Improvement of sexuality after hepatitis C cure with direct acting antivirals.

Despite rarely assessed, sexuality is a relevant domain in Quality of Life. We prospectively evaluated the impact of direct-acting antiviral therapy on sexuality in a cohort of 186 patients with chronic hepatitis C (HCV). Sexual dysfunction was assessed by validated scales CSFQ-14/CSFQ-VAS at baseline and one year after treatment finalization. Median age was 55 years and 87% had mild liver disease. Basal prevalence of sexual dysfunction (62%) and fear of HCV transmission (25%) were high. After HCV cure, both sexual dysfunction prevalence and CSFQ-VAS improved (P = .058 and P < .01, respectively), and fear of HCV transmission dropped to 16% (P = .02). These changes were especially relevant in young men (<55), where sexual dysfunction decreased from 48.6% to 29.7% (P = .04) and among non-depressed patients in whom sexual dysfunction decreased from 54.6% to 47% (P < .01). Age and major depression remained as independent factors of sexual dysfunction persistence after HCV cure. Our data suggest that HCV eradication is associated with an improvement in sexuality, in those patients without depression.

Hepatitis C viremia as a risk factor for opportunistic infections in kidney transplant recipients.

The aim of the present study was to determine the clinical characteristics, frequency of opportunistic infections (OI) in HCV-positive kidney recipients, and to evaluate HCV replication as a risk factor for developing an OI. We conducted a retrospective study of all kidney recipients from 2003 to 2014. A total of 1203 kidney transplants were performed during the study period. Opportunistic infections were recorded in 251 patients (21%) and nucleic acid amplification testing (NAAT) positivity in 75 (6%). Patients who are HCV NAAT positive were more likely to present an OI than those who are HCV NAAT negative (45% vs 20%, P < 0.001). Multivariate analysis showed the factors that were independently associated with the development of OI to be acute rejection, graft loss, post-transplantation hemodialysis, and HCV replication. Liver cirrhosis after transplantation could not be considered a risk factor to develop OI. To conclude, a high index of suspicion of OI must be maintained in the case of kidney recipients with HCV replication. Active surveillance of cytomegalovirus infection and other prophylactic strategies against OI should be considered after 6 month post-transplantation. Prompt initiation of DAA therapies may be a useful option aiming to decrease the incidence of OI after transplantation.

Direct-acting antivirals are effective and safe in HCV/HIV-coinfected liver transplant recipients who experience recurrence of hepatitis C: A prospective nationwide cohort study.

Direct-acting antivirals have proved to be highly efficacious and safe in monoinfected liver transplant (LT) recipients who experience recurrence of hepatitis C virus (HCV) infection. However, there is a lack of data on effectiveness and tolerability of these regimens in HCV/HIV-coinfected patients who experience recurrence of HCV infection after LT. In this prospective, multicenter cohort study, the outcomes of 47 HCV/HIV-coinfected LT patients who received DAA therapy (with or without ribavirin [RBV]) were compared with those of a matched cohort of 148 HCV-monoinfected LT recipients who received similar treatment. Baseline characteristics were similar in both groups. HCV/HIV-coinfected patients had a median (IQR) CD4 T-cell count of 366 (256-467) cells/µL. HIV-RNA was <50 copies/mL in 96% of patients. The DAA regimens administered were SOF + LDV ± RBV (34%), SOF + SMV ± RBV (31%), SOF + DCV ± RBV (27%), SMV + DCV ± RBV (5%), and 3D (3%), with no differences between the groups. Treatment was well tolerated in both groups. Rates of SVR (negative serum HCV-RNA at 12 weeks after the end of treatment) were high and similar for coinfected and monoinfected patients (95% and 94%, respectively; P = .239). Albeit not significant, a trend toward lower SVR rates among patients with advanced fibrosis (P = .093) and genotype 4 (P = .088) was observed. In conclusion, interferon-free regimens with DAAs for post-LT recurrence of HCV infection in HIV-infected individuals were highly effective and well tolerated, with results comparable to those of HCV-monoinfected patients.

Management of biliary complications after orthotopic liver transplantation: the role of endoscopy.

Biliary complications are significant causes of morbidity and mortality after orthotopic liver transplantation (OLT). The estimated incidence of biliary complications after OLT ranges between 10%-25%, however, these numbers continue to decline due to improvement in surgical techniques. The most common biliary complications are strictures (both anastomotic and non-anastomotic) and bile leaks. Most of these problems can be appropriately managed with endoscopic retrograde colangiography (ERC). Other complications such as bile duct stones, bile casts, sphincter of Oddi dysfunction, and hemobilia, are less frequent and also can be managed with ERC. This article will review the risk factors, diagnosis, and endoscopic management of the most common biliary complications after OLT.

Clinical and immunological factors associated with lupus nephritis in patients from northwestern Colombia.

A cross-sectional and multicenter study was undertaken to analyze the clinical and immunological characteristics at diagnosis associated with nephritis in northwestern Colombian patients with systemic lupus erythematosus (SLE). Thirty-nine patients with lupus nephritis were included and were compared to 100 SLE patients without nephritis. A multivariate analysis was performed. The patients who developed nephritis had a higher frequency of oral ulcers (41% vs. 21%, OR = 3.1, 95% CI: 1.3-7.5 p = 0.01) and malar erythema (77% vs. 45%, OR = 4.4, 95% CI: 1.8-10.8 p = 0.001). Lupus nephritis was observed in 77% of cases during the first year of the disease. The frequency of anti-DNA antibodies was higher in patients with nephritis, however, differences were not statistically significant (83% vs 64%, OR = 2.6, 95% CI: 1.03-6.41, p = 0.06). The presence of other autoantibodies (anti-Ro, anti-La, anti-RNP, anti-Sm and anticardiolipin) at diagnosis was similar in both groups. This autoantibody profile remained unchanged throughout the evolution of the disease. Patients with lupus nephritis had a higher prevalence of arterial hypertension (60% vs 10%, OR = 13.7, 95% IC: 5-37, p = 0.00001) and hyperlipidemia (30% vs 7%, OR = 8.1, 95% IC: 2.5-27, p = 0.0006) at onset. Finally, patients with lupus nephritis required more hospitalizations (> 1) over the course of disease (89% vs 60%, OR = 7.8, 95% CI: 2.1-29, p = 0.002). In conclusion, lupus nephritis appears early during the course of SLE. Malar erythema, oral ulcers, hypertension and hyperlipidemia at onset of disease are associated factors. Lupus nephritis is a major risk factor leading to repeated hospitalizations. This study may help to assist in public health policies in our population in order to improve patient outcomes while simultaneously reducing disease costs.

Clinical an immunological factors associated with lupus nephritis in patients from northwestern Colombia / Factores clínicos y epidemiológicos asociados con nefritis lúpica en pacientes del noroccidente colombiano

A cross-sectional and multicenter study was undertaken to analyze the clinical and immunological characteristics at diagnosis associated with nephritis in northwestern Colombian patients with systemic lupus erythematosus (SLE). Thirty nine patients with lupus nephritis were included and were compared to 100 SLE patients without nephritis. A multivariate analysis was performed. The patients who developed nephritis had a higher frequency of oral ulcers (41 percent vs. 21 percent, OR3.1, 95 percent CI: 1.3-7.5 p 0.01) and malar erythema (77 percent vs. 45 percent, OR4.4, 95 percent CI: 1.8-10.8 p0.001). Lupus nephritis was observed in 77 percent of cases during the first year of the disease. The frequency of anti-DNA antibodies was higher in patients with nephritis, however, differences were not statistically significant (83 percent vs 64 percent, OR2.6, 95 percent CI: 1.03-6.41, p0.06). The presence of other autoantibodies (anti-Ro, anti-La, anti-RNP, anti-Sm and anticardiolipin) at diagnosis was similar in both groups. This autoantibody profile remained unchanged throughout the evolution of the disease. Patients with lupus nephritis had a higher prevalence of arterial hypertension (60 percent vs 10 percent, OR13.7, 95 percent IC: 5-37, 0.00001) and hyperlipidemia (30 percent vs 7 percent, OR8.1, 95 percent IC: 2.5-27, p0.0006) at onset. Finally, patients with lupus nephritis required more hospitalizations (1) over the course of disease (89 percent vs 60 percent, OR7.8, 95 percent IC: 2.1-29, p0.002). In conclusion, lupus nephritis appears early during the course of SLE. Malar erythema, oral ulcers, hypertension and hyperlipidemia at onset of disease are associated factors. Lupus nephritis is a major risk factor leading to repeated hospitalizations. This study may help to assist in public health policies in our population in order to improve patient outcomes while simultaneously reducing disease costs.

Aplicacion del modelo diagnostico del grupo internacional para la hepatitis autoinmune (GIHA) en una poblacion de pacientes de Medellin, Colombia / Applicability of scoring system proposed by the International Autoinmune Hepatitis group (IAHG) at Medellin's hospital

Objetivo; evaluar la aplicabilidad del modelo diagnóstico propuesto por el Grupo Internacional de Hepatitis Autoinmune (G1HA). Metodología: estudio retrospectivo, observacional, no analítico de 28 pacientes con diagnóstico de Hepatitis Autoinmune (HA1) de la ciudad de Medellín- Colombia. Resultados; se analizaron 28 pacientes con diagnóstico de HAI. Según el modelo de criterios diagnósticos de 1992 aplicado a los pacientes antes del inicio del tratamiento, 25 por ciento tuvieron diagnostico definitivo y 53 por ciento diagnóstico probable. Al aplicar los nuevos criterios, 14 por ciento tenían diagnostico definitivo y 64 por ciento probable. En ambos modelos 22 por ciento de los pacientes no alcanzaron el puntaje para clasificarlos como HA1. La concordancia entre el diagnóstico clínico y los criterios del GIHA fue de 78. 5 por ciento con ambos puntajes. Conclusiones: ambos modelos son útiles para el diagnóstico de hepatitis autoinmune. El modelo de 1998 es más especifico en nuestro estudio

Disnea en paciente con sindrome antifosfolipido: Presentacion de caso y revision de la literatura / Dyspnea in antiphospholipid syndrome

El síndrome antifosfolípido (SAF) se caracteriza por trombosis vascular y/o pérdida fetal asociada a la presencia de anticuerpos antifosfolípidos (anticardiolipina y/o anticoagulante tópico). Este síndrome puede presentarse aislado (primario - SAFP-) o secundario al lupus eritematoso sistémico (SAFS). Tanto la presentación primaria como secundaria pueden ser responsables de manifestaciones sistémicas distintas a las vasculares, entre ellas pulmonares. Aquí se presenta una paciente con disnea por hipertensión pulmonar (HTP) y enfermedad pulmonar insterstícial (EPI), en quien se diagnosticó SAFS. Las manifestaciones pulmonares del SAF son revisadas e incluyen tromboembolismo pulmonar, HTP, EPI, hemorragia pulmonar, y síndrome de dificultad respiratoria del adulto con falla multisistémica