Hepatitis: Europe

Bossi P, Tegnell A, Baka A, Van Loock F, Hendriks J, Werner A, Maidhof H, Gouvras G, Anonymous00206. · Task Force on Biological and Chemical Agent Threats, Public Health Directorate, European Commission, Luxembourg. · Euro Surveill. · Pubmed #15677840 links to  free full text

Abstract: Q fever is a zoonotic disease caused by Coxiella burnetii. Its interest as a potential biological weapon stems from the fact that an aerosol of very few organisms could infect humans. Another route of transmission of C. burnetii could be through adding it to the food supply. Nevertheless, C. burnetii is considered to be one of the less suitable candidate agents for use in a bioterrorist attack; the incubation is long, many infections are inapparent and the mortality is low. In the case of an intentional release of C. burnetii by a terrorist, clinical presentation would be similar to naturally occurring disease. It may be asymptomatic, acute, normally accompanied by pneumonia or hepatitis, or chronic, usually manifested as endocarditis. Most cases of acute Q fever are asymptomatic and resolve spontaneously without specific treatment. Nevertheless, treatment can shorten the duration of illness and decrease the risk of complications such as endocarditis. Post-exposure prophylaxis is recommended after the exposure in the case of a bioterrorist attack.

Vergani D, Alvarez F, Bianchi FB, Cançado EL, Mackay IR, Manns MP, Nishioka M, Penner E, Anonymous00232. · Institute of Liver Studies, King's College Hospital, Denmark Hill, London SE5 9RS, UK. · J Hepatol. · Pubmed #15464251 No free full text.

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Antonucci G, Antinori A, Boumis E, De Longis P, Gentile M, Girardi E, Lauria FN, Narciso P, Noto P, Palmieri F, Oliva A, Petrosillo N, Rosati S, Urso R, Tocci G, Tozzi V, Visco Comandini U, Ippolito G. · Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani, Istituto di Ricovero e Cura a Carattere Scientifico, Roma, Italy. · Infez Med. · Pubmed #15329524 links to  free full text

Abstract: It is crucial to ensure an optimal clinical management of HCV infection in HIV-co-infected persons. The reasons for the development of guidelines on HCV-infection treatment in HIV-infected persons arise from the need for a standardised management of HIV/HCV coinfection in our Institute. The aim of these guidelines are: to clarify principles of clinical management of HCV infection in HIV-infected patients to care-providers; to improve the awareness of HIV-infected patients cared for our Institute on current management of HCV infection; to improve the quality of care on this topic. These guidelines, based on Evidence based Medicine principles, have been developed by a panel of experts, who conducted a systematic review of the literature, mainly taking into account current international recommendations. In the present document, the most frequent clinical presentation occurring in the management of HIV/HCV co-infected patients at our Institution are discussed. The adherence to present guidelines and their effectiveness at our Institution, outcome indicators will be evaluated. The present guidelines cannot entirely substitute the judgement of an expert clinician. However, adherence to these guidelines will contribute to the improvement of the standard of care of HIV/HCV-co-infected persons.

Niederau C. · St. Josef Hospital Oberhausen, Klinik für Innere Medizin, Akademisches Lehrkrankenhaus der Universität Essen, Oberhausen. · Z Gastroenterol. · Pubmed #15314715 No free full text.

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Barril G, González Parra E, Alcázar R, Arenas D, Campistol JM, Caramelo C, Carrasco M, Carreño V, Espinosa M, García Valdecasas J, Górriz JL, López MD, Martín L, Ruiz P, Terruel JL, Anonymous00170. · Nefrólogo Hosp. Universitario de La Princesa, Madrid. · Nefrologia. · Pubmed #15085792 No free full text.

Abstract: The viric infections influence morbi-mortality in Chronic kidney Disease patients in hemodialysis therapy and can affect to the Staff of the Units. The guides considered the most relevant virus at the present moment: C Virus, B Virus and HIV. To prevent horizontal nosocomial transmission is necessary the observance always the universal precautions in the HD units, although sometimes can appeared seroconversions and epidemic bud when exist a break of these. Is analyzed different situations with special focus in units for acute patients. The following steps under the suspicious of the epidemic bud appeared in one of the annexes together with legislation according to this case. Respect to the staff in every one of the virus is shown prevention patterns, serologic markers to perform when an accident with infected blood occur, also is considered when treatment is indicated. The guides considered too the conditions necessary for include these patients on waiting list for kidney transplantation.

Wejstål R, Alaeus A, Fischler B, Reichard O, Uhnoo I, Weiland O, Anonymous00099. · Department of Infectious Diseases, Sahlgrenska University Hospital/Ostra, Göteborg, Sweden. · Scand J Infect Dis. · Pubmed #14514142 No free full text.

Abstract: In 1999 a Swedish national expert panel published recommendations for the treatment of chronic hepatitis C (HCV) infection. Recently, pegylated interferon (peg-IFN) products have been introduced, and an increased knowledge concerning treatment of acute HCV and HCV-human immunodeficiency virus (HIV) coinfection has been gained. As a result of this, an update of the Swedish recommendations was developed following an expert meeting in October 2002. The panel now recommends the use of peg-IFN together with ribavirin as the standard treatment. Owing to the excellent response rates in HCV genotype 2 and 3 infections, these patients can be treated for 24 weeks without preceding liver biopsy. For patients with genotype 1 infection (with a slightly below 50% sustained response rate after 48 weeks treatment) and only mild histological disease, treatment can be postponed until future better treatment options become available. In patients who fail to achieve a 99% reduction (2 log drop) in viral titre after 12 weeks of treatment, discontinuation of therapy is recommended. Patients previously treated with IFN monotherapy and not having achieved a sustained virological response are recommended the same combination treatment as treatment-naive patients. IFN monotherapy is recommended in patients with acute hepatitis C. For children with chronic HCV infection, combination treatment is mainly recommended in clinical trials. For HCV-HIV coinfected patients, combination treatment is recommended and preferably given when blood CD4 counts are above 350/ml and before antiretroviral treatment (ART) is needed. Concurrent ART or prominent liver fibrosis requires frequent monitoring because of the increased risk for mitochondrial toxicity and liver failure.

Nelson MR, Matthews G, Brook MG, Main J, Anonymous00076. · Chelsea and Westminster Hospital, London, UK. · HIV Med. · Pubmed #14511248 No free full text.

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Brook MG, Gilson R, Wilkins EL, Anonymous00075. · Central Middlesex Hospital, London, UK. · HIV Med. · Pubmed #14511247 No free full text.

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Gilling-Smith C, Almeida P, Anonymous00076. · Assisted Conception Unit, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK. · Hum Fertil (Camb). · Pubmed #12960441 No free full text.

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Puoti C, Guido M, Mangia A, Persico M, Prati D, Anonymous00025. · Department of Gastroenterology and Internal Medicine, E. De Santis Hospital, Via A. Grandi 43, 00045 Genzano, Rome, Italy. · Dig Liver Dis. · Pubmed #12846410 No free full text.

Abstract: An ad hoc committee appointed by the Italian Association for the Study of the Liver (AISF) proposed these Practice Guidelines for the management of HCV carriers with persistently normal aminotransferase levels. Only stringent ALT determinations will make it possible to distinguish these subjects from those in temporary biochemical remission. The overall prevalence in Italy has been estimated between 1.5 and 10.6%. HCV RNA quantitation and genotype determination are not predictors of the presence and severity of liver damage nor correlate with the outcome of the disease, and should not be used in clinical practice for the management and surveillance of HCV carriers with normal ALT. Only a minority of HCV carriers with normal ALT levels show a normal morphological picture (true 'healthy carriers'). Disease activity is mild in most cases; fibrosis is generally mild and cirrhosis is very rare. Histological activity, as monitored by sequential liver biopsies, seems to have very slow evolution. HCV carriers should not undergo liver biopsy on a routine basis. Liver biopsy can be reasonably proposed only in selected cases. Until the results of studies with PEG interferon plus ribavirin are available, HCV carriers should not receive antiviral treatment outside controlled experimental studies.

Michielsen P, Brenard R, Bourgeois N, De Galocsy Ch, Delwaide J, Henrion J, Horsmans Y, Nevens F, Reynaert H, Robaeys G, Sprengers D, Van Vlierberghe H, Anonymous00046. · Department of Hepatogastroenterology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem. · Acta Gastroenterol Belg. · Pubmed #12812144 No free full text.

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Hierro Llanillo L, Anonymous00303. · Servicio de Hepatología. Hospital Infantil La Paz. Madrid. España. · An Pediatr (Barc). · Pubmed #12724085 links to  free full text

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de la Vega Bueno A, Anonymous00302. · Servicio de Hepatología. Hospital Infantil La Paz. Madrid. España. · An Pediatr (Barc). · Pubmed #12724084 links to  free full text

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Muñoz Bartolo G, Anonymous00301. · Servicio de Hepatología. Hospital Infantil La Paz. Madrid. España. · An Pediatr (Barc). · Pubmed #12724083 links to  free full text

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Codoñer Franch P. · Profesora Titular de Pediatría. Hospital Universitario Dr. Peset. Universidad de Valencia. España. · An Pediatr (Barc). · Pubmed #12724082 links to  free full text

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Almeda J, Casabona J, Allepuz A, García-Alcaide F, del Romero J, Tural C, Colm J, Bolao F, Campins M, Domínguez A, Force L, Giménez A, Guerra-Romero L, Anonymous00243. · Centre de Estudis Espidemiològics sobre la Sida a Catalunya. Hospital Universitari Germans Trias i Pujol. Badalona. España. · Enferm Infecc Microbiol Clin. · Pubmed #12372236 links to  free full text

Abstract: Evidence is lacking on the possible efficacy and effectiveness of non-occupational postexposure prophylaxis (PEP). However, because of its biological plausibility, the use of antiretroviral (ARV) drugs to prevent the development of infection in certain cases of accidental or sporadic exposure has begun to be considered as common clinical practice. Previous studies performed in Spain have demonstrated both the demand and the prescription of ARV as PEP and especially the diversity and inconsistency in the criteria used. In this context, in April of 2000 the Centre for Epidemiological Studies on AIDS of Catalonia (CEESCAT) (Department of Health and Social Security of the Autonomous Government of Catalonia), in collaboration with the National AIDS Plan and the AIDS Study Group (GESIDA), promoted the creation of a working group for the drafting of recommendations for PEP against HIV outside the occupational health context. The recommendations have been made bearing in mind the exceptional character of the exposure, the time elapsed since exposure, as well as evaluation of the risk of infection according to the type of exposure and the information available on the source of infection. In addition, the recommendations include the immediate measures necessary, as well as the preventive measures and clinical follow-up required both for HIV and for other infectious agents. All PEP regimens should be started within 72 hours of exposure and appropriate daily doses of two nucleoside reverse transcriptase inhibitors (NRTIs) and a protease inhibitor (PI), or two NRTIs and a non-nucleoside reverse transcriptase inhibitor (NNRTIs), should be administered for four weeks, bearing in mind the pharmacological and clinical situation of the source person. These recommendations should be updated periodically.

Rubio R, Berenguer J, Miró JM, Antela A, Iribarren JA, González J, Guerra L, Moreno S, Arrizabalaga J, Clotet B, Gatell JM, Laguna F, Martínez E, Parras F, Santamaría JM, Tuset M, Viciana P. · Hospital 12 Octubre, Madrid, Spain. · Enferm Infecc Microbiol Clin. · Pubmed #12084354 links to  free full text

Abstract: OBJECTIVE: To provide an update of recommendation on antiretroviral treatment (ART) in HIV-infected adults.Methods. These recommendations have been agreed by consensus by a committee of the spanish AIDS Study Group (GESIDA) and the National AIDS Plan. To do so, advances in the physiopathology of AIDS and the results on efficacy and safety in clinical trials, cohort and pharmacokinetics studies published in biomedical journals or presented at congresses in the last few years have been reviewed. Three levels of evidence have been defined according to the data source: randomized studies (level A), case-control or cohort studies (level B) and expert opinion (level C). Whether to recommend, consider, or not to recommend ART has been established for each situation. RESULTS: Currently, ART with combinations of at least three drugs constitutes the treatment of choice in chronic HIV infection. In patients with symptomatic HIV infection, initiation of ART is recommended. In asymptomatic patients initiation of ART should be based on the CD41/mL lymphocyte count and on the plasma viral load (PVL): a) in patients with CD41 lymphocytes < 200 cells/mL, initiation of ART is recommended; b) in patients with CD41 lymphocytes between 200 and 300 cells/mL, initiation of ART should, in most cases, be recommended; however, it could be delayed when the CD41 lymphocyte count remains close to 350 cells/mL and the PVL is low, and c) in patients with CD41 lymphocytes > 350 cells/mL, initiation of ART can be delayed. The aim of ART is to achieve an undetectable PVL. Adherence to ART plays a role in the durability of the antiviral response. Because of the development of cross-resistance, the therapeutic options in treatment failure are limited. In these cases, genotypic analysis is useful. Toxicity limits ART. The criteria for ART in acute infection, pregnancy and postexposure prophylaxis and in the management of coinfection with HIV and hepatitis C and B virus are controversial. CONCLUSIONS: The current approach to initiating ART is more conservative than in previous recommendations. In asymptomatic patients, the CD41 lymphocyte count is the most important reference factor for initiating ART. Because of the considerable number of drugs available, more sensitive monitoring methods (PVL) and the possibility of determining resistance, therapeutic strategies have become much more individualized.

Brook MG, Anonymous00156. · · Int J STD AIDS. · Pubmed #11589797 No free full text.

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Booth JC, O'Grady J, Neuberger J, Anonymous00102. · Department of Gastroenterology, Royal Berkshire Hospital, London Road, Reading RG5 5AN, UK. · Gut. · Pubmed #11413125 links to  free full text

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Wejstål R, Fischler B, Glaumann H, Norkrans G, Reichard O, Sönnerbor A, Uhnoo I, Weiland O, Anonymous00027, Anonymous00028. · Department of Infectious Diseases, Sahlgrenska University Hospital/Ostra, Göteborg, Sweden. · Scand J Infect Dis. · Pubmed #11055647 No free full text.

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Ramsay ME. · Immunisation Division, PHLS Communicable Disease Surveillance Centre, London. · Commun Dis Public Health. · Pubmed #10598382 No free full text.

Abstract: This document updates previous PHLS guidance on the risks and management of occupational exposure to hepatitis C. In line with recent guidance from the UK Health Departments, the PHLS now recommends that all source patients, subject to appropriate consent, should be tested for evidence of hepatitis C infection. A baseline serum should be obtained from the exposed health care worker and stored for at least two years. Health care workers exposed to known infected sources should be followed up at six, 12, and 24 weeks after exposure. Serum taken at six and 12 weeks should be tested for hepatitis C virus (HCV) RNA and serum taken at 12 and 24 weeks for anti-HCV. Health care workers exposed to a source believed not to be infected do not require active follow up for hepatitis C unless requested or if they develop symptoms or signs of liver disease. Management of personnel exposed to a source whose hepatitis C status is unknown or a source unavailable for testing will depend upon a risk assessment by a designated doctor. Health care workers who are found to be positive for HCV RNA or antibody to hepatitis C should be referred to an appropriate consultant for consideration of early treatment.

Alvarez F, Berg PA, Bianchi FB, Bianchi L, Burroughs AK, Cancado EL, Chapman RW, Cooksley WG, Czaja AJ, Desmet VJ, Donaldson PT, Eddleston AL, Fainboim L, Heathcote J, Homberg JC, Hoofnagle JH, Kakumu S, Krawitt EL, Mackay IR, MacSween RN, Maddrey WC, Manns MP, McFarlane IG, Meyer zum Büschenfelde KH, Zeniya M. · Institute of Liver Studies, King's College Hospital, London, UK. · J Hepatol. · Pubmed #10580593 No free full text.

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British Andrology Society. · c/o Dr Eileen A McLaughlin, Chairman, University Division of Obstetrics & Gynaecology, St Michael's Hospital, Bristol, BS2 8EG, UK. · Hum Reprod. · Pubmed #10402397 links to  free full text

Abstract: The British Andrology Society (BAS) guidelines for the screening of semen donors have undergone a recent review, and following consultation with members of the Society and with experts in the allied professions, the following revised guidelines have been issued. Major changes include the introduction of an upper age limit for semen donors (<40 years old) and the general exclusion of men who are seropositive for cytomegalovirus as donors. The BAS recommends the screening of prospective semen donors for chromosomal abnormalities and for cystic fibrosis carrier status. Following the report of cross-contamination of human cells with hepatitis B virus within a liquid nitrogen storage vessel, the BAS recommends that steps be taken to ensure the safe cryopreservation of donor gametes.

Testino G, Borro P, Sumberaz A. · Department of Specialist Medicine, San Martino Hospital, Genova, Italy; E-mail: · J Gastrointestin Liver Dis. · Pubmed #19565040 links to  free full text

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Afef. · AFEF, 3, rue Troyon, 75017 Paris, France. · Gastroenterol Clin Biol. · Pubmed #19505784 No free full text.

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