Do oral antiseptics used in the dental routine have anti-viral efficacy? a systematic review of in vitro studies / Os antissépticos orais utilizados na rotina odontológica têm eficácia anti-viral? Uma revisão sistemática de estudos in vitro / ¿Los antisépticos orales utilizados en la rutina odontológica tienen eficacia antiviral? Una revisión sistemática de estudios in vitro

Introduction: Mouthwashes play an important role in the dental clinic, but their role on viruses requires investigation. Objective:to review in vitro studies to identify the effect of different mouthwashes on the main viruses associated with routine dental care. Methodology:The following databases were searched in September 2023: PubMed, Embase, Scopus and Web of Science databases; the Cochrane Library and the Virtual Health Library (VHL); and grey literature. In vitro studies that used mouthwashes to reduce the viral load were selected. The PICOS strategy was considered to define eligibility criteria: the Population (viruses involved in the etiology of oral infection), the Intervention (oral antiseptics), the appropriate comparator (positive and negative controls), the Outcomes of interest (reduction of viral load) and the Study design (in vitro studies). Results:Considering the eligibility criteria, 19 articles were included in this review. The efficacy of povidone-iodine (PVP-I), chlorhexidine, Listerine®, essential oils, and cetylpyridinium chloride (CPC) rinses were investigated. PVP-I (0.23%) had its effects mainly associated with coronaviruses SARS(Severe Acute Respiratory Syndrome),demonstrating a significant reduction in viral load after 15 seconds of exposure. Chlorhexidine (0.05%; 0.1% and 0.5%) was ineffective against adenovirus, poliovirus, and rhinovirus respiratory viruses. Listerine® demonstrated superior efficacy against HSV-1 and 2 viruses and influenza A, and cetylpyridine chloride also demonstrated virucidal activity against influenza A. Conclusions:The type, concentration, and time of exposure to antiseptics varied between studies. PVP-I and chlorhexidine digluconate were the most studied substances, butin general, PVP-I was more effective in reducing viral titers, especially concerning coronaviruses. Other antiseptics such as CPC, H2O2 and Listerine® have also shown significant reduction in viral load, but this is a limited number of studies (AU).

Introdução: Os enxaguantes bucais desempenham um papel importante na clínica odontológico, porém seu papel sobre os vírus requer investigações. Objetivo: revisar estudos in vitro para identificar o efeito de diferentes colutórios sobre os principais vírus associados ao atendimento odontológico de rotina. Metodologia: As seguintes bases foram pesquisadas até setembro de 2023: PubMed, Embase, Scopus e Web of Science; a Biblioteca Cochrane e a Biblioteca Virtual em Saúde (BVS); e literatura cinzenta. Foram selecionados estudos in vitro que utilizaram bochechos com o objetivo de reduzir a carga viral. A estratégia PICOS foi considerada para a definição dos critérios de elegibilidade: População (vírus envolvidos na etiologia da infecção oral), Intervenção (antissépticos orais), Comparador (controles positivos e negativos), os Desfechos de interesse (redução da carga viral) e o desenho do estudo (estudos in vitro). Resultados: Considerando os critérios de elegibilidade, 19 artigos foram incluídos para esta revisão. A eficácia da povidona-iodo (PVP-I), clorexidina, Listerine®, óleos essenciais e lavagens com cloreto de cetilpiridínio foram investigadas. O PVP-I(0.23%)teve seus efeitos principalmente associados ao coronavírusSARS (Síndrome Respiratória Aguda Severa),demonstrando uma redução significativa da carga viral após 15 segundos de exposição. A clorexidina mostrou-se ineficaz contra vírus respiratórios de adenovírus, poliovírus e rinovírus. Listerine® demonstrou eficácia superior contra vírus HSV-1 e 2 e vírus influenza A, e cloreto de cetilpiridinio também demonstrou atividade virucida contra influenza A.Conclusões:O tipo, concentração e tempo de exposição aos antissépticos variaram entre os estudos. O PVP-I e o digluconato de clorexidina foram as substâncias mais estudadas, mas no geral, o PVP-I foi mais eficaz na redução dos títulos virais, principalmente no que diz respeito aos coronavírus. Outros antissépticos como CPC, H2O2 e Listerine® também mostraram redução significativa da carga viral, mas trata-se de um número limitado de estudos (AU).

Introducción: Los enjuagues bucales son importantesen la clínica dental, sin embargo, su efecto sobre los virus requiere investigaciones. Objetivo: Revisar estudios in vitro para identificar el efecto de enjuagues bucales sobre los principales virus asociados con larutinaodontológica. Metodología: Las siguientes bases de datos fueron investigadas hasta septiembrede 2023: PubMed, Embase, Scopus y Web of Science; Biblioteca Cochrane y Biblioteca Virtual en Salud (BVS); yliteratura gris. Se seleccionaron estudios in vitro que utilizaron enjuagues bucales con el objetivo de reducir la carga viral. Se consideró la estrategia PICOS para definir los criterios de elegibilidad: Población (virus implicados en la etiología de la infección oral), Intervención (antisépticos bucales), Comparador (controles positivos y negativos), Resultados de interés (reducción de la carga viral) y diseño del estudio (in vitro). Resultados: Considerando los criterios de elegibilidad, se incluyeron 19 artículos.Se investigó la eficacia de povidona yodada (PVP-I), clorhexidina, Listerine®,aceites esenciales y enjuagues de cloruro de cetilpiridinio (CPC). PVP-I(0.23%)mostró sus efectos principalmente asociados al coronavirus SARS(Síndrome Respiratorio Agudo Severo), demostrando una reducción significativa de la carga viral después de 15 segundos. Se ha demostrado que la clorhexidina es ineficaz contra losvirus respiratorios adenovirus, poliovirus y rinovirus. Listerine® demostró una eficacia superior contra los virus HSV-1 y 2 y el virus de la influenza A, y el CPCtambién mostró actividad virucida contra la influenza A.Conclusiones: El tipo, la concentración y el tiempo de exposiciónvariaron entre los estudios. PVP-I y digluconato de clorhexidina fueron las sustancias más estudiadas, pero,PVP-I fue más efectiva en la reducción de los títulos virales, especialmente en lo que respecta a los coronavirus. Otros antisépticos como CPC, H2O2 y Listerine® también mostraron una reducción significativa de la carga viral, pero se trata de un número limitado de estudios (AU).

Variations in the treatment of acute peripheral facial paralysis. A nationwide survey / Encuesta nacional sobre la variabilidad en el tratamiento de la parálisis facial periférica aguda

Background Acute peripheral facial paralysis may be diagnosed and treated by different specialists. Objective The aim of this study was to explore the variability in the treatment of Bell’s palsy (BP) and Ramsay Hunt Syndrome (RHS) among different medical specialties. Methods An anonymous nationwide online survey was distributed among the Spanish Societies of Otorhinolaryngology (ORL), Neurology (NRL) and Family and Community Medicine (GP). Results 1039 responses were obtained. 98% agreed on using corticosteroids, ORL using higher doses than NRL and GP. Among all, only 13% prescribed antivirals in BP routinely, while 31% prescribed them occasionally. The percentage of specialists not using antivirals for RHS was 5% of ORL, 11% of NRL, and 23% of GP (GP vs. NRL p = 0.001; GP vs. ORL p < 0.0001; NRL vs. ORL p = 0,002). 99% recommended eye care. Exercises as chewing gum or blowing balloons were prescribed by 45% of the participants with statistically significant differences among the three specialties (GP vs. NRL p = 0.021; GP vs. ORL p < 0.0001; NRL vs. ORL p = 0.002). Conclusion There is general agreement in the use of corticosteroids and recommending eye care as part of the treatment of acute peripheral facial paralysis. Yet, there are discrepancies in corticosteroids dosage, use of antivirals and recommendation of facial exercises among specialties. (AU)

Introducción La parálisis facial periférica aguda puede ser diagnosticada y tratada por diferentes especialistas. Objetivo El objetivo de este estudio es analizar la variabilidad entre especialidades en el tratamiento de la parálisis de Bell (PB) y del síndrome de Ramsay-Hunt (SRH). Métodos Se distribuyó una encuesta anónima online entre los miembros de la Sociedad Española de Otorrinolaringología (ORL), la Sociedad Española de Neurología (NRL) y la Sociedad de Medicina Familiar y Comunitaria (MF). Resultados Se recopilaron 1039 respuestas. El 98% de los participantes coincidieron en el uso de corticoides, los ORL utilizaron dosis más altas que NRL y MF. Del total de encuestados, el 13% recomendaba antivirales en la PB de manera rutinaria, mientras que el 31% los recomendaba en ocasiones. El 5% de ORL, 11% de NRL, y 23% de MF (MF vs. NRL p = 0.001; MF vs. ORL p < 0.0001; NRL vs. ORL p = 0,002) no utilizaba antivirales en el tratamiento del SRH. El 99% de añadía cuidados del ojo al tratamiento de la parálisis facial. El 45% de los participantes aconsejaba ejercicios faciales como mascar chicle o inflar globos con diferencias estadísticamente significativas entre las tres especialidades (MF vs. NRL p = 0.021; MF vs. ORL p < 0.0001; NRL vs. ORL p = 0.002). Conclusión Existe acuerdo general en la utilización de corticoides y recomendar cuidados del ojo como parte del tratamiento de la parálisis facial periférica. A pesar de ello, existen diferencias en las dosis utilizadas, la utilización de antivirales o la recomendación de ejercicios faciales entre especialidades. (AU)

COVID -19: On the threshold of the fifth year. The situation in Spain / COVID-19: A las puertas del quinto año

Despite having emerged from pandemic status, the incidence of COVID-19 episodes has recently increased in Spain, including pediatric cases and admissions to Intensive Care Units. Several recombinant variants are circulating among us, particularly XBB arising from two Omicron BA.2 sublineages with mutations in the genes encoding the spicule proteins that could increase binding to the ACE2 receptor and be more prone to immune escape. Faced with these, 3 pharmaceutical companies have developed vaccines adapted to the XBB.1.5 sublineage that are already available for administration in our setting with risks that should not be different from those of previous mRNA vaccines and with clearly favorable benefit/risk ratios. They should be applied to patients with potential for poor COVID-19 evolution and to collectives that have a particular relationship of proximity with them. Their application should be understood not only from a perspective of individual convenience but also from that of collective responsibility. The most convenient seems to be a simultaneous immunization of COVID-19 and influenza in our environment. In the therapeutic aspect, there is little to expect right now from antisera, but the already known antiviral drugs are still available and indicated, although their efficacy will have to be reevaluated due to their impact on populations that are mostly immunized and with a better prognosis than in the past. In our opinion, it is necessary to continue to make a reasonable and timely use of masks and other non-pharmacological means of protection. (AU)

Pese a haber salido de la situación de pandemia, la incidencia de episodios de COVID-19 ha aumentado recientemente en España, incluidos los casos pediátricos y los ingresos en Unidades de Cuidados Intensivos. Circulan entre nosotros diversas variantes recombinantes, particularmente la XBB surgidas de dos sublinajes Omicron BA.2 con mutaciones en los genes que codifican las proteínas de la espícula y que pudieran aumentar la unión al receptor ACE2 y ser más propensas al escape inmune. Frente a ellas, 3 empresas farmacéuticas han elaborado vacunas adaptadas al sublinaje XBB.1.5 que ya se encuentran disponibles para su administración en nuestro medio con riesgos que no deben ser diferentes a los de las vacunas mRNA previas y con relaciones beneficio/riesgos claramente favorables. Deben aplicarse a pacientes con potencial de mala evolución de COVID-19 y a los colectivos que tienen una particular relación de proximidad con ellos. Su aplicación debe ser entendida no sólo desde una perspectiva de conveniencia individual sino desde la de la responsabilidad colectiva. Lo más conveniente parece hacer una inmunización simultánea de COVID-19 y gripe en nuestro medio. En el aspecto terapéutico hay poco que esperar ahora mismo de los antisueros pero siguen estando disponibles e indicados los fármacos antivirales ya conocidos aunque su eficacia tendrá que reevaluarse por su impacto en poblaciones mayoritariamente inmunizadas y con pronóstico mejor que las de tiempos pasados. A nuestro juicio, es necesario seguir haciendo un uso razonable y puntual de mascarillas y otros medios no farmacológicos de protección. (AU)

Variations in the treatment of acute peripheral facial paralysis. A nationwide survey.

BACKGROUND: Acute peripheral facial paralysis may be diagnosed and treated by different specialists. OBJECTIVE: The aim of this study was to explore the variability in the treatment of Bell's palsy (BP) and Ramsay Hunt Syndrome (RHS) among different medical specialties. METHODS: An anonymous nationwide online survey was distributed among the Spanish Societies of Otorhinolaryngology (ORL), Neurology (NRL) and Family and Community Medicine (GP). RESULTS: 1039 responses were obtained. 98% agreed on using corticosteroids, ORL using higher doses than NRL and GP. Among all, only 13% prescribed antivirals in BP routinely, while 31% prescribed them occasionally. The percentage of specialists not using antivirals for RHS was 5% of ORL, 11% of NRL, and 23% of GP (GP vs. NRL p = 0.001; GP vs. ORL p < 0.0001; NRL vs. ORL p = 0,002). 99% recommended eye care. Exercises as chewing gum or blowing balloons were prescribed by 45% of the participants with statistically significant differences among the three specialties (GP vs. NRL p = 0.021; GP vs. ORL p < 0.0001; NRL vs. ORL p = 0.002). CONCLUSION: There is general agreement in the use of corticosteroids and recommending eye care as part of the treatment of acute peripheral facial paralysis. Yet, there are discrepancies in corticosteroids dosage, use of antivirals and recommendation of facial exercises among specialties.

Predictive models for hepatocellular carcinoma development after sustained virological response in advanced hepatitis C / Modelos predictivos para el desarrollo de carcinoma hepatocelular tras la respuesta viral sostenida en pacientes con hepatitis C avanzada

Background & aims: Life-long hepatocellular carcinoma (HCC) surveillance is recommended after sustained virological response (SVR) in patients with advanced hepatitis C. Since the identification of patients who could be safely discontinued for surveillance is essential, we aimed to identify subsets of patients with low-risk HCC. Methods: 491 patients with advanced and compensated fibrosis (≥F3) were prospectively followed after achieving SVR with interferon-free therapies. Clinical–biological parameters and liver stiffness measurement (LSM) were performed before starting treatment (ST) and at SVR, and HCC surveillance was carried out. Results: During a median follow-up of 49.8 months, 29 (5.9%) patients developed HCC [incidence rate: 1.6/100 patient-years (PYs)]. Two predictive models based on LSM (Model-A) or FIB-4 score (Model-B) were proposed. Only SVR parameters were included in the models, because they showed a higher accuracy for predicting HCC than ST measurements. Variables independently associated with HCC were LSM (HR, 1.03; 95% CI, 1.01–1.05), age (HR, 1.04; 95% CI, 1.01–1.08) and albumin levels (HR, 0.90; 95% CI, 0.84–0.97) in Model-A, and FIB-4 (HR, 1.22; 95% CI, 1.08–1.37) and albumin (HR, 0.90; 95% CI, 0.84–0.97) in model-B. Both models allow HCC risk stratification, identifying low-risk groups with an HCC incidence rate of 0.16/100 and 0.25/100 PYs, respectively. An overall increased hazard of HCC was observed over time. (AU)

Antecedentes y objetivos: En pacientes con hepatitis C avanzada se recomienda la vigilancia del carcinoma hepatocelular (CHC) de por vida tras la respuesta viral sostenida (RVS). La identificación de pacientes que podrían interrumpir de manera segura el screening es esencial, por ello nuestro objetivo fue identificar subgrupos de pacientes con bajo riesgo de desarrollo de CHC. Métodos: Se realizó un seguimiento prospectivo de 491 pacientes con fibrosis avanzada y compensada (≥F3) tras la RVS obtenida con terapias libres de interferón. Se registraron parámetros clínico-biológicos y se midió la rigidez hepática mediante elastografía de transición (ET) antes del inicio del tratamiento y en la respuesta viral sostenida y se realizó screening para el desarrollo de CHC. Resultados: Durante una mediana de seguimiento de 49,8 meses, 29 (5,9%) pacientes desarrollaron CHC. (Tasa de incidencia: 1,6/100 pacientes-año [PA]). Se propusieron dos modelos predictivos basados en la puntuación de ET (Modelo-A) o FIB-4 (Modelo-B). Se incluyeron los parámetros en RVS en los modelos porque mostraron una mayor precisión para predecir CHC que las mediciones basales. Las variables asociadas de forma independientes con CHC fueron: ET (HR 1,03 IC; IC 95%, 1,01-1,05), edad (HR 1,04; IC 95%, 1,01-1,08) y niveles de albúmina (HR 0,90; IC 95%, 0,84-0,97) en el Modelo-A, y FIB-4 (HR 1,22; IC 95%, 1,08-1,37) y albúmina (HR 0,90; IC 95%, 0,84-0,97) en el Modelo-B. Ambos modelos permiten la estratificación del riesgo de CHC, identificando grupos de bajo riesgo con una tasa de incidencia de CHC de 0,16/100 y 0,25/100 PA, respectivamente. Se observó un aumento general del riesgo de desarrollar CHC con el tiempo. (AU)

Tratamiento y prevención de la viruela del mono / Treatment and prevention of monkeypox

La viruela del mono es una zoonosis que se contagia principalmente a través del contacto directo con los fluidos y las lesiones cutáneas de personas contagiadas con vesículas aun activas. Aunque el virus fue aislado por primera vez en 1958, y el primer caso humano se identificó en un niño en 1970, en la República Democrática del Congo, la enfermedad ha aumentado progresivamente su incidencia en África, alcanzando en mayo de 2022 transmisión sostenida fuera de este continente. Al ser un virus de nueva introducción en nuestro entorno sanitario, es necesario aprender el patrón epidemiológico en un medio diferente al de las zonas tradicionalmente endémicas y conocer los tratamientos antivirales a nuestro alcance, así como las medidas profilácticas que podrían plantearse, sabiendo que como virus emergente en nuestras regiones las evidencias científicas aun son limitadas. Existen antivirales que han demostrado en modelos animales combatir eficazmente la enfermedad con muy buena tolerancia clínica. Esta enfermedad también ha obligado a revisar las características de las vacunas frente a la viruela, ya que han demostrado un efecto protector frente a la viruela del mono. Por ello, es importante disponer de un documento que recopile toda la información científica publicada a este respecto.(AU)

Monkeypox is a zoonosis that is spread mainly through direct contact with fluids and skin lesions of infected people with vesicles still active. Although the virus was isolated for the first time in 1958 and the first human case was identified in a child in 1970, in the Democratic Republic of the Congo, the disease has progressively increased its incidence in Africa reaching in May 2022 sustained transmission outside this continent. As it is a newly introduced virus in our health system, it is necessary to learn the epidemiological pattern in a different environment from that of traditionally endemic areas and to know the available antiviral treatments, as well as the prophylactic measures that could be considered, knowing that as a virus emerging in our regions, scientific evidence is still limited. There are antivirals that have been shown, in animal models, to effectively combat the disease with very good clinical tolerance. This disease has also forced us to review the characteristics of smallpox vaccines, because they have shown a protective effect against monkeypox. For this reason, it is important to have a document that compiles all the scientific information published in this regard.(AU)

Análisis de las interacciones de nirmatrelvir/ritonavir en pacientes ambulatorios en atención primaria / Nirmatrelvir/ritonavir drug-drug interactions in primary care outpatients

Fundamento. Nirmatrelvir/ritonavir es un antiviral oral con un alto potencial de producir interacciones farmacológicas. La población candidata a recibirlo es mayoritariamente vulnerable, con enfermedades crónicas y polimedicada. El objetivo es evaluar la validación farmacéutica previa a la ad-ministración del antiviral.Material y métodos. Las interacciones farmacológicas entre nirmatrelvir/ritonavir y el tratamiento habitual se consulta-ron en fichas técnicas y las herramientas de interacciones de UpToDate® y Universidad de Liverpool®. Se incluyeron las prescripciones validadas por un farmacéutico de atención primaria (abril/2022-abril/2023). Resultados. Se incluyeron 159 pacientes; en 83 se detecta-ron 168 interacciones que podían suponer un cambio en su tratamiento. Las estatinas (25,6%), anticoagulantes (10,7%) y antihipertensivos (10,7%) fueron los grupos terapéuticos más frecuentemente implicados. La suspensión (53,0%) y reducción de dosis (22,6%) fueron los cambios de trata-miento más frecuentes. Conclusiones. La revisión de potenciales interacciones far-macológicas, los ajustes posológicos y las modificaciones del tratamiento habitual del paciente han evitado potenciales to-xicidades, mejorando la seguridad de nirmatrelvir/ritonavir (AU)

Background. The oral antiviral nirmatrelvir/ritonavir inter-acts with a range of drugs. Candidate patients to receive this antiviral agent are usually vulnerable, multipathological and polymedicated. The objective is to evaluate the phar-maceutical validation prior to the administration of the an-tiviral.Material and methods. Drug-drug interactions between nirmatrelvir/ritonavir and patients’ usual treatment medi-cations were checked in product information and in the Up-ToDate® and the University of Liverpool® interaction tools. We included validated prescriptions between April/2022 and April/2023 by a Primary Care pharmacist.Results. Of the 159 study patients, 168 interactions were found in 83 individuals, which may have led to changes of their usual treatment. Statins (25.6%), anticoagulants (10.7%), and antihypertensives (10.7%) were the most fre-quently implicated therapeutic groups. Discontinuation (53.0%) and dose reduction (22.6%) were the most common treatment changes. Conclusions. Our search of potential drug interactions and subsequent dose adjustments and modifications of the pa-tient’s usual treatment has helped avoid potential toxicities ensuring a safe use of nirmatrelvir/ritonavir (AU)

Manejo de glomerulonefritis membranoproliferativa secundaria a infección por virus de hepatitis C / Management of membranoproliferative glomerulonephritis secondary to infection by hepatitis C virus

Las glomerulonefritis membranoproliferativas son ne-fropatías glomerulares poco frecuentes cuya prevalencia ha disminuido en nuestro medio. Presentan una histología característica y pueden asociarse a diferentes enfermeda-des. La presentación clínica es variada y su diagnóstico de-finitivo requiere realizar una biopsia renal. El tratamiento viene condicionado por la enfermedad de base, tratándose con inmunosupresores cuando existe una disminución del filtrado glomerular.Presentamos el caso de una mujer de 47 años con glo-merulonefritis membranoproliferativa secundaria a infec-ción por de virus de hepatitis C para describir el manejo de este tipo de pacientes, dado que se trata de una patología con una baja prevalencia (AU)

Membranoproliferative glomerulonephritis is an un-common condition that affects the glomeruli of the kid-neys; its prevalence has decreased in our environment. Membranoproliferative glomerulonephritis has a charac-teristic histology that can be associated to different diseas-es. The clinical presentation varies, and to achieve a defin-itive diagnosis a renal biopsy must be done. Treatment is based on the underlying disease; when a drop in glomer-ular filtration rate is detected, immunosuppressants are prescribed.We describe the management of a 47-year-old female with membranoproliferative glomerulonephritis second-ary to hepatitis C virus infection, a condition with very low prevalence (AU)

Hepatitis C virus-positive donors in HCV-negative recipients in liver transplantation: Is it possible in Mexico?

Hepatitis C virus (HCV) infection is a worldwide public health problem associated with significant morbidity and mortality. In the context of liver transplantation, the demand for organs continues to exceed the supply, prompting the consideration of using organs from HCV-positive donors in HCV-negative recipients. The introduction of direct-acting antivirals (DAAs), which have demonstrated great efficacy in eradicating the virus, has made transplantation of organs from donors with HCV infection possible. The present article provides a brief review of the current evidence on the use of organs from HCV-infected patients.

Long-term follow-up of HCV-infected patients with end-stage chronic kidney disease after sustained virological response with direct-acting antiviral therapy / Seguimiento a largo plazo de pacientes infectados por el virus de la hepatitis C con insuficiencia renal crónica terminal tras una respuesta virológica sostenida con tratamiento antiviral de acción directa

Background and aim: Patients with chronic kidney disease (CKD) and hepatitis C infection can be safely and effectively treated with direct-acting antivirals (DAAs). However, there is scarce data on the long-term impact of hepatitis C cure on CKD. The aim of this study was to assess the long-term mortality, morbidity and hepatic/renal function outcomes in a cohort of HCV-infected individuals with CKD treated with DAAs. Methods: 135 HCV patients with CKD stage 3b-5 who received ombitasvir/paritaprevir/ritonavir±dasabuvir in a multicenter study were evaluated for long-term hepatic and renal outcomes and their associated mortality. Results: 125 patients achieved SVR and 66 were included. Prior to SVR, 53 were under renal replacement therapy (RRT) and 25 (37.8%) had liver cirrhosis. After a follow-up of 4.5 years, 25 (38%) required kidney transplantation but none combined liver–kidney. No changes in renal function were observed among the 51 patients who did not receive renal transplant although eGFR values improved in those with baseline CKD stage 3b-4. Three (5.6%) subjects were weaned from RRT. Eighteen (27.3%) patients died, mostly from cardiovascular events; 2 developed liver decompensation and 1 hepatocellular carcinoma. No HCV reinfection was observed. Conclusions: Long-term mortality remained high among end-stage CKD patients despite HCV cure. Overall, no improvement in renal function was observed and a high proportion of patients required kidney transplantation. However, in CKD stage 3b-4 HCV cure may play a positive role in renal function. (AU)

Introducción y objetivo: Los pacientes con insuficiencia renal crónica (IRC) e infección por el virus de la hepatitis C (VHC) pueden ser tratados de forma efectiva y segura con antivirales de acción directa (AAD). El objetivo de este estudio fue evaluar la mortalidad y la evolución de la función renal y hepática a largo plazo en una cohorte de pacientes con infección por VHC e IRC tratados con AAD. Métodos: Se analizó la evolución de la función hepática y renal, así como la mortalidad en 135 pacientes con infección por VHC e IRC estadio 3b-5 que recibieron ombitasvir/paritaprevir/ritonavir±dasabuvir en un estudio multicéntrico. Resultados: Ciento veinticinco pacientes se curaron (RVS), y 66 de ellos fueron incluidos. Antes de RVS, 53 estaban bajo terapia renal sustitutiva (TRS) y 25 (37,8%) tenían cirrosis hepática. Tras un seguimiento medio de 4,5 años, 25 (38%) requirieron trasplante renal, pero ninguno combinado renal-hepático. No se observaron cambios en la función renal entre aquellos 51 pacientes que no recibieron trasplante renal a pesar de que los valores de eFGR mejoraron en aquellos pacientes con IRC estadio 3b-4 de base. Tres (5,6%) pacientes pudieron dejar la TRS. Dieciocho (27,3%) pacientes fallecieron, principalmente por eventos cardiovasculares, 2 presentaron descompensación hepática y uno carcinoma hepatocelular. No se observó ninguna reinfección por VHC. Conclusiones: La mortalidad a largo-plazo fue alta. Globalmente no se objetivó una mejora en la función renal. A pesar de ello, en estadios 3b-4, la curación del VHC podría tener un papel positivo en la función renal. (AU)

Sofosbuvir plus glecaprevir/pibrentasvir as salvage therapy after liver transplantation in NS5A inhibitor-experienced patients. A case series.

BACKGROUND: Treatment of chronic hepatitis C virus (HCV) infection with direct-acting antivirals achieves a sustained virologic response rate higher than 95%. However, virologic failure remains a clinical challenge, and data on retreatment are limited, especially in special populations such as liver transplant (LT) recipients. OBJECTIVES: This study evaluated the sofosbuvir plus glecaprevir-pibrentasvir (GLE/PIB) regimen in LT recipients who had failed to a nonstructural protein 5A (NS5A) inhibitor-based regimen. MATERIAL AND METHODS: Retrospective study of 111 liver transplant recipients between January 2018 and December 2020; 18 patients presented with HCV recurrent infection after LT, out of whom three had a history of at least one NS5A inhibitor-based regimen. Salvage therapy with sofosbuvir plus GLE/PIB was started for 12 weeks; baseline characteristics and outcomes were recorded. RESULTS: All three patients (100%) achieved an undetectable HCV viral load 12 weeks after treatment completion. No serious adverse events were observed. CONCLUSION: In our series, sofosbuvir plus GLE/PIB for 12 weeks is an effective and safe salvage therapy after LT in patients previously treated with NS5A inhibitors.

ANTECEDENTES: El tratamiento del virus de la hepatitis C (VHC) crónica con antivirales de acción directa logra tasas de respuesta virológica sostenida superiores a 95 %. Sin embargo, el manejo del fracaso virológico sigue siendo un desafío clínico y la evidencia sobre el retratamiento es limitada, especialmente en poblaciones como los receptores de trasplante hepático (TH). OBJETIVO: Este estudio evaluó el régimen de sofosbuvir más glecaprevir/pibrentasvir (GLE/PIB) en receptores de TH en quienes falló el régimen basado en inhibidores de la proteína no estructural 5A (NS5A). MATERIAL Y MÉTODOS: Estudio retrospectivo de 111 pacientes trasplantados entre enero de 2018 y diciembre de 2020; 18 pacientes presentaron infección recurrente por VHC posterior al TH, tres de ellos tuvieron antecedentes de al menos un régimen basado en inhibidores de NS5A. Se inició terapia de rescate con sofosbuvir más GLE/PIB durante 12 semanas posterior al TH; se registraron las características basales de los pacientes y sus desenlaces. RESULTADOS: En los tres pacientes se logró obtener una carga viral indetectable de VHC a las 12 semanas de finalizar el tratamiento. No se observaron eventos adversos graves. CONCLUSIÓN: En nuestra serie, sofosbuvir más GLE/PIB durante 12 semanas demostró ser una terapia de rescate efectiva y segura posterior al TH en pacientes previamente tratados con inhibidores de NS5A.

Sofosbuvir más glecaprevir/pibrentasvir como terapia de rescate postrasplante hepático en pacientes con exposición previa a inhibidores de NS5A. Serie de casos / Sofosbuvir plus glecaprevir/pibrentasvir as salvage therapy after liver transplantation in NS5A inhibitor-experienced patients. A case series

Resumen Antecedentes: El tratamiento de la infección crónica por el virus de la hepatitis C (VHC) con antivirales de acción directa logra tasas de respuesta virológica sostenida superiores a 95 %. Sin embargo, el manejo del fracaso virológico sigue siendo un desafío clínico y la evidencia sobre el retratamiento es limitada, especialmente en poblaciones como los receptores de trasplante hepático (TH). Objetivo: Este estudio evaluó el régimen de sofosbuvir más glecaprevir/pibrentasvir (GLE/PIB) en receptores de TH en quienes falló el régimen basado en inhibidores de la proteína no estructural 5A (NS5A). Material y métodos: Estudio retrospectivo de 111 pacientes trasplantados entre enero de 2018 y diciembre de 2020; 18 pacientes presentaron infección recurrente por VHC posterior al TH, tres de ellos tuvieron antecedentes de al menos un régimen basado en inhibidores de NS5A. Se inició terapia de rescate con sofosbuvir más GLE/PIB durante 12 semanas posterior al TH; se registraron las características basales de los pacientes y sus desenlaces. Resultados: En los tres pacientes se logró obtener una carga viral indetectable de VHC a las 12 semanas de finalizar el tratamiento. No se observaron eventos adversos graves. Conclusión: En nuestra serie, sofosbuvir más GLE/PIB durante 12 semanas demostró ser una terapia de rescate efectiva y segura posterior al TH en pacientes previamente tratados con inhibidores de NS5A.

Abstract Background: Treatment of chronic hepatitis C virus (HCV) infection with direct-acting antivirals achieves a sustained virologic response rates higher than 95%. However, virologic failure remains a clinical challenge, and data on retreatment are limited, especially in special populations such as liver transplant (LT) recipients. Objective: This study evaluated the sofosbuvir plus glecaprevir-pibrentasvir (GLE/PIB) regimen in LT recipients who had failed to a nonstructural protein 5A (NS5A) inhibitor-based regimen. Material and methods: Retrospective study of 111 liver transplant recipients between January 2018 and December 2020; 18 patients presented with HCV recurrent infection after LT, out of whom three had a history of at least one NS5A inhibitor-based regimen. Salvage therapy with sofosbuvir plus GLE/PIB was started for 12 weeks; baseline characteristics and outcomes were recorded. Results: All three patients (100%) achieved an undetectable HCV viral load 12 weeks after treatment completion. No serious adverse events were observed. Conclusion: In our series, sofosbuvir plus GLE/PIB for 12 weeks is an effective and safe salvage therapy after LT in patients previously treated with NS5A inhibitors.

Patients with severe mental illness and hepatitis C virus infection benefit from new pangenotypic direct-acting antivirals: Results of a literature review / Los beneficios de los nuevos antivirales pangenotípicos de acción directa en pacientes con enfermedad mental grave e infección por el virus de la hepatitis C: resultados de una revisión bibliográfica

Introduction: Hepatitis C virus (HCV) infection is a global health problem that can results in cirrhosis, hepatocellular carcinoma and even death. HCV infection is 3–20-fold more prevalent among patients with versus without severe mental illness (SMI), such as major depressive disorder, personality disorder, bipolar disorder and schizophrenia. Treatment options for HCV were formerly based on pegylated interferon alpha, which is associated with neuropsychiatric adverse events, and this contributed to the exclusion of patients with SMI from HCV treatment, elimination programmes, and clinical trials. Moreover, the assumption of poor adherence, scant access to healthcare and the stigma and vulnerability of this population emerged as barriers and contributed to the low rates of treatment and efficacy. Methods: This paper reviews the literature published between December 2010 and December 2020 exploring the epidemiology of HCV in patients with SMI, and vice versa, the effect of HCV infection, barriers to the management of illness in these patients, and benefits of new therapeutic options with pangenotypic direct antiviral agents (DAAs). Results: The approval of DAAs has changed the paradigm of HCV infection treatment. DAAs have proven to be an equally efficacious and safe option that improves quality of life (QoL) in patients SMI. Conclusions: Knowledge of the consequences of the HCV infection and the benefits of treatment with new pangenotypic DAAs among psychiatrists can increase screening, referral and treatment of HCV infection in patients with SMI.(AU)

Introducción: La infección por el virus de la hepatitis C (VHC) es un problema de salud mundial que puede provocar cirrosis, carcinoma hepatocelular e incluso la muerte. La infección por el VHC es de 3 a 20 veces más prevalente entre los pacientes con enfermedades mentales graves (EMG), como el trastorno depresivo mayor, el trastorno de personalidad, el trastorno bipolar y la esquizofrenia. Las opciones de tratamiento para el VHC se basaban anteriormente en el interferón pegilado alfa, que se asocia con efectos adversos neuropsiquiátricos, y esto contribuyó a la exclusión de los pacientes con EMG del tratamiento del VHC, tanto de los programas de eliminación como de los ensayos clínicos. Además, la mala adherencia terapéutica, el escaso acceso de los pacientes a la asistencia sanitaria y el estigma y la vulnerabilidad de esta población surgieron como barreras y contribuyeron a las bajas tasas de tratamiento y eficacia. Métodos: En este trabajo se revisa la literatura publicada entre diciembre de 2010 y diciembre de 2020 en la que se explora la epidemiología del VHC en pacientes con EMG, y vice versa, el efecto de la infección por VHC, las barreras para el manejo de la enfermedad en estos pacientes y los beneficios de las nuevas opciones terapéuticas con agentes antivirales directos pangenotípicos (AAD). Resultados: La aprobación de los AAD ha cambiado el paradigma del tratamiento de la infección por VHC. Los AAD han demostrado ser una opción igualmente eficaz y segura que mejora la calidad de vida (QoL) en los pacientes SMI. Conclusiones: El conocimiento de las consecuencias de la infección por el VHC y los beneficios del tratamiento con los nuevos AAD pangenotípicos entre los psiquiatras puede aumentar el cribado, la derivación y el tratamiento de la infección por el VHC en pacientes con EMG.(AU)

Elimination of hepatitis C virus in a prison: An 18-year experience.

INTRODUCTION: Despite the decrease of hepatitis C in Spanish prisons in the last years, it still remains a reservoir for infection. The aim of this work is to analyze the characteristics of these patients and the response to antiviral treatment over the last 18 years. METHODS: Retrospective observational study in inmates of Araba penitentiary center diagnosed with HCV infection between 2002 and 2020. A descriptive analysis of patient characteristics and the response to the three antiviral treatment modalities was performed: peg-interferon and ribavirin, peg-interferon, ribavirin and a first-generation protease inhibitor and different combinations of direct-acting antivirals. RESULTS: A total of 248 antiviral treatments were prescribed. Treatment response rate up to 2015 was 65% and 93,7% after that year. Interferon non-responders were the main cause of non-response to treatment in periods 1 and 2 (40%-50%). Conversely, in period 3 viral breakthrough (67%) was the main culprit. CONCLUSION: After 18 years, active hepatitis C infection in prison inmates has resolved with treatment according to clinical criteria. Therefore, the stay in prison may represent an opportunity to reduce the reservoir of the disease in the community, together with continued health care for those released from prison.

Treatment and prevention of monkeypox.

Monkeypox is a zoonosis that is spread mainly through direct contact with fluids and skin lesions of infected people with vesicles still active. Although the virus was isolated for the first time in 1958 and the first human case was identified in a child in 1970, in the Democratic Republic of the Congo, the disease has progressively increased its incidence in Africa reaching in May 2022 sustained transmission outside this continent. As it is a newly introduced virus in our health system, it is necessary to learn the epidemiological pattern in a different environment from that of traditionally endemic areas and to know the available antiviral treatments, as well as the prophylactic measures that could be considered, knowing that as a virus emerging in our regions, scientific evidence is still limited. There are antivirals that have been shown, in animal models, to effectively combat the disease with very good clinical tolerance. This disease has also forced us to review the characteristics of smallpox vaccines, because they have shown a protective effect against monkeypox. For this reason, it is important to have a document that compiles all the scientific information published in this regard.

Predictive models for hepatocellular carcinoma development after sustained virological response in advanced hepatitis C.

BACKGROUND & AIMS: Life-long hepatocellular carcinoma (HCC) surveillance is recommended after sustained virological response (SVR) in patients with advanced hepatitis C. Since the identification of patients who could be safely discontinued for surveillance is essential, we aimed to identify subsets of patients with low-risk HCC. METHODS: 491 patients with advanced and compensated fibrosis (≥F3) were prospectively followed after achieving SVR with interferon-free therapies. Clinical-biological parameters and liver stiffness measurement (LSM) were performed before starting treatment (ST) and at SVR, and HCC surveillance was carried out. RESULTS: During a median follow-up of 49.8 months, 29 (5.9%) patients developed HCC [incidence rate: 1.6/100 patient-years (PYs)]. Two predictive models based on LSM (Model-A) or FIB-4 score (Model-B) were proposed. Only SVR parameters were included in the models, because they showed a higher accuracy for predicting HCC than ST measurements. Variables independently associated with HCC were LSM (HR, 1.03; 95% CI, 1.01-1.05), age (HR, 1.04; 95% CI, 1.01-1.08) and albumin levels (HR, 0.90; 95% CI, 0.84-0.97) in Model-A, and FIB-4 (HR, 1.22; 95% CI, 1.08-1.37) and albumin (HR, 0.90; 95% CI, 0.84-0.97) in model-B. Both models allow HCC risk stratification, identifying low-risk groups with an HCC incidence rate of 0.16/100 and 0.25/100 PYs, respectively. An overall increased hazard of HCC was observed over time. CONCLUSION: Simple models based on non-invasive markers of liver fibrosis, LSM or FIB-4, together with age and albumin levels at SVR permit to identify subsets of patients with HCC risk clearly <1%/year, for whom HCC surveillance might not be cost-effective.

Cardiometabolic effects of direct-acting antivirals in patients with hepatitis C / Efectos cardiometabólicos de los antivirales de acción directa en pacientes con hepatitis C

El virus de la hepatitis C (VHC) se ha asociado durante mucho tiempo a varias manifestaciones extrahepáticas, entre ellas el aumento del riesgo cardiovascular. La aparición de los antivirales de acción directa (AAD) ha permitido evaluar la posible reversión de estas manifestaciones tras un tratamiento exitoso. Así, muchos estudios han aportado datos significativos sobre el efecto positivo del tratamiento con AAD en la resistencia a la insulina, la diabetes mellitus de tipo 2, la enfermedad cardiovascular y la aterosclerosis. Por el contrario, los estudios han mostrado efectos perjudiciales sobre el metabolismo de los lípidos y resultados indeterminados respecto a la función renal y el metabolismo del ácido úrico. No obstante, a medida que un mayor número de pacientes logre una respuesta virológica sostenida, se estudiarán ampliamente los efectos de la erradicación del VHC sobre los procesos cardiometabólicos, lo que permitirá obtener conclusiones más fiables sobre el alcance de los resultados extrahepáticos.(AU)

Hepatitis C virus (HCV) has long been associated with several extrahepatic manifestations, including increased cardiovascular risk. The emergence of direct-acting antivirals (DAAs) has allowed us to evaluate the potential reversal of these manifestations after successful treatment. Therefore, many studies have provided significant takeaways regarding the positive effect of DAAs therapy on insulin resistance, type 2 diabetes mellitus, cardiovascular disease and atherosclerosis. In contrast, studies have shown detrimental effects on lipid metabolism and indeterminate results regarding renal function and uric acid metabolism. Nevertheless, as more and more patients achieve sustained virological response, the effects of HCV eradication on cardiometabolic processes will be extensively studied, allowing more reliable conclusions on the extent of extrahepatic outcomes.(AU)

Long-term follow-up of HCV-infected patients with end-stage chronic kidney disease after sustained virological response with direct-acting antiviral therapy.

BACKGROUND AND AIM: Patients with chronic kidney disease (CKD) and hepatitis C infection can be safely and effectively treated with direct-acting antivirals (DAAs). However, there is scarce data on the long-term impact of hepatitis C cure on CKD. The aim of this study was to assess the long-term mortality, morbidity and hepatic/renal function outcomes in a cohort of HCV-infected individuals with CKD treated with DAAs. METHODS: 135 HCV patients with CKD stage 3b-5 who received ombitasvir/paritaprevir/ritonavir±dasabuvir in a multicenter study were evaluated for long-term hepatic and renal outcomes and their associated mortality. RESULTS: 125 patients achieved SVR and 66 were included. Prior to SVR, 53 were under renal replacement therapy (RRT) and 25 (37.8%) had liver cirrhosis. After a follow-up of 4.5 years, 25 (38%) required kidney transplantation but none combined liver-kidney. No changes in renal function were observed among the 51 patients who did not receive renal transplant although eGFR values improved in those with baseline CKD stage 3b-4. Three (5.6%) subjects were weaned from RRT. Eighteen (27.3%) patients died, mostly from cardiovascular events; 2 developed liver decompensation and 1 hepatocellular carcinoma. No HCV reinfection was observed. CONCLUSIONS: Long-term mortality remained high among end-stage CKD patients despite HCV cure. Overall, no improvement in renal function was observed and a high proportion of patients required kidney transplantation. However, in CKD stage 3b-4 HCV cure may play a positive role in renal function.

Patients with severe mental illness and hepatitis C virus infection benefit from new pangenotypic direct-acting antivirals: Results of a literature review.

INTRODUCTION: Hepatitis C virus (HCV) infection is a global health problem that can results in cirrhosis, hepatocellular carcinoma and even death. HCV infection is 3-20-fold more prevalent among patients with versus without severe mental illness (SMI), such as major depressive disorder, personality disorder, bipolar disorder and schizophrenia. Treatment options for HCV were formerly based on pegylated interferon alpha, which is associated with neuropsychiatric adverse events, and this contributed to the exclusion of patients with SMI from HCV treatment, elimination programmes, and clinical trials. Moreover, the assumption of poor adherence, scant access to healthcare and the stigma and vulnerability of this population emerged as barriers and contributed to the low rates of treatment and efficacy. METHODS: This paper reviews the literature published between December 2010 and December 2020 exploring the epidemiology of HCV in patients with SMI, and vice versa, the effect of HCV infection, barriers to the management of illness in these patients, and benefits of new therapeutic options with pangenotypic direct antiviral agents (DAAs). RESULTS: The approval of DAAs has changed the paradigm of HCV infection treatment. DAAs have proven to be an equally efficacious and safe option that improves quality of life (QoL) in patients SMI. CONCLUSIONS: Knowledge of the consequences of the HCV infection and the benefits of treatment with new pangenotypic DAAs among psychiatrists can increase screening, referral and treatment of HCV infection in patients with SMI.

Cardiometabolic effects of direct-acting antivirals in patients with hepatitis C.

Hepatitis C virus (HCV) has long been associated with several extrahepatic manifestations, including increased cardiovascular risk. The emergence of direct-acting antivirals (DAAs) has allowed us to evaluate the potential reversal of these manifestations after successful treatment. Therefore, many studies have provided significant takeaways regarding the positive effect of DAAs therapy on insulin resistance, type 2 diabetes mellitus, cardiovascular disease and atherosclerosis. In contrast, studies have shown detrimental effects on lipid metabolism and indeterminate results regarding renal function and uric acid metabolism. Nevertheless, as more and more patients achieve sustained virological response, the effects of HCV eradication on cardiometabolic processes will be extensively studied, allowing more reliable conclusions on the extent of extrahepatic outcomes.