Prevalence and clinical course of hepatitis delta infection in Greece: a 13-year prospective study.

BACKGROUND & AIMS: Hepatitis D virus (HDV) has decreased in Europe, but recent reports indicate a rising trend. We report the epidemiological changes, clinical progress, and effect of treatment on the natural course of HDV infection in Greece during the last 13 years. METHODS: Prospective data were extracted from the HepNet.Greece Cohort-Study. RESULTS: Since 1997, 4673 chronic HBV (CHB) cases (4527 adults, 146 children) have been followed prospectively. Two thousand one hundred thirty-seven patients were tested for anti-HDV [101 (4.7%) positive]. Anti-HDV testing in Greece decreased significantly (57.0% before 2003, 35.3% thereafter; p<0.001). Anti-HDV prevalence among HBsAg-positives was 4.2%; lower in native Greeks (2.8%) than in immigrants (7.5%) or in children (15.3%; p<0.001). Within 2.3 years of follow-up, HDV occurred in 11/2047 HBsAg-positive patients (2.2 new delta-infected adults and 8.7 children per 1000 HBsAg-positive annually). HDV-positive compared to CHB adults were younger (p=0.035) and had more active and advanced disease at baseline, as indicated by laboratory indices and the higher prevalence of cirrhosis at younger age. During a 4.2-year median observation, significantly more anti-HDV-positive than CHB adults developed a liver-related first event (20.0% vs. 8.5%, p Log-rank=0.014).Treatment was received by 46/90 (51.1%) patients, 40 of them interferon-based. In multivariable analysis, interferon significantly decreased disease progression in HDV-positive patients [HR=0.14 (95% CI: 0.02-0.86; p=0.033)]. CONCLUSIONS: In Greece, HDV serology is currently tested in only one-third of HBsAg-positive patients. HDV prevalence is lower in native Greeks compared to immigrants, who may contribute >50% of the HDV infection burden in Greece. Data show that HDV infection is a rapidly progressive disease, but interferon-based treatment may alter its course.

Factors affecting the increased prevalence of erectile dysfunction in Greek hypertensive compared with normotensive subjects.

Arterial hypertension is considered a risk factor for erectile dysfunction. The aim of the study was to evaluate the prevalence of erectile dysfunction in hypertensive compared with normotensive individuals of similar demographic characteristics in Greece. Furthermore, the effect of age, hypertension severity, hypertension duration, and antihypertension medication on erectile function of these subjects was investigated. The study population consisted of 634 consecutive young and middle-aged men (31-65 years) that visited our outpatient clinic. From them, 358 patients had arterial hypertension and 276 were normotensive. Erectile dysfunction was evaluated with the International Index for Erectile Function questionnaire. Erectile dysfunction was found in 35.2% of patients with essential hypertension compared with 14.1% of normotensive subjects (chi(2) = 35.92, P < .001). Patients with essential hypertension had more severe erectile dysfunction than their normotensive counterparts (chi(2) = 17.1, P < .001). Hypertension duration, hypertension severity, antihypertension medication, and age were positively correlated with erectile dysfunction. The prevalence of erectile dysfunction is higher in patients with essential hypertension compared with normotensive subjects of similar demographic characteristics. Erectile dysfunction is related to age in both groups, whereas duration and severity of hypertension as well as antihypertension drugs affect erectile function of hypertensive patients. Erectile dysfunction affects patient quality of life, underlining the need for vigorous research of this condition and appropriate management.

Beneficial effects of switching from beta-blockers to nebivolol on the erectile function of hypertensive patients.

AIM: To investigate the effect of substituting beta-blockers with nebivolol on the erectile function of patients suffering from essential hypertension. METHODS: Forty-four young and middle-aged men (31-65 years) with essential hypertension visited our outpatient clinic and took beta-blocker treatment (atenolol, metoprolol or bisoprolol) for more than 6 months. All the patients completed a questionnaire regarding erectile function (International Index for Erectile Function). Patients were then switched to an equipotent dose of nebivolol for 3 months and, at the end of this time period, filled out the same questionnaire. RESULTS: Twenty-nine out of the 44 (65.9%) patients who took beta-blockers (atenolol, metoprolol or bisoprolol) had exhibited erectile dysfunction (ED). Their systolic and diastolic blood pressure did not change significantly with the treatment switch. In 20 out of these 29 (69%) patients, a significant improvement in the erectile function score was exhibited after 3 months of nebivolol administration, and in 11 of these 20 patients, erectile function was normalized. CONCLUSION: Nebivolol seems to have a beneficial effect on ED (possibly due to increased nitric oxide availability); however, further prospective, randomized, placebo-controlled studies are needed to confirm the beneficial effects of nebivolol.