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Pregnancy and HCV chronic infection: Maternal outcome and vertical transmission
Abstracts
67 PREGNANCY AND HCV CHRONIC INFECTION: MATERNAL OUTCOME AND vERTICAL TRANSMISSION A. Colucq E. Minola’, M. Fmquelli, D. Pmti, F. Suter’, D. Savojardo. F Capioli and D. Come Cattedra di Gastmnterolo~a IRCCS Ospedale Maggiore. Milano and Dlv Malame Infettive, ‘Ospedti P.iuniti,Bergamo-Italy. Background and Aim. Based on the contlicting and scattered dam available, mesem series m mwnam women was aimed IO evaluate the prevalence~and natural co&e if HCV chronic infection and the rate oi HCV venical and ~erinatal transmission. Patients and Methods. In 17.308 consecutive subiects, aged 18-43 yrs (mean 31% SD 9 yn), am-HCV was tested by EL4 -&I and-coniied by RIBA III. In otiy those an” HCV positive, ALT, HCV-RNA and HCV viral load (and HCV geenotypem those viremic) were determined during the 1” month and the 3” tnmesrer of pregnancy and six months after delivery At the 1” and 2”d check. HBsAs and anti HIV were also determined. All the newborns of the am-HCV positive mothers were tested for ALT. anti-HCV and HCV-RNA at birth (on cord blood) and quarterly up to 24 mos; HCV genotypmg was done in rhe viremic ones. Statistics: Mann-Whimey and x2 OI Fischer’s exacr tests Results. 414 women (2.4%) were anti-HCV positwe and 283 (68%) viremic. Heroin abuse, blood transfusion(r) , health care employmem sex intercourse and unknown source were responsible for HCV mfectmn m 34. 19, 6.4 and 37%. HBV or HIV coinfection was present m 9 (2.2%) and 24 cases (6%). wtb one case of triple infection. HCV genotypes lb. 2. 3a. la. 4 and indeterminate one accounted for 31. 24. 20.19, 2 and 4%. resoectwelv ALT levels were over the ULN m 58% iniually, in 7% at the 3~~tnmes& and m 55% six months after delivery. The propwtmn of virermc women did not change. No case of “de nova*’ HBV or HIV-related infecrmn was observed. All the 438 newborns were anti-HCV positive at bmh: of the 22 (5%) viremic at birth, 20 became HCV-RNA neeative bv the 4’ monrh and 8 mitially HCV-RNA negative serwonverted, 4th an &erall rate of HCV chronic infection of 5% at 24 mos. HCV vertical transmission was confined to the vtiemic mothers and independent of viral load, mode of delivery and type of feeding. No case of HCV transmrssion was observed m the 24 HNcoinfecad mothers. Comments. Anti-HCV prevalence (2.4%) parallelled that of the local general population (l-3.2%). The decrease of ALT levels m most cases at the end of pregnancy could be related m an immunomediared pnxess. The rate of HCV transmission fmm mother m child was negligible (5%) and its modality (venial or pcrinatal) remains to be eluadared. From rbe techmczd point of YLCW,HCV-RNA testing on cord blood has a low no~mve oredicuve value.
LONG-TERM LAMIVUDINE THERAPY IMPROVES CHILD-PUGH SCORE IN PATIENTS WITH HEPATITIS B-RELATED CIRRHOSIS. P. Lamoertico, M. Iavamne, R. Romeo, E. De1Nimm and M. Colomba Dept. Medicine, IRCCS Maggiore Hospital, University of Milan. Lamivudine has been used to short-term treat patients with hepatitis B virus (HBV)-related chronic hepatitis. The efficacy and safety of long-term treatment of HBV carriers with cirrhosis has not been established. Patienrr and Merhods 44 patients (40 men, 50 p, 12 HBeAg+) with HBV-related cirrhosis (61% Child-Pugh A) were treated with lamivuclme 100 or 150 mg/daily for 19 months (E-32). 16 patients (37%) had esophageal vatices, 8 (18%) ascites and 19 (43%) had previously been treated with interferon. Baseline ALT were 136 UI/L (31-1900), HBV-DNA 446 Meq/ml Q-7300, bDNA, Chiron, >0.7 Meq/ml), IgM anti-HBc 0.72 index (0.08-3.55, MEIA, Abbott.
66 HRPATITIS B VACCINATION IN LIVER TRANSPLANT RECIPIENTS FOR HBV-RELATED CIRRHOSIS: FAILURE OF A RBINFORCED PROGRAM Daniele Di Pa&a. Massimo 0. Trinito, Carlo U. Cascimi, Giuscppe Tie and hhio AlgeIiw. Bcgy Unit, Immumpmphytis and Liver TmnspIanl Ctr, University of RomeTor Vergafq Italy. LMg-tRnl -
pssive immumpmp~tis widl antaBs (HBIG) is fbe-CmIeld smndard m prevem HBV
SUSTAINED RESPONSE RATE TO AMANTADINE HIGHER THAN THAT TO INTFRERONALONE A.Mangia, RSmtom, MRVii O.Cela, N.Minmw+, D.Bac&, G.DelI’Etbaw, A ciaopaspem’. F.VmtreUaf*,
PLUS INTERFERON
IS
M.Annese!j, V.Carrena”, AAmhitiIi.
Divisiooe di Gastmenkmlogia IRCCS ‘CSS” San Giovanni R e Bad*, Medicina Cama+, Mater@, Venow’, Casamm?, Tarauto”” e Cerignola**.
patients
aiih chionic
hq&iC.
Methods:194 pu with cbmaic hepatitis C were randomly allocated to either treatment with IFN (6 MU TIW) in combiition witIt AMA (200 mg/die) (Group 1) or as monothempy (Group 2). TIE hvo regimens were given for 48 aks. The main end point wss sustain4 HCVRNA nwativitv 6 ma afkr the end of the trcatmentz semndaw end
2 (pco.OC-5). Relapse rates W.X 26.8% in drwp 1 and 22.3% in GK&2 @=0.28j. sustained viroloei~ clearance was found in 30% of its in Gmuo I and in 16% of those in Group [email protected]). Feahues of pts accwding &h respoose’in both 8mups are shown in the table:
wN.30) Mean Age fy~~) s=(M) GenotJpe lb, 4 Genctyp za, 3 StagbIg 4
GROUP 1 NRM.70)
50.5 21(70%) 13(47%) 15(50%) 18(62%)
46.2 63(9G%) 44(63%) 2506%) 43(61%)
D vshle
it: n.s RS. RS.
GROUP 2 SR(N.15) NRfN.79)
ovalue
51.8 I1(73%) 5(33%) 10(67%) 8153%)
RS RS fi.03 p-O.0 1 n.r.
49.0 66(83%) 52(66%) 2 1(26%) 38(46%)
The wmbiitim of AMA and IFN inthe rate of sustained virolo@aI response when compared with IFN alone. In the combination therapy virological and histoIogical feahues did not sign&x@ mrrelare with therapeutic response. Conclusion: Combining IFN sith AMA is a promising theraPwtic mategy for beating mix pts with cbmnic hepatitis C.
A81
67 PREGNANCY AND HCV CHRONIC INFECTION: MATERNAL OUTCOME AND vERTICAL TRANSMISSION A. Colucq E. Minola’, M. Fmquelli, D. Pmti, F. Suter’, D. Savojardo. F Capioli and D. Come Cattedra di Gastmnterolo~a IRCCS Ospedale Maggiore. Milano and Dlv Malame Infettive, ‘Ospedti P.iuniti,Bergamo-Italy. Background and Aim. Based on the contlicting and scattered dam available, mesem series m mwnam women was aimed IO evaluate the prevalence~and natural co&e if HCV chronic infection and the rate oi HCV venical and ~erinatal transmission. Patients and Methods. In 17.308 consecutive subiects, aged 18-43 yrs (mean 31% SD 9 yn), am-HCV was tested by EL4 -&I and-coniied by RIBA III. In otiy those an” HCV positive, ALT, HCV-RNA and HCV viral load (and HCV geenotypem those viremic) were determined during the 1” month and the 3” tnmesrer of pregnancy and six months after delivery At the 1” and 2”d check. HBsAs and anti HIV were also determined. All the newborns of the am-HCV positive mothers were tested for ALT. anti-HCV and HCV-RNA at birth (on cord blood) and quarterly up to 24 mos; HCV genotypmg was done in rhe viremic ones. Statistics: Mann-Whimey and x2 OI Fischer’s exacr tests Results. 414 women (2.4%) were anti-HCV positwe and 283 (68%) viremic. Heroin abuse, blood transfusion(r) , health care employmem sex intercourse and unknown source were responsible for HCV mfectmn m 34. 19, 6.4 and 37%. HBV or HIV coinfection was present m 9 (2.2%) and 24 cases (6%). wtb one case of triple infection. HCV genotypes lb. 2. 3a. la. 4 and indeterminate one accounted for 31. 24. 20.19, 2 and 4%. resoectwelv ALT levels were over the ULN m 58% iniually, in 7% at the 3~~tnmes& and m 55% six months after delivery. The propwtmn of virermc women did not change. No case of “de nova*’ HBV or HIV-related infecrmn was observed. All the 438 newborns were anti-HCV positive at bmh: of the 22 (5%) viremic at birth, 20 became HCV-RNA neeative bv the 4’ monrh and 8 mitially HCV-RNA negative serwonverted, 4th an &erall rate of HCV chronic infection of 5% at 24 mos. HCV vertical transmission was confined to the vtiemic mothers and independent of viral load, mode of delivery and type of feeding. No case of HCV transmrssion was observed m the 24 HNcoinfecad mothers. Comments. Anti-HCV prevalence (2.4%) parallelled that of the local general population (l-3.2%). The decrease of ALT levels m most cases at the end of pregnancy could be related m an immunomediared pnxess. The rate of HCV transmission fmm mother m child was negligible (5%) and its modality (venial or pcrinatal) remains to be eluadared. From rbe techmczd point of YLCW,HCV-RNA testing on cord blood has a low no~mve oredicuve value.
LONG-TERM LAMIVUDINE THERAPY IMPROVES CHILD-PUGH SCORE IN PATIENTS WITH HEPATITIS B-RELATED CIRRHOSIS. P. Lamoertico, M. Iavamne, R. Romeo, E. De1Nimm and M. Colomba Dept. Medicine, IRCCS Maggiore Hospital, University of Milan. Lamivudine has been used to short-term treat patients with hepatitis B virus (HBV)-related chronic hepatitis. The efficacy and safety of long-term treatment of HBV carriers with cirrhosis has not been established. Patienrr and Merhods 44 patients (40 men, 50 p, 12 HBeAg+) with HBV-related cirrhosis (61% Child-Pugh A) were treated with lamivuclme 100 or 150 mg/daily for 19 months (E-32). 16 patients (37%) had esophageal vatices, 8 (18%) ascites and 19 (43%) had previously been treated with interferon. Baseline ALT were 136 UI/L (31-1900), HBV-DNA 446 Meq/ml Q-7300, bDNA, Chiron, >0.7 Meq/ml), IgM anti-HBc 0.72 index (0.08-3.55, MEIA, Abbott.
66 HRPATITIS B VACCINATION IN LIVER TRANSPLANT RECIPIENTS FOR HBV-RELATED CIRRHOSIS: FAILURE OF A RBINFORCED PROGRAM Daniele Di Pa&a. Massimo 0. Trinito, Carlo U. Cascimi, Giuscppe Tie and hhio AlgeIiw. Bcgy Unit, Immumpmphytis and Liver TmnspIanl Ctr, University of RomeTor Vergafq Italy. LMg-tRnl -
pssive immumpmp~tis widl antaBs (HBIG) is fbe-CmIeld smndard m prevem HBV
SUSTAINED RESPONSE RATE TO AMANTADINE HIGHER THAN THAT TO INTFRERONALONE A.Mangia, RSmtom, MRVii O.Cela, N.Minmw+, D.Bac&, G.DelI’Etbaw, A ciaopaspem’. F.VmtreUaf*,
PLUS INTERFERON
IS
M.Annese!j, V.Carrena”, AAmhitiIi.
Divisiooe di Gastmenkmlogia IRCCS ‘CSS” San Giovanni R e Bad*, Medicina Cama+, Mater@, Venow’, Casamm?, Tarauto”” e Cerignola**.
patients
aiih chionic
hq&iC.
Methods:194 pu with cbmaic hepatitis C were randomly allocated to either treatment with IFN (6 MU TIW) in combiition witIt AMA (200 mg/die) (Group 1) or as monothempy (Group 2). TIE hvo regimens were given for 48 aks. The main end point wss sustain4 HCVRNA nwativitv 6 ma afkr the end of the trcatmentz semndaw end
2 (pco.OC-5). Relapse rates W.X 26.8% in drwp 1 and 22.3% in GK&2 @=0.28j. sustained viroloei~ clearance was found in 30% of its in Gmuo I and in 16% of those in Group [email protected]). Feahues of pts accwding &h respoose’in both 8mups are shown in the table:
wN.30) Mean Age fy~~) s=(M) GenotJpe lb, 4 Genctyp za, 3 StagbIg 4
GROUP 1 NRM.70)
50.5 21(70%) 13(47%) 15(50%) 18(62%)
46.2 63(9G%) 44(63%) 2506%) 43(61%)
D vshle
it: n.s RS. RS.
GROUP 2 SR(N.15) NRfN.79)
ovalue
51.8 I1(73%) 5(33%) 10(67%) 8153%)
RS RS fi.03 p-O.0 1 n.r.
49.0 66(83%) 52(66%) 2 1(26%) 38(46%)
The wmbiitim of AMA and IFN inthe rate of sustained virolo@aI response when compared with IFN alone. In the combination therapy virological and histoIogical feahues did not sign&x@ mrrelare with therapeutic response. Conclusion: Combining IFN sith AMA is a promising theraPwtic mategy for beating mix pts with cbmnic hepatitis C.
A81