ABSTRACT Gastroenterology, hepatology and liver transplant exchanges between the USA and Cuba have mainly consisted of scientific events and short visits. This has facilitated Cuba’s inclusion in recognized scientific organizations, familiarity with Cuba’s biotech products for treatment of liver disease, and access by Cuban professionals to the highest level of scientific information for clinical practice. It has also given health professionals in the US a more accurate picture of Cuba’s health sector. The results of the Global Alcoholic Liver Disease Survey, which included Cuba and was designed and coordinated in the USA, opened doors to joint research and scientific publications. Until now, there have been no protocols for ongoing cooperation to enable bilateral clinical trials or continuing professional development in diagnostic, therapeutic and surgical techniques for hepatology and liver transplantation. There are many mutually beneficial research prospects in these areas. What has been accomplished to date, described in this article, is encouraging and sets the stage for future collaboration.
ABSTRACT INTRODUCTION Reference values for liver stiffness for healthy individuals vary worldwide. Different optimal cutoff values correspond to the stages of fibrosis in chronic liver disease. OBJECTIVES Characterize the distribution of liver stiffness in Cuban adults without liver disease and its association with age, serum uric acid and body mass index. METHODS A cross-sectional study was performed of 110 plasma donors recruited from the Havana Province Blood Bank January 2016 through February 2017. Measurements of liver stiffness were performed using a FibroScan elastography device on the same day of laboratory analyses and abdominal ultrasound. The Pearson coefficient was used to assess correlations, and the reference range was calculated using the mean and its 95% confidence interval. RESULTS Liver stiffness values observed ranged from 2.2–6.3 kPa. The reference range (95% CI) for the 110 subjects without known liver disease was 4.2–4.6 kPa (mean 4.4). A positive correlation was observed between liver stiffness measurements and body mass index (r = 0.255, p <0.01) and serum uric acid (r = 0.266, p <0.01). There was no correlation between liver stiffness and age. Liver stiffness in women was similar to that of men, 4.3 (2.4–6.1) and 4.5 (2.2–6.3) kPa, respectively (p = 0.086). CONCLUSIONS Liver stiffness in Cuban adults without liver disease ranges from 2.2–6.3 kPa. The reference range is 4.2–4.6 kPa. Body mass index and serum uric acid levels are positively associated with liver stiffness. CONTRIBUTION OF THIS RESEARCH This is the first Cuban study using FibroScan to measure liver stiffness; its results will enable better assessment of liver disease in clinical practice.
La hepatitis C constituye un problema de salud mundial, con estimados de más de 160 millones de personas infectadas. Esta enfermedad es responsable de alrededor de 500 000 muertes anuales. El éxito limitado del tratamiento en pacientes infectados con el virus de la hepatitis C (VHC), genotipo 1, así como los numerosos e importantes efectos adversos de la terapia con interferón pegilado más ribavirina, unido a los avances en el conocimiento del ciclo de vida y de las características de las proteínas estructurales del virus, han estimulado el desarrollo de diferentes antivirales de acción directa (AAD), muy prometedores en sus efectos terapéuticos. Sin embargo, estos nuevos productos son extremadamente costosos y además algunos de ellos han presentado múltiples eventos adversos, lo que limita su empleo en determinadas poblaciones de individuos infectados, y no evitan la reinfección con el VHC. Por lo que se necesitan tratamientos con vacunas terapéuticas como un tratamiento adicional o alternativo para las infecciones crónicas por el VHC.
Hepatitis C is a significant health problem worldwide, with incidence estimates around 160 million people and 500 000 annual deaths. The limited success of treatments in chronic genotype 1 hepatitis C virus (HCV) patients and the numerous and significant adverse effects of the therapeutic treatment with pegilated interferon and ribavirin have encouraged the development of different direct-acting antivirals (DAAs) with promising results. This was also stimulated by advances of the knowledge on virus cell cycle and the properties of its structural properties. However, DAAs are very expensive and some of those compounds have developed multiple adverse events, all these limiting their use in certain infected populations. Moreover, its use does not prevent from HCV reinfections. Hence, new treatments, such as therapeutic vaccines, have arisen as additional or combined therapies against chronic HCV infection.