Argentinian clinical practice guideline for surveillance, diagnosis, staging and treatment of hepatocellular carcinoma.

The A.A.E.E.H has developed this guideline for the best care of patients with hepatocellular carcinoma (HCC) from Argentina. It was done from May 2018 to March 2020. Specific clinical research questions were systematically searched. The quality of evidence and level of recommendations were organized according to GRADE. HCC surveillance is strongly recommended with abdominal ultrasound (US) every six months in the population at risk for HCC (cirrhosis, hepatitis B or hepatitis C); it is suggested to add alpha-feto protein (AFP) levels in case of inexeperienced sonographers. Imaging diagnosis in patients at risk for HCC has high specificity and tumor biopsy is not mandatory. The Barcelona Clinic Liver Cancer algorithm is strongly recommended for HCC staging and treatment-decision processes. Liver resection is strongly recommended for patients without portal hypertension and preserved liver function. Composite models are suggested for liver transplant selection criteria. Therapies for HCC with robust clinical evidence include transarterial chemoembolization (TACE) and first to second line systemic treatment options (sorafenib, lenvatinib, regorafenib, cabozantinib and ramucirumab). Immunotherapy with nivolumab and pembrolizumab has failed to show statistical benefit but the novel combination of atezolizumab plus bevacizumab has recently shown survival benefit over sorafenib in frontline.

Detection of hepatitis C virus (HCV) in body fluids from HCV monoinfected and HCV/HIV coinfected patients.

BACKGROUND/AIMS: The possibility of the non-parenteral Hepatitis C Virus (HCV) transmission is supported by the demonstration that the actual virus is present in several body fluids. In this study, we investigated the relationship between the detection of HCV RNA in body fluids (saliva, cervical smears, seminal fluid and peripheral blood mononuclear cells) from chronically HCV-infected patients and several viral and host factors. METHODOLOGY: This study comprised 16 HIV/ HCV coinfected and 21 HCV monoinfected patients with a median age of 38 and 45 years, respectively. HCV-RNA was detected in serum and fluids samples by reverse transcription-nested polymerase chain reaction. Genotypes were determined by using RFLP and direct nucleotide sequencing of the PCR products and plasma viral loads by using NASBA HCV-QT. RESULTS: When compared on the basis of the results of the detection of HCV-RNA in fluids, patients did not differ significantly in relation to viral load, genotype, HCV/HIV coinfection, and epidemiological host factors. CONCLUSIONS: Our data suggest that HCV can be detected in body fluids of chronically HCV-infected patients independent of these cofactors, including circulating HCV load and HCV/HIV coinfection. Studies on HCV dynamics are needed to gain insights into nonparenteral transmission of HCV.

Perfil epidemiologico de la infección por el virus de la hepatitis C en la región central de Argentina / Molecular epidemiology pattern of hepatitis C virus infection in central region of Argentina

La presencia de RNA-HCV y la distribución de genotipos se detectaron mediante técnicas moleculares (RT-nested PCR y RFLP) en 310 muestras de individuos de la región centro de Argentina. Se halló 11,8% de coinfección HCV/HIV, con mayor prevalencia de genotipo 1 (73%). La distribución de los genotipos 1 y 2 entre individuos monoinfectados fue de 49,4% y 43,9%, respectivamente. El análisis de regresión logística multivariado mostró que la edad y el uso de drogas endovenosas (UDEV) condicionó la distribución de genotipos. El genotipo 2 se halló frecuentemente entre adultos mayores y su diseminación no se pudo asociar a ninguna vía de transmisión. El genotipo 1 se lo halló principalmente en adultos jóvenes y asociados al UDEV. El notable incremento de genotipo 1, homogéneamente distribuido en todas las edades posee importantes implicancias en las decisiones terapéuticas, considerando que posee baja respuesta a laterapia antiviral.