Clinical and virological characteristics associated with severe acute hepatitis B.

To identify early predictors of a severe or fulminant course in patients with acute viral hepatitis B (AVH-B). One hundred and thirty-eight patients with symptomatic acute hepatitis B observed from 1999 to 2012 were enrolled. For each patient, the demographics, risk factors for the acquisition of hepatitis B virus (HBV) infection, clinical, biochemical and virological data (HBV DNA, HBV DNA sequences) were recorded and analysed. The HBV mutants in the polymerase region were sought in 110 (87%) patients by direct sequencing, and the rtM204V/I mutations also by an allele-specific PCR. AVH-B was severe in 13 (9.4%) of the 138 patients enrolled, fulminant in 6 (4.3%) and with a normal clinical course in 119. The 19 patients with severe or fulminant AVH-B more frequently than the 119 with a normal course stated intravenous drug use (63.2% versus 36.1%, p 0.04) and were HBV-DNA negative (31.6% versus 11.8%, p 0.03) and anti-hepatitis C virus (HCV) positive (57.9% versus 19.3%, p 0.0008); the prevalences of different HBV genotypes and of the rtM204V/I mutant were similar in these three forms of AVH-B. A multivariate logistic regression analysis identified a pre-existing HCV chronic infection as the only factor independently associated with a severe or fulminant clinical course of AVH-B (OR 4.89, 95% CI 1.5-15.94, p 0.01). A pre-existing HCV chronic infection was identified as the only factor independently associated with a severe clinical presentation of acute hepatitis B, an association most probably due to the combination of the liver lesions caused by acute hepatitis B and the pre-existing histological abnormalities related to HCV chronic infection.

Emerging concepts on inhibitors of indoleamine 2,3-dioxygenase in rheumatic diseases.

The enzyme indoleamine 2,3-dioxygenase 1 (IDO1) finely regulates both innate and adaptive immune responses through the degradation of the essential amino acid tryptophan into kynurenine and other downstream metabolites, which suppress effector T-cell function and promote the differentiation of regulatory T cells. A novel role for IDO1 as a signaling molecule and a modifier of innate inflammatory responses is now emerging. In particular, IDO1 can either support or antagonize inflammation in a context- and tissuedependent manner. Studies in experimental arthritis have unravelled a previously unappreciated role for IDO in controlling B-cell activation and autoantibody production. IDO dysregulation has been documented in patients with systemic lupus erythematosus, systemic sclerosis and Sjogren's syndrome, as well as in severe sepsis and chronic kidney disease. This article summarizes the contribution of IDO to the pathophysiology of inflammatory/autoimmune disorders, and discusses whether strategies to restore metabolic equilibrium in the kynurenine pathway might be pursued in diseases states such as rheumatoid arthritis and systemic sclerosis.

Hepatitis C virus infection among drug addicts in Italy.

There is a lack of updated nationwide records regarding hepatitis C virus (HCV) infection among drug addicts in Italy. The prevalence and characteristics of HCV infection in a national sample of drug addicts in Italy were determined. Five hundred forty-three drug addicts (mean age 35.3 years, 85.1% males), selected from 25 Italian Centers for Substance Dependence were enrolled to be evaluated for anti-HCV, HCV-RNA, HCV genotype, HBV markers, anti-HDV, and anti-HIV during the period of April-November 2009. Anti-HCV prevalence was 63.9%. HCV-RNA was detected in 68.3% of patients positive for anti-HCV. Genotypes 1 and 3 prevailed (49.3% and 39.7%, respectively). However, 9.3% of the subjects had genotype 4, a rate over threefold higher than the one observed in 1996 among drug addicts in central Italy. Needle sharing was the strongest independent predictor of the likelihood to contract an HCV infection (OR 8.9; 95% CI: 5.0-16.0). Only 19.3% of subjects received antiviral treatment for HCV. The prevalence of HBsAg and HIV positivity was 2.8% and 3.1%, respectively. The pattern of HBV markers showed that nearly one-third of subjects had been vaccinated, while 42.3% were negative for any marker of HCV. The prevalence of HCV infection is high among drug addicts in Italy. The incidence of Genotype 4 is increasing and this may lead to the spreading of the disease to the general population in the near future. Efforts should be made to improve the rate of antiviral treatment for drug addicts with HCV infection and vaccination against hepatitis B.

[Intramedullary pinning of diaphyseal fractures of both forearm bones in adults: 46 cases]. / Embrochage centromédullaire des fractures diaphysaires des deux os de l'avant-bras chez l'adulte.

PURPOSE OF THE STUDY: The goal when treating shaft fractures of the forearm bones is to obtain good bone healing with good preservation of upper limb function. We report a retrospective (1995-2004) consecutive series of patients aged 32 years on average (range 16 to 92 years) who presented 46 shaft fractures of both forearm bones. MATERIAL AND METHODS: Using Hackethal's classification by sixths, the fracture involved the 3rd and 4th sixth in 39 cases (84.7%) for the radius and 33 (71.7%) for the ulna. Seventeen (37%) patients were trauma victims with multiple injuries. Fourteen fractures (30.4%) were open and all fractures were treated: 11 stage I (23.9%), two stage II (4.3%) and one stage III (2.3%). Intramedullary pinning was used in all cases for the radius and the ulna. In 27 patients (58.6%) pinning was achieved without open access to the focus. Pin diameter was 2.5mm for 38 cases (82.6%). Self-controlled rehabilitation exercises were started immediately without complementary immobilization. Outcome was assessed in 41 patients with a mean follow-up of 18 months (range three months to seven years). RESULTS: Functional outcome, according to Tscherne and Oestern, was very good or good in 31 cases (75.5%). For 35 cases (85.4%) bone healing was achieved at mean 3.5 months for the radius and four months for the ulna. Retarded healing was noted in four cases (9.7%) for the ulna. For the 41 patients reviewed, 11 (26.8%) presented axial misalignment of one of the forearm bones with an angle strictly greater than 10 degrees for three. There were six patients with nonunion (14.6%), of both bones in two and one in four. Radioulnar synostosis was observed in four cases (9.7%). No infections or recurrent fractures were noted. DISCUSSION: The localization of the fracture line affected the outcome. Among the four cases with a fracture in the 5th sixth of the radius, two developed misalignment with an angle strictly greater than 10 degrees and one presented a secondary displacement which required revision on day 15 for plate-screw fixation of the radius. This might be due to the spreading corticals of the distal radius where pin stabilization would be less effective than for fractures in the 3rd or 4th sixths where the corticals run parallel. Outcome was less satisfactory when the fracture focus was opened. Four of the six nonunions and three of the four synostoses occurred among the 19 patients who had open pinning. This might be due to loss of the fracture hematoma. Analysis of the type of fixation has shown that our best results were obtained when we used a single 2.5 mm elastic pin. For the cases where we used a smaller pin (2 mm), we had three major misaligments, one nonunion involving both bones and one recurrent dislocation of the radial head. There were no infections or recurrent fractures in this series where the pin was removed in 27 patients (65.6%) at mean one year. CONCLUSION: Intramedullary pinning is an attractive alternative for the treatment of shaft fractures involving both forearm bones in adults. Best results are obtained if the fracture (situated outside the 5th sixth) can be stabilized without opening the focus with a single 2.5 mm pin. This method combines the advantages of closed osteosynthesis, that is, a simple nontraumatic procedure decreasing the risk of suppuration, and early return of function, limiting postoperative immobilization. It enables early sturdy bone healing with a low risk of recurrent fracture.

Synthesis and characterization of new electroactive polypyrrole-chondroitin sulphate A substrates.

Novel composite polypyrrole/chondroitin-4-sulphate films with cation-exchange properties were synthesized by the electrochemical polymerization of pyrrole in the presence of chondroitin-4-sulphate (CSA) sodium salt, acting as dopant anion at neutral pH. The negatively charged biomolecule was found to be permanently entrapped in the polypyrrole (PPy) membrane which resulted, as expected, facilitated in the mass transport by mobile cationic counterions. The porous nature of the substrates was identified as the most influential factor controlling the morphology. The morphology, in turn, affects the interaction between the material surface and the tissues on a cellular level. In this work in vitro analyses of human fibroblast response to polypyrrole/chondroitin-4-sulphate films were performed to focus on the different steps of cell reactions towards defined surface properties.

Retrieved Unicompartmental Implants with Full PE Tibial Components: The Effects of Knee Alignment and Polyethylene Thickness on Creep and Wear.

Creep and true wear of polyethylene are difficult to evaluate on radiographs of knee arthroplasties and for this reason the true rate of polyethylene wear in vivo after unicompartmental arthroplasty is not well known. This study evaluated the creep and true wear in fifty-five medial retrieved unicompartmental implants that had a flat articular surface at the time of implantation.All the full polyethylene tibial components had the same design and were retrieved from eleven to 224 months (mean 152 months) after their implantation. The postoperative varus deformity had been measured on weight-bearing radiographs of the whole limb (hip-knee-ankle angle). The retrieved implants were placed in a coordinate measuring machine and the coordinates of a grid of points were obtained. Using this system, a three dimensional scaled image of the implant could be created and was used to calculate the total penetration of the femoral condyle due to true wear and creep.Total linear penetration rates ranged from 0.18 to 2.6 millimeters per year (mean 0.25 millimeters per year). Linear penetration rates due to true wear ranged from 0.08 to 1.4 millimeters per year (mean 0.13 millimeter per year), and penetration due to creep ranged from 0.07 to 1.9 millimeters per year (mean 0.12 millimeters per year).The linear and volumetric penetration rates of the femoral condyle due to true wear were negatively correlated with the duration of implantation. The linear penetration rate due to creep was higher in the first two years after the implantation compared to the subsequent years. Using multiple linear regression analyses to remove the confounding effects of age, weight, gender and thickness of the implant, we found that an increase of the postoperative varus deformity was due to an increase of creep (p = 0.03) but not with an increase of true wear (p = 0.25). Thinner implants were due to an increase of creep (p = 0.02) but not with an increase of true wear (p = 0.34). Increase in age was in relation with decrease of wear (p = 0.02) and increase of weight with increase in creep (p = 0.03).Plastic deformation had a high influence on the penetration rate of the femoral condyle in full polyethylene implants. There is a risk of an increased penetration and a decrease of the remaining thickness of the tibial plateau when the implant is too thin, the knee mal-aligned and the patient heavy - each of these factors increasing the creep deformation. In conclusion, our study suggests that surgeons using the Lotus Mk I unicompartmental knee replacement for medial tibiofemoral arthritis should beware of the overweight patient (>90kg) with a tibial implant of less than 9 mm. There is a risk of increased penetration and decreased thickness of the tibial implant when it is too thin, the knee malaligned, and the patient heavy. All these factors increase creep deformation.

A multinucleating Escherichia coli cytotoxin perturbs cell cycle in cultured epithelial cells.

Pathogenic Escherichia coli strains produce a number of virulence-associated factors, among which cytotoxic necrotizing factor 1 (CNF1). CNF1 is a chromosomally encoded toxin that permanently activates the small GTP-binding proteins of the Rho family (Rho, Rac and Cdc42) by catalizing their deamidation at a specific glutamine residue. This activation modulates a high number of cellular functions, including the reorganization of the actin cytoskeleton, the promotion of cell spreading and the multinucleation. Indeed, accumulating evidence indicates that, in addition to the well-characterized Ras GTPases, also Rho family proteins are crucial in different points of cell cycle regulation. Here, we report that CNF1 induces a block of the cell cycle at the G(2)/M transition in epithelial cell line HEp-2, and up-regulates cyclin B1 and p53 proteins confining them in the cytoplasm region. The ability of CNF1 to perturb cell cycle progression could play a role in E. coli pathogenicity.

[Total hip arthroplasty after failure of per- and subtrochanteric fracture fixation in elderly subjects]. / Prothèses totales de hanche après echec de fixation de fractures per et sous-trochantériennes chez les sujets agés.

PURPOSE OF THE STUDY: Most pertrochanteric fractures can be successfully fixed with osteosynthesis. Osteosynthesis fails however is a small number of patients who require re-operation for implantation of a total hip prosthesis. This situation occurs in particular when the material has penetrated the acetabulum and in elderly subjects. Although this type of arthroplasty is routine practice, few series have been reported. We present here outcome and complications of total hip arthroplasty after failure of per- and sub-trochanteric fracture fixation. MATERIAL AND METHODS: Between 1990 and 2000, twenty patients aged 79 years on average (range 62-78 years) underwent revision for total hip arthroplasty after failure of osteosynthesis for fracture of the upper femur. A gliding THS had been used for fixation in 18 patients, a plate in one and a Gamma nail in one. Osteosynthesis failure was related to early disassembly in ten patients, pseudarthrosis in eight and malunion in two. Revision was performed via a posterolateral approach in all cases. A standard total hip prosthesis was used in 16 patients, a longer femoral stem was required in four. Femoral components were cemented in 18 patients and non-cemented in two. The cup was a standard cemented cup in 12, retaining and cemented in eight. RESULTS: Mean operative time and blood loss were greater than in first-intention arthroplasties. All patients had lost their independence prior to the revision procedure. Despite their age, all recovered independence after a stay in rehabilitation. Most still required crutches. Use of a retaining cup enabled avoiding dislocation in all cases. For those who did not have a retaining cup, dislocation was the most frequent complication (3/12). The difficulties observed were: 1) elimination of associated infection before surgery; many of these elderly subjects had altered ESR and CRP values for various reasons; 2) abnormal position of the trochanteric mass because of a rotation defect; 3) malunion of the upper femur in the frontal or sagittal planes; 4) more or less easily achieved positioning of the femoral piece on the calcar; 5) difficult intraoperative identification of limb length due to loss of usual landmarks on the lesser and greater trochanter; 6) removal of fracture screws which sometimes required use of a trephine and bridging the last screw hole with a longer centromedullary stem. The most frequent postoperative orthopedic problems were leg length discrepancy (1-2 cm for eight patients), gluteus medius insufficiency, limping and pain at palpation of the trochanteric area. DISCUSSION: Despite the difficult technique and the potential complications which are more important than for first-intention arthroplasties, this series demonstrates that total hip prosthesis is a reliable solution for treating fixation failures of the upper femur.

[Intra- and postoperative fractures of the femur in total knee arthroplasty: risk factors in 32 cases]. / Facteurs du risque de fracture du fémur distal dans les protheses totales du genou: Etude de 32 fractures per et postopératoires.

PURPOSE OF THE STUDY: We reviewed fractures of the distal femur occurring during or after total knee arthroplasty in order to identify risk factors. MATERIAL AND METHODS: Twelve intraoperative fractures occurred between 1990 and 2000 among 617 total knee arthroplasties performed during this period. The circumstances of these fractures were noted in comparison with other prosthetic implants. Twenty other fractures of the distal femur occurred in 20 patients who had had a total knee arthroplasty during the same time period. Mean patient age at surgery was 72 years (range 69-77). In addition to demographic data, we noted risk factors: bone demineralization related to general condition, rheumatoid arthritis or corticosteroid therapy, trochlear notch prior to the trochlear cut, bone resorption under the femoral implant, repeated knee surgery, abnormal stress on the distal femur due to hip disease, periprosthetic osteolysis without loosening related to polyethylene debris or metallosis, loosening, type of prosthesis, loss of bone stock because of the femoral implant, life of prosthesis. RESULTS: Intraoperative fractures usually occurred in specific circumstances: use of a posterior stabilized prosthesis, probably with insufficient preparation and position of the stabilization element, probably excessive impaction in osteoporotic bone (rheumatoid arthritis), difficult exposure (arthroplasty after prior osteotomy), fracture starting from the separator passing over the posterior aspect of the tibia and reaching the intercondylar notch. Independently of these intercondylar fractures, supracondylar or diaphyseal fractures were essentially observed for revision prostheses using a femoral stem. Postoperative fractures were observed in patients who had prior surgery of the distal femur (revision of femoral osteotomy, fracture of the distal femur, arthrodesis), in patients with significant loss of bone stock (posterior stabilized prosthesis), or poor bone quality (rheumatoid arthritis), and in elderly patients with neurological impairment and frequent falls. The trochlear notch did not appear to be sufficient to be the only cause of fracture but was nevertheless an element frequently associated with other risk factors. DISCUSSION AND CONCLUSION: This study shows that fracture of the distal femur occurs in certain preferential circumstances. Considering these elements, a certain number of preventive measures can be discussed for technical modifications or choice of implants.

Multinucleation and pro-inflammatory cytokine release promoted by fibrous fluoro-edenite in lung epithelial A549 cells.

An unusual cluster of malignant mesothelioma was evidenced in Biancavilla, a Sicily village where no inhabitant had been significantly and professionally exposed to asbestos. Mineralogical and environmental studies led to the identification of a new prismatic amphibole, named fluoro-edenite. We previously reported, by using the human lung epithelial A549 cells, that prismatic fluoro-edenite was unable to induce changes that could be somehow related to cellular transformation, and this was in accordance with studies carried out in vivo. More recently, a fibrous amphibole with a composition very similar to that of prismatic fluoro-edenite, was identified in Biancavilla. This fibrous fluoro-edenite was shown to induce mesothelioma in rats. In keeping with this effect in vivo, in the present work we observed multinucleation and spreading, common features of transformed cells, as well as pro-inflammatory cytokine release in A549 cells. Such cell changes occurred without interfering with the passage of the resulting multinucleated cells through the cell cycle and without condemning cells to death. Hence, in lung epithelial cells, fibrous fluoro-edenite behaved similarly to the unrelated asbestos type crocidolite, whose connection with severe inflammation and cancer of the lung is renowned.

Exposure to HAV infection in patients with chronic liver disease in Italy, a multicentre study.

We carried out a multicentre study on 2830 patients with chronic liver disease from 79 liver units (25 in northern, 24 in central and 30 in southern Italy) to evaluate naturally acquired immunity against hepatitis A virus (HAV) in relation to age, sex, geographical area of origin and entity of liver disease, and to define the strategy for specific vaccination. Antibody to HAV (anti-HAV) was detected in 1514 (53.5%) of the 2830 patients tested; the prevalence was 50.4% in males and 59.1% in females. Both in central and southern Italy the prevalence of anti-HAV positive subjects increased with increasing age from 43.3 and 44.7%, respectively, in the 0-30-year-old subjects to 80.1 and 68.3%, respectively, in those aged over 60 years. The overall prevalence was much lower in northern Italy, as were the variations from one age group to another, from 28.4% in the 0-30-year-old subjects to 38% in those aged over 60 years. 40.6% of patients with cirrhosis lacked naturally acquired protection against HAV; this percentage was higher in northern (60.5%) than in central (34.9%, P < 0.0001) and southern Italy (27.6%, P < 0.0001). The high prevalence of patients in Italy with chronic hepatitis or cirrhosis who lack naturally acquired immunity to HAV warrants the implementation of vaccination programmes against hepatitis A in such patients.

Mechanical and ultrastructural evaluation of quartz post-endodontic reconstructions.

Aesthetics is a very important element in dentistry, but requires the support of good mechanical performance. Quartz fiber used in post-endodontic reconstruction is an aesthetic material, although there is little research concerning its mechanical properties. This study evaluated the retentive property of post-endodontic reconstruction, composed of a quartz fiber post. Different thermal stresses were applied in vitro to post-endodontic reconstructions, in order to simulate oral thermal action on post-system dental structure linkage. We chose 30 human extracted teeth, endodontically treated and restored, and then divided them into three groups of 10 teeth. A different treatment was applied to each group before mechanical testing: in the 1st group no treatment was done (controls); in the 2nd group teeth were subjected, in a climatic chamber, to 10 thermo-cycles between 4 degrees C and 58 degrees C; in the 3rd group teeth were stored in a saline solution at 37 degrees C for 48 hr. The teeth then underwent tensile shear stress tests at break point using a computerized electronic dynamometer. After mechanical testing, two teeth from each group were longitudinally half-sectioned, sputter-coated in gold and observed by scanning electron microscopy (SEM). The extracted quartz fiber post of each tooth also underwent SEM observation. Mechanical test results demonstrated that thermal cyclic variations could affect bond stability between dental structures and posts in quartz fiber reconstructions, whereas their bond strength seemed unaffected by humidity increases. Quartz fiber post SEM observation demonstrated a homogeneous structure and a regular fiber disposition. Dental root canal morphology SEM images always showed a different thickness in the cement layer. (Journal of Applied Biomaterials & Biomechanics 2004; 2: 156-61).

Prevalence of genotypic resistance to nucleoside analogues and protease inhibitors in antiretroviral-naive HIV patients in Campania, Italy.

The aim of our study was to determine the prevalence of genotypic resistance to nucleoside analogues and protease inhibitors before and after 1997, the year of introduction of Highly Active Antiretroviral Therapy (HAART) in Campania (Italy). Forty-eight plasma HIV-RNA positive patients who had not been previously treated for HIV infection (naïve) were enrolled in two Divisions of Infectious Diseases. The main demographic characteristics were collected for each subject and the primary mutant genotypes were sought only in HIV-RNA positive patients with viral loads higher than 10,000 copies/ml. The diagnosis of HIV infection dated back to before 1996 for 21 out of 48 patients and to after 2000 for the other 27. INNO-Line Probe Assay (LiPA) HIV-RT and INNO-LiPA HIV protease (Innogenetics, Italy) were used to detect mutations conferring resistance to zidovudine, didanosine, zalcitabine, lamivudine, stavudine, saquinavir, indinavir, rotonavir, nelfinavir and amprenavir. No mutations associated with primary resistance to nucleoside analogues and protease inhibitors were detected in the 21 patients who had acquired HIV infection before 1996, whereas one or more mutations were seen in three of the 27 (11.1%) patients with HIV infection diagnosed after 2000. This study confirms that LiPA is a suitable tool for epidemiological surveys of HIV genotypic primary resistance. Drug-resistant HIV-1 genotypes, resistant both to nucleoside analogues and protease inhibitors, were detected only in subjects who had acquired HIV infection after 2000, most of whom had zidovudine-resistant mutants. These data suggest that the introduction of HAART has brought about the circulation of drug-resistant HIV genotypes.

Diagnosis of HCV related acute hepatitis by serial determination of IgM to HCV: a preliminary observation.

OBJECTIVE: To verify whether serial determination of titre of IgM to HCV core protein (HCV IgM) may be useful to distinguish acute hepatitis C (AHC) from reactivation of chronic hepatitis C (r-CHC), we studied 18 consecutive patients with AHC (identified by seroconversion to anti-HCV) and 15 consecutive patients who had been anti-HCV positive for at least one year at the time of reactivation. METHODS: Samples of serum were obtained from all patients on hospitalisation and every 5 days during the follow-up and stored at -80 degrees C: 54 samples of serum for the AHC group and 41 for the r-CHC group. Titres of HCV IgM were calculated as Index values by a commercially available enzyme immunoassay (HCV-IgM EIA 2.0, Abbott Laboratories, North Chicago, IL, USA). RESULTS: No difference was observed between the two groups of patients as regards age, sex, risk factors for the acquisition of HCV infection, clinical and biochemical data on presentation, prevalence of cases with detectable viremia or distribution of HCV genotypes. HCV IgM was detected with an Index value of 350 or more in only 1 (6.7%) in the r-CHC group and in 17 (94.4%) in the AHC group (p<0.01). Moreover, during the early phase of the illness we observed a wide variation in the HCV IgM Index values in AHC and consistent values in r-CHC. CONCLUSIONS: Our data indicate that AHC is characterised by high and variable titres of HCV IgM during the acute phase of the illness, which may be considered diagnostic, whereas in r-CHC the IgM titre remains stable and rarely reaches a high level.

Adherence to HIV treatment: results from a 1-year follow-up study.

We evaluated adherence to HIV treatments every 4 months during one year in 63 HIV-infected subjects using combination therapies including a protease inhibitor. A total of 18 subjects reported a high level of adherence, 14 in two evaluations, and eight a low level of adherence in all the three evaluations. The remaining 23 subjects (36.5%) reported different levels of adherence to treatment in the three evaluations. These findings suggest that the level of adherence to treatment changes markedly for each patient over time.

Isolated anti-HBc in chronic hepatitis C predicts a poor response to interferon treatment.

The sustained response to interferon-alpha treatment was evaluated in 147 anti-HCV/HCV-RNA-positive, HBsAg-negative, chronic hepatitis patients, according to HCV genotypes and the presence or absence of anti-HBs and anti-HBc. These patients had been included in a controlled study on the safety, tolerability, and efficacy of three types of interferon-alpha given at a dose of 3 MU three times weekly for 52 weeks. One hundred and two patients had HCV genotype 1, 42 a non-1 HCV genotype and 3 multiple HCV genotypes; 46 were anti-HBs and anti-HBc negative (group A), 50 anti-HBs and anti-HBc positive (group B), and 51 anti-HBs negative and anti-HBc positive ("isolated" anti-HBc, group C). Serum HBV-DNA was detected by polymerase chain reaction in 15 of the 51 (29.4%) patients in group C and in none of those in groups A or B. The Sustained Response rate was higher in patients with a non-1 HCV genotype than those with HCV genotype 1 (31% vs. 17.7%, P > 0.1). Fewer patients in group C showed a sustained response than in group A or group B (7.8% vs. 30.4%, P = 0.009 and 7.8% vs 28%, P = 0.017, respectively). Moreover, the sustained response rate was high in patients with a non-1 genotype, both in group A (42.8%) and in group B (42.8%), intermediate in patients with HCV genotype 1 (23.3% in group A and 22.2% in group B) and low in group C, irrespective of HCV genotype (8.3% for genotype 1 and 7.1% for other genotypes). The data indicate that patients with HCV chronic hepatitis and isolated anti-HBc show a poor response to IFN-alpha, irrespective of the HCV genotype.

Does HIV infection favor the sexual transmission of hepatitis C?

BACKGROUND: There are widely discrepant findings on the sexual transmission of hepatitis C virus (HCV), commonly transmitted by the parenteral route. Coinfection with HCV is common in subjects infected with HIV. GOAL: This case-control study evaluated the prevalence of anti-HCV in subjects with hetero- or homosexual contact and no history of intravenous drug abuse or blood transfusion, according to the presence or absence of HIV infection. STUDY DESIGN: In this case-control study, the cases considered were 106 consecutive patients who showed positive anti-HIV test results. For each case, two control subjects were selected who had been screened for HIV infection at the authors' center and found to have anti-HIV-negative test results, and who matched the case in terms age (+/- 5 years), gender, and risk factor for parenterally transmitted infections. RESULTS: The prevalence of subjects with positive test results for hepatitis B surface antigen (HBsAg) was similar between cases and control subjects (4.7% versus 2.4%). Positivity for anti-hepatitis B core antigen in connection with negative test results for HBsAg was observed more frequently in the 106 cases than in the 212 control subjects (33.9% versus 15.6%; P = 0.0003). Anti-HCV positivity was more frequent in the cases than in the control subjects (15.1% versus 5.2%; P = 0.005). In particular, among subjects who had hetero- or homosexual intercourse with a steady partner who had positive anti-HIV test results, anti-HCV positivity was observed in 18.7% of the 32 cases and 1.6% of the 64 control subjects (P = 0.008). CONCLUSION: This study demonstrated that in subjects who had only a sexual risk factor for parenterally transmitted infections, HIV may enhance the sexual transmission of HCV.

Antibodies to hepatitis A virus in Italian patients with chronic liver disease.

To improve our knowledge for future hepatitis A virus (HAV) vaccination strategies we carried out a multicentre study on naturally acquired immunological protection against HAV in patients with chronic hepatitis in Italy. We enrolled 830 consecutive patients with chronic hepatitis on their first observation at one of the six Italian liver units participating in the study. Six hundred and fifty-eight patients (79.3%) were positive for total anti-HAV and 172 (20.7%) were negative. The anti-HAV negative patients were younger (median age 33, range 11-78) than the anti-HAV positive (median age 56, 18-87). There was a higher prevalence of cases with circulating anti-HAV among the 508 patients residing in southern Italy than in the 322 residing in northern Italy (88.8% vs. 64%, P < 0.001). No significant difference in the anti-HAV prevalence was observed between patients from northern Italy and those from southern Italy aged 0-30 years or in those over 60 years, while in those 31-60 years old there was a higher prevalence of anti-HAV positive patients from southern Italy (90.2% vs. 65.8%, P < 0.0001). Of the patients with liver cirrhosis in this study, only 3 of the 26 (11.5%) from northern Italy and 8 of the 228 (3.5%) from southern Italy had no immunological protection against HAV infection. The data suggest that the number of patients with chronic liver disease without naturally acquired immunity against HAV is substantial in Italy, particularly in the north of the country, and that new vaccination strategies are needed.