[Clinical characteristics and prognosis of Staphylococcus aureus bacteremia]. / Características clínicas, pronóstico y factores asociados de la bacteriemia por Staphylococcus aureus en la actualidad.

OBJECTIVE: Staphylococcus aureus bacteremia patients characteristics at a tertiary hospital are described, and complications, mortality and associated factors are analyzed. METHODS: Data from patients with S. aureus bacteremia admitted between March 2020 and February2021 at Miguel Servet university hospital in Zaragoza were retrospectively analyzed. RESULTS: Results showed a 14 days mortality of 24.2% and an 30 days mortality of 40%. Overall survival decreased with complications appearance [HR 3.1 (1.2-8.05)] and age over 65 years [HR 3.1 (1.4-6.6)]. The adjusted analysis showed correlation between a higher mortality at 14 and 30 days with age over 65 years [OR 6.3 (1.7-23.1)], sepsis presence [OR 19.3 (5.4-68.7)] and number of positive (+) blood cultures ≥3 [OR 5.4 (0.8-34.1)]. Mortality at 14 days was associated with sepsis presence [OR 58.2 (5.7-592.9)], number of positive (+) blood cultures ≥3 [OR 14.1 (1.1-173.7)] and an older age [OR 1.1 (1.03-1.1)]. Analyzing time to positive blood cultures ≤12 hours and number of positive blood cultures ≥ 3 at the same time, frequency of sepsis increased [30 patients (66.6%) vs 15 patients (33.3%); OR 3.4 (IC95% 1.5-8)]. CONCLUSIONS: High 14- and 30-days mortality were found, as well as a worse evolution in older age patients, with sepsis presence, and with greater number of positive blood cultures and times to positive blood cultures ≤12 h.

[Impact of Staphylococcus aureus bacteremia in COVID-19 patients]. / Impacto de la bacteriemia por Staphylococcus aureus en pacientes con COVID-19.

OBJECTIVE: The disease caused by SARS-CoV-2 (COVID-19) has been a challenge for healthcare professionals since its appearance. Staphylococcus aureus has been described as one of the main pathogens causing bacterial infections in viral pandemics. However, co- infection with S. aureus causing bacteremia in patients with COVID-19 has yet to be well studied. METHODS: We performed a e study of S. aureus bacteremia (SAB) at Hospital Miguel Servet (Zaragoza) from March 2020 to February 2021. The clinical characteristics, mortality and risk factors of adults hospitalized patients with BSA associated COVID-19 compared to patients without COVID-19. RESULTS: A total of 95 patients with SAB were identified. 27.3% were positive for SARS-CoV-2. SAB represented 9.9% of bacteremia, being the second agent in frequency after E. coli. Nosocomial bacteremia was more frequent in the group of COVID-19 patients. The most frequent source of BSA in these patients was the respiratory source (26.9% vs 0%; P<0.001) followed by the skin (15.5% vs 15.9%; P=1). The development of sepsis was more frequent in COVID-19 patients (61,5% vs 7,8%; P=0,336) and among them, who received dexamethasone at doses > 6 mg/day (62.5% vs. 37.5%, P<0.05). CONCLUSIONS: Our data suggest that BSA has a negative impact on the evolution of patients with COVID-19. However, further and preferably prospective studies are required to obtain solid data on the impact of BSA on coronavirus patients.

Meningitis por Enterococcus faecium secundaria a anestesia epidural. A propósito de un caso y revisión de la literatura / Enterococcus faecium meningitis secondary to epidural anesthesia. About a case and review of the literature

La meningitis séptica secundaria a anestesia epidural es una complicación rara, pero grave, que suele estar relacionada con contaminación exógena a partir de técnicas de asepsia inadecuadas, por lo que los microorganismos más frecuentes observados son S. aureus y S. salivarius. Nosotros describimos el caso de una mujer que, tras la realización de anestesia epidural para un parto eutócico, presentó una meningitis séptica por Enterococcusfaecium (E. faecium), que recidivó posteriormente, probablemente debido a una ventriculitis piogénica que pasó inadvertida en el primer episodio. Destacamos la rareza del caso, hacemos hincapié en extremar las medidas de asepsia y revisamos la literatura sobre el tratamiento más adecuado en este tipo de complicaciones.(AU)

Septic meningitis secondary to epidural anesthesia is a rare but serious complication that is usually related to exogenous contamination from inadequate aseptic techniques, so the most frequent microorganisms observed are S. aureus and S. salivarius. We describe the case of a woman who, after receiving epidural anesthesia for normal delivery, presented septic meningitis due to E. faecium with recurrence after antibiotic treatment, probably secondary to pyogenic ventriculitis undetected in the first episode. We highlight the rarity of the case, emphasizing the need for strict aseptic technique, and review the literature on the most appropriate treatment for this type of complication.(AU)

Enterococcus faecium meningitis secondary to epidural anesthesia. About a case and review of the literature.

Septic meningitis secondary to epidural anesthesia is a rare but serious complication that is usually related to exogenous contamination from inadequate aseptic techniques, so the most frequent microorganisms observed are S. aureus and S. salivarius. We describe the case of a woman who, after receiving epidural anesthesia for normal delivery, presented septic meningitis due to E. faecium with recurrence after antibiotic treatment, probably secondary to pyogenic ventriculitis undetected in the first episode. We highlight the rarity of the case, emphasizing the need for strict aseptic technique, and review the literature on the most appropriate treatment for this type of complication.

Enterococcus faecium meningitis secondary to epidural anesthesia. About a case and review of the literature. / Meningitis por Enterococcus faecium secundaria a anestesia epidural. A propósito de un caso y revisión de la literatura.

Septic meningitis secondary to epidural anesthesia is a rare but serious complication that is usually related to exogenous contamination from inadequate aseptic techniques, so the most frequent microorganisms observed are S. aureus and S. salivarius. We describe the case of a woman who, after receiving epidural anesthesia for normal delivery, presented septic meningitis due to E. faecium with recurrence after antibiotic treatment, probably secondary to pyogenic ventriculitis undetected in the first episode. We highlight the rarity of the case, emphasizing the need for strict aseptic technique, and review the literature on the most appropriate treatment for this type of complication.

Evolución y pronóstico de la infección por el virus de la hepatitis C en pacientes monoinfectados y coinfectados por VIH en una unidad de enfermedades infecciosas: análisis retrospectivo del periodo 1992-2005 / Progression and prognosis of hepatitis C virus infection in a cohort of HIV-co-infected and non-co-infected patients in an infectious diseases unit between 1992-2005

Introducción. La coinfección por VIH en la hepatitis C crónica supone un factor de peor pronóstico, con mayor lesión hepática y progresión a cirrosis y hepatocarcinoma. Material y métodos. Análisis retrospectivo de 52 pacientes con hepatitis C crónica atendidos en una unidad de enfermedades infecciosas durante el periodo 1992-2005. Se valora: evolución de la hepatopatía crónica por VHC en pacientes coinfectados y no coinfectados por VIH, factores relacionados con el pronóstico de la enfermedad hepática, tasa de supervivencia y probabilidad de evolución a cirrosis en ambos grupos. Resultados. Hubo 29 pacientes coinfectados, con edad inferior (31 [4] vs. 35 [25], p<0,05) y con mayor incidencia de uso de drogas parenterales (26 [91,3] vs. 11 [64,4], p<0,04). No se encontraron diferencias significativas respecto a la respuesta global a los tratamientos entre ambos grupos. Cinco pacientes desarrollaron cirrosis (2 coinfectados y 3 monoinfectados), observándose un mayor riesgo en aquellos con un grado inicial de fibrosis severo (HR 8,30, IC 95% [1,13-60,65], p<0,05). La tasa global de evolución a cirrosis fue de 1,6/100 pacientes/año, reduciéndose a 1,19/100 pacientes/año al incluir a los respondedores al tratamiento. Fallecieron 13 pacientes (25%), sin diferencias en mortalidad, por causas mayoritariamente no hepáticas (64,4%). La probabilidad de supervivencia fue del 55,9% en coinfectados frente al 66,6% en monoinfectados (NS). Conclusiones. El grado de fibrosis hepática se asoció a peor evolución y desarrollo de cirrosis. La decisión de tratar redujo la tasa de progresión a cirrosis. No se observaron diferencias respecto a mortalidad ni factores relacionados con una mayor supervivencia (AU)

Introduction: HIV co-infection in chronic hepatitis C is a poor prognosis factor and accelerates liver damage and progression to cirrhosis and hepatocarcinoma. Material and methods: Retrospective analysis of 52 cases with chronic hepatitis C between 1992 and 2005. We performed an analysis of: outcome of chronic HepC liver disease in co-infected and non-co-infected individuals, factors related to prognosis of hepatic disease, survival ratio and cirrhosis-ratio in both groups. Results: A total of 29 patients were co-infected, with differences in age (31 [4] vs 35 [25], p < .05) and use of parenteral drugs (26 [91.3] vs 11 [64.4], p < .04). There were no differences in overall response to therapies in both groups. Five patients developed cirrhosis, with a higher risk in those who had severe hepatic fibrosis (HR 8.30, 95% CI [1.13-60.65], p < .05). Overall cirrhosis-progression ratio was 1.6/100 patients/year, and 1.19/100 patients/year, taking into account the treatment-responders. Thirteen patients (25%) died, with no differences in mortality between groups due to non-hepatic causes (64.4%). Survival ratio was 559% in co-infected versus 66.6% in non-co-infected (NS). Conclusions: Hepatic fibrosis was related to a worse prognosis and hepatic cirrhosis. Treatment reduced cirrhosis-progression ratio. There were also no differences in the mortality ratio or for related survival factors (AU)

Necrosis avascular de cadera asociada al consumo de alcohol en un portador heterocigoto de la mutación C282Y/H63D de hemocromatosis / Hip avascular necrosis associated to alcohol consumption in a heterocygous carrier of the hemochromatosis mutations C282Y and H63D

Se presenta el caso de un paciente de 45 años de edad afecto de coxalgia izquierda de varios meses de evolución y una hepatopatía aguda. En las pruebas realizadas se observa una necrosis avascular de cadera (NAC) y en el estudio genético una mutación en el gen HFE implicado en la mayoría de los casos de hemocromatosis hereditaria (HH). En la bibliografía revisada, la HH no aparece como factor etiológico de la NAC, aunque de manera poco frecuente está descrita su asociación. Por este motivo, ante la presencia de una NAC se deben valorar los factores etiológicos conocidos y la posibilidad de asociación con la HH para poder realizar el diagnóstico y tratamiento precoz de esta enfermedad potencialmente grave

A case of a 45-year old male patient suffering left coxalgia of several month evolution and acute hepatopathy is presented. Hip avascular necrosis (HAN) was observed in the tests performed. The genetic study showed a mutation in the HFE gene involved in most of the cases of hereditary hemochromatosis (HH). In the literature reviewed, HH does not appear as an etiological factor of HAN, although this association has been described in rare cases. Thus, when HAN is present, the known etiological factors and the possibility of association with HH should be evaluated to be able to make the diagnosis and perform an early treatment of this potentially serious disease

Necrosis avascular de cadera asociada al consumo de alcohol en un portador heterocigoto de la mutación C282Y/H63D de hemocromatosis / HIP avascular necrosis associated to alcohol consumption in a heterocygous carrier of the hemochromatosis mutations C282Y and H63D

Se presenta el caso de un paciente de 45 años de edad afecto de coxalgia izquierda de varios meses de evolución y una hepatopatía aguda. En las pruebas realizadas se observa una necrosis avascular de cadera (NAC) y en el estudio genético una mutación en el gen HFE implicado en la mayoría de los casos de hemocromatosis hereditaria (HH). En la bibliografía revisada, la HH no aparece como factor etiológico de la NAC, aunque de manera poco frecuente está descrita su asociación. Por este motivo, ante la presencia de una NAC se deben valorar los factores etiológicos conocidosy la posibilidad de asociación con la HH para poder realizar el diagnóstico y tratamiento precoz de esta enfermedad potencialmente grave

A case of a 45-year old male patient sufferingleft coxalgia of several month evolution and acute hepatopathy is presented. Hip avascular necrosis (HAN) was observed in the tests performed. The genetic study showed a mutation in the HFE gene involved in most of the cases of hereditary hemochromatosis (HH).In the literature reviewed, HH does not appear as an etiological factor of HAN, although this association has been described in rare cases. Thus, when HAN is present, the known etiological factors and the possibility of association with HH should be evaluated to be able to make the diagnosis and perform an early treatment of this potentially serious diseaseB HTTP/1

[Valuation of APRI and Forns models for non-invasive diagnosis of fibrosis in patients with hepatitis C in coinfected and non-coinfected with HIV]. / Valoración de los modelos APRI y Forns para el diagnóstico no invasivo de fibrosis en pacientes con hepatitis C coinfectados y no coinfectados por VIH.

BACKGROUND: APRI and Forns (IF) index are noninvasive models consisting of routine laboratory data for the prediction of liver fibrosis in patients with chronic hepatitis C. The aim of our study was to confirm the value of these models to predict significant fibrosis in these patients and if they may decrease the need for performing liver biopsy specimens in coinfected and HIVnon-coinfected. PATIENTS AND METHOD: We included 60 patients with chronic hepatitis C and histologic data, 33 were coinfected with HIV. Mild fibrosis (F0-F1) was found in 73% patients, severe fibrosis (F3-F4) in 23% and cirrhosis in 18.3%. We calculated and compared APRI and IF with the stage of liver fibrosis. RESULTS: The APRI score < 0.5 or > 1.5 and IF < 4.2 or > 6.9, as predictors of mild or severe fibrosis, were only available in 53% and 49%. Neither laboratory nor APRI and IF were associated with liver fibrosis in non-coinfected patients. We only found association in HIV coinfected patients: severe fibrosis (F3-4) whit higher gammaglobulins [24.5% vs. 30% (p < 0.05)] and Gamma-GT levels [77 (46.5) vs. 32 (48.5) (p < 0.05)], and lower prothrombin time [72% vs. 91% (p < 0.05) ] and platelets.109 count [129 (40) vs. 170 (78) (p < 0.05)]; APRI was lower than 0.5 in 41.6% patients with mild fibrosis (F0-1) against none with severe (F3-4) (p < 0.05); specifity (E) of APRI < 0.5 for predicting mild fibrosis was 100%, but sensivity (S) was very low (41%), with a positive preditive value (VPP) of 100%, but a negative predictive value (VPN) also very low ( 36.3%). CONCLUSIONS: Our study showed that these models don t avoid the need for liver biopsies. More than a half of patients are not appropriately classified according to findings on liver biopsy and S and VPN are very low. The combination of these index with gammaglobulins, Gamma-GT, AST, ALT and platelet levels and protrombine time, only may be an approach to degree of fibrosis or inflammation liver in HIV co-infected patients.

Valoración de los modelos APRI y Forns para el diagnóstico no invasivo de fibrosis en pacientes con hepatitis C coinfectados y no coinfectados por VIH / Valuation of APRI and Forns model of non-invasive diagnosis of fibrosis in patients with hepatitis C in coinfected and non-coinfected with HIV

Introducción: Los índices APRI y de Forns (IF), son modelos no invasivos a partir de datos rutinarios de laboratorio para la predicción de fibrosis hepática en pacientes con hepatitis crónica C. El propósito de nuestro estudio es confirmar el valor de estos modelos para predecir fibrosis significativa en estos pacientes y si pueden disminuir la necesidad de la biopsia hepática en coinfectados y no coinfectados por el VIH. Pacientes y métodos: Incluimos 60 pacientes con hepatitis crónica y datos histológicos, 33 coinfectados por VIH. El 73% tenía fibrosis leve (F0-F1), el 23% grave (F3-F4) y el 18,3% cirrosis histológica. Calculamos y comparamos los índices APRI e IF con el grado de fibrosis hepática. Resultados: Los valores de APRI 1,5 e IF 6,9, indicativos de fibrosis leve o severa, sólo han podido aplicarse en el 53% y 49% de los casos respectivamente. Ningún parámetro bioquímico, ni el APRI o el IF se asociaron con el grado de fibrosis en los pacientes no coinfectados con el VIH. Sólo observamos asociaciones en los pacientes VIH(+): la fibrosis severa (F3-4) con un mayor nivel de gammaglobulinas [24,5% vs. 30% (p < 0,05)] y de GGT [77 (46,5) vs. 32 (48,5) (p < 0,05)], y una menor tasa de protrombina [72 vs. 91% (p < 0,05)] y de plaquetas 109 [129 (40) vs. 170 (78) (p < 0,05)]; se observó un mayor porcentaje de APRI < 0,5 (41,6%) con fibrosis leve (F0-1) frente al observado (0) en la grave (F3-4) (p < 0,05); la especificidad (E) del APRI < 0,5 para establecer fibrosis leve o inexistente fue del 100%, pero la sensibilidad (S) era excesivamente baja (41%), con un valor predictivo positivo (VPP) de 100%, pero un valor predictivo negativo (VPN) muy bajo (36,3%). Conclusiones: Nuestro estudio mostró que estos modelos no evitan la necesidad de biopsias hepáticas. Más de la mitad de los pacientes no pueden ser clasificados apropiadamente y la S y VPN son muy bajos. La combinación de estos índices con los niveles de gammaglobulinas, Gamma- GT, GOT, GPT, plaquetas y tiempo de protrombina, sólo han podido servir de orientación sobre el grado de fibrosis o inflamación hepáticas, y de forma limitada a los pacientes coinfectados con el VIH

Background: APRI and Forns (IF) index are noninvasive models consisting of routine laboratory data for the prediction of liver fibrosis in patients with chronic hepatitis C. The aim of our study was to confirm the value of these models to predict significant fibrosis in these patients and if they may decrease the need for performing liver biopsy specimens in coinfected and HIVnon-coinfected. Patients and method: We included 60 patients with chronic hepatitis C and histologic data, 33 were coinfected with HIV. Mild fibrosis (F0- F1) was found in 73% patients, severe fibrosis (F3-F4) in 23% and cirrhosis in 18.3%. We calculated and compared APRI and IF with the stage of liver fibrosis. Results: The APRI score 1.5 and IF 6.9, as predictors of mild or severe fibrosis, were only available in 53% and 49%. Neither laboratory nor APRI and IF were associated with liver fibrosis in non-coinfected patients. We only found association in HIV coinfected patients: severe fibrosis (F3-4) whit higher gammaglobulins [24.5% vs. 30% (p < 0.05)] and Gamma-GT levels [77 (46.5) vs. 32 (48.5) (p < 0.05)], and lower prothrombin time [72% vs. 91% (p < 0.05) ] and platelets.109 count [129 (40) vs. 170 (78) (p < 0.05)]; APRI was lower than 0.5 in 41.6% patients with mild fibrosis (F0-1) against none with severe (F3-4) (p < 0.05); specifity (E) of APRI < 0.5 for predicting mild fibrosis was 100%, but sensivity (S) was very low (41%), with a positive preditive value (VPP) of 100%, but a negative predictive value (VPN) also very low ( 36.3%). Conclusions: Our study showed that these models don’t avoid the need for liver biopsies. More than a half of patients are not appropriately classified according to findings on liver biopsy and S and VPN are very low. The combination of these index with gammaglobulins, Gamma-GT, AST, ALT and platelet levels and protrombine time, only may be an approach to degree of fibrosis or inflammation liver in HIV co-infected patients

[Characteristics of chronic hepatitis C in patients infected by human immunodeficiency virus]. / Características de la hepatitis crónica C en pacientes infectados por el virus de la inmunodeficiencia humana.

OBJECTIVES: To know the characteristics of chronic hepatitis C in HIV-infected patients and whether there are differences compared with HIV-negative patients, in order to obtain orientative helpful data for the diagnostic-therapeutic decision making, a usually difficult issue in these patients. PATIENTS AND METHODS: Sixty patients with criteria of chronic hepatitis C virus (HCV) criteria were studied. Thirty-three of these patients were coinfected with HIV. The possible associations between the degree of histologic damage and several variables wee studied: age, estimated time of evolution of HCV infection, transaminases, gammaglobulins, GGT, and alcohol consumption. On the other hand, the possible differences regarding the histologic hepatic aggression were assessed. An attempt was made to know whether HIV could negatively influence the evolution of chronic hepatitis C. RESULTS: A direct relationship was observed between hepatic damage, HAI and levels of GOT, GPT, GGT (p < 0.005), and gammaglobulins (p < 0.01). The degree of hepatic fibrosis was directly correlated with the GGT level (mild fibrosis: 47 +/- 34 U/l; severe fibrosis: 86 +/- 60 U/l) (p < 0.05) and the estimated evolution time of infection (p < 0.05). Alcohol consumption was associated with the fibrosis degree (p < 0.01). The degree of histologic damage was similar in the HIV-positive group (HAI: 8.3 +/- 3.6) and HIV-negative patients (HAI: 7.2 +/- 2.8), although the degree of lobular involvement was higher in HIV-positive patients (p < 0.05). CONCLUSIONS: Patients with chronic hepatitis C and infected with HIV did not have a higher degree of hepatic damage than HIV-negative patients. GOT, GPT, and gamma globulin levels, as well as a longer evolution time of HCV infection were associated with a higher degree of hepatic histologic activity. Alcohol consumption seemed to be associated with a poorer course of the liver disease in these patients.

[Clinical implications of hepatitis C virus genotype in human immunodeficiency virus infected patients with chronic liver disease]. / Implicaciones clínicas del genotipo del virus de la hepatitis C en infectados por el virus de la inmunodeficiencia humana con hepatopatía crónica.

OBJECTIVE: To know the prevalence of viral genotype in patients infected with hepatitis C virus (HCV) and coinfected with HIV and evaluate its clinical implications. PATIENTS AND METHODS: The genotype of the HVC was studied (INNO-LiPA HCV II, Imnogenetics, Belgium) in 40 patients coinfected with HIV; from 28 of these patients histologic data of chronic hepatitis were available. The most prevalent genotype was analyzed in this type of patients and its associations with different issues: risk behavior, histologic activity of liver disease and viremia level (quantitative PCR, Amplicor HCV, Roche Diagnostics). RESULTS: Genotype 1 was the most prevalent (55%), and subtype 1a predominated (36.3%). In most cases genotypes 1a and 3 were found (65%) and in four cases (10%) there was coinfection with two genotypes. The most common risk behavior was parenteral drug use (PDU) (34 cases), which might account for the higher prevalence of genotypes 1 and 3. A mild hepatic histologic activity was most frequently associated with genotype 3 compared with genotype 1 (63.6% versus 46.6%). The Knodell histologic activity index (HAI) was higher in the four patients with coinfection 1 + 3 versus the remaining patients (11.2 +/- 2.8 versus 7.8 +/- 3.6). The percentage of patients with genotype 1 with a viral load > 10(5) was higher than that of patients with genotype 3 (80% versus 7.6% [4]) (p < 0.05); in the two cases with subtype 1b viremia levels exceeded this limit. CONCLUSIONS: The prevalent HCV genotypes in patients coinfected with HIV in our environment seem to be 1a and 3, which is probably associated with the more common high risk behavior of PDU among these patients. Genotype 3 seems to be associated with a milder histologic liver damage and a lower viral load, and these two characteristics might be related. The HCV genotype should be considered in subjects coinfected with HIV to obtain a better clinical and prognostic evaluation of the chronic liver disease it causes.

[Interferon treatment of chronic hepatitis C in human immunodeficiency virus infected patients]. / Tratamiento con interferón de la hepatitis crónica C en infectados por el virus de la inmunodeficiencia humana.

OBJECTIVE: To know the efficiency and tolerance of INF therapy for chronic virus C hepatitis (HCV) in HIV infected patients compared with non infected patients. PATIENTS AND METHODS: INF-alpha was administered to 39 patients with chronic hepatitis C virus infection criteria. In 17 cases (43.5%) there was coinfection with HIV. Histologic data were available from 30 patients (75%) and also of viral load during therapy (Amplicor HCV, Roche Diagnostics) from 8 patients. We determined the response at the end of the first two months of therapy (ER), at the end of therapy (FR) and after discontinuation (DR) when the transaminase level was normalized and viral RNA was not detected in cases when it was measured. The response rates to INF were compared between HIV-positive and HIV-negative patients and the secondary effects observed evaluated, as well as tolerance and severity, with a particular emphasis on the CD4 lymphocyte level among HIV-positive patients. RESULTS: An ER was obtained in nine HIV-positive patients (52.9%) and thirteen HIV-negative patients (59%); an FR in eight HIV-positive patients (47%) and eleven HIV-negative patients (50%), and DR in two HIV-positive patients (13.3%) and four HIV-negative patients (28%); although a lower rate of DR was observed among HIV-positive patients, these differences were not significant. The disappearance of HCV ARN at the end of therapy was similar for both groups of patients in whom it was measured: five HIV-positive patients (62.5%) and twelve HIV-negative patients (63.1%). We must consider that HIV-positive patients had a higher number of poor response predictors to INF. Secondary reactions were observed in a higher number of HIV-negative patients (81.8% versus 40.9%) and the level of CD4 lymphocytes was markedly reduced during and after therapy in three patients. CONCLUSION: INF therapy in chronic hepatitis C virus infection in HIV-positive patients initially has a similar efficiency to that observed in HIV-negative patients, although perhaps the maintained response rate is lower. A higher number of secondary reactions among HIV-positive patients was not observed, although possible reductions in CD4 levels must be considered among these patients. The use of INF in these patients --if properly selected--is therefore not contraindicated.

[Characteristics of the carriers of antibodies to hepatitis C virus with normal transaminases levels in HIV infected patients]. / Características de los portadores de anticuerpos frente al virus de la hepatitis C con transaminasas normales en infectados por el VIH.

BACKGROUND: To know the characteristics of the carriers of antibodies to hepatitis C virus (HCV) with persistently normal transaminases levels ("carriers") in coinfected with HIV, the incidence of the real viral activity and the factors that could determine it. PATIENTS AND METHODS: We analyzed 114 patients with criteria for chronic hepatitis C, 41 with detectable antibodies (anti-HCV), but without chemical evidence of a deteriorations of the liver function, all of them infected with HIV. In 6 patients was possible to determine the genotype of the HCV (INNO-LiPA HCV Innogenetics. Belgica) and in 32 the HCV-RNA (Amplicor HCV Roche Diagnostics). We compared the characteristics that could be differential between both groups, investigating the possible factors that could define the group of "carriers" with detectable viral activity. RESULTS: From the 32 "carriers" in which we could determine the HCV-RNA, 15 (46.8%) had a positive result. The incidence of women in the "carriers" group was higher (41.4% vs 22.8%) (p < 0.05). The serum levels of gammaglobulin (gr/dl) was higher in the chronic hepatitis group (2.23 +/- 0.6 vs 1.9 +/- 0.5) (p < 0.01); however, these levels were higher for the 15 patients RNA (-) patients (2.19 +/- 0.7 vs 1.66 +/- 0.41) (p < 0.01). The genotype distribution of HCV found in the "carriers" group with detectable viremia was: genotype 1(5 patients), subtype la (3 patients), subtype lb (2 patients) an genotype 3 (3 patients). There was no significant difference with respect to age, sex, degree of immunosuppression or the length of the infection with HCV. CONCLUSIONS: Approximately half of our "carriers" of anti-HCV without evidence of changes in the liver function, infected with HIV, show detectable viremia and so probably liver biopsy would be indicated. Women are more often "carriers" and the high levels of gammaglobulin could define the existence of a real viral activity.

[Viremia levels of the chronic hepatitis c virus in HIV infected patients, clinical implications]. / Niveles de viremia del virus de la hepatitis crónica C en infectados por el virus de inmunodeficiencia humana. Implicaciones clínicas.

BACKGROUND: To know the clinical implications of the viremia level and its evolution in time of the hepatitis C virus (HCV) in patients with chronic hepatitis and infected with the Human Immunodeficiency Virus (HIV). PATIENTS AND METHODS: We have studied the viremia level of the HCV in a a 38 patients group with active chronic hepatitis and infected with the HIV, using a quantitative PCR technic (Amplicor HCV, Roche Diagnostics); we had histological data in 33 of these patients. In 20 patients was analyzed the evolution in time of the viremia level with two or three serialized measurements (20 and 10 patients respectively), throughout 7.5 and 14.8 months on the average. We have analyzed some aspects like the risky behaviors associated with transmission, the estimated time from the contagious, the degree of histological damage and the immunitary impairment. RESULTS: We have observed a tendency to present a higher viremia level (logarithmic expression) with longer evolution time from the infection (p = 0.08). The viral load had an inverse relation with the degree of histological fibrosis (Light fibrosis: 4.5 +/- 0.8 log vs Severe fibrosis: 3.7 +/- 0.8 log) (p < 0.01) and a direct relation with the Knodell histological activity index (HAI), only with those patients with a lower fibrosis degree (p < 0.01). There was no relation between the viremia level of the HCV and the degree of immunosuppression measured by the CD4 lymphocyte count, at least in those patients in which it was higher than 200/mm3. We have not observed relations between the viral load and the age or the transaminases level. The evolution in time of the viremia tended to rise from 3.7 +/- 1.3 to 4.5 +/- 0.9 log in 14.8 months on the average, although there were some cases with tendency to decrease. We have not observed relation between its increase/month and the degree of histological damage or the CD4 lymphocyte count. CONCLUSIONS: The viral load of the HCV in HIV-infected patients seems to have an inverse relation with the degree of liver fibrosis and direct relation with the histological activity when the fibrosis light and so it could indirectly inform us about the liver aggression. The degree of immunosuppression measured by the CD4 lymphocyte count, when these are > 200/mm3, doesn't seem to influence the viremia level of the HCV. The evolution of the viral load in time tend to rise although there could be some cases with intermittent or descending evolution, without these tendencies have any clinical implications.