Chronic immunosuppression is associated with increased and more severe viral infections. However, little is known about the association between immunosuppression and severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. Our aim was to describe the clinical course of patients with immunosuppressed autoimmune hepatitis (AIH) during coronavirus disease 2019 (COVID‐19) infection in Italy. Our study is a case series of patients with AIH treated with immunosuppression, who tested positive for SARS‐CoV‐2 in March 2020 during the outbreak of COVID‐19. Ten patients from seven different hospitals in Italy were diagnosed with COVID‐19 during the outbreak of SARS‐CoV‐2 in March 2020. Seven subjects were female (70%), and age ranged from 27 to 73 years. Before the onset of SARS‐CoV‐2 infection, all patients were taking immunosuppressive therapy for AIH, and eight of them were on biochemical remission. Two other patients had recent acute onset of their AIH, and consequently started high‐dose steroids, as per induction protocol. All patients had a respiratory syndrome and a positive nasal swab for SARS‐CoV‐2. Five patients developed a computed tomography–confirmed COVID‐19 pneumonia. Six subjects received a combination of antiretroviral and antimalarial drugs. In seven patients, the dosage of immunosuppressive medication was changed. Liver enzymes were repeated during SARS‐CoV‐2 infection in all hospitalized cases; they remained within the normal range in all cases, and improved in the two acute cases treated with high‐dose steroids. The clinical outcome was comparable to the reported cases occurring in non‐immunosuppressed subjects. Conclusion: Patients under immunosuppressive therapy for AIH developing COVID‐19 show a disease course presumptively similar to that reported in the non‐immunosuppressed population. These data might aid in medical decisions when dealing with SARS‐CoV‐2 infection in immunocompromised patients.

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GER with or without hiatal hernia is not a contraindication for obese patients undergoing a Lap-Band procedure. It accomplishes by a single operation satisfactory treatment of these two disturbing diseases.

Background and aims:It is paramount to identify predictors of treatment failure with direct antiviral agents in 'field-practice' patients, including people who inject drugs (PWID). Data on the efficacy of glecaprevir/pibrentasvir (GLE/PIB) in a field-practice scenario are scant. The multicentre MISTRAL study enrolled 1177 patients, including PWID, to assess real-life efficacy and safety of GLE/PIB and to identify the predictive factors for this treatment. Methods:This was a prospective, longitudinal study. The outcome variable was the rate of sustained virological response (SVR) at week 12.Results: A total of 123 patients (10%) were infected from hepatitis C virus (HCV) 3.METAVIR fibrosis score was F4 in 104 subjects (9%); 118 patients (10%) were PWID.Overall, 1163/1177 (99%) patients achieved SVR. The baseline clinical factors discriminating between treatment success and treatment failure were age at treatment (P = 0.031) and creatinine level (P = 0.034). SVR rates were not influenced by gender, substance abuse, previous treatment, treatment duration, fibrosis or chronic kidney disease stage. Compared with non-substance users, the 118 PWID exhibited a significantly different genotype pattern distribution (χ 2 < 0.001). A total of 40/118 (33.9%) of substance users were HCV3 compared to 83/1056 (7.9%) non-substance users.Only 6 patients (0.5%) reported a serious adverse event. Conclusions:The MISTRAL study provides evidence of GLE/PIB efficacy in a fieldpractice scenario in a highly epidemic HCV area in southern Italy; it unveiled significant differences in genotype distribution among the most underserved and difficult-to-treat patient subgroups including PWID. K E Y W O R D S cirrhosis, direct-acting antiviral, efficacy, HCV genotype, substance abuse Keypoints • The MISTRAL study shows that glecaprevir/pibrentasvir is effective for the treatment of hepatitis C virus in a field-practice scenario in a highly epidemic area in southern Italy. Handling editor: Alessio Aghemo S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Persico M, Aglitti A, Milella M, et al. Real-life glecaprevir/pibrentasvir in a large cohort of patients with hepatitis C virus infection: The MISTRAL study. Liver Int.

BACKGROUND:\ud Direct Antiviral Agents (DAA) demonstrated high efficacy among HCV-infected patients in registered trials. Nevertheless, the impact of these therapies on liver stiffness measurement(LSM) and liver functionality in "real-life" is not well-known. Aim of the present study was to evaluate the SVR impact on LSM and clinical parameters of DAA-therapy on a real-life population of HCV patients with F3/F4 fibrosis.\ud METHODS:\ud 749 HCV genotype 1-4 patients with F3/F4 hepatitis undergoing antiviral therapy, were consecutively enrolled in four centers of Hepatology of Italy. Clinical, biochemical and imaging data were collected at the baseline(T0), at the End of Therapy(EoT) and after 12 weeks(SVR12).\ud RESULTS:\ud Out of 749 patients, 69.7% was F4 and 30.3% was F3. SVR12 was reached in 97,5%. LSM significantly decreased from T0 to EoT(p<0.001) whereas it did not from EoT to SVR12(p:ns). Moreover, in F4 no significant differences were found in Child and MELD between T0, EoT and SVR12(p=ns). At the univariate analysis of clinical and liver parameters, baseline high glucose(p<0.005), type 2 diabetes(p<0.001), low ALT(p<0.001), low PLTs(p<0.005), and the presence of esophageal varices (EV)(p<0.001) were found to be associated with a lack of a significant EoT LSM improvement. At a multiple regression, ALT(p<0.05), Diabetes(p<0.005) and EV(p<0.05), were inversely associated with significant LSM reduction.\ud CONCLUSIONS:\ud Virological response to DAA is associated with fibrosis regression and recovery of liver functionality and this can be detected as early as EoT. HCV eradication is associated with a rapid and significant clinical improvement that lasts overtime and seems to be negatively influenced by diabetes and E