Hepatitis: Palumbo E

Palumbo E. · Pediatrics Department, Sondrio Hospital, Italy. · Braz J Infect Dis. · Pubmed #19219271 links to  free full text

Abstract: Until recently, the only generally approved treatment for chronic hepatitis B was alpha-interferon; however, it gives only moderate efficacy in terms of sustained response (biochemical, virological and histological). In fact, only 20% to 40% of treated patients respond to therapy, with lower percentages (~ 10%) among patients infected with precore-mutant strains of HBV (HBeAb HBV-DNA positive). The FDA of the USA approved the use of lamivudine in adult patients affected by chronic hepatitis B in 1998. In this review, we focused on the pharmacokinetic and pharmacodynamic properties and efficacy and tolerability of lamivudine in the treatment of chronic hepatitis B cases that are both HBeAg and anti-HBe-positive.

Palumbo E. · Clinic of Paediatric, Hospital of Sondrio, Foggia, Italy. · Am J Ther. · Pubmed #18356637 No free full text.

Abstract: Three nucleotide/nucleoside analogs are used for chronic hepatitis B (HBV): lamivudine, adefovir dipivoxil, and entecavir. Lamivudine and adefovir are advantageous for oral administration and safety but induce a sustained response after withdrawal of therapy in only a minority of patients. Thus, the treatment should be given in trials in a majority of patients for a long period of time. In addition, the long-term efficacy of lamivudine is limited by the frequent emergence of drug-resistant HBV mutants. Adefovir is associated with a low frequency of resistance, but its antiviral effect is not optimal. Entecavir, a cyclopentyl guanosine analog, is a potent inhibitor of HBV-DNA polymerase and it inhibits both priming and elongation steps of viral DNA replication. In phase II and III clinical trials, entecavir was found to be superior to lamivudine for all primary end points evaluated in both nucleoside-naive and lamivudine-resistant patients, and it was effective in both HBeAg-positive and HBeAg-negative nucleoside-naive patients. Only one trial has shown cases of viral resistance to this drug. The approved dosage in treatment-naive patients is 0.5 mg per day orally, whereas in patients who have failed lamivudine therapy or who are known to harbor lamivudine-resistant mutants, the approved dosage is 1.0 mg per day. Recent preliminary results show that clevudine, telbivudine, and emtricitabine may be potent analogs available for the treatment of HBV. Further studies are being conducted to assess the long-term efficacy and safety of these drugs.

Palumbo E. · Clinic of Paediatrics, Hospital of Sondrio, Foggia, Italy. · Ther Drug Monit. · Pubmed #18223455 No free full text.

Abstract: Three nucleotide/nucleoside analogs are currently used for the treatment of chronic hepatitis B: lamivudine, adefovir dipivoxil, and entecavir. Lamivudine and adefovir are beneficial for oral administration and safety, but only a few of the patients treated experience a sustained response after therapy withdrawal. Entecavir, a cyclopentyl guanosine analog, is a potent inhibitor of chronic hepatitis B virus DNA polymerase, inhibiting both the priming and elongation steps of viral DNA replication. In phase II and phase III clinical trials, entecavir was found to be superior to lamivudine for all primary end points evaluated in both nucleoside-naive and lamivudine-resistant patients as well as being effective in both HBeAg-positive and HBeAg-negative nucleoside-naive patients. Only one trial has shown evidence of cases of viral resistance to this drug. The approved dosage in treatment-naive patients is 0.5 mg per day orally, whereas in patients who have failed lamivudine therapy or are known to harbor lamivudine-resistant mutants, the approved dosage is 1.0 mg per day.

Palumbo E. · Clinica Malattie Infettive, Università, Foggia. · Recenti Prog Med. · Pubmed #18044403 No free full text.

Abstract: This work underlines as many people arrive in our country by migratory phenomena and as many of them come by areas, particularly Sub-Sahara Africa, endemic for HBV infection. This could determine a higher prevalence of this infection in our area. The most part of subjects could be infected by a non-D genotype (genotype D is prevalent in Italy) characterized by a different natural history and response to antiviral therapies with the necessity of a different clinical and therapeutic approach.

Palumbo E. · Department of Paediatrics and Infectious Diseases, Hospital of Sondrio, Via Dell' Arcangelo Michele 4, 71100 Foggia, Italy. · Mini Rev Med Chem. · Pubmed #17692045 No free full text.

Abstract: Acute infection due to hepatitis C virus results in a chronic progression in 50-84% of cases. In the light of the risk of developing chronic disease and the response rate to treatment once the disease is established, it is very important to consider early treatment of acute hepatitis C before it progresses to the chronic form. The aim of this review is to evaluate the real efficacy and tolerance of Peg-interferon alpha-2b in monotherapy and in association with ribavirin in the treatment of patients affected by acute C hepatitis, to delineate the viral factors correlated with the sustained virological response and to consider when treatment should be started in relation to onset and what is the optimal duration of therapy. Also the pharmacodynamic and pharmacokinetic characteristics of PEG-IFN alpha-2b and ribavirin are reassessed. The analysis of literature demonstrates that Peg-interferon alpha-2b treatment is efficacious in terms of attaining sustained virological response (71-94% of cases). Treatment must be started within three months of onset and must be prolonged for three months. Only two studies have provided evidence the needed of a prolonged treatment for six months for genotype 1 infections. In all studies therapy has been generally well tolerated. Sustained virological response is independent of baseline viral load and of HCV genotypes in patients treated for six months, while in subjects treated for three months it seems to be dependent on HCV-genotype, with genotype 1 characterized by a less favourable outcome. Combination therapy with ribavirin does not seem to increase the response rate but could be proposed as a second choice to patients not responding to IFN monotherapy.

Palumbo E. · Department of Pediatrics, Hospital of Sondrio, Sondrio, Italy. · Am J Ther. · Pubmed #17515708 No free full text.

Abstract: The aim of this review is to examine the impact of hepatitis B virus (HBV) genotypes on biochemical and virologic response to antiviral drugs (alfa-interferon and pegylated-interferon alfa-2b, lamivudine, and adefovir dipivoxil) actually used for the treatment of chronic hepatitis, HBV related. International literature evidences that HBV genotypes D and C are associated with a lower rate of favorable response to alfa-interferon and pegylated-interferon alfa-2b therapy than genotypes A and B. The rate of resistance to lamivudine was higher in patients with genotype A infection than in patients infected by genotype D, whereas no difference in the risk of lamivudine resistance is found between patients with genotype B and patients with genotype C. In regard to the new nucleotide analogue, adefovir dipivoxil, a preliminary trial appears to provide no evidence of any difference in virologic response among the different HBV genotypes. The current study has determined that the different HBV genotypes have a very important impact on response to antiviral therapy, in particular interferon treatment. For this reason, determining the HBV genotype could be helpful for predicting the outcome of antiviral therapy in patients affected by chronic hepatitis B.

Scotto G, Palumbo E, Fazio V, Cibelli DC, Saracino A, Tartaglia A, Angarano G. · Infectious Diseases Unit, University of Foggia, Foggia, Italy. · Am J Ther. · Pubmed #16772763 No free full text.

Abstract: The efficacy of lamivudine (LAM) at 100 mg/d for 1 year in normalizing serum ALT levels and suppressing HBV DNA has been demonstrated in many studies. However, frequent relapses make long-term results modest. In the present study, we evaluated the efficacy of LAM administered for 3 years in patients with chronic active anti-HBe-positive hepatitis. Thirty-four patients with chronic active anti-HBe-positive hepatitis were treated with LAM (100 mg) once daily for 3 years. Before treatment, all patients demonstrated serum ALT levels >2 times normal levels for >6 months and HBV DNA positivity >5 pg/mL as determined by the sandwich hybridization test for nucleic acid. Both ALT and HBV DNA were monitored during therapy. After 12 months of therapy, 24 of 34 patients (70.6%) showed evidence of HBV DNA clearance and normal ALT levels; 22 of 34 (64.7%) and 19 of 34 (55.8%) patients maintained a complete response after 2 and 3 years of therapy, respectively. The long-term LAM therapy (>1 year) was not associated with an increase in the response of intially nonresponder patients. The YMDD variant emerged in 17.6% of patients in the first year, in 35.2% during the second year, and 52.9% during the third year of treatment. LAM was well tolerated during the 3-year therapy in all patients. Patients with chronic active anti-HBe-positive hepatitis demonstrated that the LAM response rate tends to decrease over time due to the emergence of YMDD variants.

Scotto G, Palumbo E, Fazio V, Tartaglia A, Saracino A, Angarano G. · Clinic of Infectious Diseases, University of Foggia, Italy. · New Microbiol. · Pubmed #16240690 No free full text.

Abstract: Adefovir dipivoxil (ADV), a new nucleotide analogue, has demonstrated activity against lamivudine-resistant HBV both in vivo and in vitro. Herein, we present eight lamivudine-resistant patients with chronic anti-HBe positive hepatitis B treated orally with adefovir dipivoxil at 10 mg/die to evaluate the efficacy and safety of this drug and to determine the possible development of clinical ADV resistance. After 48 weeks of therapy, 4/8 (50%) patients demonstrated a complete response with normalization of alaninoaminotransferase levels (ALT, normal value < 40 IU/L) and undetectable serum HBV- DNA (< 100 copies/ml tested by a PCR assay). In 3/8 subjects (37.5%), we observed a partial response with a > 50% reduction of both ALT and HBV DNA levels. Only one patient did not respond. Adefovir was well-tolerated and no patient presented adverse events related to treatment; there were no changes in renal parameters. We conclude that in patients with anti-HBe positive chronic hepatitis B resistant to lamivudine, a 48-week ADV treatment resulted in significant biochemical and virological improvement without major adverse effects.

Scotto G, Fazio V, Palumbo E, Cibelli DC, Saracino A, Angarano G. · Clinic of Infectious Diseases, University of Foggia, Italy. · New Microbiol. · Pubmed #15782623 No free full text.

Abstract: This prospective open-label randomized trial of chronic hepatitis C genotype-1b patients compared compared the efficacy and safety of peg-interferon alfa-2b administered once-weekly versus interferon alfa-2b thrice-weekly or daily, both in combination with ribavirin. Seventy-eight previously untreated patients, with biopsy-documented genotype 1 chronic HCV and persistently elevated ALT levels and detectable HCV RNA, were randomized (26 subjects each) to receive: interferon alfa-2b at 6MIUs.c./three-times-weekly (group A) or interferon alfa-2b, 3MIUs.c./daily (group B) or peg-interferon alfa-2b 1.5mcg/Kg s.c./once-weekly (group C). All regimens included standard weight-based doses of ribavirin (800, 1,000 or 1,200 mg/day) administered for 52-weeks. Patients in the three groups were comparable for age, sex, viral load, ALT value and histological-activity-index (HAI). Therapy was completed by 22, 20 and 23 patients in groups A, B and C, respectively. At the end of treatment, a complete (biochemical and virological) response was observed in 50.0% patients of group A, 57.7% of group B and 65.4% of group C. After an additional 24-weeks of follow-up, a sustained response was observed in 26.9%, 46.1% and 50.0% of patients in groups A, B or C, respectively. Therapy was discontinued by 4, 6 and 2 patients because of adverse events in the above three groups. In naive patients with chronic genotype-lb hepatitis C, a 48 week therapy with peg-interferon or interferon at daily doses combined with ribavirin were both more effective than treatment with thrice-weekly interferon in inducing end of treatment and sustained response. Peg-interferon treatment was better tolerated and provoked significantly fewer therapy discontinuations.

Palumbo E, Scotto G, Cibelli DC, Faleo G, Saracin A, Angarano G. · Clinic of Infectious Diseases, University of Foggia, Foggia, Italy. · East Mediterr Health J. · Pubmed #19166160 No free full text.

Abstract: This study in Italy aimed to evaluate the epidemiological, clinical and therapeutic aspects of hepatitis B virus (HBV) infection in a population of recent (< 6 months) immigrants. Between February 2003 and December 2004, 83 (9.3%) out of 890 immigrants tested positive for hepatitis B surface antigen. All were men and 62.6% came-from Africa, 21.6% from Asia and 16.8% from Eastern Europe. About half (54.3%) of the patients had elevated alanine aminotransferase levels and detectable serum HBV DNA. Genotype distribution was as follows: E (20 cases), D (14 cases) and A (11 cases). Our study underscores the potential of migratory flow to introduce genotype non-D hepatitis B virus into our country.

Palumbo E, Scotto G, Faleo G, Cibelli DC, Angarano G. · Clinic of Infectious Diseases, University of Foggia, Foggia, Italy. · Braz J Infect Dis. · Pubmed #17684630 links to  free full text

Abstract: This study evaluated the prevalence of HBV infection in a population of South American immigrants in Italy and to determine in patients with detectable serum HBV-DNA the HBV genotypes. Between April 2005 and April 2006 a total of 130 South American immigrants were tested for HBsAg. In HBsAg positive patients the biochemical and virological activity of infection and the possible presence of co-infections (HCV, HDV, HIV) were evaluated. In patients with detectable serum HBV DNA, the HBV genotype was determined by INNOLiPA. Among the 130 subjects tested, 14 (10.7%) resulted HBsAg positive. All were men, with a mean age of 22 years (range 19-37) and 12 (85.7 %) came from Brazil, while 2 (14.3%) came from Ecuador. All patients infected by HBV had elevated alanine-aminotransferase serum levels (mean level was 127 IU/L, range 74-312) and serum HBV DNA detectable by PCR-Real Time (mean level 1,037,652 copies/mL, range 19,876-1,377,648). Genotype distribution was as follow: genotype D, 9 (64.2%), genotype A, 5 (35.8%). All patients infected by genotype D came from Brazil, while among the patients infected by genotype A, three came from Brazil and two from Ecuador. Our study evidences a moderate prevalence of HBV-infection in South American immigrants with the identification of two genotypes, D and A. These genotypes are not the most prevalent in the South America and this is probably the expression of a possible geographical redistribution of HBV genotypes.

Palumbo E, Scotto G, Faleo G, Cibelli DC, Saracino A, Angarano G. · Clinic of Infectious Diseases, University of Foggia, Italy. · Arq Gastroenterol. · Pubmed #17639184 links to  free full text

Abstract: BACKGROUND: The genetic heterogeneity of the HBV genome has been established and eight genotypes can be classified according to the criterion of >8% differences in the complete nucleotide sequence of the viral genome. AIMS: To evaluate the prevalence of HBV-infection in a population of immigrants and to determine in patients with detectable serum HBV-DNA the HBV-genotypes. METHODS: Between January 2005 and December 2005 a total of 556 immigrants were tested for HBsAg. In HBsAg positive patients the biochemical and virological activity of infection and the possible presence of co-infections (HCV, HDV, HIV) were evaluated. In patients with detectable serum HBV DNA, the HBV-genotype was determined by INNOLiPA. RESULTS: Among the 556 subjects tested, 60 (10.7%) resulted HBsAg positive. All were men, and 42 (70%) come from Africa, 10 (16.6%) from Asia and 9 (14.4%) from East-Europe. 28/60 (46.6%) patients presented normal ALT levels (<40 IU/L) and undetectable serum HBV DNA (<100 copies/mL in real-time PCR), while 32 (53.4%) patients had ALT levels above laboratory normal values and detectable serum HBV DNA. Genotype distribution was as follow: genotype E, 16 (50%), genotype D, 9 (28.1%), genotype A, 7 (21.9%). CONCLUSION: Our study evidences a moderate prevalence of HBV-infection in immigrants, particularly in sub-Saharan African people, and the potentiality of migratory flow in the introduction of genotype non-D hepatitis B virus, potentially characterized by a different natural history and, possibly, a different response to antiviral treatment.

Palumbo E. · · Recenti Prog Med. · Pubmed #17547362 No free full text.

Abstract: Adefovir dipivoxil is an analogue nucleotide recently approved for the treatment of chronic hepatitis HBV-related. Some recent studies have evidenced that treatment with 10 mg/die orally with adefovir dipivoxil is efficacy and well tolerate in patients with chronic hepatitis B, both HBeAg-positive and anti-HBe-positive, with LAM-resistance. Also, adefovir dipivoxil effectively suppresses lamivudine-resistant HBV in patients with chronic hepatitis B after liver transplantation, compensated or decompensated liver disease and co-infection with HIV. Other studies are needed to evaluate the efficacy of prolonged treatment in relation to emerge of adefovir-resistant HBV mutants.

Palumbo E. · Dipartimento Materno Infantile, Ospedale di Sondrio. · Recenti Prog Med. · Pubmed #17547361 No free full text.

Abstract: Acute hepatitis C is characterized by a frequent evolution in chronic form (70-85% of cases). The recent literature evidences that Peg-interferon alpha-2b is efficacy for the treatment of acute hepatitis C (90% of sustained response). Treatment, independently by HCV genotype and baseline viral load, must be prolonged for three months and it must be started into three months by onset.

Scotto G, Palumbo E, Fazio V, Cibelli DC, Saracino A, Angarano G. · Clinic of Infectious Diseases, University of Foggia, Italy. · Infez Med. · Pubmed #17127828 links to  free full text

Abstract: The aim of our study was to assess the efficacy and tolerability of lamivudine alone versus lamivudine plus alpha-interferon for treatment of chronic active hepatitis B, anti-HBe positive. In all, 59 patients were randomly divided into 3 groups: A) 21 patients received lamivudine at 100 mg/daily orally for 52 weeks; B) 20 patients received lamivudine at 100 mg/die plus alpha-interferon at 6 MU subcutaneously three times weekly for 52 weeks; C) 18 patients received the same combination therapy for 40 weeks after pre-treatment with lamivudine for 12 weeks. The complete sustained response in the three groups was 33.3% vs 35.0% vs 33.3%, respectively. Our study demonstrates that in anti-HBe positive chronic hepatitis B a 12-month course of lamivudine plus a-interferon combination therapy is as beneficial as lamivudine monotherapy. Moreover, the combination therapy for 40 weeks after pre-treatment with lamivudine for 12 weeks did not increase the sustained response.

Scotto G, Palumbo E, Fazio V, Saracino A, Angarano G. · Infectious Diseases Unit, University of Foggia, Italy. · J Chemother. · Pubmed #16572893 No free full text.

Abstract: The aim of the study was to evaluate the biochemical and virological response and the histological changes in 34 chronic hepatitis B anti-Hbe-positive patients treated with lamivudine at 100 mg/day orally for five years. Liver biopsies were performed in all patients at least 6 months before starting therapy and 3 months after the stop of treatment. After 12 months of therapy, 70.6% of patients showed evidence of HBV DNA clearance and normal ALT levels; 64.7% and 55.8% of patients maintained a complete response after two and three years of therapy, respectively, 47% after four years and 44.1% after five years. The histological activity index improved in 13%, remained unchanged in 61% and worsened in 26% of patients with tyrosine-methionine-aspartate-aspartate (YMDD) variants compared to 63, 27 and 0% without variants, respectively. The authors conclude that the clinical benefit of lamivudine is greatest for patients without YMDD variants after 5 years of extended treatment.

Scotto G, Cibelli DC, Saracino A, Prato R, Palumbo E, Fazio V, Scarabaggio T, Monno L, Angarano G. · Department of Infectious Diseases, University of Foggia, Foggia, Italy. · J Infect. · Pubmed #16026843 No free full text.

Abstract: OBJECTIVES: To assess the prevalence of cryoglobulinemia in three groups of patients: HCV-positive/HIV-negative, HCV/HIV co-infected and HIV mono-infected. METHODS: From September 2002 to December 2003, 58 patients with documented HCV infection, 70 subjects with HIV/HCV co-infection, and 48 subjects with HIV infection alone were enrolled. Serum samples were tested for detectable cryoglobulins, liver enzymes, HCV viral load and HCV genotypes. Plasma HIV-RNA levels and CD4+ cell count were also evaluated in HIV-positive subjects. RESULTS: Cryoglobulinemia was detected in 24.1% HCV mono-infected, 14.2% HCV/HIV co-infected and 6% HIV mono-infected patients. A significant statistical correlation was found between the presence of cryoglobulins and HCV infection (P = 0.03), while cryoglobulins were unrelated to HIV mono-infection (P = 0.16) and HCV/HIV co-infection (P=0.7). No significant correlation was observed between the presence of cryoglobulinemia and alanine transaminase (ALT) levels, HCV viremia and duration of HCV infection. Circulating cryoglobulins in HIV patients were not correlated with plasma HIV viral load, CD4+ cell count or duration of HIV infection. Only two HCV mono-infected patients complained of arthralgia. CONCLUSION: A similar rate of cryoglobulinemia prevalence was detected in the patient groups with an HCV-related infection. HIV infection does not appear to play a significant role in cryoglobulin production.

Scotto G, Saracino A, Pempinello R, El Hamad I, Geraci S, Palumbo E, Cibelli DC, Angarano G, Anonymous00013. · SIMIT Società Italiana di Malattie Infettive e Tropicali), Commissione per lo studio delle malattie infettive negli immigrati. · Ann Ig. · Pubmed #15869166 No free full text.

Abstract: AIM: To retrospectively evaluate the prevalence of hepatitis in immigrant patients hospitalised in 48 Italian Operative Unit of Infectious Diseases during 2002. METHODS AND PATIENTS: in our study we included the clinical data of 2255 immigrated patients hospitalised, during the period between 01/01/2002-31/12/2002, in ordinary admission or in Day Hospital in Infectious Diseases O.U. and we have evaluated the prevalence of hepatitis in this population. RESULTS: 282 patients affected by hepatitis has been evidenced (12.5% of total hospitalised patients). The prevalent form was HBV-related (41.6% in chronic forms and 48.4% in acute), while the rate for HCV were less (37.5% in chronic and 3% in acute). The most part of patient were men (59.6%), with a mean age of 34.2 years and come from east-European countries (34.39%). CONCLUSION: Viral hepatitis are the third infectious diseases evidenced in immigrated population. HBV-chronic hepatitis is the prevalent form in immigrated patients, as expression of absence of vaccine prophylaxis in many countries. HCV-form was less frequent and it is particularly presents in east-European patients, probably as expression of endogenous drug abuse.

Scotto G, Palumbo E, Fazio V, Cibelli DC, Saracino A, Angarano G. · Infectious Diseases Clinic, University of Foggia, Via L. Pinto 1, I-71100 Foggia, Italy. · Infection. · Pubmed #15750757 No free full text.

Abstract: Acute hepatitis C often progresses to chronic infection (70%). In this clinical study, we evaluated if early treatment with peginterferon alfa-2b can prevent acute hepatitis C from developing into a chronic disease. Six patients with acute hepatitis C, based on a well-documented hepatitis C virus (HCV) seroconversion with high alanine aminotransferase (ALT) levels (> 10 x ULN) and persistent HCV RNA titers after 3 months from disease onset, were consecutively treated with peginterferon alfa-2b at 1.5 microg/kg/weekly/sc for 24 weeks. The viral load was quantified by PCR assay. Response was defined as undetectable HCV RNA and normal ALT levels at the end of therapy and after a 6-month follow-up. All patients completed therapy; at the end of therapy, 5/6 patients (83%) responded and no relapses were observed during follow-up. No correlation was found between treatment response and pretreatment viral load, viral genotype, and interval between acute infection diagnosis and start of therapy.

Scotto G, Saracino A, Pempinello R, El Hamad I, Geraci S, Panunzio M, Palumbo E, Cibelli DC, Angarano G, Anonymous00230. · SIMIT (Italian Society of Infectious and Tropical Diseases) Committee for Study of Infectious Diseases in Immigrants, Infectious Diseases Clinic, University of Foggia, Via Mastelloni 17, 71100 Foggia, Italy. · J Immigr Health. · Pubmed #15744478 No free full text.

Abstract: The aim of this article is to retrospectively evaluate the patient characteristics and the most common infectious diseases in immigrant patients hospitalized in 46 Italian infectious disease clinics during 2002. The main Italian infectious disease clinics were invited to fill in a questionnaire that regarded the number and type of hospital admissions, the country of origin, and demographic features (age, sex, and resident state) of immigrants. A total of 46 clinics including 2255 patients participated in the study. Most patients were men (63%) with an age between 16 and 40 years (63.4%) covered by the National Health Service (71%) and coming from Africa (44.3%). The main infectious diseases observed were: 378 (16.76%) cases of HIV infection, 303 (13.43%) cases of tuberculosis diseases, 282 (12.5%) cases of various forms of viral hepatitis, 177 (7.84%) cases of respiratory diseases, and 196 (8.69%) gastrointestinal diseases. Tropical diseases found were 134 (5.94%) including 95 cases of malaria (70.9%). In conclusion, a broad range of diseases was noted in immigrants which were directly correlated with conditions of poverty. Only a few tropical diseases were diagnosed and therefore the immigrant should not be considered as an infectious disease carrier.

Scotto G, Cibelli DC, Palumbo E, Sarracino A, Fazio V, Conte PE, Angarano G. · Clinica di Malattie Infettive, Universita degli Studi di Foggia and Dipartimento di Laboratorio, Ospedali Riuniti di Foggia, Italy. · Infez Med. · Pubmed #15316295 links to  free full text

Abstract: The aim of our study was to compare the prevalence of mixed cryoglobulinemia in a group of HCV positive/HIV- negative patients with respect to a group of HCV/HIV co-infected subjects. Between September 2002 and May 2003, 58 patients with proven HCV infection and 67 subjects with HIV/HCV co-infection were enrolled. Serum was assessed for detectable cryoglobulins, liver enzymes, HCV viral load and HCV genotypes. In HIV positive patients, plasma HIV RNA and CD4+ cell count were determined. A chi-square test was used to compare the prevalence of cryoglobulins in our two categories of patients. Cryoglobulinemia was detected in 14/58 HCV mono-infected patients (24.1%) and in 10/67 HCV/HIV co-infected patients (14.9%), without any significant statistical difference between the two groups (p=0.2). Only two HCV mono-infected patients complained of arthralgia. No significant correlation was found between the presence of cryoglobulinemia and ALT levels, HCV viremia and duration of HCV infection. In HIV patients circulating cryoglobulins were not correlated with plasma HIV viral load, CD4 cell count and with duration of HIV infection. In conclusion, mixed cryoglobulinemia may be detected in a similar rate in the two groups and HIV infection does not appear to play a significant role in cryoglobulin production.

Scotto G, Fazio V, D'Alessandro G, Monno L, Saracino A, Palumbo E, Angarano G. · UO Infectious Diseases, University of Foggia, Italy. · J Biol Regul Homeost Agents. · Pubmed #15065760 No free full text.

Abstract: The aim was to confirm the influence of HLA Class II antigens on the progression of HCV infection and to assess the relationship between these antigens and histological damage, HCV viral load and HCV genotype. 143 patients were enrolled and divided into three groups. Group A included 34 anti-HCV positive, HCV-RNA negative patients with ALT persistently normal; group B included 39 patients with HCV-RNA positive and abnormal ALT level; group C included 70 normal subjects. Serological HCL typing was performed with lymphocytotoxicity test by Terasaky and McClelland, using lymphobeads HLC class II. The frequency of HLA DR11 (5) was significantly higher in the control group (52.9%) and in group A (64.7%), than in group B (28.2%). Allele HLA DR6 was demonstrated in a similar proportion (26%) among control group and group B, while HLA DR14 (6) was less frequent among controls (18% vs 1.4%). In group A the frequency of HLA DR14 (6) was 3% compared to group B, HLA DR17 (3) was prevalent (15.4%) in group B. Liver damage was associated with the detection of HLA DR14 (6) and HLD DR17 (3) antigens. Significantly lower levels of HCV-RNA were measured in subjects with HLA DR11 (5) than in these with either DR6 or DR17 (3). HLA class II antigens appear crucial for resolution or progression of HCV hepatitis. The punctual identification of these genetic factors may, therefore, prove to be useful in predicting disease evolution, in guiding the appropriate therapy for patients with poor prognosis, and in encouraging the development of now therapeutic strategies.