Manifestaciones extrahepáticas de la infección por el virus de la hepatitis C

Hepatitis C virus predominantly affects the liver, although it may also produce a number of extrahepatic manifestations, such as mixed cryoglobulinemia, salivary and lacrimal gland dysfunction, and several types of kidney disease. The pathogenesis of these conditions is not completely understood, but immunologic mechanisms are involved in many cases. In some patients with hepatitis C virus infection, the extrahepatic manifestations predominate and their proper diagnosis and management is very important.

Usefulness of a hypertension education program

BACKGROUND

Our objective was to assess knowledge about hypertension, its medical consequences in hospitalized patients with hypertension and in their relatives, and to evaluate the usefulness of a simple education program to improve such knowledge.

METHOD

As part of a cohort study, six clinical physicians reviewed the medical charts of all hospitalized patients in the departments of medicine, general surgery, and orthopedic surgery. Patients with the antecedent of hypertension, patients without the antecedent of hypertension but with at least two measurements of blood pressure above normal limits during hospitalization, and the relatives or friends who were accompanying patients with known or unknown hypertension were included. Patients received an education program about hypertension. Knowledge about hypertension and its complications was assessed on the basis of three items before the education program and 4 months later.

RESULTS

A total of 102 patients entered the study and 95 completed it. An association was found between higher education level and knowledge about hypertension; differences were significant with two of the three employed items (P < 0.005). Compared with baseline, knowledge about hypertension was improved 4 months after the education program; differences were significant with the three employed items (P < 0.005).

CONCLUSIONS

Simple and easy-to-implement programs can be useful in improving knowledge about hypertension.

[Metabolic disorders associated with HIV and antiretroviral therapy]

In the last few years, recently developed antirretroviral treatment has allowed a dramatic improvement in the prognosis of HIV disease. As a result, other medical problems are taking increasing relevance in the follow up of the patients infected by such virus. In this article, metabolic disorders associated with HIV, as well as those provoked by antiretroviral therapy, are comprehensively reviewed.

Hepatitis C virus and human immunodeficiency virus coinfection in Spain

OBJECTIVE AND METHODS

In a cross-sectional study, based on a cohort composed of HIV-infected patients of fifteen tertiary level institutions of Spain, the main data of the entire cohort are described, characteristics of patients with or without hepatitis C coinfection are compared, and the possible association of hepatitis C virus coinfection with socioeconomic, HIV-related, and hepatitis B-related variables is assessed.

RESULTS

A total of 4,709 patients are studied. Median of age is 37 years, 78.3% are male. HIV risk behaviours are: parenteral drug use in 63.8% of patients, heterosexual in 22.3%, and homosexual in 10.8%. Serology of hepatitis C is positive in 69.2% of participants. The following variables are associated with increased prevalence of hepatitis C coinfection, both in univariate and in multivariate analysis: HIV risk behaviour, positive anti-HBs, longer time elapsed since HIV infection diagnosis, younger age, lower social status, lower CD4 cell count increase between nadir and last available result, and lower educational level (all P<0.001). Patients with heterosexual behaviour are more frequently coinfected than patients with homosexual behaviour (P<0.001).

CONCLUSION

This study highlights that, in Spain, more than two thirds of patients with HIV infection are coinfected with hepatitis C virus.

A sewing needle in the liver

An 85-year-old woman with Alzheimer's dementia was hospitalized because of prolonged fever, breathlessness, and generalized pain. Blood analysis showed an elevated erythrocyte sedimentation rate, and temporal artery biopsy showed giant cell arteritis. Prednisone therapy was instituted, and the patient's condition partially improved. Incidentally, abdominal radiographs revealed a sewing needle in the right upper quadrant, and computed tomography (CT) showed that the needle was lodged in the liver parenchyma.

Catastrophic antiphospholipid-antibody syndrome and danazol

We report a case of catastrophic antiphospholipid-antibody syndrome, with renal and neurological manifestations, which presented shortly after the institution of danazol for the treatment of refractory thrombocytopenia.

Temporal arteritis and Guillain-Barré syndrome

The association of temporal arteritis and Guillain-Barré syndrome has rarely been reported. We describe a patient who sequentially suffered from both disorders. An 81-year-old woman presented with headache and loss of appetite. Analysis showed anemia and an erythrocyte sedimentation rate of 94 mm/hr. Temporal artery biopsy disclosed giant cell arteritis. Upon treatment with prednisone, all symptoms improved. A few weeks later, the patient began having low back pain, paresthesias, ascending weakness, and unexplained intermittent hypotension. Examination showed absent tendon reflexes in the knees. Cerebrospinal fluid contained one mononuclear cell/dL, and a protein level of 81 mg/dL. An electrophysiologic study revealed reduced nerve conduction velocities. Intravenous immunoglobulin therapy was instituted, and all symptoms slowly disappeared. This is the third reported case of Guillain-Barré syndrome in association with temporal arteritis. The other two patients recovered. Although the association of Guillain-Barré syndrome and temporal arteritis in these three patients could be coincidental, a common immunologic mechanism is also a possibility.

Adherence, side effects and efficacy of stavudine plus lamivudine plus nelfinavir in treatment-experienced HIV-infected patients

OBJECTIVES

To evaluate adherence, side effects and efficacy of a modality of highly active antiretroviral therapy (HAART) in HIV-infected patients.

METHODS

In a cohort, prospective study, 65 previously treated patients received stavudine plus lamivudine plus nelfinavir. Fifty-three participants (81%) had a history of intravenous drug use. Patients were evaluated at 3-month intervals. The association of adherence with demographic variables, hepatitis C virus infection, number of stopped antiretroviral regimens, HIV RNA level, CD4 cell count, and adverse effects to drugs was assessed.

RESULTS

After a median follow-up of 12 months, 30 participants (46%) showed adequate adherence in all visits. An association was observed between adherence and female sex: 18 of 47 men (38%) vs. 12 of 18 women (67%) presented adequate adherence in all visits (P=0. 0416). An association was also observed between adherence and low baseline HIV RNA level (P=0.0229). Discontinuation of treatment took place because of refusal to take medication in 11 participants (17%) and because of side effects in seven participants (11%). Undetectable HIV RNA level was achieved in 26 patients (40%) at 3 months and in lower percentages at months 6, 9 and 12.

CONCLUSIONS

Overall adherence to the employed HAART regimen was poor. Female sex and low baseline HIV RNA were associated with better adherence. Refusal to take medications and side effects were the main reasons to stop therapy. At 3 months' follow-up, virological efficacy was achieved in 40% of patients.

Superior vena cava syndrome during the treatment of pulmonary tuberculosis in an HIV-1 infected patient

Tuberculosis is nowadays an uncommon cause of superior vena cava syndrome (SVCS). We report the case of an HIV-infected patient who presented with respiratory symptoms accompanied by cervical and mediastinal lymphadenopathy. Sputum examination showed acid-fast bacilli, and treatment was instituted with isoniazid, rifampicin, pyrazinamide and ethambutol. A few days later SVCS developed, presumably as a consequence of inflammatory lymphadenitis. With corticosteroids, all symptoms disappeared. To our knowledge, no cases of SVCS provoked by this kind of paradoxical reaction have been described previously.