrasound monitoring of alcholic liver steatosis during glutathione (GSH) treatment.

In addition to clinical and laboratory alterations, the ultrasound picture in patients with liver steatosis may be quite clearly and closely connected to the histological aspects of this disease. Moreover, these patients have been found to have a reduced hepatocytic and plasmatic glutathione (GSH) level and consequently a reduced liver detoxicating capacity. The aim of this study was to evaluate the therapeutic action of exogenous GSH and its positive modifying role, not only in hepatic function indices (transaminase - GT), but also in the ultrasound picture, in a group of alcholic subjects suffering from carying levels of hepatic steatosis.

Long-term immunogenicity and safety of an inactivated hepatitis A vaccine in haemophilic patients.

As a consequence of recent outbreaks of HAV infection by blood products, 91 patients, haemophiliacs and subjects with bleeding disorders (10 of whom were also anti-HIV positive) susceptible to HAV infection received a formalin-inactivated hepatitis A vaccine (HAVRIX 720 Elisa Units, SmithKline Beecham). Subcutaneous injections were given in the deltoid region at 0, 1 and 6 months. The seroconversion rates and litres, expressed in GMT IU/1, were determined at 1, 2, 6, 7, 12, 18 and 24 months. No adverse reactions to the vaccine were observed. The highest percentage of responders observed was 98.7% in anti-HIV negative and 71.4% in anti-HIV positive patients. The anti-HAV GMT titres were higher in anti-HIV negative than in anti-HIV positive patients. The inactivated hepatitis A vaccine is safe, clinically well tolerated, and provides long-term protection against HAV infection.

[Glutathione in the treatment of chronic fatty liver diseases]. / Il glutatione nella terapia delle epatopatie croniche steatosiche.

In chronic steatosic liver disease, alcohol or non-alcohol related or HBV, HCV, HDV associated, a reduction in hepatic glutathione and, consequently, in the detoxifying effects of hepatocytes is observed. Intravenous administration of high dose glutathione in patients with chronic steatosic liver disease has shown that glutathione significantly improves the rate of some hepatic tests (bilirubin, GOT, GPT, GT) even several months after treatment interruption. Further confirmation of the efficacy of GSH treatment is provided by the reduction of malondialdehyde, a marker of hepatic cell damage. The optimal results obtained in patients receiving 1800 mg/die/i.v. advocate the use of this high dosage.

HCV third generation test in hemodialysis patients.

In order to evaluate the sensitivity of HCV test, Ortho Second and Third Generation HCV Elisa Tests were used in 315 sera collected from dialysis patients. The agreement between the two tests was 96.5%. RIBA Second and Third generation and PCR were tested in the eleven discordant sera and in specimens collected in 1992 from the same patients and in 20 Ortho-2 and Ortho-3 HCV negative patients. Ortho-3 test is capable of detecting anti-HCV seroconversion earlier than Ortho-2 with increased sensitivity and specificity, as is confirmed by RIBA and PCR tests.

Detection of antibodies to HCV in haemodialysis patients using two second generation ELISA tests.

Ortho HCV Elisa Test System 2nd Generation and Abbott HCV EIA 2nd Generation tests were used in 293 sera collected from dialysis patients in order to determine the prevalence of anti-HCV in this risk group and the sensitivity of the two tests. The agreement between the two tests employed was 98.3%. All reactive sera were confirmed using Ortho Riba and Abbott Supplemental tests. 91.9% sera were confirmed positive by Ortho RIBA and 100% by Abbott Supplemental test. The anti-HCV prevalence in haemodialysis patients increased with age, duration of dialysis treatment and number of transfusions. Our study confirms the higher prevalence of anti-HCV in haemodialysis patients using 2nd generation tests and their specificity.

Long-term persistence of anti-HBs after hepatitis B immunization in thalassaemic patients.

An epidemiological study was carried out on 114 beta-thalassaemics in order to select those subjects susceptible to hepatitis B virus (HBV) infection for hepatitis B vaccination. The results confirmed the high risk of HBV infection in these patients: 9.6% were HBsAg positive, 29.8% were anti-HBs positive/anti-HBc positive, and 9% were anti-HBc positive. In 60 HBV-negative patients, 20 micrograms doses of hepatitis B vaccine were administered on a schedule of 0, 1 and 6 months. Sera were collected for six years to determine the seroconversion rate and the anti-HBs titre. Seroconversion reached a maximum rate of 93% 12 months after the first vaccination dose and was 80% at the final control (72 months). Highly protective anti-HBs titres were observed until the last control in a high percentage of subjects. The HBVax hepatitis B vaccine has been shown to be safe, immunogenic and effective in beta-thalassaemics.

Long-term immunogenicity safety and efficacy of a recombinant hepatitis B vaccine in healthy adults.

Two hundred healthy adults seronegative for HBV markers received three 10 or 20 mcg injections of a vaccine formulated from HBsAg produced by a recombinant strain of the yeast Saccharomyces cerevisiae. The vaccine was administered intramuscularly at 0, 1, and 6 months in the deltoid region. The seroconversion rates, expressed in GMT/IU/1 were determined at 1, 2, 6, 7, 12, 24, 36 and 48 months following the initial injection. No severe or serious adverse reactions attributable to the HB vaccines were observed in any subject. The seroconversion rates following the 20 mcg dose of recombinant vaccine were always higher than those observed after the 10 mcg dose, but the differences were not statistically significant. Also the GMT values were lower after the 10 mcg dose of vaccine. Females showed a higher anti-HBs response than males; an age-dependent effect was observed in the anti-HBs response as regards both the percentage of responders and the antibody concentrations in the serum. No adverse reactions to the vaccine were observed. The rDNA vaccine did not induce a response to yeast-derived impurities and did not increase anti-yeast IgE antibody titres. The results of this study have shown that the Amgen rDNA vaccine is safe and clinically well tolerated, and that it provides protection against infection and disease. A vaccination dose of 20 mcg appears more advantageous for healthy adult subjects.

Prevalence and incidence of hepatitis C virus (HCV) in hemodialysis patients: study of risk factors.

The prevalence of antibodies against hepatitis C virus (HCV) was assessed in 246 hemodialysis patients who attended a dialysis unit in Bari, using a recombinant enzyme immunoassay test (Abbot Lab.). Fifty-six (22.8%) sera were reactive to anti-HCV. The reactivity was confirmed in 46 specimens (18.7%) using the Abbott EIA HCV neutralization test. The anti-HCV prevalence was higher in males than in females and increased with age, duration of dialysis and number of transfusions. Moreover, a correlation between the presence of anti-HCV and the persistent increase of ALT was noted. The HCV-infection attack rate was calculated using the frozen sera collected from 1984 to 1990: the incidence of infection in the first year was 6.1%, and in following years 4.6%, 4.9%, 3.1%, 2.1% and 2.2%, respectively.

Immunogenicity and efficacy of anti-hepatitis B vaccines in hemodialysis patients.

The 7-year follow-up with plasma-derived and 2-year follow-up with r-DNA vaccines have indicated the safety, immunogenicity and persistence of a vaccine-induced antibody response in hemodialysis patients. The results of our study indicate that these subjects have a lower and often inadequate immunogenic response to the HB vaccine and that the r-DNA vaccine gives a better seroconversion rate than the plasma-derived vaccines.

Hepatitis C virus in hemodialysis patients.

Anti-HCV prevalence in 284 hemodialysis patients was assessed using the Abbott HCV-EIA test. Anti-HCV positivity was found in 19.4% of patients, was higher in males than in females and progressively increased with age. A correlation between time of dialysis treatment, transfusions and ALT course was found. These data suggest that HCV infection is a very important risk in dialysis units.

Hepatitis B virus infection in hospital staff: epidemiology and persistence of vaccine-induced antibodies.

To establish the epidemiology of viral hepatitis B (HBV) infection in hospital staff the sera of 2462 workers and 176 professional nursing students were examined. The prevalences of HBsAg and anti-HBs among the workers were 4.5 and 42.2% and among the students were 2.3 and 15.3%, respectively. The risk of infection showed a correlation with the profession of the hospital workers, the various jobs carried out in different departments, age, and the number of working years. The anti-hepatitis vaccination with HBVax and HEVAC-B vaccines was used on 142 professional students and 996 hospital workers. Five years after the beginning of the vaccine cycle the percentage of responders observed among the students was 75 (HBVax) and 79% (HEVAC-B). Among the hospital staff the response registered was 66 and 71%, respectively. The best recorded response among the youngest subjects suggests that the anti-hepatitis vaccination should be obligatory for hospital workers at the beginning of their working period or professional training.

[Prevalence and occurrence of infections caused by hepatitis B virus in the dialysis units in the Apulia region]. / Prevalenza ed incidenza dell'infezione da virus dell'epatite B (HBV) nelle unità di dialisi della regione puglia.

Sera of 803 hemodialysis patients and 413 staff members were tested to evaluate the relationship between infectivity markers and spread of HBV infection in dialysis units. HBsAg was detected in 13.8% patients undergoing chronic hemodialysis and 3.9% staff members. High prevalence of HBeAg and DNA polymerase activity was observed only in HBsAg positive patients. The highest titers of HBsAg and anti-HBc were detected in hemodialysis patients, whereas asymptomatic carriers showed low titers of these markers. A highly significant correlation was recorded between detection of HBeAg in patients and presence of serum DNA activity. These data suggest that in HBsAg hemodialysis patients a more active viral replication occurs and a higher contagiousness of these subjects.

Treatment of typhoid fever in pregnancy.

Ethical and medical problems arise with typhoid infections in pregnant women. In spite of preventive care, this disease is still present and dangerous. Thirty such cases have been studied in our Clinic where treatment was carried out with four different drug regimens: chloramphenicol, ampicillin, these two drugs in association, and cotrimoxazole. On the whole the therapy was proven efficient: the infection was resolved and pregnancy continued. Only three cases of abortion and two malformed babies were observed. Aspects of reciprocal interference between infection and pregnancy are discussed and the choice of the most effective therapy is evaluated.

[Comparative evaluation of 5 third-generation methods for the detection of HBsAg]. / Valutazione comparativa di cinque tecniche di terza generazione per la ricerca dell'HBsAg.

Five third generation methods for detection of HBsAg in serum were evaluation: AUSRIA II, Micro-RIA, Hepanosticon, Enzygnost, Antigen-TG. Sera of 340 patients with acute and chronic hepatitis and 160 controls were examined with these techniques. The haemoagglutination and latex tests were less sensitive than the RIA, Micro-RIA and ELISA methods. The RIA procedure remains the more sensitive, as demonstrated with sera diluted. False positive results, frequently depending on the excess of antibodies, were observed in ELISA, haemoagglutination and latex tests. The results confirm that the RIA procedure is still highly specific and sensitive, but ELISA is also a very alternative method for HBsAg detection.

[Sensitivity and specificity of 2 methods of determining surface antigen (HBsAg) in various forms of hepatitis B pathology]. / Sensibilità e specificità di due metodiche di dosaggio dell'antigene di superficie (HBsAg) in varie forme di patologia da virus B dell'epatite (HBV).

A passive haemoagglutination method (rHA) was compared to a solid-phase radioimmunoassay (RIA) in detecting hepatitis B surface antigen (HBsAg) in order to evaluate their sensitivity and specificity. The test was performed on sera from 297 subjects with acute and chronic hepatitis, 23 asymptomatic HBsAg-RIA positive carriers, 20 patients with infectious mononucleosis, 110 HBsAg RIA negative healthy persons; 30 sera positive for rheumatoid factor and/or autoantibody were also tested. Our data confirm that RIA is highly specific and rarely shows false negative results, depending on antibody excess, rHA shows less sensitivity than RIA in detecting HBsAg especially in sera of patients with acute hepatitis.