Valutazioni cliniche e immunologiche in pazienti affetti da HBV cronico durante la terapia con analoghi nucleosidici/nucleotidici e Peg-IFN: studio pilota per la prevenzione dell'epatocarcinoma

Aim:HBV infection in adults is often self-limiting and results in an acute hepatitis but in 10% of infected adults we have the development of a chronic infection. Recently at Department of Infectious Diseases of the University of Sassari we have been observed important clinical data of 6 patients with chronic HBV with peripheral neuropathy NUCs correlated; subsequently for these patients has been blocked administration of NUCs changing the therapeutic plane doing a switch with PEG-IFN Into the period of therapeutic switch, we found a clinic resolution of infection and during follow-up time, we observed in two patient, a complete seroconversion anti-HBsAg. In order to study the progress of immune response they were selected three patients being treated with NUCs at least 5 years in the various phases of the therapeutic switch with PEG-IFN until follow-up. Methods: at different intervals of time during and after the therapeutic switch, we stimulated ex vivo blood samples of patients and healthy controls, with three different pool of recombinant peptides of HBV genotype D (core, polymerase, surface) and we were performed flow cytometric analysis.Results:during administration of PEG-IFN we found for one patient, between 4th week of treatment and 2n d follow-up, on the lymphocytes subpopulation of CD4+, an increase of IL17 cytokine, with peak about of 3.6%. induced by core peptides. We observed a similar production of IL-17 also dependent of CD8+, but with a peak at the fourth week during treatment at the ALT peak. Conclusion: realistically the switch with PEG-IFN has immunomodulatory activity through the control of specific CD8+, preventing massive liver injury and stimulating innate response mediate by NK cells that restrict viral infection.