Presence of genotypic resistance to antiretroviral drugs in a cohort of therapy-naive HIV-1-infected Italian patients.
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Adult↗
Biomedical subjects
G Verucchi
Publications and source records attributed to G Verucchi.
Hepatitis B virus infection in native versus immigrant or adopted children in Italy following the compulsory vaccination.
BACKGROUND: Compulsory vaccination of children against hepatitis B virus (HBV) infection was introduced in Italy in 1991. PATIENTS AND METHODS: To evaluate the current importance of pediatric HBV infection, we studied 359 HBsAg-positive children admitted to 16 centers in Italy from 1991 to 1998. 185 patients were natives of Italy and 174 (39 immigrants and 135 adopted) came from highly endemic countries (eastern Europe: 60.9%, Asia: 16.7%, Africa: 14.9% and Central and South America: 5.7%). RESULTS: Transaminase Levels were moderately altered in both Italian (mean 134 UI/L) and foreign children (mean 168 UI/L). In total, 77% of ItaLian children and 88% of foreign children tested HBeAg positive. High transaminase levels and HBeAg positivity were more frequent in adopted children. Follow-up of 317 patients showed that the incidence of HBeAg/anti-HBe serum conversion was similar in all cohorts, but in adopted children it occurred at an earlier age and was associated with HBsAg clearance in 5%. CONCLUSION: HBV is not frequent in Italian children today, but it is common among children coming from highly endemic areas. The vaccination of nonimmune native populations must be strongly recommended.
Adolescent↗
An epidemiological survey of hepatitis C virus infection in Italian children in the decade 1990-1999.
BACKGROUND: A retrospective-prospective survey of Italian children with hepatitis C virus (HCV) infection was planned in 1998 to explore the epidemiologic features of infection during the past decade. METHODS: Anti-HCV-positive patients (or HCV RNA-positive infants) aged 1 month to 16 years, consecutively observed in 20 pediatric Institutions, were considered. An anonymous epidemiologic questionnaire based on clinical records was used. RESULTS: From 1990 through March 1999, 606 patients were observed (296 boys, average age 5.8 years). Maternal infection (46% of cases) and blood transfusions (34%) were the most frequent risk factors. Of 279 infected mothers, 61% did not recall a putative source of infection (by history, many could possibly have had exposure through routes such as therapeutic injections with nondisposable material), whereas 94 (34%) admitted drug abuse, including 49 (17%) coinfected with human immunodeficiency virus (HIV). Only 157 (26%) children were born after 1991: 90% of their mothers were infected (11% were HIV coinfected vs. 25% mothers of older children, P < 0.01). CONCLUSIONS: Maternal infection is a prominent source of pediatric HCV infection in Italy. The fact that most mothers had a history of covert exposure to HCV, probably through percutaneous routes that are no longer operating, and that the number of those with HIV coinfection has decreased suggests that the frequency of pediatric infection could decrease in the future.
Adolescent↗
Metabolic complications of HIV-1 antiretroviral therapy: the lipodystrophy syndrome.
The lipodystrophy syndrome is one of the complications reported with increased frequency in patients with HIV-1 infection receiving antiretroviral therapy. The wide range of prevalence estimates may be due to differing definitions, methods and patient populations. We described the various pathogenic theories and the morphological and metabolic alterations associated with this syndrome. Even if no effective treatment exists, a correct lifestyle, adequate diet and physical exercise seem to be very important. Moreover drug therapies should be used with care to avoid potentially harmful interactions with antiretroviral agents. Ideally, the future effort to define the mechanism of lipodystrophy would be multidisciplinary and would involve not only experts in AIDS research but also nutritionists, endocrinologists and cardiologists.
Anti-HIV Agents↗
Outcome of liver disease and response to interferon treatment are not influenced by hepatitis B virus core gene variability in children with chronic type B hepatitis.
BACKGROUND/AIMS: Hepatitis B virus (HBV) core gene heterogeneity may influence the outcome of liver disease and the response to interferon (IFN) therapy in adult HBV carriers. The aim of this study was to evaluate the possible association between HBV core gene variability and evolution of chronic hepatitis in children. METHODS: We examined serum samples from 25 children with HBV chronic hepatitis and HBe antigen (HBeAg) positivity who were followed-up for a mean of 7.4 years. Seven cases spontaneously seroconverted to anti-HBe, becoming HBV healthy carriers; nine cases were successfully treated with IFN; nine cases were non-responders to IFN therapy. HBV-DNA was extracted from one serum sample ("I") collected during the HBeAg positive phase, and from a second sample ("II") collected after the anti-HBe seroconversion or, in non-responders, after stopping therapy. The entire core gene of the HBV isolates was amplified and sequenced. RESULTS: Each isolate showed single or no missense mutation independently of the clinical behavior of the patients. HBeAg-defective viruses were detected in one case in both samples and in two cases only in sample "II". CONCLUSIONS: Core gene variability does not seem to be involved either in the outcome of infection or in the response to IFN treatment in children with HBV chronic hepatitis. Considering that most of the HBV carriers in our area acquire the infection in childhood, our data suggest that core gene heterogeneity is not a major cause of progression to chronicity.
Adolescent↗
Virus-induced autoimmunity in hepatitis C virus infections: a rare event.
Serial serum samples from 16 Italian patients presenting with acute hepatitis C virus (HCV) infections (which progressed to chronic hepatitis in six) were screened for the non-organ-specific autoantibodies most frequently associated with autoimmune hepatitis (AIH), as well as for antibodies against the hepatic asialoglycoprotein receptor (ASGP-R) and against the GOR peptide. One patient had low titres (1:10-1:80) of liver-kidney microsomal (LKM-1) antibodies during the recovery phase and three others had transient low titres of anti-smooth muscle (IgM class, 1:10) or anti-ASGP-R (1:150-1:300). Anti-GOR was detected in 43 (65%) of 66 sera from 13 of these patients. There was no correlation between any of these findings and progression to chronicity. By comparison, 18 patients with AIH studied concurrently before institution of immunosuppressive therapy all had antinuclear and/or smooth muscle antibodies, or LKM-1, at 1:40-1:640 and anti-ASGP-R at 1:300-1:2,100. None of these 18 had evidence of HCV infection and all were seronegative for anti-GOR. The findings indicate that the autoantibodies usually associated with AIH are rare in HCV infections but the virus can very occasionally induce a transient autoimmune response. Anti-GOR appears to be an antibody specifically related to HCV infection and is probably not a marker of induced autoimmunity, and it does not predict progression to chronic hepatitis.
Acute Disease↗
Infective diseases during pregnancy and their teratogenic effects.
TORCH group infections (toxoplasmosis, others, rubella, cytomegalovirus, herpes) are the most serious infectious diseases during pregnancy due to the seriousness of possible embryo-fetal lesions. Rates of transmission and degree of the damage on the product of conception have been described as well as congenital malformation pictures and neonatal illness still observed following to Toxoplasma, HSV, VZV, CMV and Rubella virus infections. Too often, it is very hard to discriminate between primary and recurrent infections in pregnancy, notwithstanding the possible implications. Since at present, neither effective vaccines nor resolutive therapies are available against viral infections, the main means against infection of the foetus still remains the prevention of infections in the pregnant woman.
Congenital Abnormalities↗
Cell-mediated immunity in infectious mononucleosis.
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Adolescent↗
Liver autoreactivity in acute virus A, B and non-A, non-B hepatitis.
As part of an investigation into the question of whether virus-induced autoreactivity might contribute to liver damage in viral hepatitis, serial studies (from onset through recovery) of circulating liver autoantibodies have been performed in patients with uncomplicated acute virus A (AVH-A), B (AVH-B) and non-A, non-B (AVH-NANB) hepatitis in whom the time of onset of symptoms could be precisely documented. One hundred and forty-four sera from 35 patients were tested by radioimmunoassay for autoantibodies against the liver-derived lipoprotein complex, LSP, and also against one of its constituents--the asialoglycoprotein receptor, known as hepatic lectin (HL). Anti-LSP antibodies were found in all 10 patients with AVH-A, in 17/18 with AVH-B and in 3/7 with AVH-NANB at titres that declined during recovery. Anti-HL antibodies were detected concurrently in 6 of the AVH-A patients and in 5 with AVH-B but on only 1 occasion in 1 patient with AVH-NANB. Transient cellular immunity to LSP, assayed by a T-lymphocyte migration inhibitory factor test, was detected in 4 of the 6 AVH-B patients tested, 2 of whom also showed concurrent reactivity to HL, but these cellular immune responses did not correlate with production of anti-LSP and/or anti-HL. The findings indicate that humoral immune responses to liver cell surface antigens are frequently triggered by hepatitis A and B viruses, possibly via induction of autoreactive, T-cell independent, liver antigen-specific B lymphocytes. These liver-specific autoreactions have the potential to contribute to hepatocellular damage in virus A and B hepatitis but it seems unlikely that autoimmunity plays a significant pathogenetic role in NANB viral infections.
Adult↗
Hemolytic anemia as a complication of Epstein-Barr virus infection: a report of two cases.
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Adolescent↗
[Endoscopic treatment of obstructive cholangitis].
A long catheter can be positioned in the bile ducts by means of a fibre glass gastroduodenoscope, thus making it possible to drain bile and inject medicaments locally. This technique gives excellent results and is particularly indicated in cases of choledocic lithiasis complicated by cholangitis in order to clear up the infection and send the patient in for surgery in ideal condition.
Aged↗
Diathermy ERCP: an alternative method for endoscopic retrograde cholangiopancreatography (ERCP) in jaundiced patients.
Standard ERCP was unsuccessful in 5 jaundiced patients. This problem was surmounted in 4 of these patients by endoscopically inducing a small choledochoduodenal fistula through which a catheter could be inserted and diagnostic cholangiograms were obtained. In the fifth patient, the attempt to create a fistula was insufficient, and the contrast material infiltrated the duodenal wall with transient ensuing fever. In subsequent observations, the induced fistulas promptly healed. The method is offered as an alternative procedure when standard ERCP fails.
Adult↗
Serum trypsin-like immunoreactivity after endoscopic retrograde cholangiopancreatography.
Serum trypsin-like immunoreactivity (TLI) was studied in 31 patients before and after endoscopic retrograde cholangiopancreatography. None of the patients developed clinical acute pancreatitis. Generally, the serum TLI peak was observed within the first 6 hours after the examination. Most patients (73%) showed a pathologically high TLI but very high values were not frequent (19%). Successful pancreatic opacification was followed by a significant increase in serum TLI which was pathologically high in nearly all cases (18/20). On the contrary, after cholangiography alone abnormal values were less frequent (4/8) and the increase was not significant. In most patients TLI and amylase responses were in agreement. A significant, though poor, linear relation was found between serum TLI and serum amylase 3, 6 and 12 hours after the examination.
Amylases↗
Polyphasic type A hepatitis: histological features.
The histology of polyphasic type A hepatitis was analyzed in liver biopsy specimens of two patients. The microscopic examination showed, together with changes of acute viral hepatitis, portal plasma cell infiltration, limiting plate erosion and porto-portal bridging necrosis. These features, although sometimes described in classical HAV hepatitis, appear to be similar to those commonly observed in severe and evolving forms of acute hepatitis due to other hepatotropic viruses. Only careful serological analyses can lead to a correct diagnosis and prognosis in case of polyphasic type A hepatitis.
Adult↗
Serum protease inhibitors in acute viral hepatitis.
Serum levels of alpha 1-antitrypsin (alpha 1-AT) and alpha 2-macroglobulin (alpha 2-M) and, as controls, alpha 1-acid glycoprotein (alpha 1-AG) and haptoglobin were evaluated by means of laser nephelometry in 17 patients with acute viral hepatitis (AVH) type A, 16 with AVH-B, 12 with AVH-NANB and 8 with fulminant hepatitis B. On admission, alpha 1-AT levels were elevated in one third of AVH-A and AVH-B cases, but subsequently declined; alpha 2-M levels were elevated in about 40% of AVH-B patients during the 2nd, 3rd and 4th week after admission. No significant correlation was found between elevated levels of protease inhibitors and aminotransferase values or drug addiction and delta coinfection. alpha 1-acid glycoprotein and haptoglobin levels were always normal or low. Protease inhibitors did not show any elevation in fulminant hepatitis, while changes were found only in a few patients with AVH-NANB. Thus, no clearcut pattern of changes in protease inhibitors has been found in association with each type of hepatitis, although alpha 1-AT and alpha 2-M elevations are mainly found in AVH-B.
Acute Disease↗
Role of prostaglandin E2 on defective interferon-gamma production during type B acute viral hepatitis.
Interferon-gamma (IFN-gamma) and prostaglandin E2 (PGE2) production was evaluated in cultured peripheral blood mononuclear cells taken from patients with type B acute viral hepatitis at the onset of symptoms, at 1st and 2nd week of disease, and from healthy controls. Concanavalin A-stimulated cells cultured for 24, 48 and 72h showed significantly higher IFN-gamma levels compared to basal release in both groups, whereas no statistically significant differences were found in most experimental conditions as regard PGE2 synthesis. No differences were found in IFN-gamma production by comparing patients with acute viral hepatitis to the control group, whereas PGE2 was significantly increased during the disease. IFN-gamma and PGE2 levels did not show any significant change in acute viral hepatitis during the follow-up. A statistically significant correlation was found only in control group between IFN-gamma and PGE2 levels in unstimulated cultures. PGE2 seems to play a central role in regulating interferon production during viral infection. This may suggest a new therapeutic approach in viral hepatitis utilizing a combination of interferon and prostanoid inhibitory substances, above all in patients who do not respond to interferon therapy alone.
Acute Disease↗
[Viral hepatitis A with atypical course. Clinical, biochemical, and virologic study of 7 cases].
The aim of our study was to assess the clinical, biochemical and virological profile of patients with atypical viral hepatitis A (protracted, relapsed and cholestatic forms). Five patients with the relapsed form and 2 patients with the cholestatic form were studied among 95 patients hospitalized in our Division of Infectious Diseases for viral hepatitis A during the years 1988 to 1998. A relapse was defined by a decrease in serum alanine transaminase levels > or = 50% followed by a > or = 50% increase in the minimal value. The protracted form was defined by elevated serum alanine transaminase levels for more than 6 months. The cholestatic form was defined by the highest value of bilirubinemia above 15 mg/dL or by a persistent jaundice for more than 8 weeks. All 5 of the protracted-relapsed forms had a biphasic course: the median time between onset and relapse of the disease was 8 weeks, and serum aminotransferase activities returned to the normal range within an average of 45 weeks after relapse. The two cholestatic forms were characterized by a very high level of bilirubinemia (24.58 and 19.03 mg/dL) and by protracted jaundice with itching (3 and 8 months). All patients were tested for hepatitis B and C, Cytomegalovirus and Epstein-Barr virus, with negative results. In short, viral hepatitis A is a benign, self-limiting disease which usually resolves in a few weeks. In a non-negligible percentage of cases (3-21%), however, it can assume atypical forms, which are more serious in patients with chronic liver diseases.
Adolescent↗