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Sineglazova AV, Sineglazova AV. [Hepatitis C awareness among therapists and general practitioners. Survey results]. TERAPEVT ARKH 2020; 92:5-12. [PMID: 33720597 DOI: 10.26442/00403660.2020.11.000664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 12/25/2020] [Indexed: 11/22/2022]
Abstract
AIM In order to improve the diagnosis and treatment of chronic hepatitis C in the framework of this study was the awareness among general practitioner (GPs) and physicians in various districts of Chelyabinsk Oblast was assessed. MATERIALS AND METHODS A continuous study of hepatitis C virus (HCV) awareness among therapists and GPs was conducted within the framework of the regional research-to-practice conference Multidisciplinary Issues of Family Medicine on May 19, 2018. 78 questionnaires have been distributed. Thus, 78 therapists from different districts of Chelyabinsk Oblast took part in the study. For these purposes, a questionnaire of 12 questions developed by Olga I. Sagalova was used. The study involved 78 therapists from different districts of Chelyabinsk Oblast. 20.52% (n=16) of respondents were from the healthcare institutions (HCI) of urban districts of Chelyabinsk Oblast, 39.74% (n=31) were from the HCIs of municipal districts of Chelyabinsk Oblast, and 39.74% (n=31) from the HCIs of the city of Chelyabinsk. RESULTS The survey revealed certain gaps in therapists awareness of the natural course of the disease, diagnosis, routing, the natural course of HCV infection, as well as its extrahepatic manifestations. The survey results indicate a lack of understanding among physicians and therapists of tactics for managing patients with HCV infection and emphasize the need to improve interdisciplinary interaction between infectious disease specialists, primary care doctors and doctors of other specialties including the development and implementation of an educational strategy for non-infectious disease doctors. CONCLUSION The results indicate the needs to increase the level of education among doctors in the diagnosis and management of patients with HCV in accordance with guidelines and to include screening for HCV infection in the guidelines for selected chronic non-communicable diseases as part of the initial examination.
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Affiliation(s)
| | - A V Sineglazova
- Kazan State Medical University of the Russian Federation Ministry of Health
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Cardoso AC, Perez RM, de Figueiredo-Mendes C, Carvalho Leite N, Moraes-Coelho HS, Villela-Nogueira CA. Prevalence and predictive factors of moderate/severe liver steatosis in chronic hepatitis C (CHC) infected patients evaluated with controlled attenuation parameter (CAP). J Viral Hepat 2018; 25:1244-1250. [PMID: 29768686 DOI: 10.1111/jvh.12930] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 04/16/2018] [Indexed: 12/15/2022]
Abstract
A novel controlled attenuation parameter (CAP) using FibroScan® has been developed for assessment of liver steatosis. The aim was to evaluate the frequency and associated factors for moderate/severe steatosis evaluated by CAP in CHC patients submitted to transient elastography (TE) by FibroScan® . CHC patients underwent TE with CAP evaluation. The classification of steatosis was defined as: CAP < 222 dB/m = S0; CAP ≥ 222 dB/m and <233dB/m = S1; ≥233 dB/m < 290dB/m = S2 and >= 290 dB/m = S3. The prevalence of moderate/severe steatosis (CAP ≥ S2) and the related independent factors were identified by a logistic regression analysis. A significance level of 5% was adopted. 1104 CHC patients, 85% genotype-1 were included (mean age 55 ± 11 years; 46% male, mean BMI 25 ± 4 Kg/m2 ). Systemic arterial hypertension and type 2 diabetes mellitus prevalences were 39% and 17%, respectively. Liver stiffness measurement ≥ 9.5 kPa was observed in 39% of patients and steatosis was identified in 50% (S1 = 7%, S2 = 28% and S3 = 15%). The variables independently associated with moderate/severe steatosis were: male gender (OR=1.35; P = .037; 95% CI:1.01-1.81); systemic arterial hypertension (OR=1.57; P = .002; 95% CI:1.17-2.10) and BMI (OR=1.17; P < .01;95% CI:1.12-1.22). In conclusion, when CAP was adopted as a tool to detect steatosis, genotype 1 CHC patients presented a high prevalence of moderate/advanced steatosis. In these patients, liver steatosis was associated mostly to metabolic factors (arterial hypertension and high BMI).
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Affiliation(s)
- A C Cardoso
- Hepatology Unit, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - R M Perez
- Hepatology Unit, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Gastroenterology Department, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil.,D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | | | - N Carvalho Leite
- Hepatology Unit, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - H S Moraes-Coelho
- Hepatology Unit, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - C A Villela-Nogueira
- Hepatology Unit, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Pasi KJ, Rangarajan S, Georgiev P, Mant T, Creagh MD, Lissitchkov T, Bevan D, Austin S, Hay CR, Hegemann I, Kazmi R, Chowdary P, Gercheva-Kyuchukova L, Mamonov V, Timofeeva M, Soh CH, Garg P, Vaishnaw A, Akinc A, Sørensen B, Ragni MV. Targeting of Antithrombin in Hemophilia A or B with RNAi Therapy. N Engl J Med 2017; 377:819-828. [PMID: 28691885 DOI: 10.1056/nejmoa1616569] [Citation(s) in RCA: 254] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Current hemophilia treatment involves frequent intravenous infusions of clotting factors, which is associated with variable hemostatic protection, a high treatment burden, and a risk of the development of inhibitory alloantibodies. Fitusiran, an investigational RNA interference (RNAi) therapy that targets antithrombin (encoded by SERPINC1), is in development to address these and other limitations. METHODS In this phase 1 dose-escalation study, we enrolled 4 healthy volunteers and 25 participants with moderate or severe hemophilia A or B who did not have inhibitory alloantibodies. Healthy volunteers received a single subcutaneous injection of fitusiran (at a dose of 0.03 mg per kilogram of body weight) or placebo. The participants with hemophilia received three injections of fitusiran administered either once weekly (at a dose of 0.015, 0.045, or 0.075 mg per kilogram) or once monthly (at a dose of 0.225, 0.45, 0.9, or 1.8 mg per kilogram or a fixed dose of 80 mg). The study objectives were to assess the pharmacokinetic and pharmacodynamic characteristics and safety of fitusiran. RESULTS No thromboembolic events were observed during the study. The most common adverse events were mild injection-site reactions. Plasma levels of fitusiran increased in a dose-dependent manner and showed no accumulation with repeated administration. The monthly regimen induced a dose-dependent mean maximum antithrombin reduction of 70 to 89% from baseline. A reduction in the antithrombin level of more than 75% from baseline resulted in median peak thrombin values at the lower end of the range observed in healthy participants. CONCLUSIONS Once-monthly subcutaneous administration of fitusiran resulted in dose-dependent lowering of the antithrombin level and increased thrombin generation in participants with hemophilia A or B who did not have inhibitory alloantibodies. (Funded by Alnylam Pharmaceuticals; ClinicalTrials.gov number, NCT02035605 .).
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Affiliation(s)
- K John Pasi
- From the Royal London Haemophilia Centre, Barts and the London School of Medicine and Dentistry (K.J.P.), National Institute for Health Research (NIHR) Biomedical Research Centre (T.M.), Guy's and St. Thomas' NHS Foundation Trust, King's College London (D.B.), St. George's Healthcare NHS Trust Haemophilia Centre (S.A.), and Royal Free Hospital London (P.C.), London, the Haemophilia, Haemostasis and Thrombosis Centre, Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), Quintiles IMS, Reading (T.M.), Royal Cornwall Hospitals NHS Trust, Truro (M.D.C.), Manchester Royal Infirmary, Manchester (C.R.H.), and University Hospital Southampton NHS Foundation Trust, Southampton (R.K.) - all in the United Kingdom; University Multiprofile Hospital for Active Treatment Sveti Georgi and Medical University Plovdiv, Plovdiv (P. Georgiev), University Hospital for Hematology, Sofia (T.L.), and the Department of Hematology, University Hospital of St. Marina, Varna (L.G.-K.) - all in Bulgaria; University Hospital of Zurich, Zurich, Switzerland (I.H.); National Research Center for Hematology, Moscow (V.M.), and Research Institution of Hematology and Blood Transfusion, Kirov (M.T.) - both in Russia; Alnylam Pharmaceuticals, Cambridge (C.-H.S., P. Garg, A.V., A.A., B.S.), and Codiak Biosciences, Woburn (B.S.) - both in Massachusetts; and the University of Pittsburgh and Hemophilia Center of Western Pennsylvania, Pittsburgh (M.V.R.)
| | - Savita Rangarajan
- From the Royal London Haemophilia Centre, Barts and the London School of Medicine and Dentistry (K.J.P.), National Institute for Health Research (NIHR) Biomedical Research Centre (T.M.), Guy's and St. Thomas' NHS Foundation Trust, King's College London (D.B.), St. George's Healthcare NHS Trust Haemophilia Centre (S.A.), and Royal Free Hospital London (P.C.), London, the Haemophilia, Haemostasis and Thrombosis Centre, Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), Quintiles IMS, Reading (T.M.), Royal Cornwall Hospitals NHS Trust, Truro (M.D.C.), Manchester Royal Infirmary, Manchester (C.R.H.), and University Hospital Southampton NHS Foundation Trust, Southampton (R.K.) - all in the United Kingdom; University Multiprofile Hospital for Active Treatment Sveti Georgi and Medical University Plovdiv, Plovdiv (P. Georgiev), University Hospital for Hematology, Sofia (T.L.), and the Department of Hematology, University Hospital of St. Marina, Varna (L.G.-K.) - all in Bulgaria; University Hospital of Zurich, Zurich, Switzerland (I.H.); National Research Center for Hematology, Moscow (V.M.), and Research Institution of Hematology and Blood Transfusion, Kirov (M.T.) - both in Russia; Alnylam Pharmaceuticals, Cambridge (C.-H.S., P. Garg, A.V., A.A., B.S.), and Codiak Biosciences, Woburn (B.S.) - both in Massachusetts; and the University of Pittsburgh and Hemophilia Center of Western Pennsylvania, Pittsburgh (M.V.R.)
| | - Pencho Georgiev
- From the Royal London Haemophilia Centre, Barts and the London School of Medicine and Dentistry (K.J.P.), National Institute for Health Research (NIHR) Biomedical Research Centre (T.M.), Guy's and St. Thomas' NHS Foundation Trust, King's College London (D.B.), St. George's Healthcare NHS Trust Haemophilia Centre (S.A.), and Royal Free Hospital London (P.C.), London, the Haemophilia, Haemostasis and Thrombosis Centre, Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), Quintiles IMS, Reading (T.M.), Royal Cornwall Hospitals NHS Trust, Truro (M.D.C.), Manchester Royal Infirmary, Manchester (C.R.H.), and University Hospital Southampton NHS Foundation Trust, Southampton (R.K.) - all in the United Kingdom; University Multiprofile Hospital for Active Treatment Sveti Georgi and Medical University Plovdiv, Plovdiv (P. Georgiev), University Hospital for Hematology, Sofia (T.L.), and the Department of Hematology, University Hospital of St. Marina, Varna (L.G.-K.) - all in Bulgaria; University Hospital of Zurich, Zurich, Switzerland (I.H.); National Research Center for Hematology, Moscow (V.M.), and Research Institution of Hematology and Blood Transfusion, Kirov (M.T.) - both in Russia; Alnylam Pharmaceuticals, Cambridge (C.-H.S., P. Garg, A.V., A.A., B.S.), and Codiak Biosciences, Woburn (B.S.) - both in Massachusetts; and the University of Pittsburgh and Hemophilia Center of Western Pennsylvania, Pittsburgh (M.V.R.)
| | - Tim Mant
- From the Royal London Haemophilia Centre, Barts and the London School of Medicine and Dentistry (K.J.P.), National Institute for Health Research (NIHR) Biomedical Research Centre (T.M.), Guy's and St. Thomas' NHS Foundation Trust, King's College London (D.B.), St. George's Healthcare NHS Trust Haemophilia Centre (S.A.), and Royal Free Hospital London (P.C.), London, the Haemophilia, Haemostasis and Thrombosis Centre, Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), Quintiles IMS, Reading (T.M.), Royal Cornwall Hospitals NHS Trust, Truro (M.D.C.), Manchester Royal Infirmary, Manchester (C.R.H.), and University Hospital Southampton NHS Foundation Trust, Southampton (R.K.) - all in the United Kingdom; University Multiprofile Hospital for Active Treatment Sveti Georgi and Medical University Plovdiv, Plovdiv (P. Georgiev), University Hospital for Hematology, Sofia (T.L.), and the Department of Hematology, University Hospital of St. Marina, Varna (L.G.-K.) - all in Bulgaria; University Hospital of Zurich, Zurich, Switzerland (I.H.); National Research Center for Hematology, Moscow (V.M.), and Research Institution of Hematology and Blood Transfusion, Kirov (M.T.) - both in Russia; Alnylam Pharmaceuticals, Cambridge (C.-H.S., P. Garg, A.V., A.A., B.S.), and Codiak Biosciences, Woburn (B.S.) - both in Massachusetts; and the University of Pittsburgh and Hemophilia Center of Western Pennsylvania, Pittsburgh (M.V.R.)
| | - Michael D Creagh
- From the Royal London Haemophilia Centre, Barts and the London School of Medicine and Dentistry (K.J.P.), National Institute for Health Research (NIHR) Biomedical Research Centre (T.M.), Guy's and St. Thomas' NHS Foundation Trust, King's College London (D.B.), St. George's Healthcare NHS Trust Haemophilia Centre (S.A.), and Royal Free Hospital London (P.C.), London, the Haemophilia, Haemostasis and Thrombosis Centre, Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), Quintiles IMS, Reading (T.M.), Royal Cornwall Hospitals NHS Trust, Truro (M.D.C.), Manchester Royal Infirmary, Manchester (C.R.H.), and University Hospital Southampton NHS Foundation Trust, Southampton (R.K.) - all in the United Kingdom; University Multiprofile Hospital for Active Treatment Sveti Georgi and Medical University Plovdiv, Plovdiv (P. Georgiev), University Hospital for Hematology, Sofia (T.L.), and the Department of Hematology, University Hospital of St. Marina, Varna (L.G.-K.) - all in Bulgaria; University Hospital of Zurich, Zurich, Switzerland (I.H.); National Research Center for Hematology, Moscow (V.M.), and Research Institution of Hematology and Blood Transfusion, Kirov (M.T.) - both in Russia; Alnylam Pharmaceuticals, Cambridge (C.-H.S., P. Garg, A.V., A.A., B.S.), and Codiak Biosciences, Woburn (B.S.) - both in Massachusetts; and the University of Pittsburgh and Hemophilia Center of Western Pennsylvania, Pittsburgh (M.V.R.)
| | - Toshko Lissitchkov
- From the Royal London Haemophilia Centre, Barts and the London School of Medicine and Dentistry (K.J.P.), National Institute for Health Research (NIHR) Biomedical Research Centre (T.M.), Guy's and St. Thomas' NHS Foundation Trust, King's College London (D.B.), St. George's Healthcare NHS Trust Haemophilia Centre (S.A.), and Royal Free Hospital London (P.C.), London, the Haemophilia, Haemostasis and Thrombosis Centre, Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), Quintiles IMS, Reading (T.M.), Royal Cornwall Hospitals NHS Trust, Truro (M.D.C.), Manchester Royal Infirmary, Manchester (C.R.H.), and University Hospital Southampton NHS Foundation Trust, Southampton (R.K.) - all in the United Kingdom; University Multiprofile Hospital for Active Treatment Sveti Georgi and Medical University Plovdiv, Plovdiv (P. Georgiev), University Hospital for Hematology, Sofia (T.L.), and the Department of Hematology, University Hospital of St. Marina, Varna (L.G.-K.) - all in Bulgaria; University Hospital of Zurich, Zurich, Switzerland (I.H.); National Research Center for Hematology, Moscow (V.M.), and Research Institution of Hematology and Blood Transfusion, Kirov (M.T.) - both in Russia; Alnylam Pharmaceuticals, Cambridge (C.-H.S., P. Garg, A.V., A.A., B.S.), and Codiak Biosciences, Woburn (B.S.) - both in Massachusetts; and the University of Pittsburgh and Hemophilia Center of Western Pennsylvania, Pittsburgh (M.V.R.)
| | - David Bevan
- From the Royal London Haemophilia Centre, Barts and the London School of Medicine and Dentistry (K.J.P.), National Institute for Health Research (NIHR) Biomedical Research Centre (T.M.), Guy's and St. Thomas' NHS Foundation Trust, King's College London (D.B.), St. George's Healthcare NHS Trust Haemophilia Centre (S.A.), and Royal Free Hospital London (P.C.), London, the Haemophilia, Haemostasis and Thrombosis Centre, Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), Quintiles IMS, Reading (T.M.), Royal Cornwall Hospitals NHS Trust, Truro (M.D.C.), Manchester Royal Infirmary, Manchester (C.R.H.), and University Hospital Southampton NHS Foundation Trust, Southampton (R.K.) - all in the United Kingdom; University Multiprofile Hospital for Active Treatment Sveti Georgi and Medical University Plovdiv, Plovdiv (P. Georgiev), University Hospital for Hematology, Sofia (T.L.), and the Department of Hematology, University Hospital of St. Marina, Varna (L.G.-K.) - all in Bulgaria; University Hospital of Zurich, Zurich, Switzerland (I.H.); National Research Center for Hematology, Moscow (V.M.), and Research Institution of Hematology and Blood Transfusion, Kirov (M.T.) - both in Russia; Alnylam Pharmaceuticals, Cambridge (C.-H.S., P. Garg, A.V., A.A., B.S.), and Codiak Biosciences, Woburn (B.S.) - both in Massachusetts; and the University of Pittsburgh and Hemophilia Center of Western Pennsylvania, Pittsburgh (M.V.R.)
| | - Steve Austin
- From the Royal London Haemophilia Centre, Barts and the London School of Medicine and Dentistry (K.J.P.), National Institute for Health Research (NIHR) Biomedical Research Centre (T.M.), Guy's and St. Thomas' NHS Foundation Trust, King's College London (D.B.), St. George's Healthcare NHS Trust Haemophilia Centre (S.A.), and Royal Free Hospital London (P.C.), London, the Haemophilia, Haemostasis and Thrombosis Centre, Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), Quintiles IMS, Reading (T.M.), Royal Cornwall Hospitals NHS Trust, Truro (M.D.C.), Manchester Royal Infirmary, Manchester (C.R.H.), and University Hospital Southampton NHS Foundation Trust, Southampton (R.K.) - all in the United Kingdom; University Multiprofile Hospital for Active Treatment Sveti Georgi and Medical University Plovdiv, Plovdiv (P. Georgiev), University Hospital for Hematology, Sofia (T.L.), and the Department of Hematology, University Hospital of St. Marina, Varna (L.G.-K.) - all in Bulgaria; University Hospital of Zurich, Zurich, Switzerland (I.H.); National Research Center for Hematology, Moscow (V.M.), and Research Institution of Hematology and Blood Transfusion, Kirov (M.T.) - both in Russia; Alnylam Pharmaceuticals, Cambridge (C.-H.S., P. Garg, A.V., A.A., B.S.), and Codiak Biosciences, Woburn (B.S.) - both in Massachusetts; and the University of Pittsburgh and Hemophilia Center of Western Pennsylvania, Pittsburgh (M.V.R.)
| | - Charles R Hay
- From the Royal London Haemophilia Centre, Barts and the London School of Medicine and Dentistry (K.J.P.), National Institute for Health Research (NIHR) Biomedical Research Centre (T.M.), Guy's and St. Thomas' NHS Foundation Trust, King's College London (D.B.), St. George's Healthcare NHS Trust Haemophilia Centre (S.A.), and Royal Free Hospital London (P.C.), London, the Haemophilia, Haemostasis and Thrombosis Centre, Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), Quintiles IMS, Reading (T.M.), Royal Cornwall Hospitals NHS Trust, Truro (M.D.C.), Manchester Royal Infirmary, Manchester (C.R.H.), and University Hospital Southampton NHS Foundation Trust, Southampton (R.K.) - all in the United Kingdom; University Multiprofile Hospital for Active Treatment Sveti Georgi and Medical University Plovdiv, Plovdiv (P. Georgiev), University Hospital for Hematology, Sofia (T.L.), and the Department of Hematology, University Hospital of St. Marina, Varna (L.G.-K.) - all in Bulgaria; University Hospital of Zurich, Zurich, Switzerland (I.H.); National Research Center for Hematology, Moscow (V.M.), and Research Institution of Hematology and Blood Transfusion, Kirov (M.T.) - both in Russia; Alnylam Pharmaceuticals, Cambridge (C.-H.S., P. Garg, A.V., A.A., B.S.), and Codiak Biosciences, Woburn (B.S.) - both in Massachusetts; and the University of Pittsburgh and Hemophilia Center of Western Pennsylvania, Pittsburgh (M.V.R.)
| | - Inga Hegemann
- From the Royal London Haemophilia Centre, Barts and the London School of Medicine and Dentistry (K.J.P.), National Institute for Health Research (NIHR) Biomedical Research Centre (T.M.), Guy's and St. Thomas' NHS Foundation Trust, King's College London (D.B.), St. George's Healthcare NHS Trust Haemophilia Centre (S.A.), and Royal Free Hospital London (P.C.), London, the Haemophilia, Haemostasis and Thrombosis Centre, Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), Quintiles IMS, Reading (T.M.), Royal Cornwall Hospitals NHS Trust, Truro (M.D.C.), Manchester Royal Infirmary, Manchester (C.R.H.), and University Hospital Southampton NHS Foundation Trust, Southampton (R.K.) - all in the United Kingdom; University Multiprofile Hospital for Active Treatment Sveti Georgi and Medical University Plovdiv, Plovdiv (P. Georgiev), University Hospital for Hematology, Sofia (T.L.), and the Department of Hematology, University Hospital of St. Marina, Varna (L.G.-K.) - all in Bulgaria; University Hospital of Zurich, Zurich, Switzerland (I.H.); National Research Center for Hematology, Moscow (V.M.), and Research Institution of Hematology and Blood Transfusion, Kirov (M.T.) - both in Russia; Alnylam Pharmaceuticals, Cambridge (C.-H.S., P. Garg, A.V., A.A., B.S.), and Codiak Biosciences, Woburn (B.S.) - both in Massachusetts; and the University of Pittsburgh and Hemophilia Center of Western Pennsylvania, Pittsburgh (M.V.R.)
| | - Rashid Kazmi
- From the Royal London Haemophilia Centre, Barts and the London School of Medicine and Dentistry (K.J.P.), National Institute for Health Research (NIHR) Biomedical Research Centre (T.M.), Guy's and St. Thomas' NHS Foundation Trust, King's College London (D.B.), St. George's Healthcare NHS Trust Haemophilia Centre (S.A.), and Royal Free Hospital London (P.C.), London, the Haemophilia, Haemostasis and Thrombosis Centre, Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), Quintiles IMS, Reading (T.M.), Royal Cornwall Hospitals NHS Trust, Truro (M.D.C.), Manchester Royal Infirmary, Manchester (C.R.H.), and University Hospital Southampton NHS Foundation Trust, Southampton (R.K.) - all in the United Kingdom; University Multiprofile Hospital for Active Treatment Sveti Georgi and Medical University Plovdiv, Plovdiv (P. Georgiev), University Hospital for Hematology, Sofia (T.L.), and the Department of Hematology, University Hospital of St. Marina, Varna (L.G.-K.) - all in Bulgaria; University Hospital of Zurich, Zurich, Switzerland (I.H.); National Research Center for Hematology, Moscow (V.M.), and Research Institution of Hematology and Blood Transfusion, Kirov (M.T.) - both in Russia; Alnylam Pharmaceuticals, Cambridge (C.-H.S., P. Garg, A.V., A.A., B.S.), and Codiak Biosciences, Woburn (B.S.) - both in Massachusetts; and the University of Pittsburgh and Hemophilia Center of Western Pennsylvania, Pittsburgh (M.V.R.)
| | - Pratima Chowdary
- From the Royal London Haemophilia Centre, Barts and the London School of Medicine and Dentistry (K.J.P.), National Institute for Health Research (NIHR) Biomedical Research Centre (T.M.), Guy's and St. Thomas' NHS Foundation Trust, King's College London (D.B.), St. George's Healthcare NHS Trust Haemophilia Centre (S.A.), and Royal Free Hospital London (P.C.), London, the Haemophilia, Haemostasis and Thrombosis Centre, Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), Quintiles IMS, Reading (T.M.), Royal Cornwall Hospitals NHS Trust, Truro (M.D.C.), Manchester Royal Infirmary, Manchester (C.R.H.), and University Hospital Southampton NHS Foundation Trust, Southampton (R.K.) - all in the United Kingdom; University Multiprofile Hospital for Active Treatment Sveti Georgi and Medical University Plovdiv, Plovdiv (P. Georgiev), University Hospital for Hematology, Sofia (T.L.), and the Department of Hematology, University Hospital of St. Marina, Varna (L.G.-K.) - all in Bulgaria; University Hospital of Zurich, Zurich, Switzerland (I.H.); National Research Center for Hematology, Moscow (V.M.), and Research Institution of Hematology and Blood Transfusion, Kirov (M.T.) - both in Russia; Alnylam Pharmaceuticals, Cambridge (C.-H.S., P. Garg, A.V., A.A., B.S.), and Codiak Biosciences, Woburn (B.S.) - both in Massachusetts; and the University of Pittsburgh and Hemophilia Center of Western Pennsylvania, Pittsburgh (M.V.R.)
| | - Liana Gercheva-Kyuchukova
- From the Royal London Haemophilia Centre, Barts and the London School of Medicine and Dentistry (K.J.P.), National Institute for Health Research (NIHR) Biomedical Research Centre (T.M.), Guy's and St. Thomas' NHS Foundation Trust, King's College London (D.B.), St. George's Healthcare NHS Trust Haemophilia Centre (S.A.), and Royal Free Hospital London (P.C.), London, the Haemophilia, Haemostasis and Thrombosis Centre, Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), Quintiles IMS, Reading (T.M.), Royal Cornwall Hospitals NHS Trust, Truro (M.D.C.), Manchester Royal Infirmary, Manchester (C.R.H.), and University Hospital Southampton NHS Foundation Trust, Southampton (R.K.) - all in the United Kingdom; University Multiprofile Hospital for Active Treatment Sveti Georgi and Medical University Plovdiv, Plovdiv (P. Georgiev), University Hospital for Hematology, Sofia (T.L.), and the Department of Hematology, University Hospital of St. Marina, Varna (L.G.-K.) - all in Bulgaria; University Hospital of Zurich, Zurich, Switzerland (I.H.); National Research Center for Hematology, Moscow (V.M.), and Research Institution of Hematology and Blood Transfusion, Kirov (M.T.) - both in Russia; Alnylam Pharmaceuticals, Cambridge (C.-H.S., P. Garg, A.V., A.A., B.S.), and Codiak Biosciences, Woburn (B.S.) - both in Massachusetts; and the University of Pittsburgh and Hemophilia Center of Western Pennsylvania, Pittsburgh (M.V.R.)
| | - Vasily Mamonov
- From the Royal London Haemophilia Centre, Barts and the London School of Medicine and Dentistry (K.J.P.), National Institute for Health Research (NIHR) Biomedical Research Centre (T.M.), Guy's and St. Thomas' NHS Foundation Trust, King's College London (D.B.), St. George's Healthcare NHS Trust Haemophilia Centre (S.A.), and Royal Free Hospital London (P.C.), London, the Haemophilia, Haemostasis and Thrombosis Centre, Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), Quintiles IMS, Reading (T.M.), Royal Cornwall Hospitals NHS Trust, Truro (M.D.C.), Manchester Royal Infirmary, Manchester (C.R.H.), and University Hospital Southampton NHS Foundation Trust, Southampton (R.K.) - all in the United Kingdom; University Multiprofile Hospital for Active Treatment Sveti Georgi and Medical University Plovdiv, Plovdiv (P. Georgiev), University Hospital for Hematology, Sofia (T.L.), and the Department of Hematology, University Hospital of St. Marina, Varna (L.G.-K.) - all in Bulgaria; University Hospital of Zurich, Zurich, Switzerland (I.H.); National Research Center for Hematology, Moscow (V.M.), and Research Institution of Hematology and Blood Transfusion, Kirov (M.T.) - both in Russia; Alnylam Pharmaceuticals, Cambridge (C.-H.S., P. Garg, A.V., A.A., B.S.), and Codiak Biosciences, Woburn (B.S.) - both in Massachusetts; and the University of Pittsburgh and Hemophilia Center of Western Pennsylvania, Pittsburgh (M.V.R.)
| | - Margarita Timofeeva
- From the Royal London Haemophilia Centre, Barts and the London School of Medicine and Dentistry (K.J.P.), National Institute for Health Research (NIHR) Biomedical Research Centre (T.M.), Guy's and St. Thomas' NHS Foundation Trust, King's College London (D.B.), St. George's Healthcare NHS Trust Haemophilia Centre (S.A.), and Royal Free Hospital London (P.C.), London, the Haemophilia, Haemostasis and Thrombosis Centre, Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), Quintiles IMS, Reading (T.M.), Royal Cornwall Hospitals NHS Trust, Truro (M.D.C.), Manchester Royal Infirmary, Manchester (C.R.H.), and University Hospital Southampton NHS Foundation Trust, Southampton (R.K.) - all in the United Kingdom; University Multiprofile Hospital for Active Treatment Sveti Georgi and Medical University Plovdiv, Plovdiv (P. Georgiev), University Hospital for Hematology, Sofia (T.L.), and the Department of Hematology, University Hospital of St. Marina, Varna (L.G.-K.) - all in Bulgaria; University Hospital of Zurich, Zurich, Switzerland (I.H.); National Research Center for Hematology, Moscow (V.M.), and Research Institution of Hematology and Blood Transfusion, Kirov (M.T.) - both in Russia; Alnylam Pharmaceuticals, Cambridge (C.-H.S., P. Garg, A.V., A.A., B.S.), and Codiak Biosciences, Woburn (B.S.) - both in Massachusetts; and the University of Pittsburgh and Hemophilia Center of Western Pennsylvania, Pittsburgh (M.V.R.)
| | - Chang-Heok Soh
- From the Royal London Haemophilia Centre, Barts and the London School of Medicine and Dentistry (K.J.P.), National Institute for Health Research (NIHR) Biomedical Research Centre (T.M.), Guy's and St. Thomas' NHS Foundation Trust, King's College London (D.B.), St. George's Healthcare NHS Trust Haemophilia Centre (S.A.), and Royal Free Hospital London (P.C.), London, the Haemophilia, Haemostasis and Thrombosis Centre, Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), Quintiles IMS, Reading (T.M.), Royal Cornwall Hospitals NHS Trust, Truro (M.D.C.), Manchester Royal Infirmary, Manchester (C.R.H.), and University Hospital Southampton NHS Foundation Trust, Southampton (R.K.) - all in the United Kingdom; University Multiprofile Hospital for Active Treatment Sveti Georgi and Medical University Plovdiv, Plovdiv (P. Georgiev), University Hospital for Hematology, Sofia (T.L.), and the Department of Hematology, University Hospital of St. Marina, Varna (L.G.-K.) - all in Bulgaria; University Hospital of Zurich, Zurich, Switzerland (I.H.); National Research Center for Hematology, Moscow (V.M.), and Research Institution of Hematology and Blood Transfusion, Kirov (M.T.) - both in Russia; Alnylam Pharmaceuticals, Cambridge (C.-H.S., P. Garg, A.V., A.A., B.S.), and Codiak Biosciences, Woburn (B.S.) - both in Massachusetts; and the University of Pittsburgh and Hemophilia Center of Western Pennsylvania, Pittsburgh (M.V.R.)
| | - Pushkal Garg
- From the Royal London Haemophilia Centre, Barts and the London School of Medicine and Dentistry (K.J.P.), National Institute for Health Research (NIHR) Biomedical Research Centre (T.M.), Guy's and St. Thomas' NHS Foundation Trust, King's College London (D.B.), St. George's Healthcare NHS Trust Haemophilia Centre (S.A.), and Royal Free Hospital London (P.C.), London, the Haemophilia, Haemostasis and Thrombosis Centre, Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), Quintiles IMS, Reading (T.M.), Royal Cornwall Hospitals NHS Trust, Truro (M.D.C.), Manchester Royal Infirmary, Manchester (C.R.H.), and University Hospital Southampton NHS Foundation Trust, Southampton (R.K.) - all in the United Kingdom; University Multiprofile Hospital for Active Treatment Sveti Georgi and Medical University Plovdiv, Plovdiv (P. Georgiev), University Hospital for Hematology, Sofia (T.L.), and the Department of Hematology, University Hospital of St. Marina, Varna (L.G.-K.) - all in Bulgaria; University Hospital of Zurich, Zurich, Switzerland (I.H.); National Research Center for Hematology, Moscow (V.M.), and Research Institution of Hematology and Blood Transfusion, Kirov (M.T.) - both in Russia; Alnylam Pharmaceuticals, Cambridge (C.-H.S., P. Garg, A.V., A.A., B.S.), and Codiak Biosciences, Woburn (B.S.) - both in Massachusetts; and the University of Pittsburgh and Hemophilia Center of Western Pennsylvania, Pittsburgh (M.V.R.)
| | - Akshay Vaishnaw
- From the Royal London Haemophilia Centre, Barts and the London School of Medicine and Dentistry (K.J.P.), National Institute for Health Research (NIHR) Biomedical Research Centre (T.M.), Guy's and St. Thomas' NHS Foundation Trust, King's College London (D.B.), St. George's Healthcare NHS Trust Haemophilia Centre (S.A.), and Royal Free Hospital London (P.C.), London, the Haemophilia, Haemostasis and Thrombosis Centre, Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), Quintiles IMS, Reading (T.M.), Royal Cornwall Hospitals NHS Trust, Truro (M.D.C.), Manchester Royal Infirmary, Manchester (C.R.H.), and University Hospital Southampton NHS Foundation Trust, Southampton (R.K.) - all in the United Kingdom; University Multiprofile Hospital for Active Treatment Sveti Georgi and Medical University Plovdiv, Plovdiv (P. Georgiev), University Hospital for Hematology, Sofia (T.L.), and the Department of Hematology, University Hospital of St. Marina, Varna (L.G.-K.) - all in Bulgaria; University Hospital of Zurich, Zurich, Switzerland (I.H.); National Research Center for Hematology, Moscow (V.M.), and Research Institution of Hematology and Blood Transfusion, Kirov (M.T.) - both in Russia; Alnylam Pharmaceuticals, Cambridge (C.-H.S., P. Garg, A.V., A.A., B.S.), and Codiak Biosciences, Woburn (B.S.) - both in Massachusetts; and the University of Pittsburgh and Hemophilia Center of Western Pennsylvania, Pittsburgh (M.V.R.)
| | - Akin Akinc
- From the Royal London Haemophilia Centre, Barts and the London School of Medicine and Dentistry (K.J.P.), National Institute for Health Research (NIHR) Biomedical Research Centre (T.M.), Guy's and St. Thomas' NHS Foundation Trust, King's College London (D.B.), St. George's Healthcare NHS Trust Haemophilia Centre (S.A.), and Royal Free Hospital London (P.C.), London, the Haemophilia, Haemostasis and Thrombosis Centre, Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), Quintiles IMS, Reading (T.M.), Royal Cornwall Hospitals NHS Trust, Truro (M.D.C.), Manchester Royal Infirmary, Manchester (C.R.H.), and University Hospital Southampton NHS Foundation Trust, Southampton (R.K.) - all in the United Kingdom; University Multiprofile Hospital for Active Treatment Sveti Georgi and Medical University Plovdiv, Plovdiv (P. Georgiev), University Hospital for Hematology, Sofia (T.L.), and the Department of Hematology, University Hospital of St. Marina, Varna (L.G.-K.) - all in Bulgaria; University Hospital of Zurich, Zurich, Switzerland (I.H.); National Research Center for Hematology, Moscow (V.M.), and Research Institution of Hematology and Blood Transfusion, Kirov (M.T.) - both in Russia; Alnylam Pharmaceuticals, Cambridge (C.-H.S., P. Garg, A.V., A.A., B.S.), and Codiak Biosciences, Woburn (B.S.) - both in Massachusetts; and the University of Pittsburgh and Hemophilia Center of Western Pennsylvania, Pittsburgh (M.V.R.)
| | - Benny Sørensen
- From the Royal London Haemophilia Centre, Barts and the London School of Medicine and Dentistry (K.J.P.), National Institute for Health Research (NIHR) Biomedical Research Centre (T.M.), Guy's and St. Thomas' NHS Foundation Trust, King's College London (D.B.), St. George's Healthcare NHS Trust Haemophilia Centre (S.A.), and Royal Free Hospital London (P.C.), London, the Haemophilia, Haemostasis and Thrombosis Centre, Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), Quintiles IMS, Reading (T.M.), Royal Cornwall Hospitals NHS Trust, Truro (M.D.C.), Manchester Royal Infirmary, Manchester (C.R.H.), and University Hospital Southampton NHS Foundation Trust, Southampton (R.K.) - all in the United Kingdom; University Multiprofile Hospital for Active Treatment Sveti Georgi and Medical University Plovdiv, Plovdiv (P. Georgiev), University Hospital for Hematology, Sofia (T.L.), and the Department of Hematology, University Hospital of St. Marina, Varna (L.G.-K.) - all in Bulgaria; University Hospital of Zurich, Zurich, Switzerland (I.H.); National Research Center for Hematology, Moscow (V.M.), and Research Institution of Hematology and Blood Transfusion, Kirov (M.T.) - both in Russia; Alnylam Pharmaceuticals, Cambridge (C.-H.S., P. Garg, A.V., A.A., B.S.), and Codiak Biosciences, Woburn (B.S.) - both in Massachusetts; and the University of Pittsburgh and Hemophilia Center of Western Pennsylvania, Pittsburgh (M.V.R.)
| | - Margaret V Ragni
- From the Royal London Haemophilia Centre, Barts and the London School of Medicine and Dentistry (K.J.P.), National Institute for Health Research (NIHR) Biomedical Research Centre (T.M.), Guy's and St. Thomas' NHS Foundation Trust, King's College London (D.B.), St. George's Healthcare NHS Trust Haemophilia Centre (S.A.), and Royal Free Hospital London (P.C.), London, the Haemophilia, Haemostasis and Thrombosis Centre, Hampshire Hospitals NHS Foundation Trust, Basingstoke (S.R.), Quintiles IMS, Reading (T.M.), Royal Cornwall Hospitals NHS Trust, Truro (M.D.C.), Manchester Royal Infirmary, Manchester (C.R.H.), and University Hospital Southampton NHS Foundation Trust, Southampton (R.K.) - all in the United Kingdom; University Multiprofile Hospital for Active Treatment Sveti Georgi and Medical University Plovdiv, Plovdiv (P. Georgiev), University Hospital for Hematology, Sofia (T.L.), and the Department of Hematology, University Hospital of St. Marina, Varna (L.G.-K.) - all in Bulgaria; University Hospital of Zurich, Zurich, Switzerland (I.H.); National Research Center for Hematology, Moscow (V.M.), and Research Institution of Hematology and Blood Transfusion, Kirov (M.T.) - both in Russia; Alnylam Pharmaceuticals, Cambridge (C.-H.S., P. Garg, A.V., A.A., B.S.), and Codiak Biosciences, Woburn (B.S.) - both in Massachusetts; and the University of Pittsburgh and Hemophilia Center of Western Pennsylvania, Pittsburgh (M.V.R.)
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Wu CK, Chang KC, Tseng PL, Lu SN, Chen CH, Wang JH, Lee CM, Lin MT, Yen YH, Hung CH, Hu TH. Comparison of Therapeutic Response and Clinical Outcome between HCV Patients with Normal and Abnormal Alanine Transaminase Levels. PLoS One 2016; 11:e0142378. [PMID: 26968010 PMCID: PMC4788146 DOI: 10.1371/journal.pone.0142378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/21/2015] [Indexed: 02/07/2023] Open
Abstract
Background and Aims Patients with chronic hepatitic C (HCV) infection and normal serum alanine transaminase (ALT) levels were considered to have mild disease. In Taiwan, these patients were not suggested for interferon (IFN) based therapies. The aim of study is to compare therapeutic outcomes between HCV patients with normal and elevated ALT levels. Methods We conducted a retrospective study on 3241 HCV patients treated by IFN based therapies. Patients with normal ALT levels were classified as group A (n = 186) while those with elevated ALT levels were group B (n = 3055). Results At baseline, incidence of diabetes mellitus, low platelet counts and cirrhosis were significantly higher in group B patients. The sustained virologic response (SVR) rate was comparable between the 2 groups (65.3% vs. 65.3%, P = .993). But significantly higher incidence of HCC development after HCV treatment was observed in group B (7.4% vs. 3.2%, P = .032). No significant differences with respect to the outcome of liver decompensation, spontaneous bacterial peritonitis, and mortality were noted between 2 groups. Multivariate analysis showed younger age, female gender, non-HCV genotype 1, lower viral load, higher platelet counts and non-cirrhosis were favorable factors for achieving SVR, rather than ALT levels. Further analysis revealed older age, cirrhosis, lower platelet levels and non- peg-interferon treatment are risk factors of HCC development. Conclusions HCV patients with normal ALT levels had similar response to antiviral therapy and low rate of HCC development after therapy. Antiviral therapies begun at early course of HCV infection may be beneficial to prevent disease progression.
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Affiliation(s)
- Cheng-Kung Wu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Chin Chang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Po-Lin Tseng
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Nan Lu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Hung Chen
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jing-Houng Wang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chuan-Mo Lee
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ming-Tsung Lin
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Hao Yen
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chao-Hung Hung
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tsung-Hui Hu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- * E-mail:
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Sasaki Y, Ohfuji S, Fukushima W, Tamori A, Enomoto M, Habu D, Iwai S, Uchida-Kobayashi S, Fujii H, Shiomi S, Kawada N, Hirota Y. Effect of caffeine-containing beverage consumption on serum alanine aminotransferase levels in patients with chronic hepatitis C virus infection: a hospital-based cohort study. PLoS One 2013; 8:e83382. [PMID: 24349501 PMCID: PMC3859663 DOI: 10.1371/journal.pone.0083382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 11/04/2013] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION To date, there have been no prospective studies examining the effect of coffee consumption on serum alanine aminotransferase (ALT) level among individuals infected with the hepatitis C virus (HCV). We conducted a hospital-based cohort study among patients with chronic HCV infection to assess an association between baseline coffee consumption and subsequent ALT levels for 12 months. MATERIALS AND METHODS From 1 August 2005 to 31 July 2006, total 376 HCV-RNA positive patients were recruited. A baseline questionnaire elicited information on the frequency of coffee consumption and other caffeine-containing beverages. ALT level as a study outcome was followed through the patients' medical records during 12 months. The association between baseline beverage consumption and subsequent ALT levels was evaluated separately among patients with baseline ALT levels within normal range (≤45 IU/L) and among those with higher ALT levels (>45 IU/L). RESULTS Among 229 patients with baseline ALT levels within normal range, 186 (81%) retained normal ALT levels at 12 months after recruitment. Daily drinkers of filtered coffee were three times more likely to preserve a normal ALT level than non-drinkers (OR=2.74; P=0.037). However, decaffeinated coffee drinkers had a somewhat inverse effect for sustained normal ALT levels, with marginal significance (OR=0.26; P=0.076). In addition, among 147 patients with higher baseline ALT levels, 39 patients (27%) had ALT reductions of ≥20 IU/L at 12 months after recruitment. Daily drinkers of filtered coffee had a significantly increased OR for ALT reduction (OR=3.79; P=0.034). However, in decaffeinated coffee drinkers, OR could not be calculated because no patients had ALT reduction. CONCLUSION Among patients with chronic HCV infection, daily consumption of filtered coffee may have a beneficial effect on the stabilization of ALT levels.
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Affiliation(s)
- Yachiyo Sasaki
- Department of Gerontological Nursing, Graduate School of Nursing, Osaka City University, Osaka, Japan
- Department of Public Health, Graduate School of Medicine, Osaka City University, Osaka, Japan
- * E-mail:
| | - Satoko Ohfuji
- Department of Public Health, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Wakaba Fukushima
- Department of Public Health, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Akihiro Tamori
- Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Masaru Enomoto
- Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Daiki Habu
- Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka, Japan
- Department of Medical Nutrition, Graduate School of Human Life Science, Osaka City University, Osaka, Japan
| | - Shuji Iwai
- Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | | | - Hideki Fujii
- Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Susumu Shiomi
- Department of Nuclear Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Norifumi Kawada
- Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yoshio Hirota
- Department of Public Health, Graduate School of Medicine, Osaka City University, Osaka, Japan
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Abdel-Khalek EE, El-Fakhry A, Helaly M, Abdel-Aal I, Zalata K. Alanine Aminotransferase Levels in Nile Delta Citizens Infected with Chronic Hepatitis C Virus. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2012. [DOI: 10.29333/ejgm/82439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Muga R, Sanvisens A, Fuster D, Tor J, Martínez E, Pérez-Hoyos S, Muñoz A. Unhealthy alcohol use, HIV infection and risk of liver fibrosis in drug users with hepatitis C. PLoS One 2012; 7:e46810. [PMID: 23056462 PMCID: PMC3467291 DOI: 10.1371/journal.pone.0046810] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 09/06/2012] [Indexed: 02/07/2023] Open
Abstract
Aim To analyze alcohol use, clinical data and laboratory parameters that may affect FIB-4, an index for measuring liver fibrosis, in HCV-monoinfected and HCV/HIV-coinfected drug users. Patients and Methods Patients admitted for substance abuse treatment between 1994 and 2006 were studied. Socio-demographic data, alcohol and drug use characteristics and clinical variables were obtained through hospital records. Blood samples for biochemistry, liver function tests, CD4 cell count, and serology of HIV and HCV infection were collected at admission. Multivariate linear regression was used to analyze the predictors of FIB-4 increase. Results A total of 472 (83% M, 17% F) patients were eligible. The median age at admission was 31 years (Interquartile range (IQR) 27–35 years), and the median duration of drug use was 10 years (IQR 5.5–15 years). Unhealthy drinking (>50 grams/day) was reported in 32% of the patients. The FIB-4 scores were significantly greater in the HCV/HIV-coinfected patients (1.14, IQR 0.76–1.87) than in the HCV-monoinfected patients (0.75, IQR 0.56–1.11) (p<0.001). In the multivariate analysis, unhealthy drinking (p = 0.034), lower total cholesterol (p = 0.042), serum albumin (p<0.001), higher GGT (p<0.001) and a longer duration of addiction (p = 0.005) were independently associated with higher FIB-4 scores in the HCV-monoinfected drug users. The effect of unhealthy drinking on FIB-4 scores disappeared in the HCV/HIV-coinfected patients, whereas lower serum albumin (p<0.001), a lower CD4 cell count (p = 0.006), higher total bilirubin (p<0.001) and a longer drug addiction duration (p<0.001) were significantly associated with higher FIB-4 values. Conclusions Unhealthy alcohol use in the HCV-monoinfected patients and HIV-related immunodeficiency in the HCV/HIV-coinfected patients are important risk factors associated with liver fibrosis in the respective populations
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Affiliation(s)
- Roberto Muga
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma Barcelona, Barcelona, Spain.
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Alanine aminotransferase levels in citizens of Nile Delta infected with the chronic hepatitis C virus. EGYPTIAN LIVER JOURNAL 2012. [DOI: 10.1097/01.elx.0000412374.28852.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Claassen CW, Diener-West M, Mehta SH, Thomas DL, Kirk GD. Discordance between CD4+ T-lymphocyte counts and percentages in HIV-infected persons with liver fibrosis. Clin Infect Dis 2012; 54:1806-13. [PMID: 22460963 DOI: 10.1093/cid/cis294] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Cirrhosis of the liver can induce splenic sequestration of peripheral blood cells, recently suggested to reduce the number but not percentage of circulating CD4(+) T cells in persons uninfected with human immunodeficiency virus (HIV). We investigated whether earlier stages of liver fibrosis prior to cirrhosis were associated with discordance between CD4 count (CD4N) and CD4 percentage (CD4%) in HIV-infected patients. METHODS In cross-sectional analysis of 287 HIV-infected participants of the AIDS Linked to the Intravenous Experience cohort, we evaluated CD4N, CD4%, and transient elastography staging of liver fibrosis. High CD4(+) lymphocyte discordance was defined as higher CD4% relative to CD4N based on accepted clinical cutoffs; multivariable logistic regression was used to determine covariates associated with discordance. RESULTS Of 287 participants, 99 (34.4%) had high CD4(+) discordance, which increased to 76% of 114 participants with marked lymphopenia (total lymphocyte count [TLC] ≤1200 cells/μL). In multivariable analysis, the odds of having high CD4(+) discordance was increased in persons with significant liver fibrosis compared to those without fibrosis (odds ratio, 1.69; 95% confidence interval [CI], .95-2.96); the odds ratio of discordance increased to 2.66 (95% CI, 1.11-6.40) among the subset of participants with TLC ≤1200 cells/μL. The odds for discordance associated with cirrhosis were of similar magnitude as those observed with significant fibrosis. CONCLUSIONS In HIV-infected persons, liver fibrosis is associated with discordant peripheral CD4(+) lymphocyte results, especially in the setting of marked lymphopenia. Clinicians should also consider CD4% when interpreting absolute CD4(+) counts of HIV-infected persons with known or suspected liver disease, particularly if TLC is <1200 cells/μL.
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Affiliation(s)
- Cassidy W Claassen
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
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Drumright LN, Hagan H, Thomas DL, Latka MH, Golub ET, Garfein RS, Clapp JD, Campbell JV, Bonner S, Kapadia F, Thiel TK, Strathdee SA. Predictors and effects of alcohol use on liver function among young HCV-infected injection drug users in a behavioral intervention. J Hepatol 2011; 55:45-52. [PMID: 21145862 PMCID: PMC3094600 DOI: 10.1016/j.jhep.2010.10.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 10/06/2010] [Accepted: 10/07/2010] [Indexed: 01/16/2023]
Abstract
BACKGROUND & AIMS Hepatitis C virus (HCV) screening can provide opportunities to reduce disease progression through counseling against alcohol use, but empirical data on this issue are sparse. We determined the efficacy of a behavioral intervention in reducing alcohol use among young, HCV-infected injection drug users (IDUs) (n=355) and assessed whether changes in liver enzymes were associated with changes in alcohol consumption. METHODS Both the intervention and attention-control groups were counseled to avoid alcohol use, but the intervention group received enhanced counseling. Logistic regression, ANOVA, and continuous time Markov models were used to identify factors associated with alcohol use, changes in mean ALT and AST levels, and change in alcohol use post-intervention. RESULTS Six months post-intervention, alcohol abstinence increased 22.7% in both groups, with no difference by intervention arm. Transition from alcohol use to abstinence was associated with a decrease in liver enzymes, with a marginally greater decrease in the intervention group (p=0.05 for ALT; p=0.06 for AST). In multivariate Markov models, those who used marijuana transitioned from alcohol abstinence to consumption more rapidly than non-users (RR=3.11); those who were homeless transitioned more slowly to alcohol abstinence (RR=0.47); and those who had ever received a clinical diagnosis of liver disease transitioned more rapidly to abstinence (RR=1.88). CONCLUSIONS Although, behavioral counseling to reduce alcohol consumption among HCV-infected IDUs had a modest effect, reductions in alcohol consumption were associated with marked improvements in liver function. Interventions to reduce alcohol use among HCV-infected IDUs may benefit from being integrated into clinical care and monitoring of HCV infection.
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Affiliation(s)
- Lydia N. Drumright
- At the time of work on study: University of California, San Diego, Department of Medicine, Division of Global Public Health, La Jolla, CA; Current affiliation: Centre for Infection Prevention and Management, Division of Infectious Diseases and Immunology, Department of Medicine, Imperial College London, London, United Kingdom
| | - Holly Hagan
- National Development and Research Institute, Center for Drug Use and HIV Research, New York, NY
| | | | - Mary H. Latka
- At the time of the study: Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY; Current affiliation: The Aurum Institute, Johannesburg, South Africa
| | | | - Richard S. Garfein
- University of California, San Diego, Department of Medicine, Division of Global Public Health, La Jolla, CA
| | - John D. Clapp
- Center for Alcohol and Drug Studies, School of Social Work, San Diego State University, San Diego, CA
| | - Jennifer V. Campbell
- At the time of the study: Seattle-King County Department of Public Health, HIV/AIDS Prevention Program, Seattle, WA
| | - Sebastian Bonner
- Center for Urban Epidemiologic Studies, New York Academy of Medicine
| | - Farzana Kapadia
- At the time of the study: Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY, Current affiliation: New York University, Community Public Health Program New York, NY
| | | | - Steffanie A. Strathdee
- University of California, San Diego, Department of Medicine, Division of Global Public Health, La Jolla, CA
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11
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[Efficacy of combined antiviral therapy with pegylated interferon alpha-2a and ribavirin for chronic hepatitis C infection in intravenous drug users]. SRP ARK CELOK LEK 2010; 138:43-9. [PMID: 20425908 DOI: 10.2298/sarh1002043r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Hepatitis C Virus infection represents not just a medical, but also a socio-economic problem. It is estimated that among 170 million infected, 60% belongs to the category of intravenous drug users (IDUs). OBJECTIVE The aim of this paper was to compare the response to the combined therapy of pegylated interferon alfa 2a and ribavirin, in the group of patients with HCV infection who were intravenous drug users (IDUs) and in patients who were identified in the other way of transmission of HCV. Also to identify the influence of the therapy on diseases of addiction, during the course of HCV infection and on the effects of the combined therapy of pegylated interferon alfa 2a and ribavirin. METHODS We conducted a retrospective-prospective study, on 60 patients, treated with combined antiviral therapy--pegylated interferon alfa 2a and ribavirin. 30 patients were from the group of IDUs, and 30 patients from other epidemiological groups. RESULTS There were significant differences between the age of the patients (30.2 +/- 7.1 vs. 39.3 +/- 11.2 years; p = 0.002), but no significant difference in the duration of the HCV infection between the two groups of patients (8.9 +/- 7.4 vs. 13.1 +/- 7.0 years; p > 0.05). A large number of the patients in the group of IDUs had a problem with the abstinence of the drug abuse. In this group, there was the influence of alcohol (30%) and other substances with potential hepatotoxicity: marihuana (23.3%) and psychoactive drugs (73.6%). Staging of the liver fibrosis was not influenced by those two parameters and was similar in both groups (p > 0.05). The genotype 3a was dominant in intravenous drug users (50.0%) and genotype 1b in the control group of the patients (76.6%). In both groups, SVR was achieved at a higher percentage (86% vs. 70.00%; p > 0.05), but among the intravenous drug users the relapses of HCV infection were at a lower percentage (3.3% vs. 20.0%; p = 0.044). Side effects were noticed in solitary cases in both of the examined groups, but severe side effects were found only in the control group of the patients. Relapse of drug abuse was noticed in 6.66% of cases. CONCLUSION We have registered that the group of intravenous drug users has the same or even better response to the antiviral therapy than other epidemiological groups and that the use of drugs does not change the course of HCV infection.
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Langohr K, Sanvisens A, Fuster D, Tor J, Serra I, Rey-Joly C, Rivas I, Muga R. Liver enzyme alterations in HCV-monoinfected and HCV/HIV-coinfected patients. Open AIDS J 2008; 2:82-8. [PMID: 19274066 PMCID: PMC2627513 DOI: 10.2174/1874613600802010082] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Revised: 07/28/2008] [Accepted: 10/06/2008] [Indexed: 01/06/2023] Open
Abstract
UNLABELLED Hepatitis C virus (HCV) is the most common blood-borne infection in developed countries and co-infection with the Human Immunodeficiency Virus (HIV) is frequent in individuals with history of injecting drug use (IDU).We aimed to analyze liver transaminases in HCV monoinfected and HCV/HIV co-infected patients to assess the effect of HIV infection on liver enzyme elevations.We studied 429 current IDUs admitted to substance abuse treatment (82.5% males). Serum samples for liver tests, HIV infection and viral hepatitis serologies were obtained at admission. RESULTS Median age was 30 years (IQR:27-34), median duration of IDU was 10 years (IQR:5-14), 52% of patients were HCV/HIV co-infected, 40.8% were HCV monoinfected, and 7.2% were HCV and HIV- seronegatives. Elevated AST was associated with male gender and lower CD8(+) cell count in the HCV monoinfected patients, and with age and lower cholesterol in the HCV/HIV coinfected subjects. ALT elevation was associated with younger age, higher body mass index and male gender in the monoinfected patients, and with higher CD4(+) cell counts and lower cholesterol in the co-infected group. Male sex was strongly associated with elevated ALT and AST transaminase in the monoinfected but not in dual-infected subjects.These data suggest that the effect of gender on liver enzymes may be lost in patients with HIV infection. The overall differences observed between groups regarding liver enzyme elevations are of clinical relevance in the management of IDUs with chronic hepatitis C.
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Affiliation(s)
- Klaus Langohr
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Human Pharmacology and Clinical Neurosciences Research Unit. Institut Municipal d'Investigació Mèdica / IMIM, Barcelona, Spain
| | - Arantza Sanvisens
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Daniel Fuster
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Jordi Tor
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Isabel Serra
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Celestino Rey-Joly
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Inmaculada Rivas
- Municipal Centre for Drug Abuse Treatment (Centro Delta), Badalona, Spain
| | - Roberto Muga
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Yu RB, Hong X, Ding WL, Tan YF, Zhang YX, Sun NX, Wu GL, Zhan SW, Ge DF. The association between the genetic polymorphism of HLA-DQA1, DQB1, and DRB1 and serum alanine aminotransferase levels in chronic hepatitis C in the Chinese population. J Gastroenterol Hepatol 2008; 23:1394-402. [PMID: 18028350 DOI: 10.1111/j.1440-1746.2007.05215.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND AIM To investigate a possible association between HLA genes with serum alanine aminotransferase (ALT) levels and evaluate whether the HLA-DQA1, DQB1, and DRB1 genes could influence the development of liver damage in chronic hepatitis C. METHODS A total of 145 patients with chronic hepatitis C virus (HCV) infection (36 patients with persistently normal ALT values; 109 patients with elevated ALT levels) and 160 uninfected healthy controls were examined for HLA-DQA1, DQB1, and DRB1 molecules by using polymerase chain reaction-sequencing based typing (PCR-SBT). RESULTS Among the patients chronically infected with HCV, the frequencies of DQA1*0501, DQB1*0301, and DRB1*0401 alleles were significantly increased in the normal ALT group compared with those with abnormal ALT levels, whereas that of DQB1*0201 was significantly lower. As compared to uninfected healthy controls, DQA1*0501, DQB1*0301, and DRB1*0401 allele frequencies were also statistically higher in the normal ALT group, whereas that of DQB1*0201 was the inverse. The haplotype frequencies of DQA1*0301-DQB1*0301, DQA1*0501-DQB1*0301, and DRB1*1101-DQB1*0301 were found to be significantly higher in the normal ALT group. Multivariate logistic regression indicated that female sex, and the DQB1*0301 allele and DRB1*0401 allele were independently associated with normal ALT values, whereas DQB1*0201 allele was the inverse. CONCLUSIONS These results suggest that particular HLA alleles may have an influence on the serum ALT level of chronic HCV infection as a host genetic factor in the Chinese population. The DQA1*0501, DQB1*0301, and DRB1*0401 alleles, and the DQA1*0301-DQB1*0301, DQA1*0501-DQB1*0301, and DRB1*1101-DQB1*0301 haplotypes seem to be associated with low hepatitis activity; whereas DQB1*0201 allele is closely correlated with the progression of liver injury in chronic HCV infection.
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Affiliation(s)
- Rong-Bin Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jiangsu Province Laboratory of Pathogen Biology, Nanjing Medical University, Nanjing, China
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Balagopal A, Philp FH, Astemborski J, Block TM, Mehta A, Long R, Kirk GD, Mehta SH, Cox AL, Thomas DL, Ray SC. Human immunodeficiency virus-related microbial translocation and progression of hepatitis C. Gastroenterology 2008; 135:226-33. [PMID: 18457674 PMCID: PMC2644903 DOI: 10.1053/j.gastro.2008.03.022] [Citation(s) in RCA: 210] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 02/29/2008] [Accepted: 03/13/2008] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Human immunodeficiency virus (HIV)-1 infection has been associated with enhanced microbial translocation, and microbial translocation is a mechanism through which alcohol and some enteric conditions cause liver disease. We hypothesized that HIV promotes liver disease by enhancing microbial translocation. METHODS We studied human cohorts in which hepatitis C virus (HCV) and HIV outcomes were carefully characterized. RESULTS HIV-related CD4(+) lymphocyte depletion was strongly associated with microbial translocation as indicated by elevated levels of circulating lipopolysaccharide (LPS), LPS-binding protein, soluble CD14, and fucose-binding lectin (AAL) reactive to immunoglobulin G specific for the alpha-galactose epitope and suppressed levels of endotoxin core antibodies (EndoCAb IgM) in HIV-infected subjects compared with the same persons before they had HIV infection and compared with HIV-uninfected subjects. The same measures of microbial translocation were strongly associated with HCV-related liver disease progression (cirrhosis), eg, LPS, odds ratio, 19.0 (P = .002); AAL, odds ratio, 27.8 (P < .0001); in addition, levels of LPS were elevated prior to recognition of cirrhosis. CONCLUSIONS Microbial translocation may be a fundamental mechanism through which HIV accelerates progression of chronic liver disease.
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Affiliation(s)
- Ashwin Balagopal
- Division of Infectious Diseases, Viral Hepatitis Center, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A
| | - Frances H. Philp
- Division of Infectious Diseases, Viral Hepatitis Center, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A
| | - Jacquie Astemborski
- Division of Infectious Diseases, Viral Hepatitis Center, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A
| | - Timothy M. Block
- Hepatitis B Foundation and The Drexel Institute for Biotechnology and Virology Research of Drexel College of Medicine, Doylestown, Pennsylvania, U.S.A
| | - Anand Mehta
- Hepatitis B Foundation and The Drexel Institute for Biotechnology and Virology Research of Drexel College of Medicine, Doylestown, Pennsylvania, U.S.A
| | - Ronald Long
- Hepatitis B Foundation and The Drexel Institute for Biotechnology and Virology Research of Drexel College of Medicine, Doylestown, Pennsylvania, U.S.A
| | - Gregory D. Kirk
- Division of Infectious Diseases, Viral Hepatitis Center, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A
| | - Shruti H. Mehta
- Division of Infectious Diseases, Viral Hepatitis Center, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A
| | - Andrea L. Cox
- Division of Infectious Diseases, Viral Hepatitis Center, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A
| | - David L. Thomas
- Division of Infectious Diseases, Viral Hepatitis Center, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A
| | - Stuart C. Ray
- Division of Infectious Diseases, Viral Hepatitis Center, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A
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Kresina TF, Sylvestre D, Seeff L, Litwin AH, Hoffman K, Lubran R, Clark HW. Hepatitis infection in the treatment of opioid dependence and abuse. Subst Abuse 2008; 1:15-61. [PMID: 25977607 PMCID: PMC4395041 DOI: 10.4137/sart.s580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Many new and existing cases of viral hepatitis infections are related to injection drug use. Transmission of these infections can result directly from the use of injection equipment that is contaminated with blood containing the hepatitis B or C virus or through sexual contact with an infected individual. In the latter case, drug use can indirectly contribute to hepatitis transmission through the dis-inhibited at-risk behavior, that is, unprotected sex with an infected partner. Individuals who inject drugs are at-risk for infection from different hepatitis viruses, hepatitis A, B, or C. Those with chronic hepatitis B virus infection also face additional risk should they become co-infected with hepatitis D virus. Protection from the transmission of hepatitis viruses A and B is best achieved by vaccination. For those with a history of or who currently inject drugs, the medical management of viral hepatitis infection comprising screening, testing, counseling and providing care and treatment is evolving. Components of the medical management of hepatitis infection, for persons considering, initiating, or receiving pharmacologic therapy for opioid addiction include: testing for hepatitis B and C infections; education and counseling regarding at-risk behavior and hepatitis transmission, acute and chronic hepatitis infection, liver disease and its care and treatment; vaccination against hepatitis A and B infection; and integrative primary care as part of the comprehensive treatment approach for recovery from opioid abuse and dependence. In addition, participation in a peer support group as part of integrated medical care enhances treatment outcomes. Liver disease is highly prevalent in patient populations seeking recovery from opioid addiction or who are currently receiving pharmacotherapy for opioid addiction. Pharmacotherapy for opioid addiction is not a contraindication to evaluation, care, or treatment of liver disease due to hepatitis virus infection. Successful pharmacotherapy for opioid addiction stabilizes patients and improves patient compliance to care and treatment regimens as well as promotes good patient outcomes. Implementation and integration of effective hepatitis prevention programs, care programs, and treatment regimens in concert with the pharmacological therapy of opioid addiction can reduce the public health burdens of hepatitis and injection drug use.
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Affiliation(s)
- Thomas F Kresina
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD
| | - Diana Sylvestre
- Department of Medicine, University of California, San Francisco and Organization to Achieve Solutions In Substance Abuse (O.A.S.I.S.) Oakland, CA
| | - Leonard Seeff
- Division of Digestive Diseases and Nutrition, National Institute on Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, DHHS, Bethesda, MD
| | - Alain H Litwin
- Division of Substance Abuse, Albert Einstein College of Medicine, Montefiore Medical Center Bronx, NY
| | - Kenneth Hoffman
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD
| | - Robert Lubran
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD
| | - H Westley Clark
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD
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Kim WR, Flamm SL, Di Bisceglie AM, Bodenheimer HC. Serum activity of alanine aminotransferase (ALT) as an indicator of health and disease. Hepatology 2008; 47:1363-70. [PMID: 18366115 DOI: 10.1002/hep.22109] [Citation(s) in RCA: 553] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- W Ray Kim
- Mayo Clinic College of Medicine, Rochester, MN, USA.
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Abstract
A disease whose reputation is often worse than its reality, hepatitis C is usually benign. Most infected individuals do not experience symptoms requiring treatment, and roughly half of those treated will become free of detectable virus for an extended, perhaps permanent, period. Moreover, a growing body of data suggests that drug users can attain successful treatment outcomes, even when not completely abstinent. Addiction professionals belong in the forefront of prevention and management of this disease. We can assist our patients by helping them stabilize their lifestyles, correcting misperceptions about the disease, teaching prevention and health maintenance, promoting access to diagnosis and treatment, monitoring for treatment side effects, and providing encouragement to remain in treatment.
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Uto H, Kurogi J, Takahama Y, Kusumoto K, Hayashi K, Ido A, Kohara M, Stuver SO, Moriuchi A, Hasegawa S, Oketani M, Tsubouchi H. Alanine aminotransferase flare-up in hepatitis C virus carriers with persistently normal alanine aminotransferase levels in a hyperendemic area of Japan. J Gastroenterol 2007; 42:673-80. [PMID: 17701131 DOI: 10.1007/s00535-007-2078-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Accepted: 05/27/2007] [Indexed: 02/04/2023]
Abstract
BACKGROUND The clinical features of hepatitis C virus (HCV) carriers with persistently normal alanine aminotransferase (PNALT) levels (ALT < or = 34 IU/l) have not been fully elucidated. We investigated clinical factors associated with ALT flare-up in PNALT individuals in a HCV hyperendemic area of Japan. METHODS We analyzed 101 HCV carriers who had PNALT between 1993 and 2000. The first occurrence of ALT flare-up (ALT > or = 35 IU/l) between 2001 and 2005 was evaluated by the Kaplan-Meier method. Multivariate analysis of factors predicting ALT flare-up were conducted using Cox proportional hazards models. RESULTS The mean follow-up period was 2.8 years, and the 5-year cumulative incidence of ALT flare-up was estimated to be 31.8%. In multivariate analysis, an ALT level of 20-34 IU/l and a high serum ferritin level (> or =90 ng/ml) in the most recently available data up to the year 2000, as well as H63D heterozygosity in the HFE gene, were independently and strongly associated with the incidence of ALT flare-up (Hazard ratios = 5.6, 3.1, and 4.8, respectively). In addition, HFE H63D heterozygosity was significantly associated with higher serum ferritin levels in subjects with PNALT (153.8 + or - 73.3 ng/ml in subjects with the 63HD genotype vs. 89.4 + or - 51.3 ng/ml in subjects with the 63HH genotype, P = 0.043). CONCLUSIONS HCV carriers with PNALT in this population were at risk for ALT flare-up. Basal ALT levels, serum ferritin levels, and HFE polymorphism are potentially important predictors of ALT flare-up.
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Affiliation(s)
- Hirofumi Uto
- Digestive Disease and Life-style related Disease, Health Research Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-0056, Japan
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Yu ML, Dai CY, Lee LP, Hou NJ, Hsieh MY, Huang JF, Lin ZY, Chen SC, Hsieh MY, Wang LY, Chang WY, Chuang WL. A 24-week course of high-dose interferon-alpha plus ribavirin for Taiwanese chronic hepatitis C patients with persistently normal or near-normal alanine aminotransferase levels. Liver Int 2006; 26:1187-95. [PMID: 17105583 DOI: 10.1111/j.1478-3231.2006.01358a.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIMS We aimed to evaluate the efficacy, advantage, and safety of a 24-week regimen with high-dose interferon-alpha (INF-alpha; 6 million units thrice weekly) plus ribavirin (1000-1200 mg/day) combination therapy for 46 Taiwanese chronic hepatitis C (CHC) patients with persistently normal or near-normal alanine aminotransferase (PNALT) levels. METHODS Ninety-two age- and sex-matched CHC patients with elevated ALT levels (> 2 times the upper limit of normal range) with a ratio of 1:2, treated with the same regimen, served as a control. RESULTS The sustained virologic response (SVR) rate was comparable between PNALT (67.4%) and elevated ALT (65.2%) groups (intention-to-treat analysis). The two groups had similar rates of discontinuation and incidence of adverse effects. Viral genotype 1b, baseline viral loads, body mass index, and age were significant factors negatively associated with SVR. Further decline of ALT levels throughout the follow-up period was observed in sustained responders of the PNALT group. None of the eight patients with ALT flares developed icteric hepatitis. The virologic efficacy was sustained in a 3-year extended follow-up period. CONCLUSION high-dose INF-alpha with ribavirin combination therapy is effective, safe, and well tolerated in CHC patients with PNALT levels. The ALT assay might not be used as a single biochemical marker for determination of treatment consideration.
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Affiliation(s)
- Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Zeuzem S, Alberti A, Rosenberg W, Marcellin P, Diago M, Negro F, Prati D, Puoti C, Roberts SK, Shiffman ML. Review article: management of patients with chronic hepatitis C virus infection and "normal" alanine aminotransferase activity. Aliment Pharmacol Ther 2006; 24:1133-49. [PMID: 17014573 DOI: 10.1111/j.1365-2036.2006.03073.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Hepatitis C virus infection, a major cause of chronic liver disease, occurs with normal serum alanine aminotransferase activity in approximately 25% of patients. These patients have historically remained untreated but substantial evidence indicates liver damage, progression of disease and impaired quality of life in some individuals. AIM To review the current management of patients with chronic hepatitis C and normal alanine aminotransferase activity. METHODS This review represents the summary of discussions at a Clinical Workshop with a comprehensive literature searching of available databases (PubMed and Embase). RESULTS Current limits defining normal serum alanine aminotransferase activity are not representative of a "healthy" status. Most patients with hepatitis C and normal alanine aminotransferase levels have histologically proven liver damage that, although generally mild, may be significant (> or =F2) in up to 20% of patients and progresses at approximately 50% of the rate in patients with elevated alanine aminotransferase levels. Some patients have persistently normal alanine aminotransferase activity and may have a more benign outcome, but a significant proportion (> or =20%) experience periods of increased serum alanine aminotransferase activity which may be associated with enhanced disease progression. CONCLUSIONS A treatment approach that considers host and virus-related variables and optimizes patient and cost benefits may therefore provide more effective management of patients with chronic hepatitis C and normal alanine aminotransferase activity.
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Affiliation(s)
- S Zeuzem
- Department of Internal Medicine, , Saarland University Hospital, 66421 Homburg/Saar, Germany.
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Bruce MG, Bruden D, McMahon BJ, Christensen C, Homan C, Sullivan D, Deubner H, Hennessy T, Williams J, Livingston S, Gretch D. Hepatitis C infection in Alaska Natives with persistently normal, persistently elevated or fluctuating alanine aminotransferase levels. Liver Int 2006; 26:643-9. [PMID: 16842319 DOI: 10.1111/j.1478-3231.2006.01281.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND/AIMS An estimated one-third of patients with chronic hepatitis C virus (HCV) infection have persistently normal alanine transaminase (PNALT); however, in many previous studies alanine aminotransferase (ALT) levels were followed for < or = 12 months. METHODS We analyzed data from a population-based cohort of 935 Alaska Natives with HCV, recruited from 1994 to 2005, to determine the proportion of persons with PNALT, persistently elevated ALT (PEALT), and fluctuating ALT (FLUXALT) to determine factors for each ALT state. We selected persons with two positive HCV RNA results > or = 1 year apart and > or = 6 ALT levels measured over the subsequent 3 years with at least 1 month between ALT measurements (n = 265). We defined a person as having PNALT, PEALT, or FLUXALT when all six ALT levels were normal, elevated, or did not fit either of the above two categories, respectively, during the 3-year follow-up period. RESULTS Among 208 persistently HCV RNA-positive persons, 13 had PNALT, 121 PEALT, 74 FLUXALT. Among 77 persons who underwent liver biopsy, those with PEALT were more likely to have Ishak fibrosis scores > 2 compared with persons with FLUXALT (44% vs. 10%, OR 7.0, 95% CI: 1.5-33.2). No statistically significant differences were found in ALT classification by age, gender, infection duration, median body mass index, alcohol consumption, residence, risk behavior, RNA level, or genotype. CONCLUSIONS Only 6% of persons with chronic HCV had PNALT. Persons with PEALT were significantly more likely to have higher fibrosis scores on liver biopsy than those with FLUXALT. Previous studies with short follow-up periods may have overestimated the proportion of persons with normal ALT levels.
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Affiliation(s)
- Michael G Bruce
- Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska.
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Sánchez-Conde M, Berenguer J, Miralles P, Alvarez F, Carlos Lopez J, Cosin J, Pilar C, Ramirez M, Gutierrez I, Alvarez E. Liver biopsy findings for HIV-infected patients with chronic hepatitis C and persistently normal levels of alanine aminotransferase. Clin Infect Dis 2006; 43:640-4. [PMID: 16886160 DOI: 10.1086/506440] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2006] [Accepted: 05/11/2006] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Severe liver fibrosis is common in patients coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) who have a high alanine aminotransferase (ALT) level. However, little is known about the frequency, liver biopsy findings, and significance of a persistently normal ALT level in coinfected patients. METHODS We analyzed clinical data and histological findings for 256 patients coinfected with HIV and HCV, 24 (9.4%) of whom had an ALT level within the normal range on > or =2 separate occasions within a 6-month period. RESULTS The proportion of patients demonstrating advanced stages of fibrosis (F3 and F4) was 78 (33.7%) of 232 patients in the high ALT level group, compared with 0 (0%) of 24 patients in the persistently normal ALT level group (P<.001). Among patients with persistently normal ALT levels, 23 (96%) had any grade of fibrosis, and 7 (29%) had stage F2 of fibrosis. No differences were found between both groups with respect to age, sex, HIV transmission category, Centers for Disease Control and Prevention clinical category, CD4+ cell count (both nadir and baseline values), type of antiretroviral therapy, years since onset of HCV infection, alcohol use, or HCV load. However, the proportion of patients infected with HCV genotype 3 was significantly higher among patients with high ALT levels than in patients with persistently normal ALT levels (61 [26.9%] of 232 patients vs. 1 [4.2%] of 24 patients; P=.04). CONCLUSIONS Histological abnormalities are significantly milder in patients coinfected with HIV and HCV who have persistently normal ALT levels than those found in patients with high ALT levels. However, a subgroup of patients with persistently normal ALT levels may have significant cases of fibrosis. Liver biopsy may be recommendable in patients coinfected with HIV and HCV who have persistently normal ALT levels, to determine the extent of liver fibrosis and, consequently, to assess suitability for treatment.
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Gonzalez SA, Liu RC, Edlin BR, Jacobson IM, Talal AH. HIV/Hepatitis C Virus-Coinfected Patients With Normal Alanine Aminotransferase Levels. J Acquir Immune Defic Syndr 2006; 41:582-9. [PMID: 16652026 DOI: 10.1097/01.qai.0000214806.90841.c8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS The significance of normal alanine aminotransferase (ALT) levels in patients with HIV/hepatitis C virus (HCV) coinfection is not well understood. METHODS We performed a cross-sectional retrospective analysis on consecutive HIV/HCV-coinfected patients (n = 89) who underwent a liver biopsy during a 2-year period. Similar data were also collected on HCV-monoinfected patients (n = 117). RESULTS Mean ALT levels and the percentage of patients with normal ALT (< or =40 U/L) levels were similar in HIV/HCV-coinfected (mean +/- SD, 81.7 +/- 56.1 U/L; 21%) and HCV-monoinfected patients (97.3 +/- 100.7 U/L; 18%; P = 0.19 and 0.54, respectively). Coinfected patients, however, had significantly advanced necroinflammation (P= 0.001) and fibrosis (P = 0.02) compared with monoinfected patients. The percentage of patients with advanced necroinflammation (grades 3 or 4) was lower in HCV-monoinfected patients with normal ALT levels compared with those with elevated ALT (5% vs 20%, respectively). In contrast, the percentage of coinfected patients with advanced necroinflammation was similar whether the patient had normal or elevated ALT levels (32% vs 37%, respectively). CONCLUSIONS In coinfected patients, normal ALT levels are not an indicator of mild necroinflammation and may not portend a more benign disease course.
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Affiliation(s)
- Stevan A Gonzalez
- Center for the Study of Hepatitis C and Division of Gastroenterology and Hepatology, Department of Medicine, Weill Medical College of Columbia University, 525 East 68th Street, New York, NY 10021, USA
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Wilson LE, Torbenson M, Astemborski J, Faruki H, Spoler C, Rai R, Mehta S, Kirk GD, Nelson K, Afdhal N, Thomas DL. Progression of liver fibrosis among injection drug users with chronic hepatitis C. Hepatology 2006; 43:788-95. [PMID: 16557548 DOI: 10.1002/hep.21091] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Although most hepatitis C virus (HCV) infections are acquired by injection drug use, prospective data on the progression of liver fibrosis are sparse. Baseline liver biopsies were obtained (1996-1998) on a random sample of 210 out of 1667 HCV-positive injection drug users (IDUs). Subjects were followed biannually, with a second biopsy offered to those eligible. Paired biopsies were scored 0 to 6 (modified Ishak score), significant fibrosis was defined as score 3 or greater, and progression of fibrosis was defined as an increase 2 or more units or clinical evidence of end-stage liver disease. Predictive values of blood markers [FibroSURE, aspartate aminotransferase-to-platelet-ratio index (APRI) and alanine aminotransferase (ALT)] were assessed for detection of contemporaneous and future liver fibrosis. Among 119 prospectively followed IDUs, 96% were African American; 97% HCV genotype 1a/b; 27% HIV-infected, and median age was 42 years. Most (90.7%) did not have significant liver fibrosis at first biopsy. Although predictive value for detecting insignificant fibrosis at first biopsy was greater than 95% for FibroSURE, APRI, and ALT, specificities were 88.9%, 72.7%, and 72.7%, respectively. After 4.2 years median follow-up, 21% had progression of fibrosis, which was significantly associated with serum level of HCV RNA and ALT. No serological test had predictive value greater than 40% for contemporaneous or future significant fibrosis. Even initial biopsy result had only a 30.4% value for predicting future significant fibrosis. In conclusion, significant liver fibrosis and progression were detected in some, but not most, IDUs in this cohort. In this setting with low fibrosis prevalence, FibroSURE, ALT, and APRI tests predict insignificant fibrosis; however, further work is needed to find noninvasive markers of significant liver fibrosis.
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Affiliation(s)
- Lucy E Wilson
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21231-1002, USA
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25
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Bini EJ, Mehandru S. Sustained virological response rates and health-related quality of life after interferon and ribavirin therapy in patients with chronic hepatitis C virus infection and persistently normal alanine aminotransferase levels. Aliment Pharmacol Ther 2006; 23:777-85. [PMID: 16556180 DOI: 10.1111/j.1365-2036.2006.02819.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Few studies have evaluated interferon and ribavirin therapy in hepatitis C virus-infected patients with persistently normal alanine aminotransferase (ALT) levels. AIM To determine the efficacy and safety of combination therapy in this population, and to evaluate the impact of treatment on health-related quality of life. METHODS Forty-six hepatitis C virus-infected patients with persistently normal ALT levels and 92 matched subjects with elevated ALT levels were treated with interferon-alpha2b plus ribavirin for up to 48 weeks. Health-related quality of life was measured prior to therapy and 24 weeks after completion of treatment using the Hepatitis Quality of Life Questionnaire. RESULTS Overall, 32.6% of patients with normal ALT levels and 28.3% of those with elevated ALT levels had undetectable hepatitis C virus RNA at 24 weeks after completion of treatment (P = 0.60). Three patients in the normal ALT group had mild transient ALT elevations during therapy. Compared with baseline, treatment was associated with significant improvements in nearly all domains of health-related quality of life in both groups of patients. CONCLUSIONS In hepatitis C virus-infected patients with persistently normal ALT levels, interferon-alpha and ribavirin therapy is efficacious, safe, and associated with significant improvements in health-related quality of life.
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Affiliation(s)
- E J Bini
- Department of Medicine and Division of Gastroenterology, VA New York Harbor Healthcare System and NYU School of Medicine, New York, NY 10010, USA.
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26
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Behrendt CE, Ruiz RB. Hyperglycemia among persons with hepatitis C: not the classical diabetic phenotype. Diabetes Res Clin Pract 2006; 71:68-74. [PMID: 15951046 DOI: 10.1016/j.diabres.2005.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2004] [Revised: 04/21/2005] [Accepted: 04/28/2005] [Indexed: 01/03/2023]
Abstract
Using data from the Third National Health and Nutrition Examination Survey (United States, 1988-1994), we compared clinical phenotypes of hepatitis C virus (HCV)-seropositive and seronegative adults aged 20-89 years with hyperglycemia (impaired fasting glucose (IFG) or type 2 diabetes, n=3566 including 86 with HCV). Seroprevalence was higher among younger persons (3.4% for ages 20-59 versus 0.9% for ages 60-89, p=0.002), while traditional correlates of diabetes (hypertension, coronary heart disease) were more prevalent among older persons (both comparisons, p<0.0001). To prevent confounding by age, younger and older persons were analyzed separately. In both age groups, HCV was associated with signs of hepatic impairment and B-cell clonal expansion (higher alanine aminotransferase (ALT) and serum globulin, lower total cholesterol and platelet count). Only among younger persons, however, was HCV also associated with a marker for advanced hepatic fibrosis (elevated serum ferritin) and absence of the classical diabetic phenotype (overweight, coronary heart disease). In addition, among younger persons, HCV was currently associated with family history of diabetes, positively in persons with diabetes and inversely in those with IFG, suggesting that family history of diabetes may serve as a cofactor for progression from HCV-associated IFG to diabetes.
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Affiliation(s)
- Carolyn E Behrendt
- Epidemiology, Safety and Risk Management, Pfizer Global Research and Development, La Jolla, CA, USA.
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27
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Bel Haj NB, Giaffer MH. Challenges and Controversies in the Management of Hepatitis C Virus Infection (Part 1). Qatar Med J 2005. [DOI: 10.5339/qmj.2005.2.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
Hepatitis C virus (HCV) is emerging as a public health issue in most counties worldwide. The prevalence of HCV infection varies among different geographical areas from 0.5% to 40% with an overall global prevalence of 3%. The WHO estimates that around 170 million people are chronically infected with HCV world wide. Hepatitis CV infection causes a slowly progressive liver disease in over 60% of infected individuals culminating into cirrhosis and ultimately leading to liver failure and hepatocellular carcinoma (HCC). Chronic liver disease due to HCV infection is now the leading indication for livertransplantation both in Europe and the USA. Although the incidence of acute hepatitis C has decreased over the last decade, the number of individuals with HCV-related liver disease continues to rise and is projected to peak around year 2015. As such HCV infection imposes a significant burden on the already exhausted health resources, particularly in the developing counties where the infection is endemic and its incidence is increasing.
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Mehta SH, Thomas DL, Sulkowski MS, Safaein M, Vlahov D, Strathdee SA. A framework for understanding factors that affect access and utilization of treatment for hepatitis C virus infection among HCV-mono-infected and HIV/HCV-co-infected injection drug users. AIDS 2005; 19 Suppl 3:S179-89. [PMID: 16251816 DOI: 10.1097/01.aids.0000192088.72055.90] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Treatment for hepatitis C virus (HCV) is rarely received by injection drug users (IDU), particularly those co-infected with HIV. We propose a framework for understanding factors that affect utilization and adherence to HCV therapy among HCV mono-infected and HIV/HCV-co-infected IDU. Provision of treatment requires calculation of risks and benefits including evaluation of a number of time-varying factors that collectively determine a gradient of treatment eligibility, advisability and acceptability, the relative importance of which may differ in co-infected and mono-infected IDU. Treatment eligibility is determined by a number of non-modifiable and modifiable contraindications, the latter of which can change over time rendering patients who were once ineligible eligible. Among those eligible, treatment need can be assessed by liver biopsy and therapy may be deferred in those with no liver disease and started in those with significant liver disease. Among those with moderate disease, further consideration of treatment advisability (medical factors that affect treatment response) and acceptability (individual, provider and environmental barriers) is needed before treatment decisions are made. These factors are dynamic and thus should be continually evaluated even among those who may not initially appear to be ready for treatment. An evaluation of this framework is needed to determine applicability and feasibility. Until then, treatment decisions should be made on an individual basis after careful consideration of these issues by provider and patient and efforts to develop novel strategies for identifying IDU who need treatment most (alternatives to liver biopsy) and multidimensional approaches to deliver treatment for HCV while addressing other factors including HIV infection, depression and drug use should be continued.
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Affiliation(s)
- Shruti H Mehta
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
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29
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Abstract
Fifteen years after the discovery of the hepatitis C virus, a substantial amount of information has been learned about the natural history of infection. Testing for viral nucleic acid made it possible to accurately diagnose chronic infection and provided a more precise estimate of the overall frequency of viral persistence. Although cirrhosis and hepatocellular carcinoma can arise in persons with chronic hepatitis C, these outcomes do not always occur. The cirrhosis risk is greater in those who are infected at older ages, those who drink >50 g of alcohol each day, and persons coinfected with HIV. However, much of the person-to-person variability in progression of chronic hepatitis C remains unexplained. The ability to detect persons at highest risk of progression remains incomplete and represents an important future challenge in the understanding of the natural history of hepatitis C.
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Affiliation(s)
- David L Thomas
- Johns Hopkins School of Medicine, 1503 E. Jefferson Street, Baltimore, MD 21231, USA
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30
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Benson CA, Kaplan JE, Masur H, Pau A, Holmes KK. Treating Opportunistic Infections among HIV-Infected Adults and Adolescents: Recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association/Infectious Diseases Society of America. Clin Infect Dis 2005. [DOI: 10.1086/427906] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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31
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Cox AL, Netski DM, Mosbruger T, Sherman SG, Strathdee S, Ompad D, Vlahov D, Chien D, Shyamala V, Ray SC, Thomas DL. Prospective evaluation of community-acquired acute-phase hepatitis C virus infection. Clin Infect Dis 2005; 40:951-8. [PMID: 15824985 DOI: 10.1086/428578] [Citation(s) in RCA: 167] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2004] [Accepted: 11/16/2004] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND More than two-thirds of hepatitis C virus (HCV) infections in Western countries are caused by injection drug use, but prospective clinical data regarding the most common mode of HCV acquisition are rare, in part because acute-phase HCV infection is usually asymptomatic. METHODS To characterize acute-phase HCV infection, 179 HCV antibody-negative injection drug users were prospectively evaluated; 62 (34%) of these patients had seroconverted. Twenty of the participants who seroconverted had long-term follow-up with consistent monthly sampling before and after seroconversion, allowing detailed study. RESULTS The first indication of HCV infection was the presence of HCV RNA in serum, which preceded elevation of alanine transaminase levels and total bilirubin levels to > or =2 times baseline in 45% and 77% of patients, respectively. No subjects had jaundice. The median time from initial viremia to seroconversion was 36 days (range, 32-46 days). In one instance, viremia was detected 434 days before seroconversion. However, in no other case was HCV RNA detected >63 days before seroconversion. In subjects with viral persistence, a stable level of HCV RNA in the blood was noted in some subjects within 60 days after the initial detection of viremia, but in others, it was not apparent until >1 year later. In subjects with long-term viral clearance, HCV became persistently undetectable as early as 94 and as late as 620 days after initial viremia. CONCLUSIONS These data underscore the importance of nucleic acid screening of blood donations to prevent HCV transmission and of long-term follow-up to ascertain whether there is viral persistence, at least among injection drug users.
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Affiliation(s)
- Andrea L Cox
- Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
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Abstract
Liver biopsy is traditionally the 'gold standard' for the evaluation of liver diseases. There are several situations in which its role is being challenged. In hepatitis C, liver biopsy helps assess prognosis and treatment candidacy. An important exception is genotype 2 or 3 because treatment is more likely to succeed and therapy is relatively short in duration. For hepatitis B, liver biopsy gives some prognostic information, but serologic tests and hepatic biochemical tests are the primary determinants of treatment candidacy. Non-alcoholic fatty liver disease can be accurately diagnosed without a liver biopsy and, furthermore, there are no specific therapies available. The role of liver biopsy to assess methotrexate-associated hepatotoxicity remains controversial. Finally, patients with focal liver lesions usually do not require biopsy and, in the case of hepatocellular carcinoma, biopsy carries a risk of needle-track seeding. In short, the need for liver biopsy depends on the specific situation and should be performed when there is sufficient uncertainty about diagnosis, severity of disease, prognosis, and treatment decisions.
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Affiliation(s)
- M S Campbell
- Hospital of the University of Pennsylvania, Division of Gastroenterology, Philadelphia, PA, USA
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33
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French AL, Benning L, Anastos K, Augenbraun M, Nowicki M, Sathasivam K, Terrault NA. Longitudinal effect of antiretroviral therapy on markers of hepatic toxicity: impact of hepatitis C coinfection. Clin Infect Dis 2004; 39:402-10. [PMID: 15307009 DOI: 10.1086/422142] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2003] [Accepted: 03/11/2004] [Indexed: 12/23/2022] Open
Abstract
To characterize longitudinal hepatic toxicity of antiretroviral therapy in HIV-infected women with and without hepatitis C virus (HCV) infection, we measured alanine and aspartate aminotransferase values among women initiating highly active antiretroviral therapy (HAART). For 312 HIV/HCV coinfected women who received HAART for a mean of 1.8 years, the prevalence of elevated aminotransferase levels >3 times and >5 times the upper limit of normal (ULN) was low (<12% and <4%, respectively), and the prevalence of elevated aminotransferase levels declined over time. When we analyzed trends in aminotransferase levels according to type of HAART received among HCV-infected and uninfected women, we found that mean aminotransferase levels declined among 539 women receiving therapy with protease inhibitors (decreases of 5.34%-4.23% of the ULN per year; P values for trend of.007-.06), but mean values among 128 women receiving therapy with nonnucleoside reverse-transcriptase inhibitors remained stable (from decreases of 1.65% to increases of 7.57% of the ULN per year; P values of.19-.71). Our findings lend support to assertions that antiretroviral therapy is safe for women with HCV infection.
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Affiliation(s)
- Audrey L French
- CORE Center/Cook County Hospital, Rush Medical College, Chicago, IL 60612, USA.
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Reddy KR. Hepatitis C with normal liver enzymes: to treat or not to treat. Con: most patients should not be treated. Am J Gastroenterol 2004; 99:973-5. [PMID: 15180710 DOI: 10.1111/j.1572-0241.2004.40510_2.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Affiliation(s)
- Aijaz Ahmed
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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36
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Sylvestre DL, Clements BJ. The utility of indirect predictors of hepatitis C viremia. Drug Alcohol Depend 2004; 74:15-9. [PMID: 15072803 DOI: 10.1016/j.drugalcdep.2003.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2003] [Revised: 10/21/2003] [Accepted: 11/04/2003] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Although the majority of injection drug users (IDUs) have been exposed to hepatitis C (HCV), only 60-85% remain chronically viremic and at risk for HCV-induced progressive liver damage or transmitting HCV to others. Access to direct viral testing to establish the presence or absence of viremia is limited due to its expense. This study of 500 current and former IDUs examines the utility of demographic and biochemical features as a means of indirectly predicting HCV viremia. METHODS Retrospective chart and laboratory review. RESULTS Overall, 409 (81.8%) were viremic at the time of presentation. HCV viremia did not correlate with the presence of active drug or alcohol use, drug of abuse, duration of drug use, or length of injecting career, but was more common in males and African-Americans. An elevated ALT, found in 36% of patients, was the best biochemical predictor: 95.6% of these patients were viremic. Other predictors of viremia included thrombocytopenia, hypoalbuminemia, elevated GGT, and total bilirubin level, with a stepwise increase in viremia seen as the number of abnormal biochemical predictors increased. The absence of HCV viremia was more difficult to predict. Viremia was found in 66.3% of those lacking all biochemical predictors and even in 43.8% of those in the lowest 10th percentile of ALT. CONCLUSION Although indirect demographic and laboratory parameters may be used to help predict viremia in 40% of HCV-exposed IDUs, they are inadequate substitutes for direct viral testing and instead should be used only as an adjunct to education and referrals in high-risk patients.
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Affiliation(s)
- Diana L Sylvestre
- Department of Medicine, University of California at San Francisco, San Francisco, CA 94143, USA.
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Abstract
Nearly three million persons in the United States are viremic with hepatitis C (HCV). Despite a decreasing incidence of HCV in this country, the prevalence of HCV-related chronic liver disease is increasing. Most infections in the United States are acquired by intravenous drug use. The chronicity rate of HCV is high, reaching 85% in some populations, and the risk of progression to advanced liver disease is as high as 20% within twenty years of infection. Host factors like alcohol use accelerate the rate of progression. The enzyme immunoassay is the preferred initial test for diagnosis; the third generation assay has greater than a 99% specificity in immunocompetent patients. Barring contraindications, the standard of care for treatment of chronic HCV has become pegylated interferon and ribavirin. With this therapy, the cure rate for treatment-naïve patients is about 55%, but rates are higher in certain groups. Common side effects of therapy include neuropsychiatric symptoms, influenza-like symptoms and hematological abnormalities.
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Affiliation(s)
- Brian L Pearlman
- Center for Hepatitis C, Atlanta Medical Center, Atlanta, GA 30312, USA.
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38
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Jamal MM, Abdelkarim BZ. Chronic hepatitis C with persistently normal aminotransferase levels: do we have an adequate definition? Am J Gastroenterol 2003; 98:1455-6. [PMID: 12873562 DOI: 10.1111/j.1572-0241.2003.07535.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Davis GL, Albright JE, Cook SF, Rosenberg DM. Projecting future complications of chronic hepatitis C in the United States. Liver Transpl 2003; 9:331-8. [PMID: 12682882 DOI: 10.1053/jlts.2003.50073] [Citation(s) in RCA: 456] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chronic hepatitis C virus (HCV) infection is common and often results in slowly progressive liver disease. Although acute hepatitis C is now uncommon, most patients with acute infection have developed chronic hepatitis, and, therefore, the pool of infected patients is large. We used a modification of a previously described natural history model for HCV infection to project the number of cases of HCV infection, cirrhosis, and liver failure over the next 40 years. The model estimated the prevalence of HCV infection in the United States was 3.07 x 10(6) in 1993 (compared with an adjusted National Health and Nutrition Evaluation Survey (NHANES) III estimate of 2.8 to 3.5 x 10(6)). A gradual decline in the prevalence of infection should occur by year 2040 because of aging and natural deaths among the infected pool. However, as the duration of infection increases in the surviving cohort, the proportion with cirrhosis will increase from 16% to 32% by 2020 in an untreated population. Complications of cirrhosis also will increase dramatically over the next 20 years: hepatic decompensation (up 106%), hepatocellular carcinoma (up 81%), and liver-related deaths (up 180%). Although current treatment regimens eradicate HCV in over 50% of cases, many more patients would need to be treated to significantly impact disease progression. Identification and treatment of every case of HCV infection (with or without cirrhosis) would reduce the number of cases of decompensated cirrhosis by almost half after 20 years. Despite the declining incidence of acute HCV infection, chronic hepatitis C is common. The prevalence of cirrhosis and the incidence of its complications will increase over the next 10 to 20 years, because the duration of infection increases among those with chronic hepatitis C. These data emphasize the need for greater access to transplantation by expansion of the donor pool, increasing use of split livers and living donors, and novel options such as xenotransplantation.
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Affiliation(s)
- Gary L Davis
- Division of Hepatology, Baylor Regional Transplant Institute, Baylor University Medical Center, Dallas, TX 75246, USA.
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Hui CK, Belaye T, Montegrande K, Wright TL. A comparison in the progression of liver fibrosis in chronic hepatitis C between persistently normal and elevated transaminase. J Hepatol 2003; 38:511-7. [PMID: 12663245 DOI: 10.1016/s0168-8278(03)00004-7] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Detectable serum hepatitis C virus (HCV) RNA in HCV patients with persistently normal alanine transaminase (PNALT) has been found to be associated with significant liver damage. AIMS The primary outcome of this study was to compare the histological progression of fibrosis in patients with PNALT and elevated alanine transaminase (ALT). METHODS Forty patients with PNALT (Group 1) and 41 patients with elevated ALT (Group 2) were recruited into this study. Only patients with fibrosis of F0 to F2 were recruited into this study. RESULTS The median time to second liver biopsies was 6.3 (range 2.0-11.1) years. Nine patients (22.5%) in Group 1 and 17 patients (41.5%) from Group 2 had progression of fibrosis. There was a trend towards a significantly higher cumulative probability of fibrosis progression in Group 2 (P=0.06). In patients with an initial F0 to F1 fibrosis, there was a significant difference in cumulative probability of fibrosis progression between Groups 1 and 2 (22.6% (7/31) vs. 43.3% (13/31), respectively, P=0.02). CONCLUSIONS Anti-HCV patients with PNALT with an initial fibrosis of F0 or F1 were less likely to develop progression of fibrosis than those with elevated ALT, although patients with PNALT may have histologically and clinically progressive disease.
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Affiliation(s)
- Chee-Kin Hui
- Department of Medicine, GI Research (111B), Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA
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Fernández-Villar A, Sopeña B, Vázquez R, Ulloa F, Fluiters E, Mosteiro M, Martínez-Vázquez C, Piñeiro L. Isoniazid hepatotoxicity among drug users: the role of hepatitis C. Clin Infect Dis 2003; 36:293-8. [PMID: 12539070 DOI: 10.1086/345906] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2002] [Accepted: 10/22/2002] [Indexed: 11/03/2022] Open
Abstract
The incidence of and risk factors associated with hepatotoxicity in patients with chronic hepatitis have not been systematically studied. Therefore, we conducted a prospective study that included former drug users who were treated with isoniazid for latent tuberculosis infection. Of 415 patients, 20 (4.8%; 95% confidence interval [CI], 3-7.4) had hepatotoxicity diagnosed, and 6 (1.4%; 95% CI, 0.5-3.2) developed clinical hepatitis, none of whom had serious symptoms. The only 2 factors independently associated with isoniazid hepatotoxicity were excessive alcohol consumption (odds ratio [OR]; 4.2, 95% CI, 1.6-10.8; P=.002) and a high baseline alanine transaminase level (OR, 4.3; 95% CI, 1.6-11.4; P=.002). The presence of hepatitis C virus antibodies was associated with hepatotoxicity only on univariate analysis. Treatment with isoniazid in drug users appears to be safe and well tolerated, although frequent asymptomatic elevations in transaminase levels were observed.
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Renou C, Pol S, Halfon P, Caillat-Zucman S. Controversies about the histological features of chronic HCV patients with persistently normal alanine transaminase levels: what can be done about the present definition? Gastroenterology 2002; 123:1748-9; author reply 1749. [PMID: 12404260 DOI: 10.1053/gast.2002.36876] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Rai R, Wilson LE, Astemborski J, Anania F, Torbenson M, Spoler C, Vlahov D, Strathdee SA, Boitnott J, Nelson KE, Thomas DL. Severity and correlates of liver disease in hepatitis C virus-infected injection drug users. Hepatology 2002; 35:1247-55. [PMID: 11981775 DOI: 10.1053/jhep.2002.33151] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Between May 1996 and June 1998, 210 members of a cohort of 1,667 hepatitis C virus (HCV)-infected injection drug users (IDUs) were selected for liver biopsy procedure after stratification based on 2 consecutive serum alanine transaminase (ALT) levels. Liver histology, which could be fully evaluated for 207 subjects, was classified by using the modified Ishak scores. At the time of biopsy, the median age of subjects was 41.3 years and the median estimated duration of HCV infection was 20.7 years; 94% were African American; 78% men; 31% were human immunodeficiency virus (HIV) seropositive; and 76% had HCV genotype 1a or 1b. Total modified histologic activity index (MHAI) scores ranged from 0 to 9, and 26.6% had a total MHAI score of 5 or greater. Persons with a total MHAI score of 5 or greater were more likely to be HIV infected (P =.04). Higher fibrosis, indicated by Ishak modified fibrosis scores of 3 to 6, was present in 10.1% of subjects and was found more often in those older than 46 years of age (the highest quartile) (P <.01). Both fibrosis scores of 3 or greater and total scores of 5 or greater were associated with elevated ALT, aspartate transaminase (AST), and gamma-glutamyl transpeptidase (GGT) levels (P <.01). When serial values were considered, the results of liver enzyme testing could reduce the probability of an IDU having a fibrosis score of 3 or greater from 10% to 3%. In conclusion, these data indicate that severe liver disease is uncommon in this urban, HCV-infected IDU cohort, especially in younger persons and those with repeatedly normal liver enzymes.
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Affiliation(s)
- Rudra Rai
- Division of Gastroenterology, The Johns Hopkins School of Medicine, Baltimore, MD 21231-1001, USA
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Sadaphal P, Astemborski J, Graham NMH, Sheely L, Bonds M, Madison A, Vlahov D, Thomas DL, Sterling TR. Isoniazid preventive therapy, hepatitis C virus infection, and hepatotoxicity among injection drug users infected with Mycobacterium tuberculosis. Clin Infect Dis 2001; 33:1687-91. [PMID: 11641824 PMCID: PMC2650436 DOI: 10.1086/323896] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2001] [Revised: 06/07/2001] [Indexed: 12/16/2022] Open
Abstract
Treatment of latent Mycobacterium tuberculosis infection with isoniazid can cause hepatotoxicity, but the risk of isoniazid-associated hepatotoxicity among persons coinfected with hepatitis C virus (HCV) is unknown. We conducted a prospective study among 146 injection drug users with M. tuberculosis infection and normal baseline hepatic transaminase values who were treated with isoniazid. Of 146 participants, 138 (95%) were HCV-seropositive. Thirty-seven participants (25%) were human immunodeficiency virus (HIV)-seropositive. Thirty-two (22%; 95% confidence interval [CI], 16%-30%) of 146 participants developed transaminase value elevations to >3 times the upper limit of normal. Transaminase value elevation was associated with concurrent alcohol use but not with race, age, presence of hepatitis B surface antigen, HIV-1 infection, or current injection drug use. Isoniazid was withdrawn from 11 participants (8%; 95% CI, 4%-13%). Of 8 deaths during follow-up, none were attributed to isoniazid-associated hepatotoxicity. The risk of transaminase value elevation and drug discontinuation for HCV-infected persons receiving isoniazid was within the range reported for populations with lower HCV prevalence.
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Affiliation(s)
- Pankaj Sadaphal
- Department of Epidemiology, The Bloomberg School of Public Health, Johns Hopkins University
| | - Jacquie Astemborski
- Department of Epidemiology, The Bloomberg School of Public Health, Johns Hopkins University
| | - Neil M. H. Graham
- Department of Epidemiology, The Bloomberg School of Public Health, Johns Hopkins University
- Virco Laboratories, Mechelen, Belgium
| | - Laura Sheely
- Department of Epidemiology, The Bloomberg School of Public Health, Johns Hopkins University
| | - Margaret Bonds
- Department of Epidemiology, The Bloomberg School of Public Health, Johns Hopkins University
| | - Azalia Madison
- Department of Epidemiology, The Bloomberg School of Public Health, Johns Hopkins University
- Baltimore City Health Department, Eastern Chest Clinic, The Johns Hopkins University School of Medicine, Baltimore
| | - David Vlahov
- Department of Epidemiology, The Bloomberg School of Public Health, Johns Hopkins University
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York
| | - David L. Thomas
- Department of Epidemiology, The Bloomberg School of Public Health, Johns Hopkins University
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore
| | - Timothy R. Sterling
- Department of Epidemiology, The Bloomberg School of Public Health, Johns Hopkins University
- Baltimore City Health Department, Eastern Chest Clinic, The Johns Hopkins University School of Medicine, Baltimore
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore
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45
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Shehab TM, Sonnad SS, Lok AS. Management of hepatitis C patients by primary care physicians in the USA: results of a national survey. J Viral Hepat 2001; 8:377-83. [PMID: 11555196 DOI: 10.1046/j.1365-2893.2001.00310.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hepatitis C is a major health problem worldwide, yet very little research has been performed to assess the knowledge base and practice patterns of primary care physicians (PCPs) regarding hepatitis C. The aim of this study is to determine the knowledge base and practice patterns of a nationwide cohort of PCPs. A survey was developed to assess the knowledge of PCPs regarding risk factors for hepatitis C, management of hepatitis C patients and attitude regarding testing for hepatitis C. The survey was mailed to 4000 PCPs in the USA. A total of 1412 (39%) PCPs completed the survey. The vast majority, > 90%, of PCPs correctly identified the most common risk factors for hepatitis C. However, only 59% indicated they ask all patients about hepatitis C risk factors, 70% reported they test all patients with hepatitis C risk factors and 78% test all patients with elevated liver enzymes for hepatitis C. Most (72%) PCPs would refer an HCV-positive patient with elevated aminotransferase but only 28% would refer an HCV-positive patient with normal aminotransferase to a specialist. One-fourth of the PCPs did not know what treatment to recommend for hepatitis C patients. Our data suggest that hepatitis C patients may be underdiagnosed and under-referred. Specific educational initiatives and practice guidelines for PCPs are needed to optimize the recognition of patients at risk for hepatitis C and to ensure appropriate testing and referral.
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Affiliation(s)
- T M Shehab
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan 48109, USA
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46
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Lee SS, Sherman M. Pilot study of interferon-alpha and ribavirin treatment in patients with chronic hepatitis C and normal transaminase values. J Viral Hepat 2001; 8:202-5. [PMID: 11380798 DOI: 10.1046/j.1365-2893.2001.00286.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Combination interferon-alpha (IFN-alpha) and ribavirin treatment has become standard therapy for patients with chronic hepatitis C and elevated transaminase levels (> 1.5 x upper limit of normal). No previous study has specifically examined the efficacy of this treatment in patients with normal transaminase values. In this pilot study, we treated 19 patients, with normal or near-normal ALT values on at least three occasions, and histologically mild disease, with induction IFN-alpha2b, 5 mega units daily for 4 weeks, then 3 mega units thrice weekly for 44 week, plus concomitant ribavirin 1000 mg or 1200 mg daily for 48 weeks. Nine of the 19 (47%) showed sustained virological response, defined as undetectable HCV-RNA at 24 weeks after the end of treatment. No ALT flares were observed in any patient. We conclude that combination induction IFN-alpha and ribavirin therapy may be effective in patients with normal-ALT, and appears not to induce flares of ALT activity. Controlled trials of this treatment in this subgroup of patients with hepatitis C are warranted.
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Affiliation(s)
- S S Lee
- Liver Unit, University of Calgary, 3330 Hospital Dr. NW, Calgary, Alberta T2N 4N1, Canada.
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47
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Dufour DR, Lott JA, Nolte FS, Gretch DR, Koff RS, Seeff LB. Diagnosis and monitoring of hepatic injury. II. Recommendations for use of laboratory tests in screening, diagnosis, and monitoring. Clin Chem 2001. [PMID: 11106350 PMCID: PMC7110382 DOI: 10.1093/clinchem/46.12.2050] [Citation(s) in RCA: 221] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose: To review information on the use of laboratory tests in screening, diagnosis, and monitoring of acute and chronic hepatic injury. Data Sources and Study Selection: A MEDLINE search was performed for key words related to hepatic diseases, including acute hepatitis, chronic hepatitis, alcoholic hepatitis, cirrhosis, hepatocellular carcinoma, and etiologic causes. Abstracts were reviewed, and articles discussing use of laboratory tests selected for review. Additional articles were selected from the references. Guideline Preparation and Review: Drafts of the guidelines were posted on the Internet, presented at the AACC Annual Meeting in 1999, and reviewed by experts. Areas requiring further amplification or literature review were identified for further analysis. Specific recommendations were made based on analysis of published data and evaluated for strength of evidence and clinical impact. Recommendations: Although many specific recommendations are made in the guidelines, only some summary recommendations are listed here. In acute hepatic injury, prothrombin time and, to a lesser extent, total bilirubin are the best indicators of severity of disease. Although ALT is useful for detecting acute and chronic hepatic injury, it is not related to severity of acute hepatic injury and only weakly related to severity of chronic hepatic injury. Specific tests of viral markers should be the initial differential tests in both acute and chronic hepatic injury; when positive, they are also useful for monitoring recovery from hepatitis B and C.
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Affiliation(s)
- D R Dufour
- Pathology and Laboratory Medicine Service, Veterans Affairs Medical Center, Washington, DC 20422, USA.
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48
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Morisco F, Leone D, Tuccillo C, Iasevoli P, Sessa G, De Luise G, De Dominicis R, Caporaso N. Subjects positive for hepatitis C virus RNA with normal aminotransferase levels, a "trompe l'oeil" clinical picture? Dig Liver Dis 2000; 32:598-602. [PMID: 11142558 DOI: 10.1016/s1590-8658(00)80842-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Quite often subjects affected by chronic hepatitis C virus infection have no clinical signs of liver disease and serum aminotransferase values never go beyond the upper limit of normal. Yet these subjects, defined "asymptomatic HCV carriers", often have active viral replication and various degrees of histological damage. AIMS To verify, in a population of antibody to hepatitis C virus carriers, if normal serum aminotransferase values in hepatitis C virus-RNA positive differed considerably from those in hepatitis C virus-RNA negative subjects. SUBJECTS/METHODS We followed 24 anti-hepatitis C virus-positive subjects (15 hepatitis C virus-RNA positive and 9 negative) by measuring alanine and aspartate aminotransferase levels at 3-month intervals for a median of 40 months (range 6-77). RESULTS Determinations resulted repeatedly and rigorously within the normal range in all participants. Alanine aminotransferase values were higher in hepatitis C virus-RNA positives than in negatives (mean +/- SD: 0.609+/-0.172 vs 0.434+/-0.153 times the upper limit of normal; p<O.001). Aspartate aminotransferase values in both groups reflected the same consistent difference (mean +/- SD: 0.652+/-0.170 vs 0.528+/-0.151 times the upper limit of normal, p<0.001). CONCLUSIONS Our findings demonstrate that biochemical activity exists in asymptomatic hepatitis C virus-RNA-positive carriers, but it is so slight that serum aminotransferase levels do not go beyond the upper limit of normal. With the prevailing range of normality, serum aminotransferase determination is a helpful but not reliable marker of disease activity in chronic hepatitis C virus infection. The normal range for aminotransferases needs to be redefined in order to set up a more accurate diagnostic profile of subjects with chronic hepatitis C virus infection.
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Affiliation(s)
- F Morisco
- Dept. of Food Science, University of Naples, Federico II, Italy
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49
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Gordon SC, Fang JW, Silverman AL, McHutchison JG, Albrecht JK. The significance of baseline serum alanine aminotransferase on pretreatment disease characteristics and response to antiviral therapy in chronic hepatitis C. Hepatology 2000; 32:400-4. [PMID: 10915749 DOI: 10.1053/jhep.2000.9321] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We sought to determine whether pretreatment serum alanine aminotransferase (ALT) levels in patients with chronic hepatitis C virus (HCV) correlate with demographic features and other disease characteristics and whether these values influence response to therapy. A total of 1,744 patients with HCV received either interferon alfa-2b and placebo or combination interferon alfa-2b and ribavirin for 24 or 48 weeks. Of these, 105 individuals (6%) had minimally raised serum ALT determinations at entry visit of </=1.3 x the upper limit of normal (ULN). By analysis of variance both pretreatment histologic activity index (HAI) scores (P <.0001) and fibrosis scores (P =.003) were significantly lower among patients with baseline ALT levels </=1.3 x ULN. Individuals with lower pretreatment ALT values were younger and weighed less than the ALT >1.3 x ULN cohort. Baseline ALT was not related to gender, race, baseline viral level, or HCV genotype. Using logistic regression analysis, the only demographic feature associated with ALT </=1.3 x ULN was lower baseline weight and lower baseline HAI score. There was no difference in sustained response between patients with baseline ALT levels </=1.3 x ULN and those with >1.3 x ULN, in all treatment groups (26 of 105, 24.8% for ALT </=1.3 x ULN; 440 of 1, 639, 26.8% for ALT >1.3 x ULN). We conclude that HCV patients with minimally raised ALT values (</=1.3 x ULN) weigh less, and have lower histologic inflammatory scores than patients with more conventionally elevated ALT levels. Despite these differences, these patients have a similar sustained response to antiviral therapy.
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Affiliation(s)
- S C Gordon
- William Beaumont Hospital, Royal Oak, MI and Wayne State University School of Medicine, Detroit, MI, USA.
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50
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Mallat D, Schiff E. Viral hepatitis. Curr Opin Gastroenterol 2000; 16:255-61. [PMID: 17023883 DOI: 10.1097/00001574-200005000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Viral hepatitis accounts for most liver diseases seen in hepatology practice. In the past year studies have been focused on uncovering the basic mechanisms of viral-cellular interactions, the knowledge of which will contribute to more effective treatment. Hepatitis A virus outbreaks still occur, even in the most developed countries, which points to the need for more comprehensive vaccination measures. Lessons learned from the treatment of HIV with combination antiviral therapies are being applied to both chronic hepatitis B and C. Progress has been made toward better understanding of viral kinetics and the quasi-species of hepatitis C virus with new and more sensitive diagnostic methods. Several therapeutic protocols are emerging to identify and tailor the management approach in various subsets of the population. Although posttransplantation hepatitis B has been more effectively managed with lamivudine therapy, no major advances have been accomplished in the treatment of recurrent hepatitis C among transplant recipients. Major advances in the field of viral hepatitis including A to E and TT viruses during the past year are highlighted.
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Affiliation(s)
- D Mallat
- Center for Liver Diseases, University of Miami, Miami, Florida 33136, USA
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