The influence of NAFLD on the risk of atherosclerosis and cardiovascular diseases.

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in developed countries and is associated with obesity, dyslipidaemia, diabetes, and metabolic syndrome. Atherosclerosis and cardiovascular diseases are also highly prevalent in this group of patients, due to the presence of shared risk factors. The incidences of coronary artery calcification, hypertension, aortic valve sclerosis, diastolic dysfunction, atherosclerotic plaques, and increased carotid intima-media thickness were more common in patients with NAFLD than in those without. The present paper reviews the medical literature concerning the association between NAFLD and cardiovascular events.

Epidemiology of hepatitis C virus infections in Lódzkie voivodeship / Epidemiologia zakazen HCV w województwie lódzkim

INTRODUCTION: Epidemiology of HCV subtypes plays an increasing role in treatment decision making in the era of direct acting antivirals. Data on incidence of HCV subtypes in Poland are sparse and equivocal. AIM OF THE STUDY: The aim of this study was to assess the distribution of HCV subtypes basing on data collected in Lodzkie province in 2015. MATERIALS AND METHODS: Patients with chronic hepatitis C were evaluated for antiviral treatment in one of the three infectious diseases departments in Lodzkie province in 2015 and had HCV genotype/subtype determined. The exclusion criteria were as follows: HBV and/or HIV coinfection and age under 18 years old. RESULTS: The study included 555 patients aged from 18 to 87 years. The rate of women was 52.8%, mean age was 47.4 years and treatment-experienced patients comprised 22.7% of study group. Genotypes 1, 3 and 4 were detected in 512 (92.25%), 34 (6.13%) and 7 (1.26%) patients, respectively. Subtype determination was performed in 464 patients infected with HCV genotype 1. The frequency of subtype 1a and 1b was 18.8% and 81%, respectively. Mean age in patients with HCV 1a infection was 28.6 years and was significantly lower than in patients infected with HCV 1b (52.5 years, p<0.05). A significant correlation between age and HCV subtype was observed. CONCLUSIONS: Prevalence of subtype 1a in patients with chronic hepatitis C in Lodzkie province is high, moreover, this subtype dominates in population of young adults (18-29 years).

Efficacy and direct costs of chronic hepatitis C treatment with first generation NS3/4A protease inhibitors in a real life population.

INTRODUCTION: Recent years have brought a significant advance in chronic hepatitis C (CHC) treatment that includes development of direct acting antivirals (DAA). Two of them, boceprevir (BOC) and telaprevir (TVR), were first approved for treatment of patients infected with CHC genotype 1 in combination with pegylated interferon (P) and ribavirin (R). Our aim was to evaluate the efficacy and direct costs of BOC/PR and TVR/PR in a real life population. MATERIAL AND METHODS: The study included adult patients qualified for the CHC Therapeutic Programme treated with TVR/PR or BOC/PR. Treatment was continued for 24 or 48 weeks. Sustained virological response, treatment discontinuation due to adverse events and lack of virological response rates were compared. RESULTS: A total of 243 adult patients with CHC were included. TVR/PR and BOC/PR were administered in respectively 122 and 121 patients. Thirty-two patients (13%) were treatment-naïve, whereas liver cirrhosis/advanced fibrosis was observed in 138 patients (56.7%). Overall, 43.6% of patients achieved a sustained virologic response (SVR). In the BOC/PR group the SVR rate was significantly lower than in the TVR/PR group (33.1% vs. 54.1%; p = 0.00094). Lack of response to therapy was observed in 41.3% and 12.3% of patients receiving BOC and TVR, respectively (p < 0.00001). The direct cost of achieving SVR in one patient was 285 450 PLN with BOC and 185 757 PLN with TVR. CONCLUSIONS: The very low treatment efficacy may be the result of inclusion criteria that allowed treatment of patients with advanced liver fibrosis/liver cirrhosis or previous treatment failure. Telaprevir seems to be significantly more potent against hepatitis C virus, with similar safety and tolerance.

The prevalence and severity of 25-(OH)-vitamin D insufficiency in HCV infected and in HBV infected patients: a prospective study.

AIM OF THE STUDY: To assess the prevalence and severity of vitamin D insufficiency in patients with hepatitis C virus (HCV) infection and in patients with hepatitis B virus (HBV) infection. MATERIAL AND METHODS: This prospective study included 90 patients with chronic hepatitis C and 35 patients with chronic hepatitis B admitted to the Infectious Diseases Department between March 2013 and May 2014. Patients with chronic liver disease other than viral hepatitis, HIV co-infection, advanced liver disease and a history of diseases influencing vitamin D status were excluded. Serum vitamin D measurement as well as liver function, viral load, HCV genotype, interleukin 28 and liver fibrosis assessments were performed. RESULTS: In all patients, the mean vitamin D serum concentration was 18.8 (± 8.9) ng/ml. The mean vitamin D level in HBV infected patients was lower than in HCV infected patients (17.6 ng/ml vs. 19.3 ng/ml; p = 0.43). Vitamin D status was assessed in relation to viral load, HCV genotype, interleukin 28 and sex, but the differences were not significant. In both groups, serum vitamin D levels were significantly lower in winter compared to summer (14.2 ng/ml vs. 23.9 ng/ml in patients infected with HCV [p < 0.000001] and 14.7 ng/ml vs. 23.8 ng/ml in patients infected with HBV [p < 0.001]). CONCLUSIONS: Our study showed that in patients with chronic hepatitis C or chronic hepatitis B, insufficient 25(OH)D concentrations occur very often, but are not associated with poor virological characteristics. The only factor influencing the vitamin D level was the season.

Expression of selected genes in liver biopsy specimens in relation to early virological response in patients with chronic hepatitis C with HCV mono- and HIV/HCV co-infection.

The aim of our study was to evaluate the significance of IL-28B single-nucleotide polymorphism and hepatic expression of IFI27, SOCS3 and miR-122 in order to predict early virological response (EVR) in patients infected with HCV genotype 1 or 4. The study group consisted of 65 patients: 46 with HCV mono- and 19 with HIV/HCV co-infection. Analyses of IL-28B single-nucleotide polymorphism C/T (rs12979860) in the blood and expression of SOCS3, IFI27 and miR-122 in liver biopsy samples obtained before PegIFN and ribavirin treatment were performed by the RT-PCR method. EVR was defined as a >2log decline in HCV viremia at week 12. EVR was associated with a lower expression of IFI27 and a more frequent presence of the IL28BCC genotype. IFI27 expression was lower in patients with the CC genotype, irrespective of EVR. In multivariate logistic regression, only IL28B CC genotype and age above 40 years influenced EVR (OR =5.09 and 0.29 respectively). In contrast to IFI27, expression of miR-122 and SOCS3 in patients with different IL28B genotypes was not statistically significantly different. A correlation between miR-122 and SOCS3 was found (Rho =0.495094 p< 0.0001). Analysis of IFI27, SOCS3 and miR-122 hepatic expression does not provide substantial benefits for the prognosis of EVR. The only independent prognostic factors for EVR are age and IL28B genotype. The prognostic significance of IFI27 expression for EVR is dependent on the genetic polymorphism of IL28B.

Sustained virologic response and IL28B single-nucleotide polymorphisms in patients with chronic hepatitis C treated with pegylated interferon alfa and ribavirin.

INTRODUCTION: Hepatitis C virus (HCV) infection is a global health problem which can lead to liver cirrhosis or hepatocellular carcinoma in one-fifth of chronically infected patients. MATERIALS AND METHODS: The study group consisted of 123 patients: 90 with HCV mono- and 33 with HIV/HCV co-infection, who were treated with pegylated interferon alfa (Peg-IFN-α) and ribavirin. We analyzed selected pretreatment factors: age, sex, HIV/HCV co-infection, grade of inflammation, necrotic changes and fibrosis in histological analysis of liver bioptates, HCV viral load, HCV genotypes, and single nucleotide polymorphisms (SNPs) of IL28B and tried to find out which of them influence sustained virological response (SVR). The IL28B SNP C/T (rs12979860) was analyzed using Custom(®) SNP Genotyping Assays (Applied Biosystems). RESULTS: Multivariate analysis demonstrated that after adjusting for the other variables three predictors independently influence SVR, namely genotype 3 of HCV, presence of the CC genotype and age >40 years (OR respectively 15.14, 3.62, and 0.36). HCV mono-infected patients were infected with HCV genotype 3 or 4 less frequently (p=0.0001) compared to HIV/HCV co-infected individuals. In patients with HIV/HCV co-infection the CC variant occurred more frequently whereas CT was found less frequently (p=0.001, p=0.0146, respectively). In patients with HIV/HCV co-infection, 3 and 4 genotype of HCV occurred more frequently compared to patients with HCV mono-infection (p=0.0001). CONCLUSIONS: These data suggest that age, HCV genotype and IL28B polymorphism are useful for prediction of the response to treatment with Peg-IFN-α and ribavirin. The more frequent occurrence of HCV genotypes 3 or 4 in patients with HIV/HCV co-infection could be associated with the route of transmission.

[The influence of interferon-alpha-2b on the effectiveness of the hepatitis B vaccine in patients suffering from chronic hepatitis C]. / Wplyw interferonu alfa-2b na odpowiedz humoralna po szczepieniu przeciwko wirus owemu zapaleniu watroby typu b u chorych na przewlekle zapalenie watroby typu c.

UNLABELLED: The aim of our study was to investigate the immunogenicity of hepatitis B vaccine in a group of patients suffering from chronic heaptitis C. Thirthy seven patients with chronic hepatitis C (anti-HCV+, HCV-RNA+, histological findings) were selected. Only those patients without serological markers for HBV infection (HBsAg (-), anti-HBcT(-), anti-HBs (-)) were vaccinated the hepatitis B vaccine. The recombinant vaccine (Engerix-B SKB 20 microg) was used according to a 0, 1,2 month regime. The vaccinees were divided into two groups. Group A-12 patients with HCV infection, were treated with interferon alpha 2b during vaccination. Group B-25 patients did not recive the interferon. The seroconversion rates and the concentrations of anti-HBs were taken at month 1, 2 and 3 after the first injection. RESULTS: Patients suffering from chronic hepatitis C react much less favorably to the hepatitis B vaccine than healthy subjects. Administration of the hepatitis B vaccine coupled with interferon-alpha treatment resulted in statistically significant improvement of the immunological response to the vaccine.

[The comparison of the humoral response among the patients with liver cirrhosis and steatosis of the liver after HBV vaccination]. / Porównanie odpowiedzi humoralnej na szczepienie przeciwko wirusowemu zapaleniu watroby typu B u chorych ze stluszczeniem watroby i z marskoscia watroby.

UNLABELLED: The goal of the study was the assessment of the effectiveness of the hepatitis B vaccine among patients with liver diseases. Only those patients without serological markers for HBV infection (HBsAg-, anti-HBcT-, anti-HBs-) were selected. Twenty nine patients were vaccinated. The recombinant vaccine (Engerix-B SKB 20 microg) was used according to a 0, 1, 2 month regime. Serum samples for seroconversion rates and concentration of antiHBs were taken at month 1,2 and 3 after the first injection. The vaccines were divided into two groups. Group 1-16 patients with liver steatosis. Group 2-13 patients suffering from liver cirrhosis. The seroconversion rates and the concentrations of anti-HBs were taken at month 1,2 and 3 after the first injection. Good response to the HBV vaccine was observed in the patients with liver steatosis. 93, 7% of serocoversion to anty HB-s was observed after vaccination. The GMT of anti- HBs was 97,37 IU/l. Patients suffering from liver cirrhosis responded much less favorably to the hepatitis B vaccine than patients with liver steatosis. Seroconversion rate after third dose was 38,5%only, and GMT of anti-HBs was 18,48 IU/l. CONCLUSION: Patients suffering from the liver cirrhosis react much less favorably to the hepatitis B vaccine than patients with the liver steatosis.

[Staphylococcal toxic shock syndrome]. / Gronkowcowy zespól wstrzasu toksycznego.

[A case of menstrual toxic shock syndrome (TSS) in a woman aged 21 is reported. Diagnosis was made on clinical basis and was followed by successful treatment]