1
|
Mendes LC, Ferreira PA, Miotto N, Zanaga L, Gonçales ESL, Pedro MN, Lazarini MS, Júnior FLG, Stucchi RSB, Vigani AG. Elastogram quality assessment score in vibration-controlled transient elastography: Diagnostic performance compared to digital morphometric analysis of liver biopsy in chronic hepatitis C. J Viral Hepat 2018; 25:335-343. [PMID: 29091321 DOI: 10.1111/jvh.12822] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 09/29/2017] [Indexed: 02/06/2023]
Abstract
Vibration-controlled transient elastography (VCTE) is widely used for noninvasive fibrosis staging in chronic hepatitis C. However, internal validation is based solely on variability and success rate and lacks reproducible quality indicators. We analysed the graphic representation of shear wave propagation in comparison with morphometric results of liver biopsy, eliminating observer variability bias. Individual elastograms were classified according to two morphologic criteria: extension of wave propagation (length of the graphic representation) and shear wave dispersal (level of parallelism displayed in the elastogram). Then, a score based on these criteria stratified the elastogram in classes I through III (highest to lowest technical quality). Liver stiffness results of each measurement were compared with collagen contents in liver biopsy by morphometric analysis. A total of 3243 elastograms were studied (316 patients). Digital morphometry in liver biopsy showed significant fibrosis in 66% of samples and advanced fibrosis in 31%. Elastogram quality analysis resulted in 1438 class I measurements (44%), 1070 class II (34%) and 735 class III. Area under the receiver operating curve (AUROC) for severe fibrosis according to class (I, II and III) was 0.941, 0.887 and 0.766, respectively. For advanced fibrosis, AUROCs were 0.977, 0.883 and 0.781, respectively. Spearman's correlation testing for all classes and levels of fibrosis demonstrated significant independent association (r2 = -.95, P < .01). Our study is the first to propose measurable quality criteria for VTCE and to validate them against objective assessment of liver biopsy through digital morphometric imaging analysis. We concluded that VCTE performance is significantly influenced by quality assessment of individual measurements. Considering these criteria in clinical practice may improve accuracy.
Collapse
Affiliation(s)
- L C Mendes
- Department of Infectious Diseases, State University of Campinas, Campinas, SP, Brazil
| | - P A Ferreira
- Department of Infectious Diseases, Federal University of São Paulo, São Paulo, SP, Brazil
| | - N Miotto
- Department of Infectious Diseases, State University of Campinas, Campinas, SP, Brazil
| | - L Zanaga
- Department of Infectious Diseases, State University of Campinas, Campinas, SP, Brazil
| | - E S L Gonçales
- Department of Infectious Diseases, State University of Campinas, Campinas, SP, Brazil
| | - M N Pedro
- Department of Infectious Diseases, State University of Campinas, Campinas, SP, Brazil
| | - M S Lazarini
- Department of Infectious Diseases, State University of Campinas, Campinas, SP, Brazil
| | - F L G Júnior
- Department of Infectious Diseases, State University of Campinas, Campinas, SP, Brazil
| | - R S B Stucchi
- Department of Infectious Diseases, State University of Campinas, Campinas, SP, Brazil
| | - A G Vigani
- Department of Infectious Diseases, State University of Campinas, Campinas, SP, Brazil
| |
Collapse
|
2
|
Pedro MN, Rocha GZ, Guadagnini D, Santos A, Magro DO, Assalin HB, Oliveira AG, Pedro RDJ, Saad MJA. Insulin Resistance in HIV-Patients: Causes and Consequences. Front Endocrinol (Lausanne) 2018; 9:514. [PMID: 30233499 PMCID: PMC6133958 DOI: 10.3389/fendo.2018.00514] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 08/16/2018] [Indexed: 12/14/2022] Open
Abstract
Here we review how immune activation and insulin resistance contribute to the metabolic alterations observed in HIV-infected patients, and how these alterations increase the risk of developing CVD. The introduction and evolution of antiretroviral drugs over the past 25 years has completely changed the clinical prognosis of HIV-infected patients. The deaths of these individuals are now related to atherosclerotic CVDs, rather than from the viral infection itself. However, HIV infection, cART, and intestinal microbiota are associated with immune activation and insulin resistance, which can lead to the development of a variety of diseases and disorders, especially with regards to CVDs. The increase in LPS and proinflammatory cytokines circulating levels and intracellular mechanisms activate serine kinases, resulting in insulin receptor substrate-1 (IRS-1) serine phosphorylation and consequently a down regulation in insulin signaling. While lifestyle modifications and pharmaceutical interventions can be employed to treat these altered metabolic functions, the mechanisms involved in the development of these chronic complications remain largely unresolved. The elucidation and understanding of these mechanisms will give rise to new classes of drugs that will further improve the quality of life of HIV-infected patients, over the age of 50.
Collapse
Affiliation(s)
- Marcelo N. Pedro
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
| | - Guilherme Z. Rocha
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
| | - Dioze Guadagnini
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
| | - Andrey Santos
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
| | - Daniela O. Magro
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
| | - Heloisa B. Assalin
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
| | - Alexandre G. Oliveira
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
- Biosciences Institute, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Rogerio de Jesus Pedro
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
| | - Mario J. A. Saad
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
- *Correspondence: Mario J. A. Saad
| |
Collapse
|
3
|
Miotto N, Mendes LC, Zanaga LP, Goncales ESL, Lazarini MSK, Pedro MN, Goncales FL, Stucchi RSB, Vigani AG. Predictors of early treatment discontinuation and severe anemia in a Brazilian cohort of hepatitis C patients treated with first-generation protease inhibitors. ACTA ACUST UNITED AC 2017; 49:S0100-879X2016000700702. [PMID: 27356107 PMCID: PMC4926529 DOI: 10.1590/1414-431x20165300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/24/2016] [Indexed: 12/14/2022]
Abstract
The aim of this study was to determine risk factors for adverse events (AE)-related treatment discontinuation and severe anemia among patients with chronic hepatitis C virus (HCV) genotype 1 infection, treated with first-generation protease inhibitor (PI)-based therapy. We included all patients who initiated treatment with PI-based therapy at a Brazilian university hospital between November 2013 and December 2014. We prospectively collected data from medical records using standardized questionnaires and used Epi Info 6.0 for analysis. Severe anemia was defined as hemoglobin ≤8.5 mg/dL. We included 203 patients: 132 treated with telaprevir (TVR) and 71 treated with boceprevir (BOC). AE-related treatment discontinuation rate was 19.2% and anemia was the main reason (38.5%). Risk factors for treatment discontinuation were higher comorbidity index (OR=1.85, CI=1.05-3.25) for BOC, and higher bilirubin count (OR=1.02, CI=1.01-1.04) and lower BMI (OR=0.98, CI=0.96-0.99) for TVR. Severe anemia occurred in 35 (17.2%) patients. Risk factors for this outcome were lower estimated glomerular filtration rate (eGFR; OR=0.95, CI=0.91-0.98) for patients treated with TVR, and higher comorbidity index (OR=2.21, CI=1.04-4.67) and ribavirin dosage (OR=0.84, CI=0.72-0.99) for those treated with BOC. Fifty-five (57.3%) patients treated with TVR and 15 (27.3%) patients treated with BOC achieved sustained virological response (SVR). Among patients who received TVR and interrupted treatment due to AE (n=19), only 26.3% (n=5) achieved SVR (P=0.003). Higher number of comorbidities, lower eGFR and advanced liver disease are associated with severe anemia and early treatment cessation, which may compromise SVR achievement.
Collapse
Affiliation(s)
- N Miotto
- Divisão de Moléstias Infecciosas, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - L C Mendes
- Divisão de Moléstias Infecciosas, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - L P Zanaga
- Divisão de Moléstias Infecciosas, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - E S L Goncales
- Divisão de Moléstias Infecciosas, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - M S K Lazarini
- Divisão de Moléstias Infecciosas, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - M N Pedro
- Divisão de Moléstias Infecciosas, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - F L Goncales
- Divisão de Moléstias Infecciosas, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - R S B Stucchi
- Divisão de Moléstias Infecciosas, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - A G Vigani
- Divisão de Moléstias Infecciosas, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| |
Collapse
|
4
|
Nascimento FS, Suzuki LA, Branco N, Franco RMB, Andrade PD, Costa SCB, Pedro MN, Rossi CL. Toxoplasma-SPECIFIC IgG SUBCLASS ANTIBODY RESPONSE IN CEREBROSPINAL FLUID SAMPLES FROM PATIENTS WITH CEREBRAL TOXOPLASMOSIS. Rev Inst Med Trop Sao Paulo 2015; 57:439-42. [PMID: 26603234 PMCID: PMC4660456 DOI: 10.1590/s0036-46652015000500013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 02/05/2015] [Indexed: 11/22/2022] Open
Abstract
Cerebral toxoplasmosis can be highly debilitating and occasionally fatal in persons with immune system deficiencies. In this study, we evaluated the Toxoplasma gondii-specific IgG subclass antibody response in 19 cerebrospinal fluid (CSF) samples from patients with cerebral toxoplasmosis who had a positive IgG anti-T. gondii ELISA standardized with a cyst antigen preparation. There were no significant differences between the rates of positivity and the antibody concentrations (arithmetic means of the ELISA absorbances, MEA) for IgG1 and IgG2, but the rates of positivity and MEA values for these two IgG subclasses were significantly higher than those for IgG3 and IgG4. The marked IgG2 response in CSF from patients with cerebral toxoplasmosis merits further investigation.
Collapse
Affiliation(s)
- Fernanda S Nascimento
- Departamento de Patologia Clínica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - Lisandra A Suzuki
- Departamento de Patologia Clínica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - Nilson Branco
- Departamento de Biologia Animal, Instituto de Biologia, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - Regina M B Franco
- Departamento de Biologia Animal, Instituto de Biologia, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - Paula D Andrade
- Departamento de Medicina Interna, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - Sandra C B Costa
- Departamento de Medicina Interna, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - Marcelo N Pedro
- Departamento de Medicina Interna, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - Cláudio L Rossi
- Departamento de Patologia Clínica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| |
Collapse
|
5
|
Oliveira da Silva AM, Dos Santos DC, Limongi V, Gonçalez ESL, Pedro MN, Stucchi RSB, Boin IFSF. Co-infected HIV/hepatitis patients compared with chronic liver patients and healthy individuals: respiratory assessment through surface electromyography and spirometry. Transplant Proc 2015; 46:3039-42. [PMID: 25420817 DOI: 10.1016/j.transproceed.2014.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Co-infected HIV and hepatitis subjects are candidates for a liver transplantation because of progressive liver disease. Chronic liver disease, co-infected or not, requires assessment of respiratory function before liver transplantation. The respiratory evaluation of these 2 groups compared with healthy individuals can define deficits, and this can impair a full recovery after transplant surgery. OBJECTIVE This study sought to compare the respiratory profile in co-infected patients with chronic liver disease who are candidates for liver transplantation with that of healthy subjects. METHODS Through respiratory evaluation of flows and lung volumes (spirometry), muscle activity (surface electromyography), and maximum pressure (manovacuometer), 250 people were distributed into 3 groups: 14 patients with HIV and liver disease, 65 healthy subjects, and 171 patients with chronic liver disease. The mean age (years) was respectively 47.5 ± 6.2, 48.3 ± 14.1, and 52.9 ± 8.5. The average body mass index (kg/m(2)) of the groups was 24.6 ± 4.5, 26.0 ± 3.2, and 28.5 ± 5.3, respectively. RESULTS There was a statistical difference among the groups in the root means square (RMS) rectus abdominis (μV) (P = .0016), RMS diaphragm (μV) (P = .0001), maximal inspiratory pressure (cmH2O) (P = .001), forced exhaled volume at the end of first second (%) (P = .002), and maximal mid expiratory flow 25% to 75% (%) (P = .0001) for the Kruskal-Wallis test. The multivariate analysis among the groups showed that the RMS diaphragm had a tendency to discriminate the co-infected subjects. CONCLUSIONS The co-infected HIV group showed a muscle deficit of diaphragm and rectus abdominis activity, and the liver disease group showed lower indexes in volumes and respiratory flows.
Collapse
Affiliation(s)
| | - D C Dos Santos
- Liver Transplantation Unit, State University of Campinas, Campinas, Brazil; Department of Medical Science, State University of Campinas, Campinas, Brazil
| | - V Limongi
- Liver Transplantation Unit, State University of Campinas, Campinas, Brazil; Department of Medical Science, State University of Campinas, Campinas, Brazil
| | - E S L Gonçalez
- Department of Medical Science, State University of Campinas, Campinas, Brazil; Clinical Hospital of State University of Campinas, Campinas, Brazil
| | - M N Pedro
- Department of Medical Science, State University of Campinas, Campinas, Brazil; Clinical Hospital of State University of Campinas, Campinas, Brazil
| | - R S B Stucchi
- Liver Transplantation Unit, State University of Campinas, Campinas, Brazil
| | - I F S F Boin
- Liver Transplantation Unit, State University of Campinas, Campinas, Brazil; Department of Surgery, Unit of Liver Transplantation, State University of Campinas, Campinas, Brazil.
| |
Collapse
|
6
|
Vigani AG, Macedo-de-Oliveira A, Pavan MHP, Pedro MN, Gonçales FL. Hepatitis C virus infection, cryoglobulinemia, and peripheral neuropathy: a case report. Braz J Med Biol Res 2005; 38:1729-34. [PMID: 16302087 DOI: 10.1590/s0100-879x2005001200001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
Hepatitis C virus (HCV) is essentially hepatotropic but its manifestations can extend beyond the liver. It can be associated with autoimmune diseases, such as mixed cryoglobulinemia, membranoproliferative glomerulonephritis, autoimmune thyroiditis, and lymphoproliferative disorders. The mechanisms that trigger these manifestations are not completely understood. We describe a 48-year-old man with chronic HCV infection (circulating HCV RNA and moderate hepatitis as indicated by liver biopsy), cryoglobulinemia, and sensory and motor peripheral neuropathy. The diagnosis of multineuropathy was confirmed by clinical examination and electromyographic tests. A nerve biopsy revealed an inflammatory infiltrate in the perineurial space and signs of demyelination and axonal degeneration. The patient had no improvement of neurological symptoms with the use of analgesics and neuro-modulators. He was then treated with interferon-alpha (3 million units subcutaneously, 3 times per week) and ribavirin (500 mg orally, twice a day) for 48 weeks. Six months after the end of therapy, the patient had sustained viral response (negative HCV RNA) and remission of neurological symptoms, but cryoglobulins remained positive. A review of the literature on the pathogenesis and treatment of neurological manifestations associated with HCV infection is presented. This report underscores the need for a thorough evaluation of HCV-infected patients because of the possibility of extrahepatic manifestations. Antiviral treatment with interferon and ribavirin can be effective and should be considered in patients with neurological complications associated with HCV infection.
Collapse
Affiliation(s)
- A G Vigani
- Grupo de Estudo das Hepatites Virais, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, 13083-970 Campinas, SP, Brazil.
| | | | | | | | | |
Collapse
|