The presence of transitory viremia without seroconversion indicates that the vertical transmission of HCV is not important. This could be related to the viral charge and ingestion of milk of HCV-RNA-positive mothers. However, to advise avoidance of maternal breast feeding, it would be necessary to conduct larger studies.
The epidemiology associated with hepatitis C virus (HCV) infection, serologic reactivity, and hepatic disease related to anti-HCV-positive donors of Granada were researched. From 1990 through 1993, medical and epidemiological information and anti-HCV and HCV RNA testing were evaluated in 46,741 blood donors. Serum samples were obtained for anti-HCV ELISA and RIBA and HCV RNA determination. A liver biopsy was conducted in all anti-HCV positives by confirmatory second-generation RIBA to analyze the hepatic lesion and the presence of HCV RNA. The anti-HCV prevalence was 1.12%. A total of 228 anti-HCV second-generation ELISA positive blood donors were analyzed. Intrafamiliar transmission rate was 1.7%. Transfusion and intravenous drug abuse (IVDA) antecedents were associated with a higher risk of seroconversion. A RIBA-positive result was related to high second- and third-generation ELISA ratios (90%), HCV RNA positivity (89%), and elevated alanine aminotransferase (ALT) levels (88%). Approximately 50% of donors with normal ALT levels had high ELISA ratios and second-generation RIBA and HCV RNA positive results. Of the second-generation RIBA indeterminate results, 42% and 82% of the c22 and 33% and 100% of the c100 reactivities were third-generation RIBA and HCV RNA positive, respectively. Liver biopsy was conducted in 85 donors, 74% of whom had a chronic hepatitis and 83% had detectable HCV RNA levels. Chronic hepatitis was diagnosed in 88% vs 43% of donors with elevated and normal alanine aminotransferase levels, respectively. ELISA and confirmatory HCV RNA determinations should be routinely employed in donor screening. A liver biopsy should be conducted in patients with elevated ALT levels and normal ALT levels when viremic.
BackgroundNoPurposeTo evaluate the prescription pattern and efficacy of telaprevir (TLP) and boceprevir (BOC) in the clinical management of chronic hepatitis C (HCV) infection in a region.Material and methodsMulticentre observational cohort study of HCV patients treated with protease-inhibitor triple therapy from September 20012 to April 2014. The information extracted from electronic health records was: age, gender, comorbidity and previous experience of HCV treatment. The virological response (VR) was assessed in patients who reached 24 and 48 weeks treatment; quick virological response rate (QVR) and discontinued treatment rates were also assessed.Results124 patients were included (TLP = 82; BOC = 42), 65% were male (63.4% treated with TVR and 69% with BOC p = 0.533). There was no difference between the selection of treatment according to comorbidity, with the exception of HIV co-infected patients (total: 8.9%; TVR: 13.6% vs. BOC: 0%; p = 0.012) or with mental illness (21.2%; 27.3% vs. 10.5%; p = 0.044). The distribution of patients according to previous experience was: treatment-naïve patients (total: 41.1%; TLP: 36.6% vs. BOC: 50%; p = 0.151), null responders (18.5%; 14.6% vs. 26.2%; p = 0.117), partial responders (12.9%; 11% vs. BOC = 16.7%; p = 0.371), relapsers (26.6%; 36.6% vs. 7.1%; p = 0.0001). At week 24, 83 patients achieved VR: 62.7%; (TLP = 66.7% BOC = 55.2%; p = 0.346). QVR rates were 53.1%; (62.2% vs.50.7%; p = 0.023). According the previous treatment experience, VR were: relapsers 81.8%, treatment-naïve patients 63.8%, partial responders: 58.3% and null responders: 37.5% (p = 0.048). At week 48, 61 patients achieved VR or 57.4% (TLP: 62.2% vs. BOC: 50%; p = 0.348). Discontinuation rate was 13.6% (TLP: 20% vs. BOC: 3.8%, p = 0.062).ConclusionTLP was the preferred treatment in HIV co-infected patients, mentally ill patients or relapsers. The statistical trend shows higher efficacy and discontinued treatment rate with TLP, but the differences are statistically irrelevant. Both drugs showed worse results in clinical management than reported in clinical trials.References and/or acknowledgementsNo conflict of interest.
A683suggest that PIM is a cost-effective treatment strategy compared to OTT for HIV-1 infected patients who have achieved sustained virological suppression.
Objective: to assess the significance of increased serum transaminase levels in neonates admitted to a Neonatal Intensive Care Unit and its relationship with blood transfusion. Methods: follow-up prospective study of 209 patients; 177 completed follow-up, of whom 129 were transfused and 48 were not; 57 were born after full gestation and 120 were born prematurely. The activity of serum levels of ALT, AST, and GGT was measured monthly up to six months of age, and until six months after the last transfusion. At the end of follow-up, and whenever an increase in serum transaminase levels was detected, the viral agents of hepatitis A, B, C, G, TT, cytomegalovirus, Epstein-Barr, and herpes 1 and 2, and toxoplasma were studied. Viral serology was also carried out in mothers and in donors when children tested positive. Results: one hundred twenty nine neonates (73%) received 461 U red blood cell transfusions (3.6 ± 3 U/patient). ALT levels increased in 54 (30.5%) patients, of whom 46 (36%) were transfused and eight (17%) were not (p < 0.05). The independent variables were 'infection by G virus' and 'parenteral nutrition for more than 12 days'; the variable 'transfusion' was close to the limit for statistical significance. Twenty patients (11.3%) had increased serum ALT levels 2.5 times above the normal value: 18 (14%) were transfused and two (4%) were not (p = 0.106). Only the G and TT viruses were related with transfusion; patients remained asymptomatic, although most neonates were chronically infected. Conclusion: follow-up showed that increased serum ALT levels are common among severely ill neonates. Blood transfusions are safe concerning most hepatotropic viruses, but transmission of viruses G and TT is possible.
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