Do symptomless HCV carriers spread infection to their relatives?
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Biomedical subjects
Publications and source records attributed to C Puoti.
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OBJECTIVE: To study the effect of ursodeoxycholic acid (UDCA) on serum liver enzyme levels [alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT)] in 101 patients with hepatitis C virus-related chronic liver disease. METHODS: Forty-nine patients were assigned to receive UDCA (450 mg/day) over a period of 6 months and 52 to receive no treatment. RESULTS: In the UDCA group, serum ALT and GGT levels significantly improved. ALT values decreased from pre-treatment levels of 157.0 +/- 62.6 IU/l to 82.5 +/- 46.4 IU/l (P < 0.05), and GGT fell from 141.3 +/- 86.2 IU/l to 66.0 +/- 49.5 IU/l (P < 0.001). No significant change occurred in the mean ALT and GGT levels in the control group. CONCLUSION: Although our encouraging preliminary results must be validated by double-blind histological trials, UDCA may be an alternative treatment for patients who fail to respond to interferon therapy.
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The route of transmission in more than 50% of the patients with hepatitis C virus (HCV) infection is unknown. Only a minority of patients have had a previous blood transfusion; sporadic spread seems to be much more important, although the role of inapparent parenteral exposure is yet to be established. Aim of this study was to investigate if a relationship exists between history for exposure to known risk factors, concurrent HBV status and histological findings (presence of cirrhosis) in patients with chronic HCV liver disease. We studied 86 subjects with chronic HCV liver disease, subdivided according to their HBV status. Fifty four patients were anti-HBV negative; in the remaining 32 subjects, antibodies to HBV were found. Our data show that: 1) history for exposure to known risk factors is more likely to be present in patients with chronic HCV liver disease and concurrent positivity for antibodies to HBV than in anti-HCV positive patients without HBV antibodies (62.5% vs 38.9%); and 2) the incidence of liver cirrhosis is higher in anti-HCV positive patients with anti-HBV antibodies than in exclusively anti-HCV positive patients (56.2% vs 12.9%). We conclude that the association of history for exposure to known risk factors and anti-HBV positivity could be a marker of progression from mild to severe liver damage in patients with chronic HCV liver disease (i.e. in the absence of both identifiable risk factors and HBV antibodies, HCV infection could have a less severe clinical outcome). Therefore, in these patients a closer follow-up and earlier interferon therapy are probably needed.
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Sulfated and unsulfated bile acid composition was studied in serum and bile in 10 patients with alcoholic cirrhosis. Samples, collected before and 2 months after portacaval anastomosis, were analyzed using a gaschromatographic method. Mean total serum bile acid levels rose from 32.0 +/- 5.3 (SE) mumol/liter before to 87.4 +/- 13.3 mumol/liter after surgery (P less than 0.005). The increase in serum bile acid levels was significantly only with respect to the unsulfated fraction (22.7 +/- 3.0 mumol/liter to 67.6 +/- 8.1 mumol/liter, P less than 0.005). Thus the percent sulfation of total serum bile acid decreased from 24.6% to 19.2%. The sulfated bile acid fraction comprised mainly chenodeoxycholate both before and after surgery. Percent sulfation of individual bile acids was not modified after portacaval anastomosis. Bile acid sulfates were present in bile only in negligible amounts. The daily urinary excretion of bile acids, studied in 6 patients, increased significantly (P less than 0.05) after surgery, the increase being due only to the unsulfated compounds. Data from this study indicate that in cirrhotic patients no significant changes occur in serum with respect to sulfated bile acids after portacaval anastomosis, despite a definite increase in serum unsulfated bile acid levels. This is likely due to the lack of an efficient enterohepatic circulation of bile acid sulfates.
Fasting serum concentrations of the individual bile acids were measured by gas chromatography in 27 patients with primary hyperlipoproteinemia (8 type IIa, 7 type IIb and 12 type IV) and in 14 healthy subjects. Total serum bile acid levels were 1618 +/- 244 ng/ml (SE) in type IIa, 1296 +/- 251 ng/ml in type IIb and 15609 +/- 263 ng/ml in type IV hyperlipoproteinemia. These values did not differ significantly from values in the control group (1505 +/- 200 ng/ml). Serum levels of cholic acid were significantly higher in patients with type IIa (551 +/- 78 ng/ml) than in those with type IIb (190 +/- 57 ng/ml, P < 0.01) and type IV (240 +/- 57 ng/ml, P < 0.02), while intermediate values were recorded in the control group (384 +/- 49 ng/ml). Ursodeoxycholic acid was found in larger amounts in hyperlipidemic patients than in controls. No significant differences with respect to other bile acids were observed between the groups examined. According to the current concepts on the enterohepatic circulation of bile acids, the findings support the hypothesis that the intestinal absorption of cholic acid may differ in various types of hyperlipoproteinemia.
UNLABELLED: Serum and biliary unsulfated bile acids were studied using a gas chromatographic method in 8 patients before and 2 months after portacaval anastomosis. Total serum bile acids were 21.6 +/- 3.6 mumol/liter before and 68.0 +/- 8.6 mumol/liter after surgery (P less than 0.005). Cholic acid rose from 26.5 +/- 3.4% to 33.8 +/- 4.8% (P less than 0.02) of the total serum bile acids, while chenodeoxycholic acid decreased from 67.9 +/- 4.1% to 60.8 +/- 4.3% (P less than 0.05). The relative concentration of cholic and chenodeoxycholic acids in bile increased slightly but not significantly after surgery, while deoxycholate fell from 8.5 +/- 1.7% to 2.1 +/- 0.6%. CONCLUSIONS: (1) in cirrhosis the serum and biliary bile acid composition are markedly different, the cholic-chenodeoxycholic ratio being much lower in serum than in bile; (2) after portacaval anastomosis serum and biliary bile acid patterns tend to become similar; (3) percent biliary deoxycholate decreases significantly after surgery.
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