Predictores de infección y mortalidad en pacientes con cirrosis hepática en el hospital de alta complejidad Virgen de la Puerta de Trujillo, Perú / Predictors of infection and mortality in patients with liver cirrhosis in the high complexity hospital Virgen de la Puerta from Trujillo, Peru

Introducción: La cirrosis hepática descompensada por infecciones bacterianas es uno de los principales diagnósticos de admisión a hospitalización, teniendo en cuenta que el riesgo per se en ello es más alto que en pacientes no cirróticos, conllevando a cifras altas de mortalidad. Objetivo: El presente estudio buscó determinar los predictores de infección y mortalidad en pacientes con cirrosis hepática, así como las características epidemiológicas-clínicas de los pacientes con cirrosis. Materiales y métodos: De manera prospectiva se recolectaron los datos de los pacientes cirróticos hospitalizados en el servicio de Gastroenterología y Medicina interna del hospital de alta complejidad Virgen de la Puerta desde el 2015 a Junio del 2018. Resultados: El estudio incluyó 66 pacientes. La frecuencia de infección fue de 37,88%, siendo más frecuente la peritonitis bacteriana espontánea (21,2%) y la mortalidad total fue de 12,12%. Al realizar regresión logística binaria y curva ROC se obtuvieron como predictores de mortalidad, el valor de MELD >13,5 (p=0,003), TP >18,26 (p=0,003) y el estadio Child Pugh C (p=0,02, IC 95% EXP(B) 0,13-0,365). Las variables que predicen ausencia de mortalidad fueron un valor de plaquetas ≥ 74 500 /mm3 (p=0,01) y Sodio ≥133 mEq/l (p=0,019). Los predictores de infección, valor de MELD ≤14,5 (p=0,0004) y el nivel de sodio ≥134,5 mEq/l (AUC 0,696, p=0,028), para predecir ausencia de infección. Conclusiones: El MELD alto es un factor predictor tanto de mortalidad como de infección. El Child Pugh C y los valores de tiempo de Protrombina altos son predictores de mortalidad. El nivel de sodio normal es un predictor de ausencia de mortalidad e infección, así como el valor de plaquetas discretamente disminuido es predictor de ausencia de mortalidad.

Introduction: Liver cirrhosis decompensated due to bacterial infections is one of the main diagnoses of admission to hospitalization, taking into account that the risk per se in it is higher than in non-cirrhotic patients, leading to high mortality rates. Objective: The present study sought to determine the predictors of infection and mortality in patients with liver cirrhosis, as well as the epidemiological-clinical characteristics of patients with cirrhosis. Material and methods: Prospective data were collected from hospitalized cirrhotic patients in the Gastroenterology and Internal Medicine Service of the Hospital High Complexity "Virgen de la Puerta", from 2015 to June 2018. Results: The study included 66 patients. The infection frequency was of 37.88%, being more frequent the spontaneous bacterial peritonitis (21.2%) and the total mortality was of 12.12%. When performing binary logistic regression and ROC curve, the MELD value> 13.5 (p=0.003), TP >18.26 (p=0.003) and the Child Pugh C stage were obtained as predictors of mortality (p=0.02, IC 95% EXP(B) 0.13-0.365). The variables that predict absence of mortality were a platelet value ≥74 500 /mm3 (p=0.01) and sodium ≥133 (p=0.019). The predictors of infection, MELD value ≤14.5 (p=0.0004) and sodium level ≥134.5 (AUC 0.696, p=0.028), to predict absence of infection. Conclusions: High MELD is a predictor of both mortality and infection. Child Pugh C and high values of Prothrombin time are predictors of mortality. The normal sodium level is a predictor of absence of mortality and infection, as well as platelet values discreetly low are predictors of absence of mortality.

Las hepatitis B y C bajo la lupa La respuesta de salud pública en la Región de las Américas, 2016 / Hepatitis B and C in the Spotlight. A public health response in the Americas, 2016

El presente informe ofrece un panorama de las epidemias actuales de hepatitis B y hepatitis C, así como de la respuesta del sector de la salud en la Región de las Américas. Su finalidad es proporcionar, en el marco de un entorno en constante cambio, un conocimiento básico de los temas principales relacionados con la respuesta a estas epidemias en la Región, para lo cual presenta un panorama de los grupos de población afectados y de la carga de las infecciones por el virus de la hepatitis B (VHB) y el virus de la hepatitis C (VHC) en la Región, además de las actuales políticas y de las prácticas del sector de la salud. Este informe, el primero en su tipo que aborda el seguimiento de los progresos en la consecución de las metas establecidas en el Plan de acción para la prevención y el control de las hepatitis virales,tiene por objeto ayudar a los Estados Miembros a adaptar sus políticas y prioridades para que puedan establecer una respuesta de salud pública eficaz e integral. Se ha producido un cambio importante en la conciencia mundial sobre las epidemias de hepatitis virales: ya no se consideran silenciosas y actualmente se observa una evolución hacia la adopción de medidas a escala mundial para eliminarlas como problema de salud pública. En la Región de las Américas, la principal carga de las hepatitis virales se debe a las hepatitis B y C; unos 2,8 millones de personas (2,2 a 8,0 millones)1presentan la infección crónica por el virus de la hepatitis B (VHB), de las cuales 2,1 millones viven...

Isolated Proteinuria in Hepatitis A Versus E Virus (HAV vs HEV) Infected Patients: A Hospital Based Observational Study.

Introduction: Viral hepatitis, either acute or chronic, may lead to nephropathies as one of its multiple extrahepatic complications which often remain clinically silent for a long period and are overlooked. Proteinuria can be a useful tool for early detection of the underlying renal impairment. This study was undertaken to detect the presence of proteinuria and to assess and compare the level of proteinuria in HAV and HEV- infected cases; the two most common causes of acute hepatitis in Bangladesh. Method: For this 100 diagnosed patients of HAV & HEV (50 each) hepatitis were screened for isolated proteinuria in a random spot urine sample during their 3rd to 4th post-ecteric follow ups. Result: 43% HAV and 45% HEV patients had high spot urinary protein with maximum incidence (54 %) occurring in 3rd decades of life. The pattern of isolated proteinuria was significantly different in HAV vs HEV cases. The mean ± SD value of spot urinary protein of HEV females was significantly higher than that of HAV where highest rate (64%) of mild proteinuria was observed in HAV and maximum number (46%) of moderate proteinuria in HEV patients. Conclusion: Spot urinary protein concentration should be checked quantitatively in every HEV as well as HAV- hepatitis patient even when clinically improved.

Interacción entre el virus de la inmunodeficiencia humana y el virus GB tipo-C durante el estado de co-infección / Interaction between HIV-1 and GB virus type-C during coinfection status

The human immunodeficiency virus (HIV) infection is one of the most important problems in public health. It is estimated that 3 3 million people are infected around the world. HIV and GBV-C share the same transmission route, being frequent the co-infection. Since both viruses replicate in CD4+ lymphocytes, recent studies have described an interaction. Decreasing of HIV viral load and higher CD4 counts have been observed in co-infected patients, leading a better clinical outcome. Nevertheless, some epidemiological studies have shown contradictory results. Additionally, in vitro models report inhibition of HIV by E1, E2, NS3 and NS5A GBV-C proteins, resulting in a decreasing of p24 antigen. This review summarizes the principal findings about co-infection and mechanisms that have been proposed for HIV-1 inhibition.

La infección por el virus de la inmunodeficiencia humana (VIH) continúa siendo uno de los principales problemas en salud pública; se estima que existen actualmente más de 33 millones de personas infectadas en el mundo. El VIH y el virus GB tipo C (GBV-C) comparten la misma vía de transmisión, por lo que es frecuente encontrar individuos co-infectados. Estudios recientes han descrito un efecto inhibitorio asociado a disminución en la carga viral de VIH, altos recuentos de CD4 y mayor tiempo de sobrevida en pacientes co-infectados, resultando en un mejor pronóstico y menor progreso a SIDA; adicionalmente, estudios in vitro indican que las proteínas virales E1, E2, NS3 y NS5A del GBV-C estarían implicadas en la inhibición del VIH-1. En el presente artículo se revisan los principales aspectos de la co-infección, y se describen los mecanismos propuestos para la inhibición de la replicación del VIH-1 mediada por las proteínas virales del GBV-C.

Falência hepática aguda / Acute liver failure

Falência hepática aguda é uma síndrome clínica devastadora, com alta taxa de mortalidade, apesar dos recentes avanços da terapia intensiva. Determinar a causa tem importantes implicações prognósticas, e o transplante de fígado é um tratamento que salva vidas em casos selecionados. O conhecimento das últimas diretrizes e protocolos pode levar a melhores resultados.

Acute liver failure is a devasting clinical syndrome, with high mortality rate, despite critical care advances. Determining the cause has important prognostic implications, and the orthotopic liver transplantation is a life-saving treatment in select cases. Knowledge of the latest guidelines and treatment protocols can lead to improved patient case.

Pruebas de laboratorio en el síndrome de Gilbert consecutivo a hepatitis / Laboratory tests in Gilbert's syndrome subsequent to hepatitis

Se efectuó un estudio descriptivo y transversal de 40 pacientes con síndrome de Gilbert consecutivo a hepatitis viral aguda, admitidos en el Servicio de Medicina Interna del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba o en la consulta especializada de Hepatología del Policlínico de Especialidades de esta institución, desde junio del 2011 hasta igual mes del 2012, a fin de determinar las características clínico humorales y la respuesta al tratamiento médico en estos. En la casuística se evaluaron las medias, medianas y desviaciones estándares, y entre los resultados se observaron una mayor representación de los hombres menores de 36 años (90,0 por ciento del total), así como un predominio de las manifestaciones de somnolencia, seguida de la astenia, ictericia leve y ausencia de síntomas; asimismo, se confirmó la elevación de la bilirrubina indirecta y su posterior disminución al aplicar la terapia con un inductor enzimático, en este caso el fenobarbital, con el cual se obtuvo, finalmente, mejoría clínica y humoral de los afectados

A descriptive and cross-sectional study was carried out in 40 patients with Gilbert's syndrome subsequent to viral hepatitis, admitted to the Internal Medicine Department of Saturnino Lora Torres Provincial Clinical Surgical Teaching Hospital of Santiago de Cuba or to the specialized hepatology service of the Polyclinic of Specialties in this institution, from June 2011 to the same month of 2012, to determine the clinical and humoral characteristics and the response to medical treatment in them. Means, medians and standard deviations were evaluated in the case material, and among the results was a greater representation of males younger than 36 years (90.0 percent of the total), and a prevalence of manifestations of drowsiness, followed by sleepiness, mild jaundice and absence of symptoms was observed. Also, the elevation of indirect bilirrubin and its subsequent reduction when applying therapy with an enzyme inducer, phenobarbital in this case, were confirmed, eventually obtaining clinical and humoral improvement of patients

Type and cause of liver disease in Korea: single-center experience, 2005-2010

BACKGROUND/AIMS: The aim of this study was to describe the types and causes of liver disease in patients from a single community hospital in Korea between April 2005 and May 2010. METHODS: A cohort of patients who visited the liver clinic of the hospital during the aforementioned time period were consecutively enrolled (n=6,307). Consistent diagnostic criteria for each liver disease were set by a single, experienced hepatologist, and the diagnosis of all of the enrolled patients was confirmed by retrospective review of their medical records. RESULTS: Among the 6,307 patients, 528 (8.4%) were classified as acute hepatitis, 3,957 (62.7%) as chronic hepatitis, 767 (12.2%) as liver cirrhosis, 509 (8.1%) as primary liver cancer, and 546 (8.7%) as a benign liver mass or other diseases. The etiologies in the acute hepatitis group in decreasing order of prevalence were hepatitis A (44.3%), toxic hepatitis (32.4%), other hepatitis viruses (13.8%), and cryptogenic hepatitis (9.1%). In the chronic hepatitis group, 51.2% of cases were attributed to viral hepatitis, 33.3% to nonalcoholic fatty liver disease, and 13.0% to alcoholic liver disease (ALD). Of the cirrhoses, 73.4% were attributable to viral causes and 18.1% to alcohol. Of the hepatocellular carcinoma cases, 86.6% were attributed to viral hepatitis and 11.6% to ALD. Among the benign tumors, hemangioma comprised 52.2% and cystic liver disease comprised 33.7%. CONCLUSIONS: Knowledge of the current status of the type and cause of liver disease in Korea may be valuable as a basis for evaluating changing trends in liver disease in that country.

Investigation of chromosomal aberrations in Egyptian hepatocellular carcinoma patients by fluorescence in situ hybridization.

BACKGROUND AND AIMS: Hepatocellular carcinoma (HCC) is a very common and highly malignant tumor, associated mainly with chronic viral hepatitis, cirrhosis of any cause, aflatoxin exposure and ethanol consumption. Cytogenetic analysis on HCC has been limited because of poor hepatocyte growth in vitro. Conventional cytogenetic studies have demonstrated frequent abnormalities of specific chromosomes in HCC. Molecular cytogenetic approaches have been applied only rarely in the characterization of HCC. The main aim of this study was to evaluate genetic aberrations of different chromosomes in HCC. The study included 35 patients with HCC, who have been diagnosed and treated at National Cancer Institute, Cairo University, Egypt. The clinico-pathologic features of the studied patient were collected from patient’s files. MATERIALS AND METHODS: Interphase cytogenetics by fluorescence in situ hybridization with the use of a panel of centromere-associated DNA probes for chromosomes 1, 4, 8, 9, 13, 17, 20 and Y were performed on paraffin-embedded HCC specimens. RESULTS: The most common chromosomal aberrations detected were gain of chromosomes 8 in 12 cases (34.28%), 17 in 6 cases (17.14%). Loss of chromosome Y was detected in 6 of male cases (30%). Monosomy 4 was also detected in 5 cases (14.28%). Negative correlation could be detected only between chromosome 4 and 8. (r = -0.381, P < 0.05). Correlations between gain or loss of chromosomes and the different clinicopathologic parameters in the patients investigated, indicated negative correlation between: chromosome Y and age and chromosome 1 and cirrhosis. CONCLUSION: Gains and losses of DNA found in this study probably involve oncogenes and tumor suppressor genes that play a role in the puzzle of hepatocarcinogenesis.

Frequency and characteristic features of portal hypertensive gastropathy in patients with viral cirrhosis

To determine the frequency and specific characteristic features of portal hypertensive gastropathy [PHG] in cirrhosis due to viral etiology. Cross-sectional descriptive study. The Aga Khan University Hospital, Karachi, from June 2006 till June 2008. Patients with hepatitis B and C cirrhosis were included who underwent screening esophago-gastro-duodenoscopy [EGD] for varices. Baveno III consensus statement was used for diagnosing PHG on endoscopy and divided them into two subgroups i.e. mild and severe. Data related to platelet/spleen ratio, MELD score and Child Turcotte Pugh [CTP] score indicating severity of cirrhosis were recorded in all patients. Findings were compared by using independent sample t-test. Out of 360 patients who underwent screening EGD, 226 [62.8%] were males. Two hundred and eighty one [78%] had hepatitis C while 79 [22%] suffered from hepatitis B related cirrhosis. Three hundred patients [83.3%] had PHG while 71 [24%] had severe PHG. Higher proportion of esophageal varices [89.7%] was present among those who had PHG [p < 0.001]. On univariate analysis lower platelet counts [117 +/- 55 vs. 167 +/- 90; p < 0.001], increased spleen size [14.1 +/- 2.9 cm vs. 12 +/- 2.4cm; p < 0.001] were found in PHG patients as compared to those without it. Similarly, lower platelet/spleen ratio was noted in patients with severe PHG [916 +/- 400 vs. 1477 +/- 899; p < 0.001]. Furthermore, on multivariate analysis CTP score > 8 MELD score > 12 and platelets/spleen ratio < 900 were significantly associated factors with severe PHG. Frequency of PHG was 83% while severe PHG was seen in 24% cases of viral hepatic cirrhosis. MELD score > 12, CTP score >/= 8 and platelets/spleen ratio

Leptin, osteocalcin, and bone mineral density in post-hepatitic liver cirrhosis

The pathophysiology of osteoporosis complicating chronic liver disease is unknown. Some studies have found leptin to be a potent inhibitor of bone formation. The aim of this study is to investigate the relationship between leptin, osteocalcin and bone mineral density [BMD] in liver cirrhosis. Sixty patients with post-hepatitic liver cirrhosis were classified into three groups: group I, 20 pre-menopausal females; group II, 20 post-menopausal females; and group III, 20 males. In addition, 21 age- and sex-matched healthy subjects [seven for each group] were included as control subjects. Patients were classified according to Child-Pugh classification into grade A [n = 0], grade B [n = 38] and grade C [n = 22]. Serum osteocalcin, leptin and parathyroid hormone [PTH], in addition to liver functions test, hepatitis B surface antigen [HBsAg], anti-hepatitis C virus [HCV], serum phosphorus and calcium were measured. Bone mineral density [BMD] was measured by calcaneal ultrasound. Leptin was elevated in all groups [I, II and III] when compared with their control groups [p < 0.01, p < 0.001 and p < 0.01, respectively]. Further, it was high in female groups [I and II] compared to males [group III], [p < 0.01 each]. BMD and serum osteocalcin decreased in each group compared with the respective control [p < 0.001; p < 0.01 in group I, p < 0.05; p < 0.001 in group II and p < 0.001; p < 0.001 in group III, respectively]. In the Child-Pugh grade C group, BMD and osteocalcin were low [p < 0.001, p < 0.05, respectively], while serum leptin was elevated [p < 0.05], when compared with grade B group. Leptin correlated negatively with serum osteocalcin [r = -0.553; p < 0.001], BMD [r = -0.229; p < 0.05], albumin [r = -0.449; p < 0.001] and albumin/globulin [A/G] ratio [r = -0.661; p < 0.001], while positively correlated with both aspartate transaminase [AST] [r = 0.462; p < 0.001], and alanine transaminase [ALT] [r = 0.483; p < 0.001]. Osteocalcin negatively correlated with intact iPTH [r = -0.370, p < 0.001], while positively correlated with BMD [r = 0.418; p < 0.001], albumin [r = 0.659; p < 0.001] and A/G ratio [r = 0.444; p < 0.001]. Serum leptin was elevated in cirrhotic patients and may have a role in the pathogenesis of osteoporosis in liver cirrhosis

Prediction of compensated liver cirrhosis by ultrasonography and routine blood tests in patients with chronic viral hepatitis / 대한간학회지

BACKGROUND/AIMS: Liver biopsy is a standard method for diagnosis of liver cirrhosis in patients with chronic hepatitis. Because liver biopsy is an invasive method, non-invasive methods have been used for diagnosis of compensated liver cirrhosis in patients with chronic hepatitis. The current study was designed to evaluate the usefulness of ultrasonography and routine blood tests for diagnosis of compensated liver cirrhosis in patients with chronic viral hepatitis. METHODS: Two hundred three patients with chronic viral hepatitis who underwent liver biopsy were included in this study and ultrasonography and routine blood tests were analyzed retrospectively. Ultrasonographic findings, including surface nodularity, parenchyma echogenecity, and spleen size, were evaluated. The diagnostic accuracy of ultrasonography and routine blood tests were examined. RESULTS: Discriminant analysis with forward stepwise selection of variables showed that liver surface nodularity, platelet count, and albumin level were independently associated with compensated liver cirrhosis (p95% specificity: platelet count 1.3; and surface nodularity. If at least one of the four variables exists in a patient with chronic viral hepatitis, we can predict liver cirrhosis with 90% specificity and 61% sensitivity. CONCLUSIONS: These results suggest that four variables (platelet count 1.3, and surface nodularity) can be used for identification of liver cirrhosis in patients with chronic viral hepatitis with high specificity.

Acute pancreatitis associated with acute viral hepatitis: case report and review of literature / Pancreatite aguda associada com hepatite A aguda: relato de caso e revisão da literatura

This case report, along with the review presented, describes a patient diagnosed with acute viral hepatitis, who developed a framework of intense abdominal pain and laboratorial alterations compatible with acute pancreatitis. The association of acute pancreatitis complicating fulminant and non-fulminant acute hepatitis virus (AHV) has been reported and several mechanisms have been proposed for this complication, but so far none is clearly involved. As acute hepatitis is a common disease, it is important to stimulate the development of other studies in order to determine local incidence and profile of patients presenting this association in our environment.

Este relato de caso, junto com a revisão de literatura, descreve um paciente com diagnóstico de hepatite viral aguda, que desenvolveu quadro de dor abdominal intensa e alterações laboratoriais compatíveis com pancreatite aguda. Casos de pancreatite aguda complicando hepatites virais agudas fulminantes e não fulminantes tem sido esporadicamente relatados e vários mecanismos são propostos para explicar esta complicação, no entanto sua causa ainda se mantém desconhecida. Como a hepatite aguda é doença comum, é importante estimular o desenvolvimento de mais estudos na América Latina que visem determinar a incidência local e o perfil dos pacientes que apresentam esta complicação.

Changes in Liver Stiffness after Acute or Chronic Liver Injury due to Viral Hepatitis - Does Fibrosis Exist after Recovery from Acute Viral Hepatitis? / 대한소화기학회지

BACKGROUND/AIMS: Liver stiffness (LS) measurement by transient elastography can estimate the degrees of liver fibrosis in patients with chronic liver disease. However, longitudinal data of LS after recovery of acute viral hepatitis are still lacking. In the present study, we aimed to evaluate among LS of patients at various stages of viral hepatitis and normal control. METHODS: Patients who had admitted at Korea University Ansan Hospital between January 2006 and January 2007 due to acute viral hepatitis and recovered were recruited (group A, n=22). We compared the liver biochmistry and LS of group A with those of healthy control group (group B, n=23), current acute viral hepatitis group (group C, n=49), and chronic viral hepatitis group (group D, n=66). RESULTS: Mean ALT, total bilirubin, and LS level of group A were not different from group B (p=0.318, p=0.116, p=0.125, respectively). However, group A had lower ALT, total bilirubin, and LS values compared to group C (all p<0.001), and lower ALT and LS values compared to group D (p=0.007, p<0.001). The mean total bilirubin was not significantly different from group D (p=0.117). CONCLUSIONS: Our data suggest that liver fibrosis is a long-term sequela of chronic hepatitis, and not developed in patients who recovered from acute viral hepatitis.

Non-B, Non-C Hepatitis as a cause of advanced chronic liver disease requiring medical admission at a rural centre in Pakistan

To study the frequency and mortality of hepatitis B and C negative chronic liver disease [CLD] at a rural tertiary centre in Pakistan. Data was collected retrospectively from the case notes of all the 176 patients consecutively admitted with advanced CLD in our medical ward during one year period. Patients, who were seropositive for hepatitis B and / or C, were separated from those who were negative for them, and the data was analysed. Thirty five patients [20%] were negative for both viral markers. They were more likely to die during the admission than those who were seropositive [11% VS 25% - p = 0.029]. A significant proportion of patients with CLD are negative for viral markers. These patients are at higher risk of mortality, and need testing for other causes of CLD as some of them may benefit from curative treatments available

Observations of hepatic encephalopathy profile in a tertiary care centre.

A study was conducted among 67 patients presenting with hepatic encephalopathy to establish the aetiological diagnosis and record the incidence of acute and chronic liver diseases. They all had undergone thorough clinical and laboratory evaluation. The factor precipitating encephalopathy was also identified. Among 67 patients 19 (28.4%) had acute liver disease and 48 (71.6%) had chronic liver disease. Majority of patients had grade 2 encephalopathy at presentation. Among the acute cases most common aetiology was acute viral hepatitis due to hepatitis B and E viruses whereas alcoholic liver disease was the most frequent cause of chronic liver disease. The most common precipitating factor was gastro-intestinal haemorrhage.

A Case of Cholestatic Hepatitis Induced by Epstein-Barr Virus Infection / 대한간학회지

Acute viral hepatitis in human can be caused by a large number of viruses with a wide range of clinical manifestations and laboratory findings. EBV is a rare causative agent of an acute hepatitis, during the course of infectious mononucleosis. Hepatic manifestations of EBV are usually mild and resolve without serious complications. EBV is rather uncommonly confirmed as an etiologic agent in acute viral hepatitis of adults and it rarely causes cholestatic hepatitis. We report a case of EBV hepatitis with cholestatic feature that was verified through serum viral marker and liver biopsy.

Hepatitis-associated aplastic anemia: successful outcome following immunosuppressive therapy.

Hepatitis-associated aplastic anemia is an uncommon variant seen in young, previously healthy individuals. The pancytopenia follows hepatitis by a few weeks and is usually severe and prolonged. Bone marrow transplantation remains the cornerstone of therapy. However, immunosuppressive therapy has been found to be effective. We report an 8-year-old girl who had non-A, B, C and E hepatitis-associated severe aplastic anemia. She became transfusion-independent and had consistent, albeit incomplete recovery after immunosuppressive therapy with antithymocyte globulin and cyclosporine.

Presence of TT virus infection in chronic hepatitis patients from a hospital in New Delhi, India.

BACKGROUND & OBJECTIVE: The recent discovery of a novel parenterally transmitted, unenveloped, single-stranded DNA virus called TT virus (TTV) in chronic hepatitis patients with unclear pathogenesis throughout the world led us to investigate, its presence in chronic hepatitis patients attending a hospital in New Delhi, India, and to evaluate its role in liver disease. METHODS: TT virus DNA was investigated in serum samples of 70 patients with various types of chronic hepatitis, and 100 healthy subjects from New Delhi, India by nested PCR using the primers that belonged to UTR (A) region of the genome. RESULTS: TTV DNA was detected in 6 of 23 patients (26%) with type B chronic hepatitis, 3 of 20 patients (15%) with type C chronic hepatitis, and 12 of 100 subjects (12%) from healthy control group with normal liver function profile tests. None of the 27 non-B, non-C chronic hepatitis patients had TTV DNA positivity. The prevalence of TTV was significantly higher in type-B chronic hepatitis patients as compared to normal subjects (P< 0.05) but comparable to type C chronic hepatitis patients. The clinical course and biochemical profiles of type B, or type C chronic hepatitis patients co-infected with TTV did not differ significantly from those without TTV infection. INTERPRETATION & CONCLUSION: Interestingly, in chronic hepatitis patients, TTV was always associated with either hepatitis B or C virus indicating a likely parenteral route of transmission. All TTV-positive subjects in healthy control group showed normal clinical and biochemical profiles. Thus, the presence of TTV infection is unlikely to influence the course of chronic hepatitis related to hepatitis B virus (HBV) or hepatitis C virus (HCV) or cause liver diseases in healthy subjects.