Hepatitis: Falagas ME

Vergidis PI, Falagas ME, Hamer DH. · Department of Medicine, Section of Infectious Diseases, Boston Medical Center, Dowling 3N, Boston, MA 02118, USA. · Infect Dis Clin North Am. · Pubmed #19393910 No free full text.

Abstract: Since the beginning of the epidemic, extensive research has been conducted in the field of HIV infection. Original research and subsequent meta-analyses have contributed to a better understanding of the disease. Epidemiologic research has shown, for example, that male circumcision reduces the risk of female-to-male transmission. Nevertheless, the question whether circumcision confers protection against HIV transmission in MSM remains open. Studies have shown a positive correlation between HIV and HSV-2 infection. However, a recent RCT found that suppressive antiherpes therapy did not affect rates of HIV acquisition. Meta-analytical studies have advanced the knowledge on the global prevalence of infection among MSM, and disparities among black and white MSM. They have also solidified the evidence that the prophylactic use of ARVs reduces the risk of MTCT. It has also been shown that prolonged ruptured of membranes increases the rates of vertical transmission, and that breastfeeding is associated with postnatal transmission. In addition, prognostic markers of disease progression have been identified. The introduction of ART has resulted in substantial improvements in morbidity and mortality for HIV-seropositive individuals. Several studies have defined recommended and alternative regimens. In a recent meta-analysis it was shown that in treatment naïve patients, NNRTI-based or boosted-PI-based regimens are superior to triple NRTI or unboosted PI-based regimens in terms of virologic suppression. Recent evidence has demonstrated that ART can be successfully used in Africa with better outcomes in those receiving free treatment. Regarding resistance testing in treatment-experienced patients with virologic failure, GRT offers a benefit of small magnitude and there is insufficient evidence to support the use of PRT, in contrast to current guidelines. Meta-analyses have also shown that interventions to improve adherence can be successfully implemented. Finally, the efficacy of the influenza and hepatitis vaccine in the setting of HIV infection has been analyzed. As our knowledge advances, further questions will inevitably arise and will need to be addressed in well-conducted trials.

Falagas ME, Karydis I, Kostogiannou I. · Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece. · PLoS One. · Pubmed #17332844 links to  free full text

Abstract: BACKGROUND: Percutaneous exposure incidents (PEIs) and blood splashes on the skin of health care workers are a major concern, since they expose susceptible employees to the risk of infectious diseases. We undertook this study in order to estimate the overall incidence of such injuries in a newly founded tertiary hospital, and to evaluate possible changes in their incidence over time. METHODOLOGY/PRINCIPAL FINDINGS: We prospectively studied the PEIs and blood splashes on the skin of employees in a newly founded (October 2000) tertiary hospital in Athens, Greece, while a vaccination program against hepatitis B virus, as well as educational activities for avoidance of injuries, were taking place. The study period ranged from October 1, 2002 to February 28, 2005. Serologic studies for hepatitis B (HBV) and C virus (HCV) as well as human immunodeficiency virus (HIV) were performed in all injured employees and the source patients, when known. High-titer immunoglobulin (250 IU anti-HBs intramuscularly) and HBV vaccination were given to non-vaccinated or previously vaccinated but serologically non-responders after exposure. Statistical analysis of the data was performed using Mc Nemar's and Fisher's tests. 60 needlestick, 11 sharp injuries, and two splashes leading to exposure of the skin or mucosa to blood were reported during the study period in 71 nurses and two members of the cleaning staff. The overall incidence (percutaneous injuries and splashes) per 100 full-time employment-years (100 FTEYs) for high-risk personnel (nursing, medical, and cleaning staff) was 3.48, whereas the incidence of percutaneous injuries (needlestick and sharp injuries) alone per 100 FTEYs was 3.38. A higher incidence of injuries was noted during the first than in the second half of the study period (4.67 versus 2.29 per 100 FTEYs, p = 0.005). No source patient was found positive for HCV or HIV. The use of high-titer immunoglobulin after adjustment for the incidence of injuries was higher in the first than in the second half of the study period, although the difference was not statistically significant [9/49 (18.37%) vs 1/24 (4.17%), p = 0.15]. CONCLUSIONS/SIGNIFICANCE: Our data show that nurses are the healthcare worker group that reports most of PEIs. Doctors did not report such injuries during the study period in our setting. However, the possibility of even relatively frequent PEIs in doctors cannot be excluded. This is due to underreporting of such events that has been previously described for physicians and surgeons. A decrease of the incidence of PEIs occurred during the operation of this newly founded hospital.

Pappas G, Papadimitriou P, Falagas ME. · Institute for Continuing Medical Education of Ioannina, Greece. · J Clin Virol. · Pubmed #17174595 No free full text.

Abstract: BACKGROUND: Hepatitis B virus infection is a global public health issue, often under-discussed due to social prejudices related to its mode of transmission. The World Wide Web, an increasingly popular means of dissemination of health-related information, can serve continuing medical practitioner awareness and enhance public health literacy. OBJECTIVE: The authors sought to investigate the existence of, and evaluate the content of websites offering information on hepatitis B. STUDY DESIGN: Sites were selected by certain criteria (sponsor, language options, free access, validation of content by independent medical and non-medical personnel), which unavoidably rendered the lists subjective. RESULTS: At least three medical personnel-oriented websites (American Association for the Study of Liver Diseases, Clinical Care Options and The Hepatitis B Foundation sites) offer significant, up to date information on hepatitis B for clinicians. Sites offering information for the public used simple patterns as fact sheets and question-answer sets. The majority of the sites were based in the US. CONCLUSIONS: Hepatitis B virus infection is adequately represented in the web, regarding the needs of medical practitioners. Dissemination of information for the public appears in various modes, and at least at present, can only safely be achieved through simplified reports on the disease.

German V, Giannakos G, Kopterides P, Liaskonis K, Falagas ME. · Department of Internal Medicine and Infectious Diseases, 401 Army General Hospital of Athens, Greece. <> · BMC Infect Dis. · Pubmed #17105648 links to  free full text

Abstract: BACKGROUND: The prevalence of hepatitis B virus infection in Greece has been decreasing over the last decades. However, recent epidemiological data are lacking. METHODS: We studied 1,840 Army recruits from 05/2004 until 10/2005, and performed serological testing for HBsAg, anti-HBsAg, and anti-HBcAg. We also examined their association with several factors, including age, residential area, socioeconomic class, and educational level. RESULTS: Mean age (+/- SD) of the recruits was 20.5 (+/- 2.1) years. Antibodies to HBV core antigen [anti-HBcAg (+)] were found in 31 (1.68%) of 1,840 participants. Only 6 (0.32%) were HBsAg (+)/anti-HBsAg (-)/anti-HBcAg (+), while 21 (1.14%) were HBsAg (-)/anti-HBsAg (+)/anti-HBcAg (+), and 4 (0.22%) were HBsAg (-)/anti-HBsAg (-)/anti-HBcAg (+). Overall, 1,144 recruits (62.17%) had antibodies against HBsAg [HBsAg (-)/anti-HBsAg (+)/anti-HBcAg (-)]; 665 recruits (36.14%) had undetectable anti-HBsAg levels. Multivariable analysis showed that younger age (OR: 0.87; 95% CI: 0.82-0.92) and advanced educational level (OR: 1.59; 95% CI: 1.32-1.93) were independently associated with serologic evidence suggestive of previous HBV vaccination. CONCLUSION: We document a further decline of the prevalence of chronic HBV infection among Greek military recruits, a fact that may support the effectiveness of the ongoing immunization programme.

Panos GZ, Lampropoulos KM, Angelousi AG, Charatsis GG, Falagas ME. · No affiliation provided · J Clin Gastroenterol. · Pubmed #17245225 No free full text.

This publication has no abstract.