RESUMO
Alcohol consumption, age at infection, and male gender have been identified as risk factors for faster fibrosis progression in patients with chronic hepatitis C (CHC). Yet the influence of liver steatosis, light to moderate alcohol consumption, or iron overload on this progression remains controversial. To analyze the effect of individual risk factors and their interaction on fibrosis progression in a group of patients with CHC and a definite date of infection, we studied 133 consecutive untreated patients. Covariates included were age, body mass index (BMI), gender, age at infection, alcohol intake, serum lipids, glycemia, serum ALT, AST, GGT, iron, and ferritin, grade and stage (METAVIR and Scheuer), and hepatic stainable iron (Perl's stain). The rate of fibrosis progression was inferred from the METAVIR score. By logistic regression analysis, hepatic steatosis (odds ratio [OR], 3.035; 95% confidence interval [CI], 1.16-7.93), serum ferritin levels higher than 290 ng/ml (OR, 5.5; 1.6-18.65), and light to moderate ethanol intake (1-50 g/day) (OR, 5.22; 1.5-17.67) were independently associated with faster fibrosis progression. There was no effect of interaction between these variables on the rate of fibrosis progression. Liver steatosis, serum ferritin levels, and light to moderate alcohol intake are associated with faster fibrosis progression in chronic hepatitis C. Combination of these factors did not further accelerate this progression. The impact of modification of these factors on progression should be tested in longitudinal studies.
Assuntos
Hepatite C Crônica/fisiopatologia , Cirrose Hepática/fisiopatologia , Adulto , Progressão da Doença , Etanol/efeitos adversos , Fígado Gorduroso/fisiopatologia , Feminino , Ferritinas/sangue , Hepatite C Crônica/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de RiscoAssuntos
Hepacivirus/fisiologia , Hepatite C/virologia , Ferimentos Penetrantes Produzidos por Agulha , Evolução Biológica , Feminino , Hepatite C/imunologia , Hepatite C/transmissão , Anticorpos Anti-Hepatite C/análise , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional , Pessoa de Meia-IdadeRESUMO
Intradermal vaccination has been proposed as an alternative for the administration of anti-hepatitis B vaccine. Patients (n=66) with chronic viral hepatitis C without cirrhosis were randomised into two groups (intramuscular, n=38; and intradermal, n=28) for prospective immunisation with 20 microg recombinant vaccine, using an ultra-rapid schedule (doses at 0, 15 and 30 days). Sero-conversion (antibody level >/=10 mU/ml) in the intramuscular group was reached by 20, 40 and 72% of patients at days 15, 30 and 60 compared to 4, 8 and 36% for the intradermal group (P=0.010 at day 60). Additionally, levels rose more rapidly in the intramuscular group (P=0.004). Our results do not support the use of intradermal route of immunisation against HBV in HCV patients.