Introduction: Data on the prevalence of HCV infection in Italy are not updated and generated by surveys performed in little towns. The current availability of drugs effective in curing HCV infection makes useful the acquisition of up-to date epidemiological findings.

a Dept. of Clinical and Molecular Medicine, Sapienza University of Rome, S. Andrea University Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy b Dept. of Digestive and Liver Disease, Sapienza University of Rome, S. Andrea University Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy c Dept. of Infectious and Tropical Diseases, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy

BACKGROUND:Hepatitis B virus (HBV) reactivation in patients positive for antibody to HB core antigen (anti-HBc), negative for HB surface antigen (HBsAg) and HBV-DNA (potential occult HBV carriers), treated with anti-tumor necrosis factor (TNF)α, is a debated question. The aim of the study was to evaluate the safety of anti-TNFα therapy in anti-HBc positive/HBsAg negative subjects with rheumatoid arthritis (RA) and spondyloarthropathy (SpA).METHODS:All consecutive HBsAg negative RA and SpA outpatients referring to the Immuno-Rheumatology Institute at the S. Andrea hospital, Sapienza, University of Rome who had to undergo anti-TNFα therapy.RESULTS:Among the 169 enrolled subjects, 20 (12%) were potential occult HBV carriers (anti-HBc positive, HBsAg and HBV-DNA negative patients with or without anti-HBs). During the follow-up (mean ± SD 45 ± 22 months), aminotransferases and HBV-DNA, tested every two and six months respectively, did not change.CONCLUSION:This study confirms the substantial safety of anti-TNFα therapy in potential occult HBV carriers RA and SpA patients.

Background and aim: Digestive symptoms are common side effects of antiviral therapy in patients with HCV chronic hepatitis (CH). The occurrence of digestive symptoms significantly impairs quality of life and requires reduction or even suspension of the therapy in up to 15% of the cases. Recent advances in pathophisiology of functional dyspepsia indicate that delay of gastric emptying time (GET) likely depending on altered Cholecystokinin (CCK) and Motilin serum levels is implicated in the onset of symptoms. In this study we evaluated digestive symptoms, GET and CCK and motilin fasting and post-prandial serum levels in patients with HCV-related CH before, during and after standard antiviral therapy. Material and methods: Twenty-eight patients (M/F 11/17 male, age range 28-70 yrs) with histologically proven HCV-related CH and absence of digestive diseases were enrolled in the study. Baseline, during the therapy (3th month) and after a month by the end of therapy patients underwent: an oriented questionnaire evaluating digestive symptoms. 13C-octanoate breath test (13C-OBT) was performed to evaluate GET. Fasting and post-prandial CCK and Motilin serum levels were assessed ELISA. Antiviral therapy was performed according to standard protocols. Results: Baseline none of the patients complained of significant digestive symptoms. GET was normal (t/2 <120 min) in all cases but 3/28 (2%). Baseline and post-prandial CCK and Motilin levels were 0.6±0.4 and 1.57±0.5 and 5.9±5.2 and 1.7±0.9, respectively. At three-month therapy, epigastric burning, belching, epigastric pain, post-prandial fullness, early satiety, bloating, nausea and vomiting were reported by 31%, 57%, 7%, 60%, 57%, 53%, 46% and 14%, respectively. GET rate was significantly delayed in all cases (p <0.0001). CCK fasting and post-prandial serum levels significantly increased (p<0.0001) while Motilin decreased in respect to baseline values (p<0.003). Interestingly, there was a direct significant relation between GI symptom score, GET and CCK and Motilin serum level (p<0.05). After 1 month by the end of therapy, all patients were symptom-free and GET as well as CCK and Motilin serum levels returned to baseline values. Conclusions: Digestive symptoms caused by HCV-antiviral therapy depend on the delay of GET as well as deregulation of CCK/Motilin homeostasis.

PURPOSE:Universal anti-hepatitis B vaccination of infants and of 12-year-old children became mandatory in Italy in 1991. The purpose of this study was to evaluate the persistence of anti-hepatitis B surface (HBs) antibodies several years after a primary course of vaccination.METHODS:In 2010, anti-HBs titers were measured in all subjects aged between 5 and 25 years residing in a southern Italian town. Individuals with an anti-hepatitis B antibody concentration of 10 IU/ml or more were considered to be protected.RESULTS:Of the 671 subjects evaluated, 149 (30%) lacked protective antibodies. Fifty-three (29.4%) of the subjects had been vaccinated ≤10 years earlier and 96 (30.3%) more than 10 years earlier (P = not significant). Subjects vaccinated in infancy were more likely to lack protective anti-HBs antibodies than subjects vaccinated at 12 years of age, regardless of the years elapsed since immunization.CONCLUSIONS:Most subjects maintained protective antibodies for a considerable number of years after vaccination. Vaccination in adolescence results in more prolonged immunogenicity than vaccination in infancy.

BACKGROUND:Treatment choice for chronic HBV infection is a continuously evolving issue, with a wide range of options. We aimed to evaluate the current practice of HBV therapies in the real world in Southern Italy. METHODS:A prospective study enrolling over a six month period (February-July 2010) all consecutive HBsAg positive subjects, never previously treated, referred to 16 liver units in two Southern Italy regions (Calabria and Sicily). RESULTS:Out of 247 subjects evaluated, 116 (46.9%) had HBV-DNA undetectable or lower than 2000 UI/ml. There were 108 (43.7%) inactive carriers, 103 (41.7%) chronic hepatitis, and 36 (14.6%) liver cirrhosis. Antiviral treatment was planned in 94 (38.0%) patients (26 cases with Interferon or Pegylated Interferon and 68 with nucleos(t)ides analogues). As many as 49.5% of subjects with chronic hepatitis did not receive antiviral treatment. DISCUSSION:The majority of chronic HBsAg carrier referring centres for evaluation were not considered suitable for antiviral treatment. Nucleos(t)ides analogues are the preferred first choice for therapy. A long-lasting period of observation may be needed to make appropriate therapeutic decisions in several cases.

There is a lack of updated nationwide records regarding hepatitis C virus (HCV) infection among drug addicts in Italy. The prevalence and characteristics of HCV infection in a national sample of drug addicts in Italy were determined. Five hundred forty‐three drug addicts (mean age 35.3 years, 85.1% males), selected from 25 Italian Centers for Substance Dependence were enrolled to be evaluated for anti‐HCV, HCV‐RNA, HCV genotype, HBV markers, anti‐HDV, and anti‐HIV during the period of April–November 2009. Anti‐HCV prevalence was 63.9%. HCV‐RNA was detected in 68.3% of patients positive for anti‐HCV. Genotypes 1 and 3 prevailed (49.3% and 39.7%, respectively). However, 9.3% of the subjects had genotype 4, a rate over threefold higher than the one observed in 1996 among drug addicts in central Italy. Needle sharing was the strongest independent predictor of the likelihood to contract an HCV infection (OR 8.9; 95% CI: 5.0–16.0). Only 19.3% of subjects received antiviral treatment for HCV. The prevalence of HBsAg and HIV positivity was 2.8% and 3.1%, respectively. The pattern of HBV markers showed that nearly one‐third of subjects had been vaccinated, while 42.3% were negative for any marker of HCV. The prevalence of HCV infection is high among drug addicts in Italy. The incidence of Genotype 4 is increasing and this may lead to the spreading of the disease to the general population in the near future. Efforts should be made to improve the rate of antiviral treatment for drug addicts with HCV infection and vaccination against hepatitis B. J. Med. Virol. 84:1608–1612, 2012. © 2012 Wiley Periodicals, Inc.

Background and Aims:In patients with chronic hepatitis C, therapy is considered effective when the sustained virological response (SVR) (undetectable HCV-RNA in serum 6 months after the end of therapy) is achieved.Although the persistence of HCV eradication in short or medium-term period (3-5 years) is well-established, little is known about the long-term follow-up.The aim of the study was to evaluate the long-term persistence of HCV eradication in patients with chronic hepatitis C (CHC) who obtained SVR.In particular, we wanted to assess the risk of longterm virological relapse and liver related-complications.Methods: From January 1989 to April 2008, 150 consecutive subjects (M/F 100/50, median age 47.69 years, range 22-67) with CHC and SVR after interferon-based therapy, were enrolled in a long-term clinical follow-up study.137 patients had pre-treatment diagnosis of CHC and 13 patients had cirrhosis.All patients received interferon-based therapy (66 with conventional IFN-monotherapy, 25 with conventional IFN and ribavirin, and 59 with pegylated IFN and ribavirin).The patients were followed with clinical, biochemical, virological and ultrasonographic assessments every 6 months until the 3 th year of follow-up and than every 12 months.HCV-RNA assessment in serum was determined by quantitative RT-PCR (cut-off <50 UI/ml).Results: The median follow-up was 8.6 years (range:2-19.8years).Serum HCV-RNA remained undetectable in all patients, indicating no risk of HCV recurrence independently from the schedule of therapy used.During the observation period 3 liver-related complications (2 HCC, 1 bleeding) were observed.The incidence rate of complication was 0.23%/person/year.All 3 of the events occurred in patients with pre-treatment cirrhosis.Only 1 out of 150 patients deceased for liver-related causes (HCC) with a mortality rate of 0.08%/person/year.Conclusions: In this large cohort of CHC patients with SVR, the eradication of the virus lasted up to 20 years after treatment.Overall, patients with CHC and SVR show an excellent prognosis with no risk of viral recurrence and a very low rate of mortality, so they can be considered healed.Patients with pre-treatment evidence of cirrhosis show a rate of liver complications that cannot be neglected.

Background and aim: In patients with chronic hepatitis C, therapy is considered effective when the sustained virological response (SVR) is achieved. SVR is defined as HCV-RNA negativity in serum 6 months after the end of therapy. Although the persistence of HCV eradication in short or medium-term period (3-5 years) is wellestablished, data about the long-term follow-up are still uncertain. The aim of the study was to evaluate the long-term persistence of HCV eradication in patients with chronic hepatitis C (CHC) who obtained SVR. In particular, we wanted to assess the risk of long-term virological relapse and liver related-complications. Material and methods: From January 1989 to Aprill 2008, 150 consecutive subjects (M/F 100/50, median age 47.69 years, range 22-67) with CHC and SVR after interferon-based therapy, were enrolled in a long-term follow-up study. 137 patients had pre-treatment diagnosis of CHC and 13 patients had cirrhosis. All of the patients received interferon-based therapy, with or without Ribavirin (66 with conventional IFN-monotherapy, 25 with conventional IFN and ribavirin, and 59 with pegylated IFN and ribavirin).The patients were followed with clinical, biochemical, virological and ultrasonographic assessments every 6 months until the 3th year of follow-up and than every 12 months. HCV-RNA assessment in serum was determined by quantitative RT-PCR. Results: The median follow-up was 8.6 years (range: 2-19.8 years). Serum HCV-RNA remained undetectable in all patients, indicating no risk of HCV recurrence, independently from the schedule of therapy used.During the observation period 3 liver-related complications (2 HCC, 1 variceal bleeding) were observed. The incidence rate of complications was 0.23%/person/year. All 3 of the events occurred in patients with pre-treatment cirrhosis. Only 1 out of 150 patients deceased for liver-related causes (HCC) with a mortality rate of 0.077%/person/year Conclusions: In this cohort of CHC patients with SVR, the eradication of the virus lasted up to 20 years after treatment. Thus, patients with CHC and SVR show an excellent prognosis with no risk of viral recurrence and a very low rate of mortality, meaning that they can be considered healed. Patients with pre-treatment evidence of cirrhosis show a rate of liver complications that cannot be neglected.

Hepatitis B virus (HBV) infection may run undetected. Unawareness of an ongoing infection delays the diagnosis of HBV-related liver disease and favours the spread of the virus. We have evaluated among hepatitis B surface antigen-positive (HBsAg) inpatients admitted to a Southern Italian hospital the proportion of those aware of their carrier status and correlated the status to signs of liver disease. All patients admitted to the San Giovanni Rotondo Hospital from March 2008 to July 2009 were tested for HBV and hepatitis C virus (HCV) markers, and those positive for HBsAg were interviewed and underwent examinations for liver function and abdominal ultrasound. Overall, of 25,000 patients admitted during the observation period 311 (1.2%) were positive for HBsAg, most of them (98%) being anti-HBe positive. HCV and HDV co-infections were ascertained in 2.9% and 0.6% of cases, respectively. Two hundred and fifty-three subjects (81%) agreed to undergo further investigation, 132 of them (52%) were HBV-DNA positive. One hundred and two patients (40.3%) were unaware of their infection; this was encountered among 29% of HBV-DNA-positive and 52% of HBV-DNA-negative subjects (P < 0.01). Subjects already aware of their infection were more likely to present with abnormal alanine aminotransferase (ALT) levels (27%vs 15%), serological presence of HBV-DNA (63.6% vs. 36%) and liver cirrhosis (30%vs. 13%). A high proportion of HBsAg-positive patients (40.3%) were unaware of their infection, which had evolved to the stage of liver cirrhosis in a consistent percentage of them.

carriers showed that 2 SNPs on chromosome 7 might be associated with HCC (P = 6.4-8.7×10 - ).In the HBV vs. HCV association analysis, there were no SNPs reached genome-wide level of significance after Bonferroni correction (P < 7.96×10 -8 (0.05/628,481), however, strong associations were observed in a 50 kb region including a gene (P = 3.6×10 -7 for marker #1, P = 5.8×10 -7 for marker #2 and P = 5.3×10 -6 for marker #3).Conclusions: Our data indicate that genetic variants in the HLA-DP locus are significantly associated with risk of persistent HBV infection.

with Rivastigmine to efficacy is unclear.We need a larger randomized controlled study to establish the results.