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Evolution of hepatitis C in children with HCV vertically transmitted
120
Posters
1PlCO6lD49 1
[p/co6/051
EVOLUTION OF HEPATlTfS C IN CHILDREN WlTH HCV VERTfCALLY TRANSMITTED Fliseo Minola. F. Berera. 0. Fracassettl. R. Tan&@. GP Qnzx~& Persiani. 0. Wcari. A. Cobmbo. 6 Paris. “HCVVerlical Transmission Sk& Group”, Ospedali Riti. BG. Italy. . . iectlvea: Many &u&es about hepatitisC virus (HCV) assess the risk of vertical transmission of HCV. but very litk is known about the ev&tion of vertically transmitted infection. We inwsfi@ed a whorl of children born of HCV infected m. Bethodp: Between January 1994 and Jum 1997, we studied 112 HCV RNA positive pregnant woman at Wo Obstetrical Depahents of OUT Hospital. Six cl&ken (5.4%), 3 males and 3 females (2 of them were twins). were HCV RNA infected at birth; their mothers were HCV-RNA positive with a confirmed diagnosis of ctronic hepatitis. Their anamnestic data, for exposure to risk factors, showed that two women had been intravenous drug users (IVDUs). one had been ha-transfused and two of them had a corrmw@acq*red infection. None were HIV positive. At the follow-up controls (birth. 3.6, 12. 18,24 months) we looked for HCVAb (ELISA). HCV-RNA (PCR), alanine amlnotransferases (ALT) In serun of our young patients. Genotypes were determined for each chiM accordng to Sirnmonds classiflcaiion. M: All the chilben were positive for HCVAb and HCV-RNA in three controls at least. In 2 cases (33.3%) ALT had been ahvays normal (n.v. ~46 mUIM) until 24 months. One baby had an acute phase with ALT=2,580 mlJknl (at sixth month), remaining akays higher than 10 times ncnmal values; this baby had an histologicaly ccnfirmed active chronic hepatitis, with hepaik fibrosis and began interferon lreabnent when 3 years old. In 3 cases (50%) ALT were atways pathological (ALT 1.5 3 n.v.) with no evidence of an acute phase. One child (female) had been lowty viraemic (at 6.12 and 18 months old), then became negative for HCVRNA and iod HCV-Ab at 24 monfhs of life. chilben’s genotypes were ahways correspond& to those of their mothers: 3 paflents had gwotype 2, 2hadgenotype3aandonepatienthadgenotypala.Conclurionr:Our data suggesf that HCV infection in children born from vlraemic mothers had a low rate (5.4%) wfth an asymptomatic devekpment Ttree paa(50%) showed, from ths begkning, an infection \rfth clrordc featwes (ALT> 1.5 n.v. persistently). Two patients (33.3%) seemed aqmptomatlc with persistent normal ALT and one baby (16,7%) had an acute severe anicteric ilness folowed by histdogicalty doamented crticizaUon.
LONG TERM PROTECTION IN MENTALLY RETARDED AGAINST HEPATITIS B: RESULTS AFTER 11 YEARS.
A Vellinaa’. P Van Damme’. R Vranckx’. J Wevler’ and A Meheus’ ‘Centre for the Evaluatim of Vaccination, WHO Cdlaborating Centre for Preventionend Contrd of Viral Hepatitis, Epidemidyy and Community Medicine, University of Antwerp. Universtiflatsplmn1, 2610 Antwerp Scientific Institute of Public Health-Institute LOUIS Pasteur, 1050 Brussels. There is a greater risk of hepatitis B virus (HBV) transmission among mentally handicapped people in residential institutions due to a higher prevalence of chronic HBV carriers in these groups. Risk factors for the higher transmission involve behavioral features, age, Down’s syndrome, residency itself and its duration. Therefore, vaccination against hepatitis B infection is today a standard procedure for such high risk groups. We report here on the results of a follow up study in an institution in Belgium where all residents were vaccinated in 1986. Subjects were divided in three groups according to their immunological response to vaccination at month 6. Group 1 (N=67 on a 0,1,6 month schedule); group 2 (N=30 on the same schedule but they needed a booster at M12) and group 3 (N=8; needing 5 doses or more). All 105 individuals were followed for five years after which all received a booster dose. Eleven years after the initial vaccination, patients were tested again for the presence of HBV serologic markers. In the first year post vaccination a sharp decline in the GMTs are seen but the decrease is much slower in subsequent years. Just prior to the booster at month 60 still 91.1% of the whole group (105 subjects) have protective levels 2 10 It-t/I. Eleven years after vaccination (6 years post booster) an overall of 95.8% of subjects from groups 1 and 2 (N = 97) still have protective levels. During the past six years, two persons developed evidence of hepatitis B infection. Analysis at year 11 shows they were anti-HBc positive. But they did not display any clinical signs of the disease during those 6 years and both are HBs Ag negative. In conclusion, we can state that despite waning anti-HBs levels, protection, by vaccination, against hepatitis B virus infection on the long term appears to be excellent. Notwithstanding the fact that our study population can be considered a high risk group, only two subjects developed a subclinical infection without becoming carriers.
1 P/CO6/052 INTERFERON VERSUS RIBAVIRIN PLUS INTERFERON IN CHRONIC HEPATITIS C PATIENTS RELAPSERS AND NON RESPONDERS TO RECOMBINANT INTERFERON Vandelli C., Renzo F., Lovat E., SardiniC., Di Marco G., Thmin&ky S., Ventura E. Departmentof Intemal Medicine. Modena Univemity;ICGEB Tries@ Italy. tlWmen~ofptiexlts(pts) Disqx&ngresultswithintehon(IFN)inthe with chronic hepatitisC (CHC), have pnnnped imereatin new hmpeutic agpaches.~data~alligherresponselateofsostainedresponse (SR) a&r a combined thenqy with IFN plus rihirin (IFNiREW). To im&i~theclillical&kacyofnatmal~~tFN/RBv~vetsrs llW alone, 31 pts (17 aon reqadzs -NR, 14 mhp6em-W MiF 16/15; mean a~4~8.9yrs)withbiopsJ’prwgHCVRNApositivecHCweretreated withnatmallmmanlealmqteIFNu,6MUtiwfor12months(mo.).Ptswho ctidnotnormalizedALTvalueattheendofthe3thro,of~,,weregiven combhadon with 800 m&la& ofrhvirin for 6 months(12 NR, SR). All Jo& werefollowedupfor12mo.after~withdrawa.Twoptsweredropout forohcaria.Tmmamh~awere-every4&HCV-RNAthlxmo.Theoverall5WailKdreqxmaein thisstadywas:biochemical (normalALT at the end follow-up)11/31 @s (35,4%), and virologic (HCV RNAnegativeattheendoffollowup)5~lpts(16,1%).Thebiochemical virologicresponsewashigherinRRptsthaninNR~~(biochemical nzpcmse:42,8% vs 29,4%; vimlogic response : 28,50/avs 5,8% The higher
of
SUSta&dresponseratewaS&UXvXditlRRptstltl&cOmbinationtherapy. Genotype lb, accordingto Simmoml’s chssilication, was found in 18 (78,3%)
ptss,HCVtype2in15%and~3io8,7%of~.HCVgenotypelbwas PreQminant in NR group (90% in NR vs 69,2% in RR). These results indicatethatthewmbinationIMplus~~rin,~~totheschedule usedinthissludy,impKWtherateofsusolinedresponsemainlyinRRpts. InNR~,the~nationseemstobelessbeneficialandthereforethe retreatment ofNR awaitsfurtherstrategies.
VACCINATED
1
PREVALENCE OF HEPATITIS G VIRUS (HGV) ANTI-E2 ANTIBODY IN VARIOUS POPULATIONS HIGH RISK OF TRANSMITTED VIRUSES.
RNA AND AT LOW
OF OR
F. Roudot-Thoraval. I. Morand-Joubert. Y. Brossard. M. Mariotti. M. Parnet. R. Girot. P. I oiseau. J.J. LefrBrg. HBpitaux Henri Mondor, CrBteil, SaintAntoine and Tenon, Paris, INTS, AP-HP Paris, France. A high prevalence of HGV RNA carriers have been reported in blood donors and in groups at risk of blood-borne viruses. However the combined detection of HGV RNA and of anti-E2 antibody is necessary to define the acurate prevalence of infection in a population. We searched for the presence of antiE2 ab(ELISA Boehringer) and HGV RNA (home-made PCR) in various groups of individuals at low or high risk of blood-borne or sexually-transmitted viruses and tried to identify risk factors for HGV infection in individuals at low risk. Populations Regular blood donors (ED) mainland (500) west Indies (189) Pregnant women (100) Multiply-transfused patients immunocompetent (196) immunodepressed (135) Homosexual men anti-HIV +ve (78) anti-HIV -ve (17) Anti-HIV+ve drua users (77)
HGV RNA +ve % 4.2 2.6 5.0
anti-E2 +ve % 8.6 14.3 11.0
HGV RNA % 12.6 16.9 16.0
9.5 17.0
14.5 5.2
23.7 21.5
24.4 11.8 25.9
16.7 29.4
41 .o 41.2 40.7
I 4.8
In regular BD, women were more often exposed than men (17.6 ~~10.3, p
Posters
1PlCO6lD49 1
[p/co6/051
EVOLUTION OF HEPATlTfS C IN CHILDREN WlTH HCV VERTfCALLY TRANSMITTED Fliseo Minola. F. Berera. 0. Fracassettl. R. Tan&@. GP Qnzx~& Persiani. 0. Wcari. A. Cobmbo. 6 Paris. “HCVVerlical Transmission Sk& Group”, Ospedali Riti. BG. Italy. . . iectlvea: Many &u&es about hepatitisC virus (HCV) assess the risk of vertical transmission of HCV. but very litk is known about the ev&tion of vertically transmitted infection. We inwsfi@ed a whorl of children born of HCV infected m. Bethodp: Between January 1994 and Jum 1997, we studied 112 HCV RNA positive pregnant woman at Wo Obstetrical Depahents of OUT Hospital. Six cl&ken (5.4%), 3 males and 3 females (2 of them were twins). were HCV RNA infected at birth; their mothers were HCV-RNA positive with a confirmed diagnosis of ctronic hepatitis. Their anamnestic data, for exposure to risk factors, showed that two women had been intravenous drug users (IVDUs). one had been ha-transfused and two of them had a corrmw@acq*red infection. None were HIV positive. At the follow-up controls (birth. 3.6, 12. 18,24 months) we looked for HCVAb (ELISA). HCV-RNA (PCR), alanine amlnotransferases (ALT) In serun of our young patients. Genotypes were determined for each chiM accordng to Sirnmonds classiflcaiion. M: All the chilben were positive for HCVAb and HCV-RNA in three controls at least. In 2 cases (33.3%) ALT had been ahvays normal (n.v. ~46 mUIM) until 24 months. One baby had an acute phase with ALT=2,580 mlJknl (at sixth month), remaining akays higher than 10 times ncnmal values; this baby had an histologicaly ccnfirmed active chronic hepatitis, with hepaik fibrosis and began interferon lreabnent when 3 years old. In 3 cases (50%) ALT were atways pathological (ALT 1.5 3 n.v.) with no evidence of an acute phase. One child (female) had been lowty viraemic (at 6.12 and 18 months old), then became negative for HCVRNA and iod HCV-Ab at 24 monfhs of life. chilben’s genotypes were ahways correspond& to those of their mothers: 3 paflents had gwotype 2, 2hadgenotype3aandonepatienthadgenotypala.Conclurionr:Our data suggesf that HCV infection in children born from vlraemic mothers had a low rate (5.4%) wfth an asymptomatic devekpment Ttree paa(50%) showed, from ths begkning, an infection \rfth clrordc featwes (ALT> 1.5 n.v. persistently). Two patients (33.3%) seemed aqmptomatlc with persistent normal ALT and one baby (16,7%) had an acute severe anicteric ilness folowed by histdogicalty doamented crticizaUon.
LONG TERM PROTECTION IN MENTALLY RETARDED AGAINST HEPATITIS B: RESULTS AFTER 11 YEARS.
A Vellinaa’. P Van Damme’. R Vranckx’. J Wevler’ and A Meheus’ ‘Centre for the Evaluatim of Vaccination, WHO Cdlaborating Centre for Preventionend Contrd of Viral Hepatitis, Epidemidyy and Community Medicine, University of Antwerp. Universtiflatsplmn1, 2610 Antwerp Scientific Institute of Public Health-Institute LOUIS Pasteur, 1050 Brussels. There is a greater risk of hepatitis B virus (HBV) transmission among mentally handicapped people in residential institutions due to a higher prevalence of chronic HBV carriers in these groups. Risk factors for the higher transmission involve behavioral features, age, Down’s syndrome, residency itself and its duration. Therefore, vaccination against hepatitis B infection is today a standard procedure for such high risk groups. We report here on the results of a follow up study in an institution in Belgium where all residents were vaccinated in 1986. Subjects were divided in three groups according to their immunological response to vaccination at month 6. Group 1 (N=67 on a 0,1,6 month schedule); group 2 (N=30 on the same schedule but they needed a booster at M12) and group 3 (N=8; needing 5 doses or more). All 105 individuals were followed for five years after which all received a booster dose. Eleven years after the initial vaccination, patients were tested again for the presence of HBV serologic markers. In the first year post vaccination a sharp decline in the GMTs are seen but the decrease is much slower in subsequent years. Just prior to the booster at month 60 still 91.1% of the whole group (105 subjects) have protective levels 2 10 It-t/I. Eleven years after vaccination (6 years post booster) an overall of 95.8% of subjects from groups 1 and 2 (N = 97) still have protective levels. During the past six years, two persons developed evidence of hepatitis B infection. Analysis at year 11 shows they were anti-HBc positive. But they did not display any clinical signs of the disease during those 6 years and both are HBs Ag negative. In conclusion, we can state that despite waning anti-HBs levels, protection, by vaccination, against hepatitis B virus infection on the long term appears to be excellent. Notwithstanding the fact that our study population can be considered a high risk group, only two subjects developed a subclinical infection without becoming carriers.
1 P/CO6/052 INTERFERON VERSUS RIBAVIRIN PLUS INTERFERON IN CHRONIC HEPATITIS C PATIENTS RELAPSERS AND NON RESPONDERS TO RECOMBINANT INTERFERON Vandelli C., Renzo F., Lovat E., SardiniC., Di Marco G., Thmin&ky S., Ventura E. Departmentof Intemal Medicine. Modena Univemity;ICGEB Tries@ Italy. tlWmen~ofptiexlts(pts) Disqx&ngresultswithintehon(IFN)inthe with chronic hepatitisC (CHC), have pnnnped imereatin new hmpeutic agpaches.~data~alligherresponselateofsostainedresponse (SR) a&r a combined thenqy with IFN plus rihirin (IFNiREW). To im&i~theclillical&kacyofnatmal~~tFN/RBv~vetsrs llW alone, 31 pts (17 aon reqadzs -NR, 14 mhp6em-W MiF 16/15; mean a~4~8.9yrs)withbiopsJ’prwgHCVRNApositivecHCweretreated withnatmallmmanlealmqteIFNu,6MUtiwfor12months(mo.).Ptswho ctidnotnormalizedALTvalueattheendofthe3thro,of~,,weregiven combhadon with 800 m&la& ofrhvirin for 6 months(12 NR, SR). All Jo& werefollowedupfor12mo.after~withdrawa.Twoptsweredropout forohcaria.Tmmamh~awere-every4&HCV-RNAthlxmo.Theoverall5WailKdreqxmaein thisstadywas:biochemical (normalALT at the end follow-up)11/31 @s (35,4%), and virologic (HCV RNAnegativeattheendoffollowup)5~lpts(16,1%).Thebiochemical virologicresponsewashigherinRRptsthaninNR~~(biochemical nzpcmse:42,8% vs 29,4%; vimlogic response : 28,50/avs 5,8% The higher
of
SUSta&dresponseratewaS&UXvXditlRRptstltl&cOmbinationtherapy. Genotype lb, accordingto Simmoml’s chssilication, was found in 18 (78,3%)
ptss,HCVtype2in15%and~3io8,7%of~.HCVgenotypelbwas PreQminant in NR group (90% in NR vs 69,2% in RR). These results indicatethatthewmbinationIMplus~~rin,~~totheschedule usedinthissludy,impKWtherateofsusolinedresponsemainlyinRRpts. InNR~,the~nationseemstobelessbeneficialandthereforethe retreatment ofNR awaitsfurtherstrategies.
VACCINATED
1
PREVALENCE OF HEPATITIS G VIRUS (HGV) ANTI-E2 ANTIBODY IN VARIOUS POPULATIONS HIGH RISK OF TRANSMITTED VIRUSES.
RNA AND AT LOW
OF OR
F. Roudot-Thoraval. I. Morand-Joubert. Y. Brossard. M. Mariotti. M. Parnet. R. Girot. P. I oiseau. J.J. LefrBrg. HBpitaux Henri Mondor, CrBteil, SaintAntoine and Tenon, Paris, INTS, AP-HP Paris, France. A high prevalence of HGV RNA carriers have been reported in blood donors and in groups at risk of blood-borne viruses. However the combined detection of HGV RNA and of anti-E2 antibody is necessary to define the acurate prevalence of infection in a population. We searched for the presence of antiE2 ab(ELISA Boehringer) and HGV RNA (home-made PCR) in various groups of individuals at low or high risk of blood-borne or sexually-transmitted viruses and tried to identify risk factors for HGV infection in individuals at low risk. Populations Regular blood donors (ED) mainland (500) west Indies (189) Pregnant women (100) Multiply-transfused patients immunocompetent (196) immunodepressed (135) Homosexual men anti-HIV +ve (78) anti-HIV -ve (17) Anti-HIV+ve drua users (77)
HGV RNA +ve % 4.2 2.6 5.0
anti-E2 +ve % 8.6 14.3 11.0
HGV RNA % 12.6 16.9 16.0
9.5 17.0
14.5 5.2
23.7 21.5
24.4 11.8 25.9
16.7 29.4
41 .o 41.2 40.7
I 4.8
In regular BD, women were more often exposed than men (17.6 ~~10.3, p