Prevalence and clinical outcome of hepatitis C infection in children who underwent cardiac surgery before the implementation of blood-donor screening
ABSTRACT There are few data on the prevalence and clinical outcome of hepatitis C infection in children. We studied 458 children who underwent cardiac surgery in Munich, Germany, before 1991, when blood-donor screening for hepatitis C was introduced in Germany. Their mean age at first operation was 2.8 years; none of the children had received blood transfusions before or 'after cardiac surgery, and none of their mothers had antibodies to the hepatitis C virus (anti-HCV). We compared these patients with 458 control subjects matched for age and sex.
Sixty-seven (14.6 percent) of the 458 patients who had undergone cardiac surgery had anti-HCV, as compared with 3 (0.7 percent) of the control subjects (P<0.001). At a mean interval of 19.8 years after the first operation, 37 (55 percent) of the 67 patients who were positive for anti-HCV had detectable HCV RNA in their blood. The infection had cleared in the other 30 patients, as evidenced by negative results on three polymerase-chain-reaction analyses performed at six-month intervals. Only 1 of the 37 patients who were positive for HCV RNA had elevated levels of liver enzymes; that patient had severe right-sided congestive heart failure. Of the 17 patients who underwent liver biopsies, only 3 had histologic signs of progressive liver damage. These three patients had additional risk factors: two had congestive heart failure, and the third had also been infected with hepatitis B virus.
Children who had undergone cardiac surgery in Germany before the implementation of blood-donor screening for hepatitis C had a substantial risk of acquiring the infection. However, after about 20 years, the virus had spontaneously cleared in many patients. The clinical course in those still infected seems more benign than would be expected in people infected as adults.
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ABSTRACT: Since the discovery of the hepatitis C virus, the goal of all treatment is to clear the virus and normalise the liver function, stopping the progression of the disease and thus reducing long-term complications of cirrhosis and hepatocellular carcinoma. The therapy for CHC used to consists of pegylated interferon alpha in combination with ribavirin and others new approved protease inhibitors, but still few of those treated can not achieved a compleat SVR. The reasons for failure are unknown, but may result from viral and host factors combined. The review here is to highlights and compare of what has been published previously. Interferon alpha (IFN-α) Interferon alpha is a member of the Interferon family, comprising a large group of multifunctional secreted proteins which have anti-viral, immunomodulatory and anti-proliferative activities. The Interferons can be classified into three types: Type I IFNs consist of IFN-alpha (IFN-α), IFN-beta (IFN-β) and IFN-omega (IFN-ω). They are produced in direct response to the virus infection and induce intracellular signalling pathways to activate transcription factors, such as the Interferon regulatory factors (IRF)-3, IRF-5, IRF-7 and NF-κB, which in turn initiates the transcription of interferon sensitive genes. IFN-α is a multi-gene family comprising more than 20 types which are synthesised by leukocytes, whereas IFN-β synthesis is seen in most cell types, in particular fibroblasts. The type II IFNs consist of INF-gamma (IFN-γ), which is synthesised by activated T lymphocytes and NK cells, in response to cytokines such as IL-12 and IL-18 or via the stimulation of T-cell or NK cell antigen receptors (Lemon et al, 2010). The third type is IFN–lamda (IFN-λ) or interleukin 28/29 -a class of cytokine with IFN-like activity.
- Virology 03/2002; 293(1):1-9. DOI:10.1006/viro.2001.1316
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ABSTRACT: Differently for what happened for the heart and the cardiovascular diseases, no data were available on the prevalence of the liver disorders in the general population. Based on these considerations we started planning a cohort study aimed to obtain data on how frequent liver disease was in the general population. Two comparable town in Northern Italy (Campogalliano, Modena, and Cormons, Gorizia) were selected on the basis of number of inhabitants, census and socio-economic background, and 6.917 were screened with an overall compliance of 70%, a percentage adequate to validate this type of study. In each patient a semi-quantitative, color-illustrated, food questionnaire including detailed questions on the use of alcoholic beverages was obtained in addition to a detailed physical examination to detect liver and the biliary diseases. Blood sample for ALT, AST, GGT, MCV and platelet count, and HBV and HCV markers were also taken.Medical Archives 02/2002; 56(1 Suppl 1):29-30. DOI:10.1016/S0168-8278(01)00151-9