The use of peginterferon in monotherapy or in combination with ribavirin for the treatment of acute hepatitis C.

BACKGROUND: Acute hepatitis C becomes chronic in 50% of cases. Early treatment seems to be effective in eradicating HCV infection, although no clear recommendations are available in terms of time of initiation, regimen and duration of therapy. We report a retrospective review of 48 patients with acute HCV infection between January 2006 and December 2007. PATIENTS AND METHODS: This multicenter retrospective study involved three Infectious Disease Units in Sicily and was carried out in three stages: (1) Collection of patients data; (2) Selection of patients according to: elevated ALT (at least 5 times above normal values), seroconversion from negative to positive anti-HCV status; (3) Final selection of patients with a minimum of 12 months follow-up. RESULTS: Out of 60 patients with a diagnosis of acute HCV infection, 48 were eligible for the study. In 13 subjects (52%) of the 25 who were not treated, the disease resolved spontaneously. 23 patients received pegylated interferon in monotherapy or in combination with ribavirin. 95% achieved a sustained virological response (SVR). Of the 22 sustained responders, 17 (70%) negativized HCV RNA within 8 weeks. No difference appeared between patients receiving monotherapy and those treated with combination therapy. Also, no difference was observed, in terms of SVR, between the two different pegylated interferons given for treatment. CONCLUSIONS: The rate of viral clearance was higher in the treated group versus the untreated one (95% versus 52%). The SVR found in our study population (95%) was comparable to that reported in other studies. The combination with ribavirin did not appear to impact our sustained response rate, although ribavirin appeared to induce a faster normalization of ALT levels.

Implementation of an Italian multicentric care network for early HIV infection diagnosis: 1999-2001 report.

BACKGROUND: Diagnosis of a new HIV infection during the primary phase (PHI) is sometimes misleading in a primary care setting. Since 1999 the Italian network for the study of acute HIV infection (ISAI) has been operative. At the time of PHI diagnosis the case is reported to the coordinating centre and enrolled in the National Register which records all epidemiological, demographic and clinical information. PATIENTS AND METHODS: From 1999 to September 2001, 51 symptomatic or asymptomatic patients with diagnosis of primary HIV infection were signalled to the coordinating centre. At screening, assessments were: interview to collect demographic and epidemiological data, clinical history (regarding PHI signs and symptoms) and, if available, relevant index case information; physical examination; routine hematology and chemistry; lymphocyte count; plasma HIV-RNA. In a subset of patients PBMC HIV-DNA, HIV-RNA, resistance genotyping and HIV subtype characterization were assessed. RESULTS: 74.5% of patients were males and all but four were Italian. Hetero and homosexual contacts were the prevalent route of HIV transmission. Forty-five patients (89%) were symptomatic and the most frequent signs and symptoms were: fever, lymphadenopathy, malaise and pharyngodinia. Baseline reverse-transcriptase (RT) and protease (PR) genotyping analysis was available for 29 patients. Only one of 29 patients harbored a virus with a resistance-associated mutation in the RT region (215Y); NNRTI mutations were identified in 3 of 29 patients. In the remaining 20 (69%) patients no mutations were found in the RT region. Sequence data from PR region were successfully obtained in 21 patients. Only one of these had a high-level resistance mutation (46L); in an additional 10 cases 1 or more secondary mutations were identified. The remaining 10 patients harbored a PR region wild type virus. One patient presenting two secondary mutations in the PR region, even if highly adherent and tolerant to drug regimen, showed a slow viral load decrease. CONCLUSIONS: Our cohort confirms the uptrend of new infections through unsafe sexual contacts involving both homosexual and heterosexual couples. Genotype sequencing for antiretroviral resistant viral variants describes a low prevalence of RT resistance-associated mutations, as well as primary mutations in the PR region. On the contrary, a higher prevalence of PR gene polymorphisms and mutations is not known with any certainty to confer resistance to NRTI and NNRTI. The identification of antiretroviral drug resistant HIV strains is strategic for clinical and therapeutical intervention, even though from a public health point of view cost-efficacy must be considered.

Current practice of chronic hepatitis B treatment in Southern Italy.

BACKGROUND: Treatment choice for chronic HBV infection is a continuously evolving issue, with a wide range of options. We aimed to evaluate the current practice of HBV therapies in the real world in Southern Italy. METHODS: A prospective study enrolling over a six month period (February-July 2010) all consecutive HBsAg positive subjects, never previously treated, referred to 16 liver units in two Southern Italy regions (Calabria and Sicily). RESULTS: Out of 247 subjects evaluated, 116 (46.9%) had HBV-DNA undetectable or lower than 2000 UI/ml. There were 108 (43.7%) inactive carriers, 103 (41.7%) chronic hepatitis, and 36 (14.6%) liver cirrhosis. Antiviral treatment was planned in 94 (38.0%) patients (26 cases with Interferon or Pegylated Interferon and 68 with nucleos(t)ides analogues). As many as 49.5% of subjects with chronic hepatitis did not receive antiviral treatment. DISCUSSION: The majority of chronic HBsAg carrier referring centres for evaluation were not considered suitable for antiviral treatment. Nucleos(t)ides analogues are the preferred first choice for therapy. A long-lasting period of observation may be needed to make appropriate therapeutic decisions in several cases.

Post-varicella acute transverse myelitis.

This report of a case of acute transverse myelitis, after otherwise uneventful varicella, further stresses the importance that the possibility of this relatively rare complication should be kept in mind in patients developing a paraplegic syndrome late in the course of the disease.

[Prospective study of HBV circulation and long-term evaluation of anti-hepatitis-B vaccination in patients undergoing hemodialysis]. / Studio prospettico sulla circolazione di HBV e valutazione a lungo termine della vaccinazione anti-epatite B in pazienti in emodialisi.

Hemodialysis patients were screened and monitored for HBV markers and at renal unit (identification EDTA 13ND) Palermo. Eighty-five patients received the hepatitis B vaccine (Haevac B Pasteur); fifty-three were followed up for more than three years; they received one of the three following schedules: 5 micrograms at 0, 1, 2 and 14 months; 5 micrograms at 0, 1, 2, 3, and 14 or 10 micrograms at 0, 1, 2, and 14 months. The best result was obtained by third schedule with a sero-conversion to anti-HBs of 83% at one month after the booster doses; and with the same percentage of anti-HBs positivity two years after the booster dose. During the study time (January 1984, March 1989) no new HBV events in patients and in the hemodialysis staff, who was also on monitoring, were observed.

Diphasic or prolonged course of viral hepatitis A in children.

A study on nine cases of diphasic viral hepatitis A was carried out in 130 children admitted to pediatric hospital from January to December 1982. One hundred and eight children (83.0%) showed IgM anti-HAV (one of them was a chronic HBsAg carrier), 19 (14.6%) were HBsAg positive at the admission and 3 (2.3%) became positive for anti-HBc IgM marker during the course of the illness. Nine anti-HAV IgM positive children showed an atypical course of their disease in that after a short period of progressive enzyme level normalization, a relapse occurred without signs of subsequent HBV, CMV or EBV infection. Probable although hypothetical interpretations of these cases are discussed.