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Hepatology highlights
Nahum Méndez-Sánchez
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nmendez@medicasur.org.mx

Correspondence and reprint request:
* Liver Research Unit, Medica Sur Clinic & Foundation. Mexico City, Mexico
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0005">Hepatitis C virus infection in patients and family members attending two primary care clinics in Puebla&#44; Mexico</span><p id="p0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">L&#243;pez-Colombo&#44; <span class="elsevierStyleItalic">et al&#46;</span></span>Hepatitis C virus &#40;HCV&#41; transmission is mainly due to parenteral exposure&#46; However&#44; in absence of such risk factor&#44; there are reports of intrafamilial spread of HCV and observational studies suggest an increased risk for households of infected subjects&#46; This risk factor has been explored in the last two decades in different geographical areas around the world&#46; However&#44; there are contradictory results&#46; Firstly&#44; Ndong-Atome&#44; <span class="elsevierStyleItalic">et al&#46;</span><a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>found in a cross-sectional study was conducted in Dienga&#44; in Gabon&#44; involving 195 household members of 14 index cases of HCV infection&#46; The investigators found an overall prevalence of antibody to HCV among household members of infected cases of 6&#46;7&#37;&#44; with a significantly higher prevalence among sexual partners &#40;35&#46;7&#37;&#41; than non-sexual partners &#40;7&#37;&#41;&#46; Furthermore&#44; the HCV strains infecting different household contacts of index cases were concordant in only 40&#37;&#44; each of who was a sexual partner&#46; This&#44; and the discordance in HCV genotypes infecting the household members&#44; indicate a limited role for intrafamilial transmission of HCV in this population&#46; In another study Honda&#44; <span class="elsevierStyleItalic">et al</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> evaluated the risk of hepatitis C virus transmission through household contact with chronic carriers using nucleotide sequence analysis&#46; HCV patients &#40;76 patients&#41; were divided into two groups&#58; familial transmission of HCV was studied in group A &#40;53 patients&#41;&#59; group B &#40;23 patients&#41; served as nonfamilial controls for group A&#46; Of 88 family members of group A patients&#44; 18 &#40;20&#37;&#41; had elevated serum ALT levels&#44; 20 &#40;23&#37;&#41; had antibodies against hepatitis C virus and 16 &#40;18&#37;&#41; had hepatitis C virus RNA in serum&#46; Nucleotide sequences of the region of the hepatitis C virus genome spanning the core and envelope genes were compared among the three groups&#46; In group B&#44; the average nucleotide sequence homology was 91&#46;0&#37; &#177; 2&#46;29&#37; &#40;a pairwise comparison was made for each of the patients&#59; n &#61; 253&#41;&#46; Isolates from two family members were significantly more homologous to isolates from corresponding patients in group A than to isolates from group B patients&#46; Of the two isolates from family members&#44; one was from a child whose mother was a patient &#40;97&#46;7&#37; homology&#41; and one was from a spouse &#40;98&#46;1&#37; homology&#41;&#46; These results strongly suggest familial transmission of the same HCV strain&#46;</p><p id="p0010" class="elsevierStylePara elsevierViewall">In this issue <span class="elsevierStyleBold">L&#243;pez-Colombo&#44; <span class="elsevierStyleItalic">et al&#46;</span></span>determined the prevalence of HCV infection in patients and family members attending two primary care clinics&#46; The investigators studied 10&#44;214 subjects&#46; They found 120 &#40;1&#46;17&#37;&#41; anti-HCV positive&#46; Of the positive subjects&#44; the HCV RNA was determined in 114 subjects and 36 were positive &#40;31&#37;&#41;&#46; The more frequent risk factors were having a family history of cirrhosis &#40;33&#46;1&#37;&#41; and having a blood transfusion prior to 1995 &#40;29&#37;&#41;&#46; The HCV genotypes found were 1a &#40;29&#37;&#41;&#44; 1b &#40;48&#46;5&#37;&#41;&#44; 2&#47;2b &#40;12&#46;8&#37;&#41;&#44; and 3a &#40;6&#46;5&#37;&#41;&#46; Also&#44; the researches found an overall prevalence of antibody to HCV among household members of infected cases of 6&#46;7&#37;&#44; with a significantly higher prevalence among sexual partners &#40;35&#46;7&#37;&#41; than non-sexual partners &#40;7&#37;&#41;&#46;</p><p id="p0015" class="elsevierStylePara elsevierViewall">This is one of the first studies carried out in Mexico on HCV infection in patients and family members&#46; The sample size of the study as well as the design are good&#46; However&#44; the present study was carried out in one state in an urban area in two Clinics&#46; It would be interesting to know the characteristics of both clinics as well as the medical attention provided and more information on the social and demographic characteristics of the population studied&#46;</p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0010">The role of <span class="elsevierStyleItalic">Interleukin 28B</span> gene polymorphism in Turkish patients with hepatocellular carcinoma</span><p id="p0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Akkiz&#44; <span class="elsevierStyleItalic">et al&#46;</span></span>It has been reported that genetic polymorphisms near the <span class="elsevierStyleItalic">interleukin-28B</span> &#40;IL28B&#41; gene might strongly associated with spontaneous and treatment-induced clearance of HCV&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Also IL28B has been associated with a poor treatment response rs12979860 T allele in patients with HCV infection and the liver fibrosis progression rate and the development of HCC&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="p0025" class="elsevierStylePara elsevierViewall">In this issue <span class="elsevierStyleBold">Akkiz&#44; <span class="elsevierStyleItalic">et al&#46;</span></span>investigated whether the rs12979860 polymorphism of IL28B gene affects the risk of HCC&#46; Those investigators carried out a case-control study of 187 confirmed HCC patients and 208 healthy subjects &#40;cancer and viral infection negative&#41; and they found that the allele and genotype analysis showed no significant differences between the risk of HCC and IL28B gene rs12979860 polymorphism &#40;OR &#61; 1&#46;10&#59; 95&#37; 0&#46;59-2&#46;08 P &#61; 0&#46;76 for genotype&#41;&#46; However&#44; in the HBV-related HCC subgroup&#44; the TT genotype increased a 1&#46;46-fold the risk of developing HCC&#44; but not statistically significant &#40;OR &#61; 1&#46;46&#59; 95&#37; 0&#46;71-2&#46;97 P &#61; 0&#46;30&#41;&#46; The authors concluded that there is not significant association between IL28B rs12979860 genotypes with the risk of developing HCC in Turkish patients&#46;</p><p id="p0030" class="elsevierStylePara elsevierViewall">Two important criticisms on this study are the sample size and the main clinical characteristics of the patients are missing&#46; In fact&#44; the sample size is not good enough to find some differences and interestingly the HCV genotypes were not included&#46; However&#44; it added a little of information on this hot topic that but need to confirm in future studies in different populations&#46;</p><p id="p0035" class="elsevierStylePara elsevierViewall">One study from Italy by Fabris&#44; <span class="elsevierStyleItalic">et al</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> those investigators studied 412 patients with cirrhosis due to hepatitis C &#40;n &#61; 199&#41;&#44; hepatitis B &#40;n &#61; 75&#41;&#44; alcohol &#40;n &#61; 110&#41;&#44; and other causes &#40;n &#61; 28&#41;&#44; of whom 256 underwent liver transplantation &#40;OLT&#41;&#46; HCC was demonstrated in the native liver of 85 OLT patients&#44; 52 with viral cirrhosis&#44; and 33 with non-viral cirrhosis respectively&#46; A group of 292 patients &#40;235 HCV and 57 HBV positive&#41; with mild chronic hepatitis and 344 healthy subjects served as controls&#46; The investigators found a significant difference &#40;p &#61; 0&#46;0005&#41; was observed in IL-28B rs12979860 genotype frequencies between patients with viral cirrhosis &#40;C&#47;C &#61; 99&#44; C&#47;T &#61; 137&#44; T&#47;T &#61; 38&#41; and those with non-viral cirrhosis &#40;C&#47;C &#61; 72&#44; C&#47;T &#61; 58&#44; T&#47;T &#61; 8&#41;&#46; Patients with HCV related cirrhosis carried more frequently the T&#47;T genotype in comparison to mild hepatitis C or HBV-related cirrhosis&#46;</p><p id="p0040" class="elsevierStylePara elsevierViewall">In more recent study Bochud&#44; <span class="elsevierStyleItalic">et al</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> analyzed the association of IL28B polymorphisms with histological and follow-up features in 2335 chronically HCV-infected Caucasian patients&#46; Assessable phenotypes before any antiviral treatment included necroinflammatory activity &#40;n &#61; 1&#44;098&#41;&#44; fibrosis &#40;n &#61; 1&#44;527&#41;&#44; fibrosis progression rate &#40;n &#61; 1&#44;312&#41;&#44; and HCC development &#40;n &#61; 1&#44;915&#41;&#46; The rare G allele at IL28B marker rs8099917 previously shown to be at risk of treatment failure was associated with lower activity &#40;P &#61; 0&#46;04&#41;&#44; lower fibrosis &#40;P &#61; 0&#46;02&#41; with a trend toward lower fibrosis progression rate &#40;P &#61; 0&#46;06&#41;&#46; When stratified according to HCV genotype&#44; most significant associations were observed in patients infected with non-1 genotypes &#40;P &#61; 0&#46;003 for activity&#44; P &#61; 0&#46;001 for fibrosis&#44; and P &#61; 0&#46;02 for fibrosis progression rate&#41;&#44; where the odds ratio of having necroinflammation or rapid fibrosis progression for patients with IL28B genotypes TG or GG <span class="elsevierStyleItalic">vs&#46;</span> TT were 0&#46;48 &#40;95&#37; confidence intervals 0&#46;30-0&#46;78&#41; and 0&#46;56 &#40;0&#46;35-0&#46;92&#41;&#44; respectively&#46; IL28B polymorphisms were not predictive of the development of HCC&#46; Based on their results the investigators concluded that there is not association between IL28B polymorphisms and the occurrence of HCC among chronically HCV-infected patients&#44; but the number of patients with HCC was likely insufficient to detect a significant effect&#44; especially as the majority of patients with HCC were infected with HCV genotype 1 independent investigations are required to clarify the possible role of IL28B gene rs12979860 polymorphism on the risk of developing HCC in a larger series and also in patients of different ethnic origins&#46;</p></span></span>"
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Article information
ISSN: 16652681
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos