RESUMO
BACKGROUND: The life cycle of the hepatitis C virus (HCV) is closely associated with lipid metabolism. Recently, NPC1L1 (a cholesterol transporter) has been reported to function as an HCV receptor. This receptor is expressed in the hepatocyte canalicular membrane and in the intestine; serving as a key transporter for the cholesterol enterohepatic cycle. OBJECTIVES: We hypothesized that HCV might have a similar cycle, so we aimed to study the presence of HCV in bile and stools of infected patients. MATERIALS AND METHODS: Blood, feces, and duodenal bile samples were collected from patients infected with HCV. The biliary viral load was normalized to the bile salt concentration of each sample and the presence of HCV core protein was also evaluated. A total of 12 patients were recruited. HCV RNA was detected in the bile from ten patients. RESULTS: The mean viral load was 2.5log10IU/60mg bile salt. In the stool samples, HCV RNA was detected in ten patients (mean concentration 2.7log10IU/g of feces). CONCLUSIONS: HCV RNA is readily detectable and is present at relatively high concentrations in the bile and stool samples of infected patients. This may be relevant as a source of infection in men who have sex with men. Biliary HCV secretion may perhaps play a role in the persistence of viral infection via an enterohepatic cycle of the virus or intrahepatic spread
INTRODUCCIÓN: El ciclo de vida del virus de la hepatitis C (VHC) está estrechamente ligado al metabolismo lipídico. Recientemente, se ha descrito que el NPC1L1 (un transportador del colesterol) actúa como un receptor del VHC. Este receptor se expresa en la membrana canalicular de los hepatocitos y en el intestino, y actúa como uno de los principales transportadores durante la circulación enterohepática del colesterol. OBJETIVOS: Planteamos la hipótesis de que el VHC podría tener un ciclo similar, por lo que nuestro objetivo fue estudiar la presencia del VHC en la bilis y en las heces de pacientes infectados. MATERIALES Y MÉTODOS: Se obtuvieron muestras de sangre, heces y bilis duodenal de pacientes infectados por el VHC. La concentración vírica en la bilis se normalizó respecto a la concentración de sales biliares de cada muestra y también se evaluó la presencia de la proteína central del VHC. Se reclutaron un total de 12 pacientes. Se detectó el ARN del VHC en la bilis de 10 pacientes. RESULTADOS: La media de la concentración vírica fue 2,5log10UI/60mg de sales biliares. En las muestras de heces, se detectó el ARN del VHC en 10 pacientes (media de la concentración 2,7log10UI/g de heces). CONCLUSIONES: El ARN del VHC es fácilmente detectable y está presente en concentraciones relativamente elevadas en las muestras de bilis y heces de pacientes infectados. Esto puede tener importancia como foco de infección en varones que mantienen relaciones sexuales con otros varones. Es posible que la secreción biliar del VHC pueda desempeñar un papel en la persistencia de la virosis a través de la circulación enterohepática del virus o la propagación intrahepática
Assuntos
Humanos , Hepatite C Crônica/virologia , Carga Viral , Hepacivirus/isolamento & purificação , Bile/virologia , Fezes/virologia , Fatores de Risco , Hepatite C Crônica/transmissãoRESUMO
Background: The availability of direct-acting antivirals (DAA) for the treatment of chronic hepatitis C virus (HCV) infection is just starting to expand in Chile. Aim: To report the initial experience of patients treated with DAA and their evolution after treatment. Material and Methods: Prospective cohort study, from June 2013 to August 2016 of patients treated with DAA for HCV in three clinical centers. The presence of cirrhosis, clinical and laboratory features; adverse events (AE) and post-treatment changes in liver function were evaluated. Sustained viral response at 12 weeks post-treatment (SVR12) was determined. Results: One hundred six patients aged 58 ± 13 years, 54% males, were included. HCV genotype 1b was present in 88% and 47% had cirrhosis. Treatment regimens were asunaprevir + daclatasvir (DCV) in 17% of patients, paritaprevir / ritonavir / ombitasvir + dasabuvir in 33%, sofosbuvir (SOF) + DCV in 19%, and SOF + ledipasvir in 30%. Twenty five percent of patients used generic drugs. SVR12 was 92.1%, with no differences between generic and brand-name drugs. Serious AE were recorded in 22% of patients, being more common in those with cirrhosis (34% vs 11.5%, p < 0.01). At 12 weeks post-treatment follow-up, there was a decrease in aminotransferase values (p < 0.01), improvement in Child-Pugh score (5.9 vs. 5.5, p = 0.03) and decreased presence of ascites (p = 0.02). Conclusions: In our setting, DAA for HCV was highly effective and safe in non-cirrhotic patients. Hepatic function and inflammation improved at 12 weeks of follow-up. AE were common in patients with cirrhosis, suggesting that these patients should be treated by experienced teams. Generic drugs had similar effectiveness compared to originals.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Antivirais/uso terapêutico , Medicamentos Genéricos/uso terapêutico , Hepatite C Crônica/tratamento farmacológico , Resposta Viral Sustentada , Antivirais/efeitos adversos , Estudos Prospectivos , Seguimentos , Medicamentos Genéricos/efeitos adversos , Hepatite C Crônica/complicações , Hepatite C Crônica/fisiopatologia , Alanina Transaminase/sangue , Cirrose Hepática/complicações , Cirrose Hepática/fisiopatologiaRESUMO
Background: Visceral fat accumulation is associated with the development of metabolic diseases. Anthropometry is one of the methods used to quantify it. aim: to evaluate the relationship between visceral adipose tissue volume (VAT), measured with magnetic resonance imaging (MRI), and anthropometric indexes, such as body mass index (BMI) and waist circumference (WC), in type 2 diabetic patients (DM2). Patients and Methods: Twenty four type 2 diabetic patients aged 55 to 78 years (15 females) and weighting 61.5 to 97 kg, were included. The patients underwent MRI examination on a Philips Intera® 1.5T MR scanner. The MRI protocol included a spectral excitation sequence centered at the fat peak. The field of view included from L4-L5 to the diaphragmatic border. VAT was measured using the software Image J®. Weight, height, BMI, WC and body fat percentage (BF%), derived from the measurement offour skinfolds with the equation of Durnin and Womersley, were also measured. The association between MRIVAT measurement and anthropometry was evaluated using the Pearson's correlation coefficient. Results: Mean VAT was 2478 ± 758 ml, mean BMI29.5 ± 4.7 kg/m², and mean WC was 100 ± 9.7 cm. There was a poor correlation between VAT, BMI (r = 0.18) and WC (r = 0.56). Conclusions: BMI and WC are inaccurate predictors of VAT volume in type 2 diabetic patients.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antropometria , /patologia , Gordura Intra-Abdominal/patologia , Imageamento por Ressonância Magnética/métodos , Fatores de Risco , Software , Estatísticas não Paramétricas , Circunferência da CinturaRESUMO
Background. Increase in visceral fat is associated to the development of fatty liver and liver fibrosis. Hepatic elastography is a novel noninvasive method for assessing liver fibrosis. Objective. To evaluate the relationship between visceral adipose tissue volume (VAT), subcutaneous adipose tissue volume (SAT) as measured by Magnetic Resonance Imaging (MRI) and transient elastography (TrE) values using ARFI (Acoustic Radiation Force Impulse) in type 2 Diabetic Mellitus patients (DM2). Methods. We included 20 DM2 patients (mean age: 62 years, range: 55-75, mean weight: 77.8 kg, range: 61.5-97). Patients underwent an MRI study in a Philips Intera 1.5T scanner. MR imaging protocol included a spectral excitation sequence centered on the fat peak. The sequence included 32 cross sections, 7mm thick, from the diaphragmatic cupula to the inferior border of the kidney. VAT was measured by using the semiautomatic Image J software. Each patient underwent a hepatic elastograpy (HE); 10 ARFI measurements were performed in the right hepatic lobe. Finally, a statistical analysis was performed by applying Pearson correlation between abdominal fat volumes and ARFI scores Results. Mean VAT was 2472 +/- 861 cc, (1173-4020 cc), whilst the mean ARFI was 1.62 ± 0.8 m/s, (0.8-3.4 m/s). Correlations obtained were r=0.08 between VAT and ARFI (p=0.72); 0.13 between SAT and ARFI (p=0.57), and -0.06 between (VAT+SAT) and ARFI (p=0.77). By subdividing the sample universe, we observed that the group with ARFI scores greater than 1.6 m/s (7 patients) had a correlation of 0.63 between VAT and ARFI (p=0.12); of 0.66 between SAT and ARFI (p=0.10), and of 0.94 between VAT+SAT and ARFI (p=0.001). In the subgroup with ARFI values inferior to 1.6 m/s (13 patients), the correlation was of 0.11 between VAT and ARFI (p=0.71); of 0.26 between SAT and ARFI (p=0.38), and of 0.32 between ( VAT+SAT) and ARFI (p=0.28). When adjusted for gender, ARFI scores greater than.
Introducción. La acumulación de grasa visceral se asocia al desarrollo de enfermedad hepática. La elastografía hepática es un método novedoso no invasivo para evaluar fibrosis hepática. Objetivo. Evaluar la relación entre el volumen de tejido adiposo visceral (VAT), volumen de tejido adiposo subcutáneo (SAT) medido por resonancia magnética (RM), con índices de elastografía hepática (EH) utilizando ARFI (fuerza de impulso de radiación acústica) en pacientes con Diabetes Mellitus tipo 2 (DM2). Métodos. Fueron incluidos 20 pacientes (edad promedio: 62 años, rango: 55-75 años, peso promedio: 77,8 kg, rango: 61,5-97 kg) con DM2. Los pacientes se sometieron a un examen de RM en un resonador Philips Intera 1.5T. Al protocolo de RM se agregó una secuencia de excitación espectral centrada en el peak de grasa. La secuencia incluyó 32 cortes transversales, grosor 7mm, desde la cúpula diafragmática hasta el borde inferior renal. En las imágenes se midió VAT utilizando el software Image J (freeware). En cada paciente se realizó una EH, utilizando ARFI con 10 medidas en lóbulo hepático derecho. Finalmente, se realizó un análisis estadístico a través de la correlación de Pearson entre los volúmenes de grasa abdominal y ARFI. Resultados. El promedio de VAT fue 2472 +/- 861 cc, (1173-4020 cc), el promedio de ARFI fue 1,62 ± 0,8 m/s, (0,8-3,4 m/s). Se obtuvieron correlaciones de r=-0,08 entre VAT y ARFI (p=0,72), de 0,13 entre SAT y ARFI (p=0,57), y de -0,06 entre (VAT+SAT) con ARFI (p=0,77). Subdividiendo el universo muestral, se encontró que el grupo con ARFI mayor que 1,6 m/s (7 pacientes) obtuvo una correlación de 0,63 entre VAT y ARFI (p=0,12), de 0,66 entre SAT y ARFI (p=0,10), y de 0,94 entre (VAT+SAT) con ARFI (p=0,001). En el subgrupo con ARFI inferior a 1,6 m/s (13 pacientes) la correlación fue 0,11 entre VAT y ARFI (p=0,71), de 0,26 entre SAT y ARFI (p=0,38), y de 0,32 entre (VAT+SAT) y ARFI (p=0,28).