Hepatitis C virus infection in Argentina: Burden of chronic disease

AIM: To estimate the progression of the hepatitis C virus (HCV) epidemic and measure the burden of HCVrelated morbidity and mortality. METHODS: Age- and gender-defined cohorts were used to follow the viremic population in Argentina and estimate HCV incidence, prevalence, hepatic complications, and mortality. The relative impact of two scenarios on HCV-related outcomes was assessed: (1) increased sustained virologic response (SVR); and (2) increased SVR and treatment. RESULTS: Under scenario 1, SVR raised to 85%-95% in 2016. Compared to the base case scenario, there was a 0.3% reduction in prevalent cases and liverrelated deaths by 2030. Given low treatment rates, cases of hepatocellular carcinoma and decompensated cirrhosis decreased < 1%, in contrast to the base case in 2030. Under scenario 2, the same increases in SVR were modeled, with gradual increases in the annual diagnosed and treated populations. This scenario decreased prevalent infections 45%, liver-related deaths 55%, liver cancer cases 60%, and decompensated cirrhosis 55%, as compared to the base case by 2030. CONCLUSION: In Argentina, cases of end stage liver disease and liver-related deaths due to HCV are still growing, while its prevalence is decreasing. Increasing in SVR rates is not enough, and increasing in the number of patients diagnosed and candidates for treatment is needed to reduce the HCV disease burden. Based on this scenario, strategies to increase diagnosis and treatment uptake must be developed to reduce HCV burden in Argentina.Fil: Ridruejo, Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Austral. Hospital Universitario Austral.; Argentina. Centro de Educaciones Médicas e Investigación Clínica "Norberto Quirno"; ArgentinaFil: Bessone, Fernando. Universidad Nacional de Rosario; ArgentinaFil: Daruich, Jorge R.. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Estes, Chris. Center For Disease Analysis; Estados UnidosFil: Gadano, Adrián Carlos. Hospital Italiano; ArgentinaFil: Razavi, Homie. Center For Disease Analysis; Estados UnidosFil: Villamil, Federico. Hospital Británico de Buenos Aires; ArgentinaFil: Silva, Marcelo Oscar. Universidad Austral. Hospital Universitario Austral.; Argentin

Pre-treatment prediction of response to peginterferon plus ribavirin in chronic hepatitis C genotype 3

AIM: To evaluate pre-treatment factors associated with sustained virological response (SVR) in patients with hepatitis C virus (HCV) genotype 3 treated with peginterferon and ribavirin (RBV). METHODS: We retrospectively analyzed treatment naive, mono-infected HCV genotype 3 patients treated with peginterferon and RBV. Exclusion criteria included presence of other liver disease, alcohol consumption and African American or Asian ethnicity. The variables collected and compared between patients who achieved an SVR and patients who did not were as follows: gender, age, fibrosis stage, diabetes, body mass index, steatosis, INFL3 polymorphism, pre-treatment HCV-RNA, type of peginterferon, RBV dose and adherence. RESULTS: A total of 107 patients treated between June, 2004 and March, 2013 were included. Mean treatment duration was 25.1 (± 1.8) wk. Overall, 58% (62/107) of the patients achieved an SVR and 42% (45/107) did not. In the multivariate logistic regression analysis, pre-treatment HCV-RNA ≥ 600000 UI/mL (OR = 0.375, 95%CI: 0.153-0.919, P = 0.032) and advanced fibrosis (OR = 0.278, 95%CI: 0.113-0.684, P = 0.005) were significantly associated with low SVR rates. In patients with pre-treatment HCV-RNA ≥ 600000 UI/mL and advanced fibrosis, the probability of achieving an SVR was 29% (95%CI: 13.1-45.2). In patients with pre-treatment HCV-RNA < 600000 UI/mL and mild to moderate fibrosis, the probability of achieving an SVR was 81% (95%CI: 68.8-93.4). CONCLUSION: In patients with HCV genotype 3 infections the presence of advance fibrosis and high pre-treatment viral load might be associated with poor response to peginterferon plus RBV. These patients could benefit the most from new direct antiviral agents-based regimes.Fil: Marciano, Sebastián. Hospital Italiano; ArgentinaFil: Borzi, Silvia Mabel. Gobierno de la Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal General de Agudos "prof. Dr. Rodolfo Rossi".; ArgentinaFil: Dirchwolf, Melisa. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: Ridruejo, Ezequiel. Universidad Austral. Hospital Universitario Austral; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; ArgentinaFil: Mendizabal, Manuel. Universidad Austral. Hospital Universitario Austral; ArgentinaFil: Bessone, Fernando. Sanatorio del Parque. Unidad de Hepatología; ArgentinaFil: Sirotinsky, María Ester. Hepatosur group; ArgentinaFil: Giunta, Diego Hernan. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Hospital Italiano; ArgentinaFil: Trinks, Julieta. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Hospital Italiano; ArgentinaFil: Olivera Sendra, Pablo Andrés. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; ArgentinaFil: Galdame, Omar Andres. Hospital Italiano; ArgentinaFil: Silva, Marcelo Oscar. Universidad Austral. Hospital Universitario Austral; Argentina. Hospital Italiano; ArgentinaFil: Fainboim, Hugo. Gobierno de la Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal General de Agudos "prof. Dr. Rodolfo Rossi".; ArgentinaFil: Gadano, Adrián Carlos. Hospital Italiano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Prospective Latin American cohort evaluating outcomes of patients with COVID-19 and abnormal liver tests on admission

Introduction & objectives: The independent effect of liver biochemistries as a prognostic factor in patients with COVID-19 has not been completely addressed. We aimed to evaluate the prognostic value of abnormal liver tests on admission of hospitalized patients with COVID-19. Materials & methods: We performed a prospective cohort study including 1611 hospitalized patients with confirmed SARS-CoV-2 infection from April 15, 2020 through July 31, 2020 in 38 different Hospitals from 11 Latin American countries. We registered clinical and laboratory parameters, including liver function tests, on admission and during hospitalization. All patients were followed until discharge or death. We fit multivariable logistic regression models, further post-estimation effect through margins and inverse probability weighting. Results: Overall, 57.8% of the patients were male with a mean age of 52.3 years, 8.5% had chronic liver disease and 3.4% had cirrhosis. Abnormal liver tests on admission were present on 45.2% (CI 42.7–47.7) of the cohort (n = 726). Overall, 15.1% (CI 13.4–16.9) of patients died (n = 244). Patients with abnormal liver tests on admission presented higher mortality 18.7% (CI 15.9–21.7), compared to those with normal liver biochemistries 12.2% (CI 10.1–14.6); P 30. Conclusions: The presence of abnormal liver tests on admission is independently associated with mortality and severe COVID-19 in hospitalized patients with COVID-19 infection and may be used as surrogate marker of inflammation.Fil: Mendizabal, Manuel. Universidad Austral. Hospital Universitario Austral; ArgentinaFil: Piñero, Federico. Universidad Austral. Hospital Universitario Austral; ArgentinaFil: Ridruejo, Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; ArgentinaFil: Anders, Margarita. Hospital Aleman; ArgentinaFil: Silveyra, María Dolores. Sanatorio Anchorena; ArgentinaFil: Torre, Aldo. Centro Médico ABC; MéxicoFil: Montes, Pedro. Hospital Nacional Daniel A. Carrión; PerúFil: Urzúa, Alvaro. Hospital Clínico de la Universidad de Chile; ChileFil: Pages, Josefina. Universidad Austral. Hospital Universitario Austral; ArgentinaFil: Toro, Luis G.. Hospitales de San Vicente Fundación de Medellín y Rionegro; ColombiaFil: Díaz, Javier. Hospital Nacional Edgardo Rebagliati Martins; PerúFil: Gonzalez Ballerga, Esteban. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Miranda Zazueta, Godolfino. Instituto Nacional de Ciencias Médicas y Nutrición; MéxicoFil: Peralta, Mirta. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: Gutiérrez, Isabel. Centro Médico ABC; MéxicoFil: Michelato, Douglas. Hospital Especializado en Enfermedades Infecciosas Instituto Couto Maia; BrasilFil: Venturelli, Maria Grazia. Hospital Nacional Guillermo Almenara Irigoyen; PerúFil: Varón, Adriana. Fundación Cardio-Infantil; ColombiaFil: Vera Pozo, Emilia. Hospital Regional Dr. Teodoro Maldonado Carbo; EcuadorFil: Tagle, Martín. Clínica Anglo-Americana; PerúFil: García, Matías. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; ArgentinaFil: Tassara, Alfredo. Hospital Aleman; ArgentinaFil: Brutti, Julia. Sanatorio Anchorena; ArgentinaFil: Ruiz García, Sandro. Hospital de Víctor Lazarte Echegaray; PerúFil: Bustios, Carla. Clínica Delgado; PerúFil: Escajadillo, Nataly. Hospital Nacional Almanzor Aguinaga Asenjo; PerúFil: Macias, Yuridia. No especifíca;Fil: Higuera de la Tijera, Fátima. Hospital General de México “Dr. Eduardo Liceaga"; MéxicoFil: Gómez, Andrés J.. Hospital Universitario Fundación Santa Fé de Bogotá; ColombiaFil: Dominguez, Alejandra. Hospital Padre Hurtado; ChileFil: Castillo Barradas, Mauricio. Hospital de Especialidades del Centro Médico Nacional La Raza; MéxicoFil: Contreras, Fernando. No especifíca;Fil: Scarpin, Aldana. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; ArgentinaFil: Schinoni, Maria Isabel. Hospital Alianza; BrasilFil: Toledo, Claudio. Universidad Austral de Chile; ChileFil: Girala, Marcos. Universidad Nacional de Asunción; ParaguayFil: Mainardi, Victoria. Hospital Central De las Fuerzas Armadas; UruguayFil: Sanchez, Abel. Hospital Roosevelt; GuatemalaFil: Bessone, Fernando. Provincia de Santa Fe. Ministerio de Salud y Medio Ambiente - Rosario. Hospital Provincial del Centenario; ArgentinaFil: Rubinstein, Fernando Adrian. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Silva, Marcelo Oscar. Universidad Austral. Hospital Universitario Austral; Argentin

Perfiles de eliminación de huevos y de géneros de nematodes gastrointestinales en vacas de cría del sudeste de Córdoba = Faecal nematode eggs shedding and genus profiles of gastrointestinal nematodes in cows herds in the southeast of Córdoba

El conocimiento actual sobre el parasitismo gastrointestinal de los bovinos adultos en la región templada de la Argentina indica que la eliminación de huevos de nematodes en heces de vacas es baja y dominada por el género Ostertagia. La intensificación de los sistemas de cría de la región pampeana hace necesario actualizar el perfil epidemiológico de la helmintiasis. El objetivo del estudio fue caracterizar las dinámicas de los huevos de nematodes por gramo de heces y géneros parasitarios mediante coprocultivos en vacas durante la parición-lactancia. Desde el otoño al verano de 2009 y 2010, se estudiaron cuatro grupos (2009: I-II; 2010: III-IV) de 30-35 vacas Braford (6-9 años de edad) con parición en julio-octubre, pertenecientes a cuatro rodeos de Noetinger (Pcia. Córdoba. Argentina). Los animales pastorearon alfalfas en abril y desde octubre a diciembre; en tanto que, desde mayo hasta setiembre consumieron verdeos de invierno y una ración de silo de sorgo. Mensualmente se determinó: hpg, géneros helmínticos en coprocultivo y condición corporal (escala 1-9). Los niveles del logaritmo de hpg y su correlación entre muestreos fueron analizados por un modelo lineal mixto (LSD, Fischer 5%). Los promedios iniciales de hpg fueron inferiores a 50 (negativos: 26-43%; 10-50: 34-54%; 60-100: 11-16%;110-200: 3-9%; > 200: 0-10%) y se incrementaron en julio de 2009 (I: 67 ± 11; II: 184 ± 50) y agosto de 2010 (III: 91 ± 22; IV: 88 ± 31) Los hpg de julio (I, II), agosto (III) y setiembre (I) fueron estadísticamente diferentes (p<0,05). La correlación para hpg consecutivos fue: 0,65 (I), 0,69 (II), 0,59 (III) y 0,65 (IV). Ostertagia spp. fue el género más prevalente (I: 42-59%; II: 23-44%; III: 14-56%; IV: 15-47%), sin tendencia de presentación estacional. Entre mayo y julio, Haemonchus spp. tuvo altas contribuciones en los grupos I (24-36%) y IV (12-41%) y Cooperia spp. en II (27-46%) y III (22-46%). Oesophagostomum spp. tuvo alta participación entre setiembre y diciembre: 10-29% (I), 11-45% (II), 7-19% (III) and 14-37% (IV). Una severa pérdida de la condición corporal ocurrió desde mayo (I: 6,9 ± 0,5 ;II: 6,8 ± 0,5; III: 5,7 ± 0,7; IV: 6,0 ± 0,7) hasta octubre (I: 5,7 ± 1,1; II: 3,6 ± 0,7; III: 4,4 ± 0,8; IV: 4,1 ± 0,5). La variación de los hpg y la presencia de diversos géneros fueron las comprobaciones más importantes del estudio. La elevada participación de los géneros Haemonchus spp. y Cooperia spp. sugiere que la respuesta inmune podría estar afectada. Puede considerarse que bajo ciertas condiciones de manejo, los hpg de las vacas se incrementen a niveles que podrían modificar la infectividad de las pasturas, principalmente en aquellos sistemas que han elevado la carga animal.The current knowledge on gastrointestinal parasitism of adult cattle of the Argentinean template regions indicates that faecal nematodes eggs shedding of cows is low, being dominated by the Ostertagia genus. The increasing intensification of beef cow systems in the Pampas region require an update of their parasite epidemiological pattern. The objective of this study was to characterize the fecal worm eggs per gram (epg) and helminth genus dynamics throughout coprocultures of cows during the pregnancy and lactation periods. From autumn to summer of 2009 and 2010, four groups (2009: I-II; 2010: III-IV) of 30-35 Braford cows (6-9 years old) calving in July-October and belonging to four herds of Noetinger (Córdoba Province, Argentina) were studied. The animals grazed on lucerne grass in April and from October to December, while from May to September the cows were on winter annual grass and a ration based on sorghum silage was daily supplied through this grazing period. At monthly intervals the epg, helminth genus and body condition (scale 1-9) were determined. The epg logarithm levels and their correlation between sampling was analyzed by a mixed lineal model (LSD, Fischer 5%). The initial epg means were bellow 50 (negative: 26-43%; 10-50: 34-54%; 60-100: 11-16%; 110-200: 3-9%; > 200: 0-10%) and increased by July 2009 (I: 67 ± 11; II: 184 ± 50) and August 2010 (III: 91 ± 22; IV: 88 ± 31). The July (I, II), August (III) and September (I) values of epg were statistical different (p<0,05). The correlation for consecutive epg were: 0,65 (I), 0,69 (II), 0,59 (III) y 0,65 (IV). Ostertagia spp. was the most prevalent genus (I: 42-59%; II: 23-44%; III: 14-56%; IV: 15-47%), without seasonal tendency of occurrence. Haemonchus spp. had high from May to July in the faeces of groups I (24-36%) and IV (12-41%) and Cooperia spp. in II (27-46%) and III (22-46%). A genus with elevated participation between September and December was Oesophagostomum spp: 10-29% (I), 11-45% (II), 7-19% (III) and 14-37% (IV). From May (I: 6,9 ± 0,5 ;II: 6,8 ± 0,5; III: 5,7 ± 0,7; IV: 6,0 ± 0,7) to October (I: 5,7 ± 1,1; II: 3,6 ± 0,7; III: 4,4 ± 0,8; IV: 4,1 ± 0,5) a severe waste in the body condition was observed. The variation of epg levels and multigeneric participation were the most important observations of this study. The increased presence of Haemonchus spp. and Cooperia spp. suggests that the immune response of cows might been affected. It could be considered that under certain management conditions the cows´ epg increase to a levels which could modify the infectivity of grazing pastures, mainly in those farms where the stocking rates have been increasedEEA Marcos JuárezFil: Descarga, Carlos Oscar. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Marcos Juárez; ArgentinaFil: Bessone, Fernando Aní­bal. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Marcos Juárez; ArgentinaFil: Ducommun, María De La Luz. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Marcos Juárez; ArgentinaFil: Masiero, Beatriz. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Marcos Juárez; ArgentinaFil: Gallardo, A. Actividad Privada; Argentin

Identification of novel recombinants of hepatitis B virus genotypes F and G in human immunodeficiency virus-positive patients from Argentina and Brazil

Made available in DSpace on 2015-09-21T17:25:15Z (GMT). No. of bitstreams: 2 license.txt: 1914 bytes, checksum: 7d48279ffeed55da8dfe2f8e81f3b81f (MD5) natalia_araujo_etal_IOC_2013.pdf: 902148 bytes, checksum: 0b088cd811d56ef6881aec7974d6abec (MD5) Previous issue date: 2013Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Departamento de Virologia Molecular. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Departamento de Virologia Molecular. Rio de Janeiro, RJ, Brasil.Centre de Recherche en Cancérologie de Lyon – INSERM U 1052/CNRS UMR 5286. Lyon, France.Universidade Federal do Rio de Janeiro. Hospital Universitário Clementino Fraga Filho. Divisão de Hepatologia. Rio de Janeiro, RJ, Brasil.Universidade Federal do Rio de Janeiro. Hospital Universitário Clementino Fraga Filho. Divisão de Hepatologia. Rio de Janeiro, RJ, Brasil.Universidade Federal da Bahia. Hospital Universitário Prof. Edgard Santos. Departamento de Hepato-Gastroenterologia. Salvador, BA, Brasil.University of Rosario. School of Medicine. Department of Gastroenterology and Hepatology. Rosario, Argentina.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Departamento de Virologia Molecular. Rio de Janeiro, RJ, Brasil.Centre de Recherche en Cancérologie de Lyon – INSERM U 1052/CNRS UMR 5286. Lyon, France.Centre de Recherche en Cancérologie de Lyon – INSERM U 1052/CNRS UMR 5286. Lyon, France.Hepatitis B virus (HBV) genotype G (HBV/G) infection is almost always detected along with a coinfecting HBV strain that can supply HBeAg, typically HBV/A2. In this study we describe, in two human immunodeficiency virus (HIV)-positive patients from Argentina and Brazil, the first report of HBV/G infection in Argentina and co-circulation of HBV/G, HBV/F and G/F recombinants in the American continent. HBV isolates carrying the 36 bp insertion of HBV/G were the most prevalent in both patients, with .99% of colonies hybridizing to a probe specific for this insertion. Phylogenetic analyses of full-length genomes and precore/core fragments revealed that F4 and F1b were the co-infecting subgenotypes in the Brazilian and Argentinian patients, respectively. Bootscanning analysis provided evidence of recombination in several clones from both patients, with recombination breakpoints located mainly at the precore/core region. These data should encourage further investigations on the clinical implications of HBV/G recombinants in HBV/HIV co-infected patients

Natural history of hepatitis C virus infection in a cohort of asymptomatic post-transfused subjects

Background &amp; aims. Studies about the natural history of hepatitis C virus (HCV) infection report variable progression to cirrhosis depending on study design. Retrospective cross-sectional liver clinic studies overestimate the rate of fibrosis progression due to inclusion of patients with more severe disease leaving mild and asymptomatic patients underrepresented. We evaluated fibrosis progression in a group of “healthy” asymptomatic subjects, attending to a voluntary campaign for the detection of HCV infection.Material and methods. A detection campaign was launched on subjects transfused before 1993. Of 1699 volunteers, 61(3.6%) had HCV infection. A liver biopsy was performed in 40 (65%). Assessed risk factors for liver fibrosis were: sex, body mass index, alcohol consumption (> 20 g/d♀ - >40g/d♂), genotype, HLA-DRB1 alleles, present age, age at infection and duration of infection.Results. 25 (62.5%) were women with a median age of 52.5 years. The median duration of infection was 21.5 years with a median age at infection of 27 years. As regards fibrosis, 25 (62.5%) had a Low Stage (F0-F1), 8 patients, 20%, had severe fibrosis, one patient (2.5%) had cirrhosis. Alcohol consumption was the only risk factor associated with fibrosis progression.Conclusions. The low progression to cirrhosis may be explained by the clinical characteristics of ourpopulation: asymptomatic middle-aged “healthy” subjects infected at young age. The progression to severe fibrosis was noticeable; hence a longer follow-up might demonstrate changes in this outcome. Significant alcohol consumption clearly worsens the natural history of HCV infection; this is no so evident for occasional or mild alcohol consumers

Liver decompensation is a frequent cause of treatment discontinuation and prognostic factor in intermediate-advanced HCC

Introduction and Objectives: With the advent of new therapeutic options for patients with hepatocellular carcinoma (HCC) for intermediate or advanced stages of the Barcelona Clinic Liver Cancer (BCLC), regional real-world data regarding prognostic survival factors are of significant importance. Patients and Methods: A multicenter prospective cohort study was conducted in Latin America including BCLC B or C patients since 15th May 2018. We report here the second interim analysis focusing on prognostic variables and causes of treatment discontinuation. Cox proportional hazard survival analysis was performed, estimating hazard ratios (HR) and 95% confidence intervals (95% CI). Results: Overall, 390 patients were included, 55.1% and 44.9% were BCLC B and C at the time of study enrollment. Cirrhosis was present in 89.5% of the cohort. Among the BCLC-B group, 42.3% were treated with TACE with a median survival since the first session of 41.9 months. Liver decompensation before TACE was independently associated with increased mortality [HR 3.22 (CI 1.64;6.33); P<.001]. Systemic treatment was initiated in 48.2% of the cohort (n=188), with a median survival of 15.7 months. Of these, 48.9% presented first-line treatment discontinuation (44.4% tumor progression, 29.3% liver decompensation, 18.5% symptomatic deterioration, and 7.8% intolerance), and only 28.7% received second-line systemic treatments. Liver decompensation [HR 2.9 (1.64;5.29); P<.0001], and symptomatic progression [HR 3.9 (1.53;9.78); P=0.004] were independently associated with mortality after first-line systemic treatment discontinuation. Conclusions: The complexity of these patients, with one-third presenting liver decompensation after systemic therapies, underlines the need for multidisciplinary team management and the central role of hepatologists