ABSTRACT Introduction: The effectiveness of the national immunization program has impacted on the reduction of the incidence of hepatitis B virus (HBV) infection in Cuba; however, the number of chronically infected patients is not negligible. These patients are diagnosed in the clinical practice, although the epidemiological studies that indicate the presence of the disease are insufficient. Objective: To describe the main clinical, biomolecular and immunological characteristics of patients with chronic hepatitis B virus infection treated at the National Institute of Gastroenterology, Havana, Cuba. Materials and methods: A total of 97 patients who had at least a 6-month history of chronic HBV infection were recruited at the above mentioned institution from January 2016 to January 2018. Descriptive statistical analyzes were performed to identify the clinical characteristics. Biochemical and virological studies, analysis of both liver stiffness values measured by transient elastography and use of antiviral therapy were also carried out. Results: All patients completed the follow-up. It was observed that 61,9 % of them were male and the median (range) age was 46 (18-84) years. The mean time since the diagnosis of the infection was 11.7 ± 8,9 years. Inactive disease without liver fibrosis or light fibrosis was present in 61,9 %. Only 2 % were negative for hepatitis B surface antigen with quantitative analysis of HBV DNA; also, 81,4 % of patients had detectable viral load and 85,5 % received one or more antiviral treatments, mainly nucleotide analogues. Conclusions: The patients with chronic HBV infection studied are mostly in the inactive phase of their disease, without significant evidence of liver damage and detectable levels of viremia. All of them have received some antiviral treatment.

RESUMEN Introducción: La efectividad del programa nacional de inmunización ha impactado en la reducción de la incidencia del virus de la hepatitis B en Cuba; sin embargo, no es despreciable la cantidad de pacientes infectados crónicos, que por esta causa, se detectan en la práctica asistencial, aunque insuficientes los estudios epidemiológicos que los caracterizan. Objetivo: Describir las principales características clínicas, biomoleculares e inmunológicas de los pacientes con VHB crónica atendidos en el Instituto de Gastroenterología de Cuba. Materiales y métodos: 97 pacientes que tenían al menos un historial de 6 meses de infección crónica con VHB fueron reclutados en la propia institución desde enero 2016 hasta enero 2018. Se realizaron análisis estadísticos descriptivos para las características clínicas, estudios bioquímicos, virológicos, grado de dureza hepática (medido por elastografía transitoria) y terapia antiviral. Resultados: Todos los pacientes completaron el seguimiento; 61,9% eran varones y la mediana (rango) de edad fue de 46 (18-84) años. La media de tiempo desde el diagnóstico de la infección fue de 11,7 ± 8,9 años. El 61,9% tenían enfermedad inactiva sin fibrosis hepática o fibrosis ligera. Solamente el 2% eran negativos para el antígeno de superficie de la hepatitis B con el DNA cuantificable del VHB, el 81,4% tenían carga viral detectable y el 85,5% recibieron uno o más tratamientos antivirales, principalmente los análogos del nucleótido/sido. Conclusiones: Los pacientes con la infección crónica del VHB estudiados, en su mayoría se encuentran en fase inactiva de su enfermedad, sin evidencia significativa de daño hepático, con niveles detectables de viremia y han recibido algún tratamiento antiviral.

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.

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.

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.

170 million people are estimated to be infected with hepatitis C virus (HCV) worldwide. The persistence of the virus in the body is due to its ability to mutate and alterations in the immune response that occurs. There are theories linking this virus lymphoma genesis. The relative risk of HCV-infected patients suffering from non-Hodgkin lymphoma is 2-4 times higher than in uninfected subjects. This association has geographic variability. Countries where the association is stronger are Italy, Japan, and the United States, and it is lesser in Canada and northern Europe. Lymphoma of the marginal zone in B cells and lymphoplasmacytic are the most well-informed in association with HCV. Indolent non-Hodgkin lymphomas associated with HCV can be treated with antiviral therapy, but the aggressive forms require specific immunochemotherapy. Hepatitis C has been shown to be a significant risk factor for hepatic toxicity in patients needing chemotherapy.

Se estima que unos 170 millones de personas están infectadas por el virus de la hepatitis C (VHC) en todo el mundo. La persistencia del virus en el organismo es consecuencia de su capacidad de mutar y de las alteraciones en la respuesta inmunológica que produce. Existen teorías que relacionan este virus con la linfomagénesis. El riesgo relativo de que pacientes infectados con el VHC padezcan linfoma no Hodgkin (LNH) es de 2 a 4 veces mayor que en los sujetos no infectados. Esta asociación tiene variabilidad geográfica: los países donde esa asociación es mayor son Italia, Japón y Estados Unidos, y donde es menor son Canadá y los del norte de Europa. El linfoma de la zona marginal de células B y el linfoplasmocitico son los más reportados en asociación con el VHC. Los LNH indolentes asociados con el VHC pueden ser tratados con terapia antiviral, no así las formas agresivas que necesitan de inmunoquimioterapia específica. Se ha demostrado que la hepatitis C es un significativo factor de riesgo para la toxicidad hepática en los pacientes que necesitan quimioterapia.

In treatment of compensating hepatic cirrhosis of viral etiology the maintained viral response with Interferon and Ribavirin is minor and it is accompanied of a greater frequency of adverse effects in relation to non-cirrhotic patients. However, due to the scarce therapeutical options for this group of patients and the need to retard the appearance of complications, was the reason of present paper. Authors present the results from a group of 36 patients diagnosed with hepatic cirrhosis from HCV in A Child's stage included in multicenter clinical trials, sponsored by the Institute of Gastroenterology; patients received a therapeutical scheme of Interferon alfa-2b plus Ribavirin during 48 weeks assessing their tolerance by clinical and hematologic adverse events. Results demonstrate that this treatment alternative is safe and well-tolerated.

En el tratamiento de la cirrosis hepática compensada de etiología vírica la respuesta viral sostenida con el interferón y ribavirina es menor y se acompaña de mayor frecuencia e intensidad de efectos adversos en relación con pacientes no cirróticos. No obstante, dadas las pocas opciones terapéuticas para este grupo de pacientes y la necesidad de retrasar la aparición de las complicaciones, nos motivamos a la realización de este trabajo. Se presentan los resultados de un grupo de 36 pacientes con diagnóstico de cirrosis hepática por el virus de la hepatitis C (VHC) en estadio de Child A incluidos en un ensayo clínico multicéntrico, liderado por el Instituto de Gastroenterología, a los que se les administró un esquema terapéutico de interferón alfa-2b más ribavirina por 48 sem, se evaluó su tolerancia a través de los eventos adversos tantos clínicos como hematológicos. Los resultados demuestran que esta alternativa de tratamiento es segura y bien tolerada.

Granular cells tumors are rare and asymptomatic lesions and by general, it is an incidental finding en high or low endoscopy. They were described for the first time by Abrikossoff in 1926. The more frequent locations are the buccal mucosa, dermis and subcutaneous cellular tissue, most of these tumors has a benign origin. This is the case of a woman aged 44 with a pyrosis history from a year ago; by high endoscopy it is noted a 8mm lesion distal to esophagus and confirmed by histological study of granular cells tumor. Elective treatment of this lesion is the endoscopic polypectomy. Despite that the malign potential is low; we suggested a close clinical and endoscopic follow-up.

Los tumores de células granulares son lesiones raras y asintomáticas, generalmente un hallazgo incidental en la endoscopia alta o baja. Fueron descritos por primera vez en 1926 por Abrikossoff. Las localizaciones más frecuentes son la mucosa bucal, la dermis y el tejido celular subcutáneo, la mayor parte de estos tumores tienen una naturaleza benigna. Presentamos el caso clínico de una mujer, de 44 años con historia de pirosis desde hace aproximadamente 1 año, se observa por endoscopia superior lesión elevada de 8 mm en tercio distal de esófago y se confirma por estudio histológico el diagnóstico de tumor de células granulares. El tratamiento de elección de esta lesión es la polipectomía endoscópica. A pesar de que el potencial maligno es escaso se sugiere seguimiento estrecho clínico y endoscópico.