Asunto(s)
Antivirales/uso terapéutico , Virus de la Hepatitis B/fisiología , Hepatitis B/prevención & control , Hepatitis C/tratamiento farmacológico , Trasplante de Hígado , Activación Viral , ADN Viral/sangre , Virus de la Hepatitis B/efectos de los fármacos , Hepatitis C/virología , Humanos , Trasplante de Hígado/efectos adversos , Estudios Prospectivos , RecurrenciaRESUMEN
BACKGROUND/AIMS: Liver transplantation (LT) in immune-suppressed human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfected patients is feasible but raises questions regarding the severity of HCV recurrence on the liver graft and preservation of immune function. We investigated whether LT is deleterious to the immune system. METHODS: Fourteen HIV-HCV coinfected patients (HIV viral load [VL] <50 copies/ml; median CD4 count of 276/mm(3) pretransplantation) were grafted for HCV-cirrhosis and followed over 2 years. Nine patients received anti-HCV therapy post-transplantation. HCV and HIV VLs and degree of acute and chronic hepatitis were monitored. Peripheral blood T-cell phenotypes and interferon-gamma (IFN-gamma) immune responses against opportunistic pathogens, HCV, and HIV-1 p24 were evaluated. RESULTS: Median HCV VLs, CD4 counts, T-cell subsets, and IFN-gamma-producing T-cell frequencies against opportunistic pathogens and HIV-1 p24 did not change over time. HCV-specific T cells were observed ex vivo in two patients pretransplantation and in two others post-transplantation. HCV-specific in vitro amplification enabled the detection of HCV-specific IFN-gamma-producing responses in three further patients post-transplantation. Anti-HCV responses were observed independently of anti-HCV therapy and were undetectable in patients with severe hepatitis or liver fibrosis. CONCLUSIONS: These results demonstrate that LT in HIV-HCV coinfected patients is not deleterious to the immune system and does not alter immune responses directed against HCV, HIV, or opportunistic pathogens.
Asunto(s)
Infecciones por VIH/complicaciones , Infecciones por VIH/inmunología , Anticuerpos contra la Hepatitis C/biosíntesis , Hepatitis C/complicaciones , Hepatitis C/inmunología , Cirrosis Hepática/inmunología , Cirrosis Hepática/cirugía , Trasplante de Hígado/inmunología , Infecciones Oportunistas Relacionadas con el SIDA/inmunología , Adulto , Recuento de Linfocito CD4 , Carcinoma Hepatocelular/etiología , Carcinoma Hepatocelular/inmunología , Carcinoma Hepatocelular/cirugía , Femenino , Proteína p24 del Núcleo del VIH/inmunología , Hepatitis C/virología , Humanos , Tolerancia Inmunológica , Técnicas In Vitro , Interferón gamma/biosíntesis , Cirrosis Hepática/etiología , Neoplasias Hepáticas/etiología , Neoplasias Hepáticas/inmunología , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Subgrupos de Linfocitos T/inmunología , Carga Viral/inmunologíaRESUMEN
Nodular regenerative hyperplasia is one of the causes of noncirrhotic portal hypertension and has recently been described in human immunodeficiency virus-infected patients, and the potential role of a prothrombotic state and hepatotoxic antiretroviral medication has been suggested. Moreover, it is now established that liver transplantation is feasible in HIV-infected patients. We describe here our experience concerning 3 HIV-infected patients with severe complications of nodular regenerative hyperplasia treated with liver transplantation.
Asunto(s)
Infecciones por VIH/complicaciones , Hepatopatías/cirugía , Trasplante de Hígado , Hígado/patología , Adulto , Femenino , Humanos , Hiperplasia/etiología , Hiperplasia/cirugía , Hepatopatías/etiología , MasculinoAsunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Profilaxis Pre-Exposición , Minorías Sexuales y de Género , Masculino , Humanos , Homosexualidad Masculina , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Infecciones por VIH/tratamiento farmacológico , Monkeypox virus , Conducta Sexual , Fármacos Anti-VIH/uso terapéuticoRESUMEN
In 2006 we conducted a cross-sectional study involving hospital clinical centres in five Italian cities to compare the sexual behaviour of HIV-positive MSM (men who have sex with men) before and after the diagnosis of HIV infection. Each centre was asked to enrol 30 HIV-positive persons aged ≥ 18 years. The questionnaire was administered to 143 MSM on average 9 years after HIV diagnosis. After diagnosis there was a decrease in the number of sexual partners: the percentage of persons who reported having had more than 2 partners decreased from 95.8% before diagnosis to 76.2% after diagnosis. After diagnosis, there was a significant decrease in the percentage of persons who had never (or not always) used a condom with their stable partner for anal sex from 69.2% before diagnosis to 26.6% after diagnosis and for oral-genital sex from 74.8% before diagnosis to 51.7% after diagnosis. Though at-risk behaviour seems to decrease after diagnosis, seropositive MSM continue to engage in at-risk practices: one fourth of them did not use a condom during sexually transmitted infections (STI) episodes, 12.5% of the participants had had sex for money, and 8.4% had paid for sex. The study shows that our sample of Italian HIV-positive MSM, though aware of being infected, engage in sexual behaviours that could sustain transmission of HIV and other STIs. The results could constitute the first step in implementing national prevention programs for persons living with HIV.
Asunto(s)
Seropositividad para VIH/psicología , Homosexualidad Masculina/psicología , Homosexualidad Masculina/estadística & datos numéricos , Conducta Sexual/psicología , Conducta Sexual/estadística & datos numéricos , Sexo Inseguro/psicología , Sexo Inseguro/estadística & datos numéricos , Adolescente , Adulto , Condones , Estudios Transversales , Seropositividad para VIH/diagnóstico , Seropositividad para VIH/epidemiología , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Parejas Sexuales , Trastornos Relacionados con Sustancias/epidemiología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Many HIV-positive persons reportedly continue to engage in at-risk behavior. We compared the sexual and drug-using practices of HIV-positive persons before and after the diagnosis of HIV infection to determine whether their behavior had changed. To this end, in 2006, we conducted a cross-sectional study involving clinical centers in five Italian cities. Each center was asked to enroll 100 persons aged 18 years or older who had a diagnosis of HIV infection that dated back at least 2 years. Data were collected with a specifically designed questionnaire, administered during a structured interview. The McNemar chi2 test was used to compare the data before and after the diagnosis. A total of 497 persons participated (65.5% males; median age of 40 years; age range, 34-45 years). The most common exposure categories were: heterosexual contact (43.4%), homosexual contact (27.2%), and injecting drug use (20.6%). Although the percentage of drug users significantly decreased after diagnosis, 32.4% of injectors continued to use drugs, and approximately half of them exchanged syringes. Regarding sexual behavior, after diagnosis there was a significant decrease in the number of sexual partners and in stable relationships and an increase in condom use, both for persons with stable partners and those with occasional partners, although the percentage varied according to the specific sexual practice. These results indicate that though at-risk behavior seems to decrease after the diagnosis of HIV infection, seropositive persons continue to engage in at-risk practices, indicating the need for interventions specifically geared toward HIV-positive persons.
Asunto(s)
Infecciones por VIH/psicología , Seropositividad para VIH/psicología , Trastornos Relacionados con Sustancias/psicología , Sexo Inseguro/psicología , Adulto , Distribución de Chi-Cuadrado , Condones/estadística & datos numéricos , Estudios Transversales , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Conducta Sexual/psicología , Abuso de Sustancias por Vía Intravenosa/psicologíaRESUMEN
BACKGROUND: In patients coinfected with hepatitis B virus (HBV) and human immunodeficiency virus (HIV), evolution toward cirrhosis and its complications is more rapid and severe than in patients infected with HBV alone. The outcome of liver transplantation in HBV-HIV-coinfected patients is poorly understood in terms of survival rate, HBV reactivation and mitochondrial toxicity on the liver graft. PATIENTS AND METHODS: Between November 2002 and June 2007, 13 HIV-positive patients underwent liver transplantation because of end-stage liver disease due to HBV with or without coinfection with hepatitis D or C virus. These patients were prospectively followed for an average of 32 +/- 5.2 months (range 10-63 months). RESULTS: All patients were alive at the end of the follow-up period and had normal liver function. Their HBV viral load was undetectable, no cccDNA was found in the liver graft and HIV infection was nonprogressive under antiretroviral therapy. Moreover, no mitochondrial toxicity was noted in the liver graft, as assessed by the spectrophotometric analysis of respiratory chain activities and by quantifying the mitochondrial DNA copy number. CONCLUSION: HBV-HIV-coinfected patients can successfully undergo liver transplantation with excellent results in terms of survival, control of HBV replication after transplantation and mitochondrial toxicity.