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"The first observation of cold-induced precipitation of serum proteins dates back to 1933, when Wintrobe and Buell first described an unusual case of multiple myeloma in a woman whose serum reversibly precipitated at cold temperatures. In 1947 Lerner and Watson showed cold-precipitable proteins to be gammaglobulins and called them ‘cryoglobulins’ and the corresponding clinical condition ‘cryoglobulinemia’. Meltzer and Franklin in 1966 provided an accurate description of the typical clinical symptoms associated with cryoglobulinemia, showed that they consisted of two different globulin components and, because of the ignorance on its etiology, called this clinical condition ‘essential mixed cryoglobulinemia’. For almost 20 years progress has been rather slow in this field, but when at the end of the ‘80s it finally became possible to detect the occurrence in the serum of antibodies to the hepatitis C virus (HCV), many groups in Europe and the United States almost simultaneously reported that a high proportion of ‘essential’ cryoglobulinemias are in fact associated with HCV infection. This hallmark has resulted in a new impetus and great enthusiasm in carrying out new researches made possible by the awareness that cryoglobulinemia is to be considered an undisputable extrahepatic manifestation of HCV infection. In addition, the evidence that HCV has tropism for hepatocytes and lymphocytes has stimulated new approaches to the autoimmune phenomena and the potential transformation in non-Hodgkin’s lymphomas which not infrequently can be discovered in these patients. The same applies to the obvious therapeutic implications, once the association between HCV infection and mixed cryoglobulinemia has been firmly established. It was thus felt that times were ripe to produce a state-of-the-art survey of the multi-faceted picture of cryoglobulinemia. This book is indeed unique in the detail of its presentation, its completeness and its fundamental approach to the subject. The most qualified authors have been invited to contribute critical articles reviewing significant developments related to each of the eight sections in which the whole treatment has been divided: from basic mechanisms governing interactions between HCV and the immune system to the immunochemical characterization of cryoglobulins and the frequently concomitant serological abnormalities; from genetic features and the role of certain cytokines and chemokines to the cellular compartments of HCV infection and replication; from the clinical manifestations of cryoglobulinemic patients and their potential susceptibility to develop non-Hodgkin’s lymphoma to conventional treatment of the syndrome and the newer, promising therapeutic advances. The reader will appreciate the immediacy of style, the striking illustrations, and the color plates. In addition, the comprehensive review of a systemic disease such as cryoglobulinemia will interest basic scientists and specialists involved in several disciplines, including internal medicine, hepatology, hematology, oncology, infectious diseases, rheumatology, nephrology and dermatology. General practitioners, graduate and post-graduate students will also find in this book an irreplaceable source of update in this fascinating field."

"HIV coinfection in HCV-infected patients accelerates the course of disease and affects the outcome of Peg-IFN/RBV combination treatment. HCV-HIV coinfected patients are suspected to have HCV mutation in NS5A-ISDR/PKR-BD region that had a role to the successfulness of Peg-IFN/RBV therapy. SNP IL-28B polymorphism is predicted to have an effect on the HCV quasi-species evolution. However, until now the effect of HCV NS5A mutation and SNP IL-28B of the host to the response of treatment is still unclear.This study aimed to determine the presence and role of HCV NS5A-ISDR/PKR-BD region mutation and host SNP IL-28B on the succes of Peg-IFN/RBV combination treatment in HCV-HIV coinfected patients.Prospective cohort study design was conducted in this study. Plasma sample was collected from 22 monoinfected and 134 HCV-HIV coinfected patients prior to therapy. All of them were treated with Peg-IFN/RBV for 48 weeks. The examination of HCV RNA was performed 24 weeks after the end of therapy. PCR nucleotide sequencing was performed after the RNA virus extraction and cDNA synthesis had been performed. Analysis of secondary structure and prediction of mutation function were assessed by PredictProtein (PP) program.Sixteen from thirthy HCV-HIV co-infection patients and none from eight HCV patients achieved SVR. Nonneutral mutation ≥ 1 was found in 23/30 subjects with HCV-HIV co-infection. The presence of nonneutral mutation ≥ 1 was observed more frequent in SVR group than non-SVR group. Nonneutral mutation ≥ 1 was associated with SVR achievement, regardless the monoinfection or coinfection status (p = 0.04). Interaction of CC gene and nonneutral mutation was not associated with SVR. Secondary structure transformation of VHC NS5A was not associated with SVR in coinfected subjects. NS5A binding site structure was different from consensus in SVR group, while the structure was similar to consensus in non-SVR group.Nonneutral mutation ≥ 1 has the most important role on the SVR achievement in patients treated with Peg-IFN/RBV. The interaction of CC-gene and nonneutral mutation was not associated with SVR. The change of secondary structure was also not associated with SVR achievement, however, the changes of NS5A binding site structure were found in HCV-HIV coinfected patients who achieved SVR.

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Koinfeksi HIV pada pasien dengan infeksi VHC dapat memperberat perjalanan penyakit dan memengaruhi keberhasilan terapi kombinasi Peg-IFN/RBV. Pasien koinfeksi VHC-HIV diduga mengalami mutasi VHC pada regio NS5A-ISDR/PKR-BD yang mempunyai peran terhadap keberhasilan terapi Peg-IFN/RBV. Polimorfisme SNP IL-28B diprediksi berpengaruh terhadap evolusi quasi-spesies VHC, namun hingga saat ini keberadaan dan peran mutasi VHC NS5A serta SNP IL-28B pejamu pada koinfeksi VHC-HIV terhadap keberhasilan terapi masih belum diketahui secara jelas.Penelitian ini bertujuan untuk mengetahui keberadaan dan peran mutasi VHC NS5A-ISDR/PKR-BD serta SNP IL-28B pejamu terhadap keberhasilan terapi dengan kombinasi Peg-IFN/RBV pada pasien koinfeksi VHC-HIV.Penelitian ini menggunakan desain studi kohort prospektif. Sampel plasma dikumpulkan dari 22 subjek monoinfeksi dan 134 subjek koinfeksi sebelum menjalani terapi. Seluruh pasien mendapatkan terapi Peg-IFN/RBV selama 48 minggu. Pemeriksaan VHC RNA setelah 24 minggu dari akhir terapi dilakukan untuk menilai respons terapi (sustained virological response/SVR 24). Sekuensing nukleotida menggunakan PCR dilakukan setelah ekstraksi RNA virus dan sintesis cDNA dari sampel plasma. Analisis struktur sekunder dan prediksi fungsi mutasi menggunakan program PredictProtein (PP).Sebanyak 16 pasien dari 30 pasien koinfeksi VHC-HIV yang mengalami SVR serta tidak ada dari 8 pasien monoinfeksi VHC yang mengalami SVR. Mutasi nonnetral ≥ 1 ditemukan pada 23/30 pasien koinfeksi VHC-HIV. Keberadaan mutasi nonnetral ≥ 1 didapatkan lebih tinggi pada kelompok SVR (14 pasien) dibandingkan dengan non-SVR (9 pasien). Mutasi nonnetral ≥1 berhubungan dengan kejadian SVR, tanpa memandang status monoinfeksi dan koinfeksi (p = 0,04). Interaksi antara gen CC dan mutasi nonnetral tidak berhubungan dengan SVR. Perubahan struktur sekunder NS5A tidak berhubungan dengan SVR pada pasien koinfeksi. Struktur binding site NS5A pada kelompok SVR didapatkan berbeda dengan konsensus, sedangkan pada kelompok non-SVR mirip dengan konsensus.Mutasi nonnetral ≥ 1 berperan terhadap kejadian SVR pada pasien yang mendapat terapi Peg-IFN/RBV. Interaksi mutasi nonnetral dan gen CC tidak berhubungan dengan pencapaian SVR. Perubahan struktur sekunder juga tidak berhubungan dengan pencapaian SVR, akan tetapi perubahan struktur binding site NS5A-ISDR/PKR-BD ditemukan pada pasien koinfeksi VHC-HIV yang mencapai SVR dengan terapi Peg-IFN/RBV."

"Hepatitis C merupakan penyebab penyakit hati kronik yang penting di seluruh dunia termasuk lndonesia. Diperkirakan terdapat 300 juta pembawa virus hepatitis C di seluruh dunia. Pada penelitian yang dilakukan di Indonesia didapatkan prevalensi anti Hepatitis C Virus (anti HCV) berkisar antara 2,1-2,5%.s Penelitian di Jakarta pada tahun 1990 memperlihatkan prevalensi anti HCV pada hepatitis kronik non B sebesar 80,4%. Hepatitis C merupakan jenis hepatitis dengan gejala k1inis yang ringan tapi dengan tingkat kronisitas dan progresifitas yang tinggi ke arah sirosis. Sekitar 70-80% hepatitis C akut akan menjadi kronik dan 20% akan berkembang menjadi sirosis bati.

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Hepatitis C is an important cause of chronic liver disease around the world, including Indonesia. It is estimated that there are 300 million carriers of the hepatitis C virus worldwide. In a study conducted in Indonesia, the prevalence of anti-Hepatitis C Virus (anti-HCV) ranged from 2.1-2.5%.s A study in Jakarta in 1990 showed an anti-HCV prevalence in chronic non-B hepatitis of 80.4%. Hepatitis C is a type of hepatitis with mild k1inis symptoms but with a high degree of chronicity and progression to arabic cirrhosis. About 70-80%. Acute hepatitis C will become chronic and 20% will develop into batic cirrhosis."

"[ABSTRAKLatar belakang. Uji saring darah donor dapat menurunkan risiko tertularnya infeksi HCV. Di Indonesia telah dilakukan uji saring terhadap antibodi HCVdan RNA HCV. Uji saring terhadap Antigen-Antibodi belum dilakukan diIndonesia. Antigen HCV biasanya ditemukan pada 0 sampai 20 hari setelah RNA HCV pertama muncul. Anti-HCV dapat terdeteksi antara 10-40 harisetelah antigen HCV terdeteksi. Atas dasar pemikiran bahwa antigen HCVmuncul didalam darah lebih dahulu daripada anti-HCV, maka penelitian yangdilakukan ingin melihat apakah penggunaan reagensia serologi antigen-antibodi HCV dapat meningkatkan keamanan darah dan apakah sensitivitas serta spesifisitasnya sudah memenuhi standard yang dikeluarkan oleh Kementerian Kesehatan bila dibandingkan terhadap metoda NAT, yaitu sensitivitas 99,8% dan spesifisitas 95%.Metodologi. Pada penelitian ini dilakukan pemeriksaan pada 135 sampel darah donor yang terdiri dari 35 sampel positif dengan NAT HCV dan 100 sampel Positif dengan NAT HCV juga non reaktif terhadap HIV, HBsAg dan Sifilis dengan uji saring anti-HCV dengan metode CMIA, Ab-Ag HCV dengan metode ELISA dan bila ada perbedaan hasil pada pemeriksaan NAT HCV,CMIA HCV dan ELISA Ag-Ab HCV dilakukan pemeriksaan dengan menggunakan imunoblot HCV.Hasil. Dari 135 sampel, pada pemeriksaan ELISA Ag-Ab HCV terhadap 35 sampel positif RNA HCV menunjukkan hasil positif pada 35 sampel tersebut,tetapi pada 100 sampel negatif RNA HCV terdapat 3 sampel reaktif dan 97 nonreaktif. Sedangkan pada 35 sampel positif RNA HCV dengan pemeriksaanCMIA anti-HCV menunjukkan hasil reaktif pada 35 sampel dan pada 100 sampel negatif RNA HCV terdapat 11 sampel reaktif dan 89 sampel non reaktif.Sensitivitas dari perbandingan hasil pemeriksaan metoda NAT HCV dengan CMIA Ab-HCV adalah 100%, spesifisitasnya adalah 89%. Sensitivitas dari perbandingan hasil pemeriksaan metoda NAT HCV dengan ELISA Ag-AbHCV adalah 100%, spesifisitasnya adalah 97%.Simpulan. Pemeriksaan Antigen-Antibodi HCV ELISA memenuhi kriteriastandar untuk digunakan sebagai uji saring darah donor. Pemeriksaan AntibodiHCV CMIA tidak memenuhi kriteria standar untuk digunakan sebagai uji saringdarah donor.

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ABSTRACTBackground. Screening of donor blood may reduce the risk of transmission of HCV infection . In Indonesia has be screened for HCV antibodies and HCVRNA . Screened against the antigen - antibody has not been done in Indonesia .HCV antigens commonly found in 0 to 20 days after HCV RNA first appears .Anti - HCV can be detected between 10-40 days after HCV antigen wasdetected . On the basis of the notion that HCV antigens appear in the blood earlier than the anti - HCV , the research done to see if the use of antigen - antibody reagents HCV serology can improve blood safety and whether thesensitivity and specificity already meet the standards issued by the Ministry of Health when compared to NAT method , the sensitivity 99.8 % and specificity of 95 % . Methodology. In this study conducted checks on 135 blood samples from 35 donors comprising the NAT HCV positive samples and 100 samples positive by HCV NAT is also non- reactive to HIV , HBsAg and syphilis with anti - HCVscreening of the CMIA method, HCV Ab-Ag ELISA method and theexamination confirmed using immunoblot HCV HCV . Results. Of the 135 samples, the Ag-Ab ELISA against HCV 35 HCV RNA positive samples showed positive results in 35 samples, but at 100 HCV RNA negative samples contained 3 samples reactive and non- reactive 97. While the35 HCV RNA positive samples with anti-HCV CMIA examination showedreactive results on 35 samples and in 100 HCV RNA negative samples contained 11 samples 89 samples reactive and non reactive. Sensitivity of theresults of the comparison method with CMIA HCV NAT-HCV Ab was 100%,specificity was 89%. Sensitivity of the results of the comparison method of NAT HCV Ag-Ab ELISA with HCV was 100%, specificity was 97%. Conclusion. Examination of HCV Antigen-Antibody ELISA meet the standard criteria for use as a screening of donor blood. Examination of HCV antibodiesCMIA does not meet the standard criteria for use as a screening of donor blood.;Background. Screening of donor blood may reduce the risk of transmission of HCV infection . In Indonesia has be screened for HCV antibodies and HCVRNA . Screened against the antigen - antibody has not been done in Indonesia .HCV antigens commonly found in 0 to 20 days after HCV RNA first appears .Anti - HCV can be detected between 10-40 days after HCV antigen wasdetected . On the basis of the notion that HCV antigens appear in the blood earlier than the anti - HCV , the research done to see if the use of antigen - antibody reagents HCV serology can improve blood safety and whether thesensitivity and specificity already meet the standards issued by the Ministry of Health when compared to NAT method , the sensitivity 99.8 % and specificity of 95 % . Methodology. In this study conducted checks on 135 blood samples from 35 donors comprising the NAT HCV positive samples and 100 samples positive by HCV NAT is also non- reactive to HIV , HBsAg and syphilis with anti - HCVscreening of the CMIA method, HCV Ab-Ag ELISA method and theexamination confirmed using immunoblot HCV HCV . Results. Of the 135 samples, the Ag-Ab ELISA against HCV 35 HCV RNA positive samples showed positive results in 35 samples, but at 100 HCV RNA negative samples contained 3 samples reactive and non- reactive 97. While the35 HCV RNA positive samples with anti-HCV CMIA examination showedreactive results on 35 samples and in 100 HCV RNA negative samples contained 11 samples 89 samples reactive and non reactive. Sensitivity of theresults of the comparison method with CMIA HCV NAT-HCV Ab was 100%,specificity was 89%. Sensitivity of the results of the comparison method of NAT HCV Ag-Ab ELISA with HCV was 100%, specificity was 97%. Conclusion. Examination of HCV Antigen-Antibody ELISA meet the standard criteria for use as a screening of donor blood. Examination of HCV antibodiesCMIA does not meet the standard criteria for use as a screening of donor blood., Background. Screening of donor blood may reduce the risk of transmission of HCV infection . In Indonesia has be screened for HCV antibodies and HCVRNA . Screened against the antigen - antibody has not been done in Indonesia .HCV antigens commonly found in 0 to 20 days after HCV RNA first appears .Anti - HCV can be detected between 10-40 days after HCV antigen wasdetected . On the basis of the notion that HCV antigens appear in the blood earlier than the anti - HCV , the research done to see if the use of antigen - antibody reagents HCV serology can improve blood safety and whether thesensitivity and specificity already meet the standards issued by the Ministry of Health when compared to NAT method , the sensitivity 99.8 % and specificity of 95 % . Methodology. In this study conducted checks on 135 blood samples from 35 donors comprising the NAT HCV positive samples and 100 samples positive by HCV NAT is also non- reactive to HIV , HBsAg and syphilis with anti - HCVscreening of the CMIA method, HCV Ab-Ag ELISA method and theexamination confirmed using immunoblot HCV HCV . Results. Of the 135 samples, the Ag-Ab ELISA against HCV 35 HCV RNA positive samples showed positive results in 35 samples, but at 100 HCV RNA negative samples contained 3 samples reactive and non- reactive 97. While the35 HCV RNA positive samples with anti-HCV CMIA examination showedreactive results on 35 samples and in 100 HCV RNA negative samples contained 11 samples 89 samples reactive and non reactive. Sensitivity of theresults of the comparison method with CMIA HCV NAT-HCV Ab was 100%,specificity was 89%. Sensitivity of the results of the comparison method of NAT HCV Ag-Ab ELISA with HCV was 100%, specificity was 97%. Conclusion. Examination of HCV Antigen-Antibody ELISA meet the standard criteria for use as a screening of donor blood. Examination of HCV antibodiesCMIA does not meet the standard criteria for use as a screening of donor blood.]"

"Antiretroviral therapy (ART) given to HIV patients to improve their immune response that damaged by HIV infection. Some patients with ART experience Immune Restoration Disease (IRD) as worsening of clinical symptoms from certain pathogens infection. The incidence of IRD concided with an increased number of CD4+ T cells. Hepatitis C virus can also infect HIV patients and may also lead to HCV IRD. The immunopathogenecity of IRD has not known yet. This study aims to look at the function of dendritic cells producing IL-12 and IFNα, and IFNγ-producing T cell responses in incidence of HCV IRD. Research subjects were 50 patients with HIV/HCV who were initiating antiretroviral therapy (ART) for up to 6 months of therapy. There are 9 people with HCV IRD who compared with non HCV IRD patients. Blood specimens were collected from study subjects at months 0, 1, 3 and 6 after ART. Then PBMC isolation was done and used for flowsitometri and ELISpot analysis.The results showed that the percentage of myeloid (mDC) and plasmacytoid dendritic cells (pDC) did not differ between HCV IRD patients and non-HCV IRD patients. It appears that the percentage of IL-12-producing mDC did not correlate significantly with IFNγ- producing T cells both in HCV IRD and non-IRD HCV patients. The percentage of IL-12-producing mDC in HCV IRD patients were lower than in non-IRD patients (p=0.003). While percentage of IFNα-producing pDC and IFNγ- producing T cells did not differ significantly between the two groups of patients. Antibody response to HCV proteins (core, NS3, NS4, and NS5) did not differ between HCV IRD and non-HCV IRD patients. The role of dendritic cells and T cell responses in HCV IRD incidence have not clearly seen.

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Terapi antiretroviral (ART) diberikan kepada pasien HIV akan memperbaiki respon imun tubuh yang rusak karena infeksi HIV. Beberapa pasien dengan ART mengalami sindrom pulih imun atau Immune Restoration Disease (IRD) berupa perburukan gejala klinis dari infeksi patogen tertentu. Kejadian sindrom pulih imun ini terjadi bersamaan dengan peningkatan jumlah sel T CD4+. Virus Hepatitis C yang menjadi patogen penyerta pada pasien HIV juga menjadi penyebab sindrom pulih imun. Belum diketahui dengan jelas imunopatogenesitas dari sindrom pulih imun ini. Penelitian ini bertujuan untuk melihat fungsi sel dendritik penghasil IL-12 dan IFNα, serta respon sel T penghasil IFNγ pada kejadian sindrom pulih imun HCV. Subyek penelitian adalah 50 pasien HIV/HCV yang sedang memulai terapi antiretroviral (ART). Terdapat 9 orang pasien dengan sindrom pulih imun HCV yang dibandingkan dengan pasien tanpa sindrom pulih imun HCV. Spesimen darah lengkap dikumpulkan dari subyek penelitian pada bulan ke-0, 1, 3 dan 6 setelah ART. Kemudian dilakukan isolasi PBMC dan analisis flowsitometri dan ELISpot.Hasil penelitian menunjukkan bahwa persentase sel dendritik mieloid (mDC) dan plasmasitoid (pDC) tidak berbeda antara pasien dengan dan tanpa sindrom pulih imun HCV. Persentase sel mDC penghasil IL-12 tidak berkorelasi secara signifikan dengan jumlah sel T penghasil IFNγ baik pada pasien dengan maupun tanpa sindrom pulih imun HCV. Pasien dengan sindrom pulih imun HCV memiliki persentase sel mDC penghasil IL-12 yang lebih rendah dibandingkan pasien tanpa sindrom pulih imun HCV (p=0,003). Sedangkan persentase sel pDC penghasil IFNα dan jumlah sel T penghasil IFNγ tidak berbeda secara signifikan antara kedua kelompok pasien. Respon antibodi terhadap protein HCV (core, NS3, NS4 dan NS5) pun tidak berbeda antara kedua kelompok pasien. Disimpulkan bahwa belum terlihat adanya peran dari sel dendritik dan respon sel T terhadap kejadian sindrom pulih imun HCV."

"Patients with liver cirrhosis frequently have infection which can deteriorate further the already impaired liver function. The most common form of infection in this particular patients are spontaneous bacterial peritonitis, urinary tract infection, and respiratory infection. Causative organism mostly Gram negative micro organism and originate from the gastrointestinal tract. The weaken of immune defense mechanism and also the altered gastrointestinal tract motility can explained most of these infection. This paper will review the bacterial infection in liver cirrhosis with some guidance in the management."

"Thoroughly revised and updated for its Fourth Edition, a comprehensive reference on hospital epidemiology and infection control. Written by over 150 leading experts, this new edition examines every type of hospital-acquired (nosocomial) infection and addresses every issue relating to surveillance, prevention, and control of these infections in patients and in healthcare workers. This new edition features new or significantly increased coverage of emerging infectious diseases, avian influenza, governmental regulation of infection control and payment practices related to hospital-acquired infections, molecular epidemiology, the increasing prevalence of community-acquired MRSA in healthcare facilities, system-wide infection control provisions for healthcare systems, hospital infection control issues following natural disasters, and antimicrobial stewardship in reducing the development of antimicrobial-resistant organisms."