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Farooq A, Waheed U, Saba N, Kaleem M, Majeed N, Wazeer A, Cheema NA, Ahmed S, Arshad M. Molecular and genetic characterization of hepatitis B virus among multitransfused thalassaemia patients in Islamabad, Pakistan. J Family Med Prim Care 2021; 10:998-1002. [PMID: 34041111 PMCID: PMC8138360 DOI: 10.4103/jfmpc.jfmpc_1880_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/24/2020] [Accepted: 12/09/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Hepatitis B virus (HBV) is the aetiological agent of transfusion-transmitted hepatitis globally. Beta thalassaemia major individuals are at greater risk of contracting HBV infection due to multiple blood transfusions required for the medical management of these patients. Based on HBV genetic variability, it is divided into 10 genotypes. The determination of HBV genotypes has significant implications for clinical management and treatment regimens. Aim: This study was performed to assess the HBV epidemiology and circulating genotypes in multi-transfused β-thalassemia major patients with the aim to be considered while formulating the treatment pattern taking into account particular needs of thalassaemia patients. Materials and Methods: This study was performed from September 2018 to June 2019, at the Department of Pathology and Transfusion Medicine, Shaheed Zulfiqar Ali Bhutto (SZAB) Medical University, Islamabad. A total of 2,260 thalassaemia patients were enrolled in the study. The study was endorsed by the Ethics Committee of the SZAB Medical University, Islamabad. The samples were serologically screened for HBsAg on the LIAISON® XL Murex HBsAg Quant assay (DiaSorin S.p.A., Italy) a chemiluminescence based immunoassay (CLIA). HBV quantitative PCR kit was used to measure the HBV DNA in serum samples. The HBV genotypes were determined using universal primers targeting the P1 and S1 region amplification. Results: Of 2,260 thalassaemia patients, 64.6% were males while 35.4% were females. The HBsAg was identified in 98 individuals (4.33%). The PCR analysis was done for these 98 patients and in this cohort, genotype D was 59.18% (n = 58), genotype A was 21.42% (n = 21) while genotype C was 19.38% (n = 19). Conclusion: The determination of HBV genotypes in the multi-transfused patients is key to the effective management of chronic HBV patients as the severity and course of the disease is dependent on a specific type of genotypes. Quality assured screening of donated blood will prevent the incidence of HBV in thalassaemia patients.
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Affiliation(s)
- Ahmad Farooq
- Department of Biological Sciences, International Islamic University, Islamabad, Pakistan.,Department of Pathology and Transfusion Medicine, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - Usman Waheed
- Department of Pathology and Transfusion Medicine, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan.,Islamabad Blood Transfusion Authority, Ministry of National Health Services, Government of Pakistan
| | - Noore Saba
- Peshawar Regional Blood Centre, Department of Health, Khyber Pakhtunkhwa, Pakistan
| | - Muhammad Kaleem
- Department of Pathology, Mohtarma Benazir Bhutto Shaheed Medical College, Mirpur, AJK, Pakistan
| | - Najma Majeed
- Department of Health, College of Medical Technology, Mirpur, AJK, Pakistan
| | - Akhlaaq Wazeer
- Department of Biological Sciences, International Islamic University, Islamabad, Pakistan.,Department of Pathology and Transfusion Medicine, Divisional Headquarters Teaching Hospital, Mirpur, AJK, Pakistan
| | - Naila Arif Cheema
- Department of Biology, National University of Technology, Islamabad, Pakistan
| | - Saeed Ahmed
- Department of Blood Bank, Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Muhammad Arshad
- Department of Biological Sciences, International Islamic University, Islamabad, Pakistan
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Prakash C, Sachdev S, Marwaha N, Hans R. Prevalence of Hepatitis B and C Viral Markers in Blood Donors Deferred from Donating Blood on the Basis of a History of Jaundice of Unknown Origin. J Clin Exp Hepatol 2019; 9:156-161. [PMID: 31024196 PMCID: PMC6476937 DOI: 10.1016/j.jceh.2018.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 03/22/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIMS The aim of the present study was to know the prevalence of viral hepatitis markers among blood donors deferred on the basis of a history of jaundice of unknown origin and to predict the impact of this deferral on blood safety. METHODS Observational study included 200 blood donors deferred on the basis of a history of jaundice of unknown origin and carried out serology and Individual Donation Nucleic Acid Testing (ID-NAT) for hepatitis B and hepatitis C. RESULTS Five (2.5%) out of 200 blood donors deferred on the basis of history of jaundice were reactive on ELISA. Three out of five were reactive for HBsAg; whereas two for anti-HCV antibodies. Out of the 12 ID-NAT initial reactive, 10 samples discriminated on further testing; 4 for HBV, 5 for HCV and 1 was co-infection (HBV + HCV). The odds of being picked up as sero reactive on ELISA was 2.53 (95% CI; 1.04-6.19) and being picked up as ID-NAT yield was 13.08 (95% CI; 5.29-32.37) in donors deferred on a history of jaundice of unknown origin as compared to selected donors without a history of jaundice, with the difference in means achieving statistically significance at P = 0.03 and <0.001 respectively.The potential of deferral on a history of jaundice of unknown origin has a capacity to interdict 2-3 HBV and/or HCV reactive blood donors on serology and 5 HBV and/or HCV reactive blood donors on ID-NAT from entering the quarantine blood supply per 100 donors. CONCLUSION The findings of the present study support that a deferral for a history of jaundice of unknown origin after attaining the age of 12 years in the present scenario of transfusion transmissible infectious disease screening in India.
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Affiliation(s)
- Chandra Prakash
- M.Sc. Medical Technology (Transfusion Medicine), Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Suchet Sachdev
- Assistant Professor, Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Address for correspondence: Suchet Sachdev, Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Tel.: +91 172 2756486.
| | - Neelam Marwaha
- Senior Professor and Head, Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rekha Hans
- Assistant Professor, Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Dranitsaris G. The cost of blood transfusions in cancer patients: a reanalysis of a Canadian economic evaluation. J Oncol Pharm Pract 2016. [DOI: 10.1177/107815520000600201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Cancer patients undergoing chemotherapy are at an increased risk for anemia. Hence, they are high consumers of allogenic blood transfusions. In 1997, an economic evaluation was undertaken at the Princess Margaret Hospital to estimate the cost of a transfusion in cancer patients. The analysis relied on published costing information and on an internal review of patient resource utilization. Overall, the cost of a blood transfusion was estimated at Can$599. Since 1997, there have been some major changes in the management of Canada's blood supply and within the Princess Margaret Hospital. Methods. In order to evaluate how these changes affected the cost of a transfusion in cancer patients, the original 1997 economic database was reanalyzed using updated 1999 costing information obtained from Canadian Blood Services (CBS) and from the Princess Margaret Hospital. Results. The reanalysis suggested that the cost of a blood transfusion in cancer patients increased from Can$599 in 1997 to Can$731 in 1999. The major incremental costs responsible for this increase were additional screening tests, increased opportunity costs for donors and a modest rise in distribution and administration within the hospital. Costs that were no longer relevant in 1999 were the cost of treating transfusion-related infections. Conclusions. These results support the findings of the original publication that a unit of blood is a highly resource intensive commodity which requires that each blood unit be used appropriately. Therefore, preventative strategies that would reduce the use of blood products have to be identified and implemented.
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Affiliation(s)
- George Dranitsaris
- Health Economics and Outcomes Research Unit, Ontario Cancer Institute/Princess Margaret Hospital, Toronto, Canada
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Into the occult: strategies for preventing transfusion-transmissible infections. Indian J Gastroenterol 2013; 32:289-90. [PMID: 23873607 DOI: 10.1007/s12664-013-0344-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 06/29/2013] [Indexed: 02/04/2023]
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Microbial pathogens of hematopoietic stem cells – screening and testing for infectious diseases. ACTA ACUST UNITED AC 2007. [DOI: 10.1097/mrm.0b013e3282cdf04a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ballester JM, Rivero RA, Villaescusa R, Merlín JC, Arce AA, Castillo D, Lam RM, Ballester A, Almaguer M, Melians SM, Aparicio JL. Hepatitis C virus antibodies and other markers of blood-transfusion-transmitted infection in multi-transfused Cuban patients. J Clin Virol 2006; 34 Suppl 2:S39-46. [PMID: 16461239 DOI: 10.1016/s1386-6532(05)80033-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND HCV was initially identified in 1989 when it was found to be the primary causative agent of non-A, non-B hepatitis,a condition associated with high rates of progressive and end-stage liver disease, cirrhosis, and hepatocellular carcinoma. Since then, appreciation of the significant worldwide health impact of HCV infection has grown. HCV infection was identified as a public health problem in Cuba in the 1990s. Despite universal blood donor screening, which was achieved in 1995 using the Cuban immunoassay system UMELISA HCV, the infection is still found in multi-transfused patients. OBJECTIVES To determine the magnitude of HCV, HBV and HIV-1&2 infections among Cuban blood recipients and to assess the role of potential risk factors. STUDY DESIGN Cross-sectional study of 318 patients from Havana City, Pinar del Río and Villa Clara, who had been previously treated with 10 or more units of allogenic blood or blood components in at least two different occasions. The patients were evaluated for HCV Ab, HBsAg, anti-HBc Ab, and HIV-1&2 Ab. Data management and statistical analysis were performed using EpiInfo and SSPS software. RESULTS Prevalence rates were 51.6% for HCV Ab; 5.3% for HBsAg; 45.0% for anti-HBc and 0% for HIV-1&2 Ab. Ten (3.1%) patients were co-infected with HCV and HBV Blood transfusion was not identified as the main risk factor for HCV transmission. The number of blood units received by the patients was not statistically associated with the HCV Ab prevalence. CONCLUSIONS Infection with HCV was identified more frequently than HBV and HIV among our study population. Patients undergoing hemodialysis were at the highest risk of becoming infected. Medical procedures including surgery, transplantation, invasive odontology, and sharing or reuse of needles and syringes, are associated with higher HCV Ab seroprevalences compared with blood transfusion alone.
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Affiliation(s)
- José M Ballester
- Institute of Hematology and Immunology, POB 8070, Havana, 10800 Cuba
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Abstract
BACKGROUND Efforts to reduce bacterial contamination in platelets (PLTs) have led to implementation of tests for bacterial detection before product release. Although relatively rare as a human pathogen, Listeria monocytogenes often causes serious illness and has a case-fatality rate of 20 percent. CASE REPORT PLTs from an asymptomatic 58- year-old Hispanic male with a long history of PLT donation were culture-positive for the presence of L. monocytogenes. The pulsed-field gel electrophoresis (PFGE) pattern of the isolate matched two other L. monocytogenes isolates in the CDC National PulseNet database. Public health investigation found no evidence that the other two isolates were epidemiologically related to the PLT donor, who remained asymptomatic. CONCLUSION A cluster of listeriosis cases was detected by PFGE but the significance is unknown. Organisms of public health significance should be reported to health departments. Better surveillance and reporting are needed in the efforts to improve blood product safety.
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Affiliation(s)
- Ramon E Guevara
- Acute Communicable Disease Control Program, Los Angeles County Department of Health Services, Los Angeles, California 90012, USA.
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Zervou EK, Georgiadou SP, Liapi GK, Karabini F, Giogiakas V, Zisiadis K, Gatselis NK, Goudevenos I, Dalekos GN. Markers of hepatitis viruses and human T-lymphotropic virus types I/II in patients who have undergone open-heart surgery: evidence of increased risk for exposure to HBV and HEV. Eur J Intern Med 2005; 16:424-8. [PMID: 16198902 DOI: 10.1016/j.ejim.2005.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2004] [Revised: 02/24/2005] [Accepted: 02/28/2005] [Indexed: 12/23/2022]
Abstract
BACKGROUND Open-heart procedure is characterized by a high-risk for contracting blood-borne infections. We evaluated the prevalence of several markers of hepatitis viruses (B-E) and human T-cell lymphotropic virus types I/II (HTLV-I/II) in a consecutive series of patients who had undergone open-heart surgery. METHODS 204 patients and 158 selected age- and sex-matched healthy volunteers were investigated. Samples were collected at least 6-12 months postoperatively. Commercial enzyme immunoassays and confirmatory immunoblot assays for HCV, HEV and HTLV-I/II were used. RESULTS None of the subjects tested positive for antibodies to HTLV-I/II. Prevalence of markers of past HBV infection and antibodies to HEV (anti-HEV) were higher in patients than in healthy controls (anti-HBc: 45.1% vs. 31%, p=0.009; anti-HBs: 31.9% vs. 22.2%, p=0.02; anti-HBe: 32.4% vs. 10.1%, p=0.000; anti-HEV: 5.4% vs. 0%, p=0.008). HBsAg and antibodies to HCV did not differ between the groups. CONCLUSIONS HTLV, HBsAg and HCV infection markers did not differ between patients and healthy controls. However, patients had significantly increased prevalence of markers of previous HBV infection suggesting that an intensive vaccination schedule against HBV preoperatively might be helpful in minimizing the risk. The increased prevalence of anti-HEV in cardiac patients requires further investigation. Prospective studies are needed in order to definitely address whether the high prevalence of exposure to HBV and HEV infections in patients who had undergone open-heart surgery is procedure-related or not and whether it has any impact on morbidity of these patients.
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Affiliation(s)
- E K Zervou
- Blood Bank at the University Hospital of Ioannina, Ioannina, Greece
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Tawk HM, Vickery K, Bisset L, Lo SK, Cossart YE. The significance of transfusion in the past as a risk for current hepatitis B and hepatitis C infection: a study in endoscopy patients. Transfusion 2005; 45:807-13. [PMID: 15847673 DOI: 10.1111/j.1537-2995.2005.04317.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The objective was to determine the contribution of transfusion in the past to the risk of current infection with hepatitis B or C among patients attending a large hospital for endoscopic procedures. STUDY DESIGN AND METHODS Blood samples had been tested for hepatitis markers by routine methods. Patients completed a comprehensive risk factor questionnaire and results were analyzed using computer software. RESULTS Twenty-seven percent of the 2120 participants in the study received transfusions in the past. There was no increase in prevalence of hepatitis B among those transfused. Compared with nontransfused participants, recipients of blood before the implementation of hepatitis C virus (HCV) screening in 1990 had a 4.6-fold increased risk of HCV infection, whereas those transfused with screened blood had a 3-fold increased risk. The difference between the odds ratios for patients before and after screening was not significant. CONCLUSIONS Because screening has almost completely eliminated HCV from the blood supply, our finding of a continuing association of HCV infection with transfusion was unexpected. It implies that there are significant other nosocomial risks for hepatitis C transmission associated with the clinical situations where patients received blood. These should be actively investigated.
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Affiliation(s)
- Hani M Tawk
- Department of Infectious Diseases and Immunology, University of Sydney, Sydney, Australia
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Pettersson M, Fischler B, Petrini P, Schulman S, Nemeth A. Recombinant FVIIa in children with liver disease. Thromb Res 2005; 116:185-97. [PMID: 15935827 DOI: 10.1016/j.thromres.2004.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2004] [Revised: 11/21/2004] [Accepted: 11/25/2004] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The aim of this study was to investigate the clinical and biochemical effects of recombinant activated factor VII (rFVIIa) in the treatment of bleeding in children with liver disease. PATIENTS AND METHODS 12 patients (0.3-15.9 years) with chronic liver disease were included. The indication for treatment was life threatening bleeding and failing conventional therapy (group A, 7 patients) or as prophylaxis before invasive procedures (group B, 6 patients). One patient received treatment on both indications. rFVIIa was administered as intravenous bolus doses of 34-163 microg/kg (median 66 mug/kg) alone or in combination with packed red cells and/or octreotide and/or fresh frozen plasma. The follow-up included repeated INR and haemoglobin measurements as well as clinical evaluation. RESULTS In group A rFVIIa was given on 22 occasions and bleeding decreased, was unchanged, increased or could not be evaluated on 10, 7, 2 and 3 occasions respectively. On 14 occasions rFVIIa and octreotide were administered simultaneously, in 8 of those bleeding decreased. In group B no bleeding complication was seen, interpreted as a positive effect. One thrombotic event was suspected but could not be verified by computerized tomography. CONCLUSIONS rFVIIa may be beneficial in the short-term management of life threatening bleeding in some children with liver disease. This effect may be further enhanced with the additional use of octreotide. Furthermore, rFVIIa is useful for prophylaxis at invasive procedures, even without additional treatment with fresh frozen plasma. The possible risk of portal vein thrombosis needs to be considered.
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Affiliation(s)
- Maria Pettersson
- Department of Paediatrics, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm S-141 86, Sweden.
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Abstract
Transfusion transmitted disease (TTD) is a major challenge to the transfusion services all over the world. The problem of TTD is directly proportionate to the prevalence of the infection in the blood donor community. In India, hepatitis B/C, HIV, malaria, syphilis, cytomegalo virus, parvo-virus B-19 and bacterial infections are important causes of concern. Hepatitis B and C infections are prevalent in India and carrier rate is about 1-5% and 1%, respectively. Post transfusion hepatitis B/C is a major problem in India (about 10%) because of low viraemia and mutant strain undetectable by routine ELISA. HIV prevalence among blood donors is different in various parts of the country. It may not be so alarming as projected by some agencies. In one study from north India, confirmed HIV positivity was found in 0.2/1000 blood donor. Post transfusion CMV is difficult to prevent but use of leukocyte filters may help to reduce it significantly. Parvo virus B-19 infection in blood donors is 39.9% which may increase morbidity in multitransfused or immunocompromised patients. Current symphilis tests may not be sensitive but it should be continued to exclude high-risk donors. Malaria is a real problem for India due to the lack of a simple and sensitive screening test. Incidence of bacterial contamination is greatly reduced due to improved collection/preservation techniques and use of antibiotics in patients. However, proper vigilance and quality control is needed to prevent this problem. Total dependence of altruistic repeat voluntary donors and use of sensitive laboratory tests may help Indian blood transfusion services to reduce incidences of TTDs.
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Affiliation(s)
- N Choudhury
- Transfusion Medicine Department, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Rae Barelly Road, Lucknow-226014, UP.
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Affiliation(s)
- C Liatsos
- Liver Transplantation and Hepatobiliary Medicine, Royal Free Hospital, Hampstead, London, UK
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Ambrosch A, König W. [Characteristics of the hepatitis C virus and viral predictors of therapeutic response]. MEDIZINISCHE KLINIK (MUNICH, GERMANY : 1983) 1999; 94:626-32. [PMID: 10603734 DOI: 10.1007/bf03045003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
NATURAL HISTORY OF HEPATITIS C-INFECTION AND VIRAL CHARACTERISTICS: Hepatitis C-virus (HCV) infection is a major cause of non-A, non-B-hepatitis and, additionally, is associated with liver cirrhosis and hepato-cellular carcinoma. The high degree of chronificity of HCV-infection is reasonable due to antigenic variability of neutralizing epitopes leading to incomplete immunoresponse with subsequent virus persistence. Besides genetic variants of HCV within a virus population (quasispecies nature of HCV), different genotypes are classified being genetically and phenotypically distinct, and geographically restricted in part. Genotyping of HCV is not only important for phylogenetic and epidemiological studies, but also a predictive marker for pathogenesis and therapy. VIRAL PREDICTORS OF HCV THERAPY: In a meta-analysis of 18 therapeutical studies of chronical HCV infections, genotype 1 and high levels of viremia determined markedly the response to interferon therapy. In this context, clinical trials have proven the effect of a combined therapy with interferon and ribavirin. Especially patients with HCV genotype 1 or high levels of viremia had a real benefit from combined antiviral therapy in comparison to monotherapy with interferon. CONCLUSION AND FUTURE CONCEPTS: Besides recent concepts improving the therapeutical response to HCV infection, further effort is necessary to develop more successful strategies for eradication of hepatitis C virus. In this context, variations of interferon therapy should be evaluated (e.g. higher and daily doses, longer duration of interferon therapy, "retarded" interferon (PEG-IFN). In addition, new therapeutical concepts should be performed including a combination of interferon with other known antiviral agents (amantadine), a combination with immunomodulators (GM-CSF, thymosin alpha 1), the development of new antiviral agents (inhibitors of viral proteases, helicases and polymerases) and the exploration of anti-viral, molecular strategies (specific ribozymes, antisense oligonucleotides and DNA-vaccination). Nevertheless, the development of an effective vaccination should be the most important challenge for the future.
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Affiliation(s)
- A Ambrosch
- Institut für Mikrobiologie, Otto-von-Guericke Universität Magdeburg.
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