Successful treatment with telaprevir of post-transplant fibrosing cholestatic hepatitis C in an HIV co-infected patient

La recurrencia de la hepatitis C post-trasplante hepático es la principal causa de pérdida del injerto en los pacientes coinfectados con el virus de la inmunodeficiencia humana (HIV). Estos pacientes presentan un riesgo elevado de recurrencia de la hepatitis C en su forma más grave, hepatitis colestásica fibrosante. En la era previa a los antivirales de acción directa, el tratamiento de la misma era ineficaz, pudiendo rescatar una minoría de los pacientes afectados. Presentamos el caso de un paciente coinfectado que desarrolló una recurrencia de hepatitis C colestásica fibrosante luego del trasplante, la cual fue tratada con éxito con interferón pegilado, ribavirina y telaprevir. Un paciente de 40 años de edad [virus de la hepatitis C (HCV) genotipo 1a; IL-28 CC] coinfectado con HIV fue sometido a un trasplante hepático por cirrosis descompensada. En el día 60 post-trasplante desarrolló ictericia progresiva y ascitis severa. La biopsia hepática transyugular confirmó el diagnóstico de recurrencia de hepatitis C colestásica fibrosante. Se realizó tratamiento con interferón pegilado, ribavirina y telaprevir por 48 semanas, logrando respuesta virológica sostenida a 12 semanas de finalizado el mismo. La negativización de la viremia en las primeras 4 semanas de tratamiento se asoció con resolución de la ascitis y la ictericia. Durante el tratamiento requirió eritropoyetina, filgrastim y transfusiones de glóbulos rojos para el manejo de la anemia y neutropenia. La triple terapia con telaprevir podría indicarse para el tratamiento de la recurrencia severa de la hepatitis C en pacientes coinfectados con HIV, especialmente en países en los que la accesibilidad a esquemas libres de interferón sea limitada

Loop-Mediated Isothermal Amplification of Trypanosoma cruzi DNA for Point-of-Care Follow-Up of Anti-Parasitic Treatment of Chagas Disease

A loop-mediated isothermal amplification assay was evaluated as a surrogate marker of treatment failure in Chagas disease (CD). A convenience series of 18 acute or reactivated CD patients who received anti-parasitic treatment with benznidazole was selected—namely, nine orally infected patients: three people living with HIV and CD reactivation, five chronic CD recipients with reactivation after organ transplantation and one seronegative recipient of a kidney and liver transplant from a CD donor. Fifty-four archival samples (venous blood treated with EDTA or guanidinium hydrochloride-EDTA buffer and cerebrospinal fluid) were extracted using a Spin-column manual kit and tested by T. cruzi Loopamp kit (Tc-LAMP, index test) and standardized real-time PCR (qPCR, comparator test). Of them, 23 samples were also extracted using a novel repurposed 3D printer designed for point-of-care DNA extraction (PrintrLab). The agreement between methods was estimated by Cohen’s kappa index and Bland–Altman plot analysis. The T. cruzi Loopamp kit was as sensitive as qPCR for detecting parasite DNA in samples with parasite loads higher than 0.5 parasite equivalents/mL and infected with different discrete typing units. The agreement between qPCR and Tc-LAMP (Spin-column) or Tc-LAMP (PrintrLab) was excellent, with a mean difference of 0.02 [CI = −0.58–0.62] and −0.04 [CI = −0.45–0.37] and a Cohen’s kappa coefficient of 0.78 [CI = 0.60–0.96] and 0.90 [CI = 0.71 to 1.00], respectively. These findings encourage prospective field studies to validate the use of LAMP as a surrogate marker of treatment failure in CD

Using clinical research networks to assess severity of an emerging influenza pandemic

BACKGROUND: Early clinical severity assessments during the 2009 influenza A H1N1 pandemic (pH1N1) overestimated clinical severity due to selection bias and other factors. We retrospectively investigated how to use data from the International Network for Strategic Initiatives in Global HIV Trials, a global clinical influenza research network, to make more accurate case fatality ratio (CFR) estimates early in a future pandemic, an essential part of pandemic response. METHODS: We estimated the CFR of medically attended influenza (CFRMA) as the product of probability of hospitalization given confirmed outpatient influenza and the probability of death given hospitalization with confirmed influenza for the pandemic (2009-2011) and post-pandemic (2012-2015) periods. We used literature survey results on health-seeking behavior to convert that estimate to CFR among all infected persons (CFRAR). RESULTS: During the pandemic period, 5.0% (3.1%-6.9%) of 561 pH1N1-positive outpatients were hospitalized. Of 282 pH1N1-positive inpatients, 8.5% (5.7%-12.6%) died. CFRMA for pH1N1 was 0.4% (0.2%-0.6%) in the pandemic period 2009-2011 but declined 5-fold in young adults during the post-pandemic period compared to the level of seasonal influenza in the post-pandemic period 2012-2015. CFR for influenza-negative patients did not change over time. We estimated the 2009 pandemic CFRAR to be 0.025%, 16-fold lower than CFRMA. CONCLUSIONS: Data from a clinical research network yielded accurate pandemic severity estimates, including increased severity among younger people. Going forward, clinical research networks with a global presence and standardized protocols would substantially aid rapid assessment of clinical severity