RESUMO
This observation reports that a hepatitis B virus (HBV) reactivation, as the result of hepatitis C virus (HCV) eradication on a dominant HCV coinfected HBV/HCV patient, was subsequently prevented by treating both viral infections together. This finding raises the question as to whether preemptive HBV treatment should be prescribed along with HCV treatment to prevent HBV from being reactive after HCV eradication in coinfected HBV/HCV patients.
Assuntos
Adenina/análogos & derivados , Antivirais/uso terapêutico , Vírus da Hepatite B/fisiologia , Hepatite B/prevenção & controle , Hepatite C/tratamento farmacológico , Organofosfonatos/uso terapêutico , Ativação Viral/efeitos dos fármacos , Adenina/uso terapêutico , Adulto , Portador Sadio/tratamento farmacológico , Portador Sadio/virologia , Quimioterapia Combinada , Hepatite B/complicações , Hepatite B/tratamento farmacológico , Vírus da Hepatite B/efeitos dos fármacos , Hepatite C/complicações , Humanos , MasculinoRESUMO
Hepatitis E is transmitted mainly by water or food, but in industrialized countries, all routes of transmission have not been identified. We describe possible zoonotic transmission of hepatitis E virus that involved direct contact between a pet pig and its owner.
Assuntos
Vírus da Hepatite E/isolamento & purificação , Hepatite E/transmissão , Doenças dos Suínos/transmissão , Zoonoses , Adulto , Animais , Animais Domésticos , Anticorpos Antivirais/sangue , Reservatórios de Doenças/veterinária , Reservatórios de Doenças/virologia , Amplificação de Genes , Genótipo , Hepatite E/veterinária , Hepatite E/virologia , Vírus da Hepatite E/classificação , Vírus da Hepatite E/imunologia , Humanos , Fígado/enzimologia , Fases de Leitura Aberta , Filogenia , RNA Viral/química , RNA Viral/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Especificidade da Espécie , Suínos , Doenças dos Suínos/virologiaRESUMO
OBJECTIVES: Fibrotest (FT) and Actitest (AT) are biochemical markers of fibrosis and activity for use as a non-invasive alternative to liver biopsy in patients with chronic hepatitis C virus (HCV). The aim of this study was to perform an external validation of FT and AT and to study the discordances between FT/AT and liver biopsy in patients with chronic hepatitis C. METHODS: A total of 519 consecutive patients with chronic HCV were prospectively included in five centers, with liver biopsy and biochemical markers taken at the same day. Fifteen patients were excluded because their biopsies could not be interpreted. Diagnostic accuracies were assessed by receiver operating characteristic (ROC) curve analysis. RESULTS: Median biopsy size was 15 mm (range: 2-58), with 9 portal tracts (1-37) and 1 fragment (1-12). 46% (230/504) were classified F2-F4 in fibrosis and 39% A2-A3 in activity. FT area under ROC curve for diagnosis of activity (A2-A3), significant fibrosis (F2-F4), and severe fibrosis (F3-F4) were 0.73 [0.69-0.77], 0.79 [0.75-0.82], and 0.80 [0.76-0.83], respectively. Among the 92 patients (18%) with 2 fibrosis stages of discordance between FT and biopsy, the discordance was attributable to FT in 5% of cases, to biopsy in 4%, and undetermined in 9%. CONCLUSIONS: This prospective independent and multicenter study confirms the diagnostic value of FT and AT found in the princeps study and suggests that FT and AT can be an alternative to biopsy in most patients with chronic HCV.
Assuntos
Biomarcadores/sangue , Hepatite C Crônica/diagnóstico , Cirrose Hepática/diagnóstico , Testes de Função Hepática/métodos , Adolescente , Adulto , Idoso , Alanina Transaminase/sangue , Apolipoproteína A-I/sangue , Aspartato Aminotransferases/sangue , Biópsia , Estudos Transversais , Feminino , Haptoglobinas/metabolismo , Hepatite C Crônica/epidemiologia , Hepatite C Crônica/patologia , Humanos , Fígado/patologia , Cirrose Hepática/epidemiologia , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Valor Preditivo dos Testes , Estudos Prospectivos , Estatística como Assunto , alfa-Macroglobulinas/metabolismoRESUMO
BACKGROUND/AIMS: Lymph nodes in the hepatoduodenal ligament seem to be a common ultrasonographic finding in patients with chronic hepatitis C. Lymphadenopathic enlargement is associated with the histological hepatic features reflecting the immunological response of the host, but the correlation between lymphadenopathy, liver histology and the cellular immunoreactivity of the host has never been studied. AIM: (1) To specify the prevalence of lymph nodes within the hepatoduodenal ligament; and (2) to investigate whether lymphadenopathies might reflect the immunological response of the host. METHODS: One hundred and eleven patients were enrolled in this study. Eleven chronic hepatitis B patients and 34 healthy volunteers served as controls. RESULTS: Lymph nodes were detectable in 90 out of the 104 chronic hepatitis C patients studied. After logistic regression, a high CD8 level and the absence of post hepatitis C cirrhosis were associated with lymph node enlargement. The total lymph node volume was correlated with transaminase levels, inflammatory activity, and stage of fibrosis. CONCLUSIONS: (1) The prevalence of lymph nodes within the hepatoduodenal ligament is high; (2) lymph node enlargement is correlated with the immunological cellular response of the host; and (3) the total lymph node volume is correlated with hepatic necroinflammatory markers and the stage of fibrosis.