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La prevalencia de las enfermedades hepáticas en el embarazo no es despreciable, ya que estas se presentan en 3%-5% de todas las gestaciones. Entre las múltiples causas se encuentran cambios fisiológicos del embarazo; enfermedad hepática preexistente, siendo las más comunes las enfermedades colestásicas (colangitis biliar primaria y colangitis esclerosante primaria), hepatitis autoinmune, enfermedad de Wilson, hepatitis virales crónicas, cirrosis establecida de cualquier etiología y paciente con historia de trasplante hepático; enfermedad hepática adquirida durante el embarazo, siendo las principales las hepatitis virales, la toxicidad inducida por medicamentos y la hepatolitiasis; hepatopatía relacionada con el embarazo, en la cual se encuentran 5 entidades principales: hiperémesis gravídica, colestasis intrahepática del embarazo, preeclampsia, síndrome HELLP e hígado graso del embarazo. La severidad de estas entidades tiene una amplia gama de presentaciones, desde la paciente que es completamente asintomática, hasta la falla hepática aguda e incluso la muerte. La gravedad del cuadro se asocia con una morbilidad y mortalidad significativas tanto para la madre como para el feto, lo cual hace que una evaluación rápida, diagnóstico certero y manejo apropiado por un equipo multidisciplinario (incluida obstetricia de alto riesgo, hepatología, gastroenterología y radiología intervencionista), en un servicio que tenga la posibilidad de ofrecer trasplante hepático, sean fundamentales para obtener buenos desenlaces.

Liver diseases develop in 3% to 5% of all gestations. Among the causes are: 1. Physiological changes of pregnancy. 2. Pre-existing liver diseases and conditions. The most common are cholestatic diseases such as primary biliary cholangitis and primary sclerosing cholangitis. Others include autoimmune hepatitis, Wilson's disease, chronic viral hepatitis, cirrhosis of any etiology and histories of liver transplantation. 3. Liver disease acquired during pregnancy, especially viral hepatitis, drug-induced toxicity and hepatolithiasis. 4. Pregnancyrelated liver diseases including hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, preeclampsia, HELLP syndrome and fatty liver of pregnancy. Severity ranges from absence of symptoms to acute liver failure and even death. Severe cases have significant morbidity and mortality for both mother and fetus. These cases require rapid evaluation, accurate diagnosis and appropriate management by a multidisciplinary team including high-risk obstetrics, hepatology, gastroenterology and interventional radiology. Availability of liver transplantation is also important for obtaining good outcomes. [ABSTRACT FROM AUTHOR]

Introduction: In Colombia, Hepatitis C virus infections have high rates of morbidity and high costs. The advent of new more effective treatments has produced a need for better knowledge of this population's characteristics to allow their proper use. Objectives: The objective of this study is to describe the epidemiological and clinical characteristics of patients with hepatitis C at a referral center for liver diseases. Materials and methods: We conducted a cross-sectional descriptive study of a population of adults with serological diagnoses of hepatitis C between 2011 and 2016. Results: We evaluated 214 clinical records of patients with confirmed serological diagnoses of hepatitis C. Their median age was 59 years, and 62% were women. The HCV genotypes of 114 patients were reported: 75% had genotype 1B. Transfusions of one or another type of blood product had been administered to 36.9% of the patients, and 5% had tattoos. The prevalence of cirrhosis was 29.4% while that of hepatocellular carcinoma was 3.3%. Hepatitis B virus coinfections were found in 1.8% of these patients, and 5.1% of the patients had human immunodeficiency virus coinfections. Conclusion: The determinants of hepatitis C virus infection in Cali are similar to those reported in scientific literature worldwide and requires emphasis on prevention in the at-risk population. Genotype 1b continues to be the most frequent in our environment which makes this population susceptible to new treatments. [ABSTRACT FROM AUTHOR]

Introducción: la infección oculta por el virus de la hepatitis B (VHB) se caracteriza por la presencia del genoma viral en suero y/o tejido hepático de individuos negativos para el antígeno de superficie HBsAg. La infección oculta se ha asociado con el desarrollo de cirrosis y carcinoma hepatocelular. Objetivo: identificar casos de infección oculta por el VHB en pacientes con diagnóstico de cirrosis y carcinoma hepatocelular, sometidos a trasplante hepático. Materiales y métodos: entre febrero de 2013 y marzo de 2014 fueron obtenidas muestras de explante hepático provenientes de pacientes con diagnóstico de cirrosis y/o carcino- ma hepatocelular. Se detectó el genoma del VHB mediante amplificación de tres regiones del genoma viral (S, Core y X). Las muestras positivas se confirmaron por reacción en cadena de la polimerasa (PCR) en tiempo real para la región S. Resultados: se analizaron 15 muestras de tejido hepático, y en dos (13,3%) se detectó el genoma del VHB mediante PCR anidada para la región S y por PCR semianidada para la región X, resultado confirmado por PCR en tiempo real. Estas muestras provenían de pacientes negativos para los marcadores serológicos de infección por el VHB, anti-HBc y anti-HBs. Conclusión: la frecuencia de infección oculta reportada en este estudio es similar a lo reportado en Brasil en muestras de biopsias obtenidas de pacientes con hepatitis crónica. Estudios adicionales son necesarios para estimar la frecuencia de infección oculta por VHB (OBI) en pacientes con hepatopatías terminales en Colombia.

Chronic hepatitis B virus infections are a serious public health problem worldwide. Its consequences can be deadly, and current treatment offers only control of the disease rather than a cure. The main limiting factors for a cure are the difficulty of destroying the cDNA of the virus in the cell nucleus and the presence of viral genetic material integrated into the DNA of the host cell. Multiple fronts of research focus on finding a definitive cure by enhancing the immune response of the host or by acting directly against the virus and its replication cycle. This article presents the main advances that have been made in this field. [ABSTRACT FROM AUTHOR]

Antecedentes: Colombia presenta un patrón de prevalencia heterogéneo para la infección por virus de la hepatitis B (VHB) con regiones de alta, moderada y baja prevalencia. Objetivo: identificar los casos de infección por VHB y caracterizar los genotipos virales en población con factores de exposición en las ciudades de Quibdó y Apartadó, Colombia. Materiales y métodos: la población del estudio correspondió a 768 individuos asintomáticos con factores de exposición a la infección por VHB. El primer análisis fue la detección del antígeno de superficie del VHB (HBsAg) por prueba rápida. En las muestras de individuos positivos para esta prueba, se confirmó la presen- cia del HBsAg por ELISA y se detectó el genoma del VHB por reacción en cadena de la polimerasa (PCR). El genotipo viral fue determinado por secuenciación y análisis filogenético. Resultados: se identificaron 17/768 individuos con infección por VHB (2,2%) según la detección del HBsAg por prueba rápida y por ELISA. Los análisis filogenéticos permitieron la identificación de los genotipos F, (subgenotipos F3 y F1a) y A en las muestras. Conclusiones: se reporta por primera vez la circulación del subgenotipo F1a en Colombia y se confirma la circulación del subgenotipo F3 y el genotipo A.

Introduction: Occult hepatitis B virus infection is characterized by the presence of the viral genome in serum and/or liver tissue from individuals who test negative for the HBsAg surface antigen. Occult infection has been associated with the development of cirrhosis and hepatocellular carcinoma. Objective: The objective of this study was to identify cases of occult hepatitis B virus infection in patients with cirrhosis and/or hepatocellular carcinoma undergoing liver transplantation. Materials and methods: Between February 2013 and March 2014 hepatic explant samples were obtained from patients with cirrhosis and/or hepatocellular carcinoma. The hepatitis B virus genome was detected by amplification of three regions of the viral genome (S, Core and X). Positive samples were confirmed by real-time PCR for the S region. Results: Fifteen hepatic tissue samples were analyzed. The genome of the hepatitis B virus was detected in two (13.3%) samples by nested PCR for the S region and by semi-nested PCR for region X. The results were confirmed by real-time PCR. These samples came from patients who had tested negative for anti-HBc and anti-HBs serological markers for hepatitis B virus infection. Conclusion: The frequency of occult infection reported in this study is similar to that reported in Brazil in biopsy specimens obtained from patients with chronic hepatitis. Additional studies are needed to estimate the frequency of occult hepatitis B in patients with end-stage liver disease in Colombia. [ABSTRACT FROM AUTHOR]

Introduction: Colombia has a varied geographical pattern of prevalence of hepatitis B virus (HBV) infections with regions of high, moderate and low prevalences. Objective: The objective of this study was to identify cases of HBV infection and characterize viral genotypes in population with factors of exposure in the cities of Quibdo and Apartado, Colombia. Materials and Methods: The study population included 768 asymptomatic individuals with factors of exposure to HBV infections. An HBV surface antigen (HBsAg) rapid detection test was the first test used. Samples from individuals who tested positive were tested with ELISA to confirm the diagnosis and with PCR to detect the HBV genome. Viral genotypes were determined by sequencing and phylogenetic analysis. Results: Seventeen individuals (17/768, 2.2%) were diagnosed with HBV infections by both the Rapid Test and Elisa. Phylogenetic analyses allowed identification of genotypes F (F3 and Subgenotype F1a) and A in the samples. Conclusions: We report for the first time the presence of the F1a subgenotype in Colombia and confirme the presence of subgenotype F3 and genotype A. [ABSTRACT FROM AUTHOR]