1,720,980 research outputs found
Hepatitis C virus lymphotropism and peculiar immunological phenotype: effects on natural history and antiviral therapy.
No full textHepatitis C virus (HCV) has been recognized to be both a hepato- and lymphotropic virus. HCV lymphotropism represents an essential lap in the pathogenesis of virus-related autoimmune and lymphoproliferative disorders, ranging from clonal expansion of B-cells with organ- and non-organ-specific autoantibody production up to overt non-Hodgkin's lymphoma along a continuous step-by-step model of B-cell lymphomagenesis, where the intermediated mixed cryoglobulinemia could be considered as a stage of suppressible antigen-driven lymphoproliferation. HCV infection of lymphoid cells could set up privileged reservoirs able to interfere with the host viral clearance efficiency and may be implicated in viral recurrence after apparently successful antiviral therapy. The HCV long-lasting extrahepatic replicative state generates an abnormal systemic immunological response, easily detectable by searching simple laboratory and clinical parameters, mainly represented by vasculitis-like skin features and hypocomplementemia. The presence or absence of this hypersensitivity pattern seems to correlate with the antiviral response and could be identified as a novel immunological cofactor. Further research is required to fully verify the real impact on therapeutic choice/regimen
Successful lamivudine monotherapy in an elderly patient suffering from HBV-related decompensated cirrhosis associated with widespread leukocytoclastic vasculitis.
No full textHepatitis B virus (HBV) infection is known to be responsible for both hepatic and extrahepatic manifestations including dermatitis, polyarthralgias and arthritis, pulmonary disease, aplastic anemia, glomerulonephritis and vasculitis. The mechanism of these extrahepatic disorders is thought to be linked to immune complex disease, but their pathogenesis is poorly clarified. Immunosuppressive treatment could promote viral load and impair hepatic disease, also worsening the vasculitis by enhancing viral antigenemia. Lamivudine is a nucleoside analogue approved for treating chronic hepatitis B, that decreases the amount of viral antigens by suppressing HBV replication. Several reports have suggested lamivudine in the treatment of vasculitis associated with HBV infection, but, although significant inhibition of HBV is achieved in the short term, resistance develops in 15-32 percent annual risk rating. We report an elderly patient whose chronic hepatitis B decompensated cirrhosis with associated refractory hepatic hydrothorax and extensive leukocytoclastic vasculitis was successfully treated with ongoing long-term lamivudine monotherapy
Do thyroid abnormalities detected in patients treated for HCV-related chronic hepatitis persist?
No full textOne hundred and twenty-one patients with HCV-related chronic hepatitis and normal baseline thyroid function were studied. Forty-six patients received IFN alpha-2b, while 75 patients had Peg-IFN alpha-2b with ribavirin more recently. Thirty patients (ten belonging to the standard IFN group) were re-treated. The pre-treatment prevalence of thyroid antibodies was 3.3%. At the end of the first antiviral treatment, the prevalence of laboratory alterations (presence of antibodies and abnormal hormonal levels) of thyroid was assessed to be 20.7% (25 patients), being quite similar for standard-interferon- and pegylated-interferon-treated patients (P = 0.63). TSH level alteration was seen in eleven patients (9.1% of the overall population and 44% of the antibodies positive patients), of whom ten were females. The anti-microsomal, anti-thyroperoxidase and anti-thyroglobulin antibodies, in combined or isolated presence, were detected in all 25 patients. During the re-treatment we noticed worsening only of previous thyroid abnormalities. No patient changed the antiviral schedule after the emerging of thyroid alterations. All eleven patients remained thyroid dysfunctional at the end of the follow-up (ten with Hashimoto's thyroiditis and one with Graves disease), meanwhile the near totality of patients with presence of antibodies remained positive. Interestingly, eight out the 14 patients who showed mood disorders after antiviral therapy, belonged to the aforementioned cohort
Abnormally high resistive index of central retinal artery by ultrasound color Doppler in patients with viral chronic liver disease: correlation with worsening liver staging.
No full textRetrobulbar-ocular circulation provides an opportunity to assess the terminal circulation of the arterial cerebral tree. To evaluate whether retrobulbar circulation in patients with chronic liver disease is affected by adaptive mechanisms, we assessed by echo color Doppler, 1. The resistive-index of the central retinal artery, a terminal branch of the ophthalmic artery, and 2. the potential interrelationships with both liver staging and the most important splanchnic Doppler-parameters used to assess portal hypertension. The resistance index (RI) of the central retinal artery was obtained and compared with other classical Doppler parameters known to be affected by portal hypertension. The RI of the central retinal artery (CRA) was higher in cirrhotic patients than in controls or subjects with chronic hepatitis; it correlated with all the Doppler parameters of portal hypertension considered, with plasma renin-activity, and norepinephrine concentrations. Similarly to renal and splanchnic hemodynamics, retinal arterial circulation assessed by duplex Doppler seems to be affected by the histology of liver disease and by the overactivity of vasoconstrictor systems
Clinical presentation and prevalence of spontaneous bacterial peritonitis in patients with cryptogenic cirrhosis and features of metabolic syndrome.
No full textBACKGROUND: Nonalcoholic steatohepatitis (NASH) may progress to cirrhosis. The prevalence and clinical relevance that spontaneous bacterial peritonitis may have in complicating ascites due to NASH-related cirrhosis have yet to be defined. METHODS: Among 611 cases of cirrhosis-associated ascites, 45 patients with cryptogenic cirrhosis were retrospectively identified. Of these, 36 patients and a control group of subjects with viral- associated ascites were followed up and compared in a case control study. Information on the onset of ascites, with or without spontaneous bacterial peritonitis, history of risk factors for multimetabolic syndrome, and serological and ascitic laboratory data were compared between groups. RESULTS: Spontaneous bacterial peritonitis occurred significantly more often in patients with cryptogenic cirrhosis than in equally symptomatic viral controls. The prevalence of obesity, diabetes and spontaneous bacterial peritonitis was significantly higher in patients with cryptogenic cirrhosis. Although liver function was similar in both groups, cryptogenic cirrhosis patients had lower aminotransferase levels. Multivariate analysis identified diabetes, juvenile obesity and spontaneous bacterial peritonitis as independent factors associated with ascites due to cryptogenic cirrhosis. CONCLUSIONS: Features suggestive of NASH are more frequently observed in patients with ascites and cryptogenic cirrhosis than in age- and sex-matched ascitic patients with well-defined viral etiology. Ascites may be a presenting symptom of NASH-related cirrhosis, and affected patients have a twofold greater risk of spontaneous bacterial peritonitis
Exaggerated immune reactions predict the outcome of interferon therapy in patients with chronic hepatitis C.
No full textHCV plays a key role as chronic antigenic driver in inducing a clonal expansion of B-lymphocytes. The hypothesis that previous immunological pattern, when expression of an exaggerated immune reaction, could affect the response to IFN therapy was tested. Using a longitudinal database, the outcomes of 124 HCV-positive patients, genotype 1b only, with circulating HCV RNA, were analyzed by a retrospective cohort design. Immunological disorder-related clinical features and visceral organ involvement were thoroughly investigated in addition to laboratory data focusing on the presence of cryoglobulins, rheumatoid factor, antinuclear antibody, complement, circulating immunocomplexes and mono-oligoclonal gamma-globulin expansion. Eighty-four patients with and forty patients without abnormal immunological status, presenting a low fibrosis score, were identified. The whole naive population was treated by IFN monotherapy at the classical schedule for six or, alternatively, up to twelve months. Of the 124 patients, 28 showed a sustained response while 50 were non-responders and 46 were relapsers. Particularly, among the 84 patients with abnormalities of the immunological status, skin involvement was detected in 71 patients and hypocomplementemia was found in 69 patients, emerging as independent predictors for the lack of response. Conclusively, a peculiar immunological phenotype, ascertained by clinical and/or laboratory findings, is associated to a lack of IFN response and could be considered a further predictive factor
Rheumatoid factor after antiviral therapy in patients with HCV chronic hepatitis.
No full textPositivity of rheumatoid factor (RF) in the course of Hepatitis C virus HCV infection has been described in many papers, with percentages between 30% and 80%, but no data are reported on the behaviour of this parameter during the treatment. In the present retrospective study, 66 patients with HCV infection and positivity for RF were observed between March 2001 and January 2004; they had received combined therapy with Peg-IFN alpha-2b 1.5 mcg/kg/weekly and ribavirin 800-1200 mg/daily (on the basis of body weight). Before treatment, all of them had presented hypertransaminasemia for at least 6 months and high viral load. No patient suffered from other hypersensitivity disorders. The follow-up period lasted for a mean period of 26+/-7 months, after which only 34 (51.5%) revealed normal transaminases activity with negativity of HCV-RNA (long-term responders, LTR), while the remaining 32 (48.5%) were classified as non responders (NR). In both groups significant variations of RF values were observed. Moreover, RF remained positive in 6 (17.6%) of the LTR group and in 17 (53.1%) of the NR group patients. These data suggest a possible inhibiting action of the combined therapy on the exaggerated immune response. This effect appears partially unrelated to the antiviral action of the therapy
Does a lower insulin resistance affect antiviral therapy response in patients suffering from HCV related chronic hepatitis?
No full textNon-alcoholic fatty liver disease: further expression of the metabolic syndrome.
No full textNon-alcoholic fatty liver disease has been associated with metabolic disorders, including central obesity, dyslipidemia, hypertension and hyperglycemia. Metabolic syndrome, obesity, and insulin resistance are major risk factors in the pathogenesis of non-alcoholic fatty liver disease. Non-alcoholic fatty liver disease refers to a wide spectrum of liver damage, ranging from simple steatosis to non-alcoholic steatohepatitis, advanced fibrosis and cirrhosis
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