Background: Before antiretroviral therapy (HAART) era studies have demonstrated the rate of liver fibrosis progression in HCV-HIV coinfected patients is faster than in patients infected only by HCV, but few studies had compared fibrosis progression rate in HCV-HIV coinfected patients on HAART.Aims: Compare the fibrosis progression rate in HCV-HIV coinfected patients on antiretroviral therapy with immune recovery with Hepatitis C monoinfected patients.Patients and Methods: Only patients with known time of HCV infection were enrolled.HBsAg positive patients and hepatitis C treatment before liver biopsy were excluded.All coinfected patients were on HAART at least two years.All patients were submitted to liver biopsy and METAVIR was used.To compare liver fibrosis progression rate the coinfected patients were matched with HCV monoinfected patients by gender, alcohol consumption, age at HCV infection (± 2 years) and estimated time of HCV infection (± 2 years).Results: 38 coinfected patients were enrolled and matched with 38 HCV only infected patients.30 patients were male in each group.The estimated time of HCV infection and age on HCV infection were 17.1±5.1 years vs. 17.6±5.2years (p = 0.66) and 22.2±7.7 years vs. 21.6±8.3 years (p = 0.75) in the monoinfected and coinfected patients, respectively.The CD4 cell count mean was 448±206 cells/mm 3 and the HIV viral load median was 760 copies/mm 3 .The mean of the liver fibrosis stages (1.5±1.2 versus.1.4±1.2;P = 0.47), periportal inflammatory activity (1.9±1.4 versus.1.8±1.2;P = 0.81), liver fibrosis progression rate (0.081 ± fibrosis unit/year vs. 0.071 ± fibrosis unit/year; P = 0.59) and proportion of liver cirrhosis was similar in coinfected and HCV monoinfected patients, respectively.Conclusions: Coinfected patients on antiretroviral therapy and immunologic recovery has liver progression rate similar to HCV monoinfected patients.

HCV infection is highly prevalent among kidney transplant (KT) recipients. The natural history and management of these patients are controversial. We sought to assess the diagnostic value of noninvasive markers of liver fibrosis in KT HCV-infected patients. This cross-sectional study included 102 KT individuals with positive HCV-RNA. Bivariate and multivariate analyses were used to identify variables associated with significant fibrosis (METAVIR >= F2). Significant fibrosis was observed in 20 patients (20%). Time after transplantation, AST level, and platelet count were identified as independent predictors of significant fibrosis. Based on the regression model, a simplified index was devised. The AUROC for the TX-3 model was 0.867 +/- 0.081 (0.909, when adjusted by DANA). Values < 4.0 of TX-3 showed a NPV of 97% and scores > 9.6 exhibited a PPV of 71%. If biopsy indication was restricted to scores in the intermediate range of TX-3, this could have been correctly avoided in 68% of cases. The APRI score provided a correct diagnosis in only 47 individuals (46%) and exhibited lower diagnostic indices for both cutoffs, as compared to the TX-3 index. Comparison of AUROCs showed a trend towards superior diagnostic accuracy for TX-3 over APRI, although the difference between AUROCs did not reach statistical significance (0.867 +/- 0.053 vs 0.762 +/- 0.066, respectively, P = 0.064). In conclusion, significant liver fibrosis can be reliably predicted in KT HCV-infected subjects by simple and widely available parameters. If additional studies confirm our results, this model might obviate the requirement for a liver biopsy in a significant proportion of those patients.

Objective. Hepatitis C is highly prevalent among kidney transplant (KT) recipients. In this population, the natural history of hepatitis C virus (HCV) infection and its proper management remains controversial. The invasiveness of the procedure and the interpretation variability of liver biopsy limit its use in these patients. We sought to evaluate the performance of YKL-40 and HA as markers of liver fibrosis in KT patients with HCV infection. Material and methods. This cross-sectional study included HCV infected KT individuals. Univariate analysis was used to identify variables associated with significant fibrosis (METAVIR >= F2). The diagnostic values of the YKL-40 and HA were compared using receiver operating characteristic (ROC) curves. Results. Eighty-five patients were included (60% males, mean age 44.9 +/- 9.4 years). Significant fibrosis was observed in 14 patients (17%). When compared to F0/F1 individuals, patients with significant fibrosis were older, showed a higher time since transplantation, and higher prevalence of diabetes. No difference was observed in YKL-40 levels between the groups. Significantly higher levels of HA were noted in METAVIR >= F2 subjects (108 vs. 37 ng/ml, p = 0.002). The AUROCs of YKL-40 and HA for predicting significant fibrosis were 0.615 and 0.765, respectively (p = 0.144). Levels of YKL-40 < 105 ng/ml and of HA < 27 ng/ml showed a NPV of 36% and 96%, respectively. YKL-40 >= 418 ng/ml and HA >= 120 ng/ml exhibited a PPV of 31% and 39%, respectively. Conclusions. Increased serum levels of HA but not of YKL-40 were associated with more advanced stages of liver fibrosis in KT HCV-infected patients.

Summary. Hepatitis C virus (HCV) infection is highly prevalent among end‐stage renal disease (ESRD) patients undergoing haemodialysis and it is an important cause of morbidity and mortality in this population. The aim of this study was to evaluate the diagnostic value of YKL‐40 and hyaluronic acid (HA) as noninvasive markers of liver fibrosis in 185 ESRD HCV‐infected patients. Significant liver fibrosis was defined as METAVIR F2, F3 or F4 stages. Significant fibrosis was observed in 45 patients (24%). By univariate analysis, higher levels of YKL‐40, HA, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma‐glutamyltransferase (GGT) as well as reduced platelet count were associated with fibrosis. However, by multivariate analysis, only AST ( P = 0.001), platelet count ( P = 0.004) and HA ( P = 0.042) were independently associated with significant fibrosis. For the prediction of significant fibrosis, the areas under receiver operating characterictic curve (AUROC) of the regression model (0.798) was significantly higher than the AUROC of YKL‐40 (0.607) and HA (0.650). No difference was noted between the AUROC of the regression model and AST to platelet ratio index (APRI) (0.787). Values <8.38 of the regression model showed a negative predictive value of 94% and scores ≥9.6 exhibited a positive predictive value of 65%. If biopsy indication was restricted to scores in the intermediate range of the regression model, it could have been correctly avoided in 61% of the cases. In conclusion, APRI and a model based on AST, platelet count and HA showed better accuracy than YKL‐40 and HA (when used solely) for the prediction of significant fibrosis in ESRD HCV‐infected patients.

We sought to assess clinical, epidemiological, biochemical, serological and histological characteristics of anti-hepatitis C virus (HCV)-positive female blood donors and compare them with men. As women are frequently the minority among blood donors, studies evaluating this population usually reflect characteristics of male gender. This retrospective study included 380 blood donors with confirmed positive anti-HCV. The mean age was 36.9 +/- 11.3 years and 33.2% were women. Compared with men, female donors showed higher prevalence of prior transfusion of blood products (P = 0.031) and lower prevalence of intravenous drug use (P = 0.001) and alcohol abuse (P < 0.001). Women exhibited lower medians of alanine aminotransferase (P < 0.001) and gamma-glutamyltransferase (P < 0.001). They also showed higher platelet count (P < 0.001) and prothrombin activity (P = 0.049), and a lower frequency of antibody against core antigen of hepatitis B virus (anti-HBc) positivity (P = 0.032). A higher proportion of spontaneous viral clearance (P = 0.001) and a lower frequency of viraemia (P < 0.001) were observed among women. On liver biopsy, women had lower prevalence of fibrosis stage > or = 2. Multivariate analysis identified age (OR = 1.050, 95% CI: 1.019-1.081, P = 0.001) and anti-HBc positivity (OR = 2.184, 95% CI: 1.010-4.722, P = 0.047) as independent predictors of significant fibrosis. Female blood donors presented higher prevalence of spontaneous viral clearance as well as biochemical and histological evidence of less advanced liver disease. These findings could be because of intrinsic characteristics of female gender or secondary to associated factors such as younger age or anti-HBc positivity.

RESISTANCE)S241 suggest HCV virus as critical in the pathogenesis of steatosis.The lack of resolution of steatosis in other genotypes suggest the potential for further liver damage in non G3 coinfected patients that achieved SVR.Further research to explore these complex relationships is needed.

See also: Methods of Disinfecting Endoscopic Material: Results of an International SurveyEndoscopy 1989; 21(06): 247-250DOI: 10.1055/s-2007-1012962