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Lo Re V, Haynes K, Forde KA, Localio AR, Schinnar R, Lewis JD. Validity of The Health Improvement Network (THIN) for epidemiologic studies of hepatitis C virus infection. Pharmacoepidemiol Drug Saf 2009; 18:807-14. [PMID: 19551699 DOI: 10.1002/pds.1784] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Before using computerized databases to study hepatitis C virus (HCV) epidemiology, the validity of the diagnosis must be assessed. We determined the accuracy of HCV diagnostic codes within The Health Improvement Network (THIN), an electronic database containing medical record data from general medical practices in the United Kingdom. METHODS Patients with initial diagnostic codes for HCV infection and nonspecific viral hepatitis between 2000 and 2007 in the THIN database were identified. Questionnaires were mailed to general practitioners caring for a random sample of 150 of these patients (75 with an HCV code; 75 with a nonspecific viral hepatitis code) to collect information on HCV and other hepatitis diagnoses. We determined the positive predictive value of the database's HCV diagnostic codes and its ability to identify the date of a new HCV diagnosis. RESULTS Usable surveys were returned for 146 (97%) patients. Among 74 patients with an HCV code and questionnaire data, HCV was confirmed in 64 (positive predictive value, 86%; 95%CI, 77-93%). In 40 (63%), the first recorded diagnosis in THIN was within 30 days of the date reported in the questionnaire (median difference, 11 days; interquartile range, 0-362 days). Among 72 patients with a nonspecific viral hepatitis code, 16 (22%) had HCV, but manual review of the database's electronic records correctly identified 12/16 (75%). CONCLUSIONS In THIN, the HCV-specific diagnostic codes are highly predictive of HCV infection. After manual review, few patients with a nonspecific viral hepatitis code were misclassified as having HCV infection.
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Affiliation(s)
- Vincent Lo Re
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, PA 19104-6021, USA.
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Abstract
Hepatitis C virus (HCV) infection remains a large-scale and significant health concern. The combination of subcutaneously administered pegylated interferon and oral ribavirin is the FDA-approved regimen for the treatment of chronic HCV infection. Combination therapy may result in a sustained virologic response leading to HCV eradication, with a reduction in risk for cirrhosis, hepatic decompensation, and hepatocellular carcinoma. However, the combination of PEG-IFN and ribavirin does not universally result in cure in all patients who undergo treatment. In this article, the authors discuss immunomodulatory therapies and clinical trials in the treatment of HCV infection.
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Abstract
BACKGROUND Hepatitis C virus may cause liver inflammation and fibrosis. It is not known whether glucocorticosteroids are beneficial or harmful for patients with hepatitis C infection. OBJECTIVES The objectives were to evaluate the beneficial and harmful effects of glucocorticosteroids for patients with acute or chronic hepatitis C infection with or without hepatitis C related autoimmune disorders. SEARCH STRATEGY Searches of The Cochrane Hepato-Biliary Controlled Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and reference lists of relevant articles and hand searches of relevant journals were performed in July 2003. Principal authors of clinical trials were approached. SELECTION CRITERIA Randomised clinical trials dealing with glucocorticosteroids for viral hepatitis C - acute or chronic with or without autoimmune disorders. DATA COLLECTION AND ANALYSIS Data were extracted by one reviewer and validated by another. Further information was sought by correspondence with the principal investigator of the trial in case the relevant data were not published. Disagreements were solved by discussion before the meta-analysis. MAIN RESULTS Eight trials randomised 384 patients with chronic hepatitis C to glucocorticosteroids plus interferon versus interferon plus placebo/no intervention, glucocorticosteroids versus interferon, or glucocorticosteroids versus placebo. Glucocorticosteroids treatment given as short pre-treatment followed by interferon or as long-term parallel treatment combined with interferon versus interferon monotherapy had no significant effect on mortality (no deaths occurred; 342 patients), virological response at six months follow-up (RR 0.85; 95% CI 0.52 to 1.38; 38 patients), or biochemical response at six months follow-up (RR 0.95; 95% CI 0.84 to 1.06; 307 patients). There was no significant difference in serious adverse events between combination therapy versus interferon monotherapy (RR 4.76; 95% CI 0.24 to 93.19; 342 patients). Glucocorticosteroids versus interferon had no significant effect on mortality (RR 2.33; 95% CI 0.27 to 17.80; 13 patients) or virological response at follow-up (RR 1.17; 95% CI 0.86 to 1.58; 13 patients). We found no trials on glucocorticosteroids for acute hepatitis C. REVIEWERS' CONCLUSIONS There is insufficient evidence neither to confirm nor exclude both beneficial and harmful effects of glucocorticosteroids for chronic hepatitis C with or without autoimmune disorders. This Review is not able to rule out potential serious adverse effects of glucocorticosteroids. Therefore, this Review cannot establish whether glucocorticosteroids treatment can be safely administrated for indications requiring glucocorticosteroids without analysing for hepatitis C virus. The effect of glucocorticosteroids for acute hepatitis C has not been examined in randomised trials.
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Affiliation(s)
- J Brok
- Centre for Clinical Intervention Research, Copenhagen University Hospital, Department 7102, H:S Rigshospitalet, Copenhagen Ø, Denmark, DK 2100
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Wright M, Goldin R, Fabre A, Lloyd J, Thomas H, Trepo C, Pradat P, Thursz M. Measurement and determinants of the natural history of liver fibrosis in hepatitis C virus infection: a cross sectional and longitudinal study. Gut 2003; 52:574-9. [PMID: 12631672 PMCID: PMC1773621 DOI: 10.1136/gut.52.4.574] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The rate of development of liver fibrosis in hepatitis C virus (HCV) infection varies between individuals. This accounts for the variation in duration of progression to cirrhosis. The aims of this study were: (1) to determine whether fibrosis progresses linearly through the grading scales and (2) to identify factors which influence the rate of fibrosis. METHODS HCV infected patients who had undergone at least one liver biopsy were identified. Biopsies were scored using the modified HAI (Ishak) and METAVIR systems, which were compared. Patients were treatment naïve at first biopsy. Demographic features were examined for their relationship to fibrosis rate (defined as fibrosis stage/infection duration) using univariate and multivariate analysis. A subgroup of patients with two biopsies was examined to test the assumption that fibrosis progresses in a linear fashion. RESULTS A total of 917 patients were included. Male sex (p<0.00001), older age at infection (p</=0.00001), and viral genotype non-1 (p=0.005) were all associated with a rapid rate of fibrosis. On multiple linear regression they accounted for 29.5% of the variability in fibrosis rate (r(2)=0.295). METAVIR and Ishak scores were highly correlated (r=0.935, p<0.0001). In 137 patients who had two biopsies, the predicted probability for an increase of 1 on the fibrosis score was too low to assess linearity. CONCLUSIONS Demographic features account for a minority of fibrosis rate variability. The Ishak and METAVIR scoring systems are equivalent. Linearity of fibrosis progression cannot be assessed in biopsies only a few years apart.
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Affiliation(s)
- M Wright
- Hepatology Section, Faculty of Medicine, Imperial College, London W2 1NY, UK.
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Balogun MA, Ramsay ME, Hesketh LM, Andrews N, Osborne KP, Gay NJ, Morgan-Capner P. The prevalence of hepatitis C in England and Wales. J Infect 2002; 45:219-26. [PMID: 12423608 DOI: 10.1053/jinf.2002.1059] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To estimate the background population prevalence of hepatitis C in England and Wales, observe the prevalence over time and assess the extent of infection outside of known risk groups. METHODS Sera from residual specimens from adult patients submitted to laboratories in England and Wales were tested for anti-HCV. Testing was carried out using a cost-effective pooling strategy. RESULTS Although the prevalence of anti-HCV was highest in 1986 (1.07%), in the multivariable analysis, prevalence did not vary significantly between the 3 periods 1986, 1991 and 1996 (P=0.14). The prevalence of infection was higher in males than in females (P=0.0013). An age-period-cohort analysis revealed a cohort effect due to a lower HCV prevalence in the most recent birth cohorts, that is, those born between the calendar years 1971-1975 and 1976-1980. CONCLUSIONS The majority of HCV infections in England and Wales were probably acquired before 1986. Infections in younger males identified in 1996 may signify more recent acquisition by injecting drug use.
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Affiliation(s)
- M A Balogun
- Immunisation Division, PHLS Communicable Disease Surveillance Centre, 61 Colindale Avenue, London, NW9 5EQ, UK.
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Pradat P, Alberti A, Poynard T, Esteban JI, Weiland O, Marcellin P, Badalamenti S, Trépo C. Predictive value of ALT levels for histologic findings in chronic hepatitis C: a European collaborative study. Hepatology 2002; 36:973-7. [PMID: 12297846 DOI: 10.1053/jhep.2002.35530] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The aim of this retrospective study was to determine the predictive value of alanine aminotransferase (ALT) levels for histologic findings in patients with chronic hepatitis C virus (HCV) infection. Data on 864 HCV RNA-positive patients were collected. ALT values were obtained at the time of biopsy (before treatment), and normal ALT values were defined as normal values obtained at serial evaluations during a 6-month period. Histologic results were scored using the METAVIR system. Among all patients, 99% of those with elevated ALT levels had a score of at least F1 (positive predictive value [PPV], 99%) and 88% had a score greater than A1F1. Among patients with persistently normal ALT values, 65% had a score of at least F1 (negative predictive value [NPV], 35%) and 26% had a score greater than A1F1. The receiver operating characteristics analysis indicates that the ALT threshold for the best compromise sensitivity-specificity was about 2.25 times the upper limit of normal (ULN). In conclusion, almost all HCV RNA-positive patients with elevated ALT levels have some degree of fibrosis. However, an important proportion of patients with persistently normal ALT levels also show some histologic signs of fibrosis; the degree of fibrosis is usually mild but is sometimes more marked, and in rare cases cirrhosis may be present. In this subset of patients, the indication of liver biopsy and the potential benefit of therapy need to be further evaluated. These results suggest the need to revisit the algorithm for liver biopsy practice.
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Puoti C, Castellacci R, Montagnese F, Zaltron S, Stornaiuolo G, Bergami N, Bellis L, Precone DF, Corvisieri P, Puoti M, Minola E, Gaeta GB. Histological and virological features and follow-up of hepatitis C virus carriers with normal aminotransferase levels: the Italian prospective study of the asymptomatic C carriers (ISACC). J Hepatol 2002; 37:117-23. [PMID: 12076870 DOI: 10.1016/s0168-8278(02)00101-0] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND/AIMS To evaluate demographic characteristics, liver histology and virological features of hepatitis C virus (HCV) carriers with normal alanine transaminase (ALT) levels. METHODS A nationwide prospective study was started in 1997. Four Italian centres have participated in this study. RESULTS Eight hundred and eighty subjects entered the study. One hundred and eighty-nine (21.5%) were excluded during the follow-up because of ALT increase. Among the 691 patients with persistent ALT normality, 72% were females. An overall prevalence of genotype 2 was found (52%). Normal liver was found in 17% of the patients; 34% had minimal chronic hepatitis, 44% mild hepatitis, 4% moderate to severe hepatitis, and 1% had cirrhosis. Clinical and virological features did not differ between subjects with ALT flares and those with persistently normal ALT. Baseline ALT levels have no effects on liver histology and clinical outcome. CONCLUSIONS Many HCV carriers have significant chronic liver damage, although in the majority of them liver lesions are minimal or mild. Up to 60% of HCV carriers in Italy harbour non-1 HCV types. Current definition of HCV carriers with persistently normal ALT levels, based upon three normal ALT values over a 6-month period, is not adequate to discriminate between carriers with persistent ALT normality and those with transient biochemical remission. Longer follow-ups are needed.
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Affiliation(s)
- Claudio Puoti
- Department of Gastroenterology and Internal Medicine, Genzano Hospital, Via Cimone 171, 00141 Rome, Italy.
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Abstract
Several aspects are revised on the subject related to drugs used, their doses, duration of treatment, different responses obtained, according different types of diseases and patients studied, as the factors able to modify the results obtained.
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Affiliation(s)
- V P Conte
- Departamento de Gastroenterologia da Faculdade de Medicina, Universidade de São Paulo
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Pellicano R, Marietti G, Leone N, Arena V, Palmas F, Rizzetto M, Ponzetto A. Mixed cryoglobulinaemia associated with hepatitis C virus infection: a predictor factor for treatment with interferon? J Gastroenterol Hepatol 1999; 14:1108-11. [PMID: 10574139 DOI: 10.1046/j.1440-1746.1999.02015.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIMS Mixed cryoglobulinaemia (MC) is a frequent finding among patients infected with hepatitis C virus (HCV). The response to treatment with alpha-interferon (alpha-IFN) in these patients is linked to predictive factors. The aim of this study was to ascertain whether the presence of MC was a predictive factor of response in patients treated with alpha-IFN for chronic hepatitis due to HCV. METHODS Thirty-two patients with MC and HCV infection (24 with chronic hepatitis and eight with cirrhosis) were compared with 30 patients with HCV infection without MC (23 chronic hepatitis, seven cirrhosis) of a similar mean age. All were treated with lymphoblastoid alpha-IFN, at 3 MU, t.i.w., for 6-12 months and then followed up. RESULTS No statistical difference was observed between the two groups in terms of sustained response (P = 0.83), relapse (P = 0.88) and non-response (P = 0.92). The mean follow up was 24.3 months (range 17-28) for patients with sustained response and for the patients with MC and 22.6 months (range 15-26) for patients without MC. CONCLUSIONS The presence of cryoglobulinaemia does not influence the response to alpha-IFN in patients with chronic HCV infection.
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Affiliation(s)
- R Pellicano
- Department of Gastroenterology, Molinette Hospital, Turin, Italy
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da Silva CM, David FL, Muscará MN, Sousa SS, Ferraz JG, de Nucci G, Polimeno NC, Pedrazzoli J. Plasma hydroxy metronidazole/metronidazole ratio in anti-HCV carriers with and without apparent liver disease. Br J Clin Pharmacol 1998; 46:176-80. [PMID: 9723829 PMCID: PMC1873660 DOI: 10.1046/j.1365-2125.1998.00758.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AIMS To evaluate plasma hydroxy-metronidazole/metronidazole ratio as a dynamic liver function test in HCV-infected individuals with/without liver disease, in the absence of liver cirrhosis. METHODS Metronidazole was administered intravenously in healthy volunteers, asymptomatic anti-HCV-positive blood donors, and in chronic hepatitis C patients. Serology to HCV was determined by a second generation assay and confirmed by gelatin particle agglutination test using recombinant antigens C22-3 and C200. Plasma concentration of metronidazole and hydroxy-metronidazole was measured by high performance liquid chromatography in samples collected 5, 10, 20 and 30 min following the end of metronidazole infusion. RESULTS Chronic hepatitis C patients had abnormal liver enzymes, while healthy volunteers and anti-HCV-positive blood donors had normal liver biochemistry tests. Plasma metronidazole concentration was similar in all groups studied. Plasma hydroxy-metronidazole/metronidazole ratio was significantly reduced in HCV-infected subjects, an effect observed 10 min after the end of drug infusion. CONCLUSIONS Metronidazole clearance is impaired in anti-HCV-positive blood donors and chronic hepatitis C patients, indicating that HCV is capable of affecting liver function at early stages of the disease. The metronidazole clearance test can detect impaired liver function in HCV-infected individuals even in the absence of liver cirrhosis.
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Affiliation(s)
- C M da Silva
- Clinical Pharmacology Unit, São Francisco University Medical School, Bragança Paulista, SP, Brazil
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Cohen Stuart JW, Boucher CA, Cooper DA, Galasso GJ, Richman DD, Thomas HC, Whitley RJ. Summary of the III International Consensus Symposium on Combined Antiviral Therapy. Antiviral Res 1998; 38:75-93. [PMID: 9707371 DOI: 10.1016/s0166-3542(98)00021-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Malaguarnera M, Di Fazio I, Restuccia S, Pistone G, Restuccia N, Trovato BA. Efficacy of different schedules in the management of chronic hepatitis C with interferon-alpha. Ann Med 1998; 30:213-7. [PMID: 9667801 DOI: 10.3109/07853899808999406] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The best results in terms of clinical remission in chronic hepatitis C are achieved by interferon (IFN)-alpha treatment. We studied 255 patients affected by chronic hepatitis C infection (HCV) and divided into 3 groups. A different IFN-alpha therapeutic schedule was adopted in each group: A) 3 million units (MU) three times per week for 6 months; B) 3 MU three times per week for 12 months; C) 6 MU three times per week for 6 months. A sustained biohumoural and virological remission was observed in only 14.5% of the patients included in group A, in 21.6% of the patients included in group B and in 8% of the patients included in group C. The adoption of more aggressive therapeutic regimens did not offer an improvement in response or patient compliance. At present, the long term efficacy of treatment may be evaluated on the basis of both biochemical and virological data.
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Affiliation(s)
- M Malaguarnera
- Department of Internal Medicine and Geriatrics, University of Catania, Italy.
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Haydon GH, Jarvis LM, Blair CS, Simmonds P, Harrison DJ, Simpson KJ, Hayes PC. Clinical significance of intrahepatic hepatitis C virus levels in patients with chronic HCV infection. Gut 1998; 42:570-5. [PMID: 9616323 PMCID: PMC1727072 DOI: 10.1136/gut.42.4.570] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The clinical significance of a single assessment of circulating hepatitis C virus (HCV) RNA and its relation to the level of intrahepatic HCV RNA remains unclear. AIMS To investigate the relation between intrahepatic HCV levels and clinicopathological characteristics of chronic HCV infection. PATIENTS Ninety eight consecutive patients with chronic HCV infection were studied; none had received alpha interferon therapy. Of these, 12 patients were repeatedly negative for HCV RNA in serum by reverse transcriptase polymerase chain reaction (RT-PCR). METHODS After diagnostic laparoscopy and liver biopsy, semiquantitative analysis of intrahepatic HCV RNA levels was carried out by limiting dilution of HCV cDNA. HCV genotypes were assessed in 96 patients by restriction fragment length polymorphism analysis of HCV cDNA. RESULTS Ten out of 12 patients who were RT-PCR negative for HCV RNA in serum were RT-PCR positive in liver; however, this group had a significantly lower intrahepatic HCV level and serum aminotransferase level than the remaining 86 patients. Histological severity (cirrhosis: n = 10); histological activity index; HCV genotype (genotype 1: n = 41; genotype 2: n = 12; genotype 3: n = 36; genotype 4: n = 7); mode of infection (intravenous drug abuse: n = 58; post-transfusion: n = 10; haemophiliac: n = 4; sporadic: n = 26) and alcohol abuse did not affect the intrahepatic virus level. There was no correlation between patient age, duration of infection, and intrahepatic HCV level. CONCLUSIONS Intrahepatic virus levels were not determined by host factors (age of patient, mode or duration of infection) or by virus factors (HCV genotype). Repeatedly negative RT-PCR for HCV RNA in serum does not indicate absence of HCV from the liver.
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Affiliation(s)
- G H Haydon
- Department of Medicine, University of Edinburgh, UK
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Nordøy I, Krarup HB, Bell H, Christensen PB, Elgjo K, von der Lippe B, De Muckadell OS, Maeland A, Ring-Larsen H, Samdal HH, Simmonds P, Skaug K, Tage-Jensen U, Schrumpf E. Interferon-alpha 2b therapy in low-activity hepatitis C: a pilot study. Scand J Gastroenterol 1997; 32:1256-60. [PMID: 9438325 DOI: 10.3109/00365529709028156] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Many patients with chronic hepatitis C have long periods of normal or near-normal liver enzyme levels, even though histologic alterations have been confirmed. The recommendation today is not to treat this patient group. METHODS In a pilot study 23 hepatitis C virus (HCV) RNA-positive patients with alanine aminotransferase (ALAT) levels less than 1.5 times upper normal limits for at least 6 months on more than three occasions and with histologic liver abnormalities compatible with chronic hepatitis C were treated with 3 MU of interferon-alpha 2b three times a week for 6 months. RESULTS Nine patients (39%) became HCV RNA-negative in serum during treatment, but only two (8.7%) remained so after 6 months' follow-up. Significantly more patients with genotype other than type 1 became HCV RNA-negative than patients with genotype 1 during treatment (P = 0.005). CONCLUSIONS Patients with low-activity chronic hepatitis C have a response to interferon-alpha treatment similar to that of patients with increased ALAT levels. Genotype seems to influence the rate of response.
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Affiliation(s)
- I Nordøy
- Medical Dept. A, Rikshospitalet, Oslo, Norway
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CRAMP MATTHEWE, WILLIAMS ROGER. Hepatitis in alcohol and drug misusers: practical issues. Addict Biol 1997; 2:411-20. [PMID: 26735946 DOI: 10.1080/13556219772462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Viral hepatitis, particularly that due to HBV or HCV, is a significant problem in the UK population of IVDUs and alcohol misusers. Patients attending drug rehabilitation clinics should be screened for HBV and HCV infection. All those found to be HBcAb negative should be vaccinated against HBV. Those found to be HBsAg or HCV antibody positive should have their liver function tests (LFTs) checked and be referred to a specialist liver clinic for further evaluation. Interferon treatment of HBV or HCV infection is effective in a proportion of cases but it is an expensive agent that requires careful monitoring. Current management regimes are centred around the modification of risk behaviour and the identification of those most in need of, and most likely to respond to, anti-viral treatment. Several new anti-viral agents are currently undergoing clinical evaluation and this together with the prospect of vaccines designed to clear an established infection means that the next few years are likely to see some major advances in the treatment of chronic viral hepatitis.
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Abstract
Chronic hepatitis caused by the hepatitis C virus (HCV) is a common condition that leads to cirrhosis and hepatocellular carcinoma. Current treatment with interferon is unsatisfactory, with a low percentage of patients who respond and uncertain high-term significance; in addition, it is associated with sometimes severe side effects. The increasing sophistication of molecular biology has enabled viral characteristics such as viral load, genotypes, and quasi-species to be identified, which may help predict a patient's response to interferon treatment. We suggest that interferon therapy for hepatitis C virus should be restricted to referral centers in the context of controlled trials.
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Malnick SD, Abend Y, Evron E, Sthoeger ZM. HCV hepatitis associated with anticardiolipin antibody and a cerebrovascular accident. Response to interferon therapy. J Clin Gastroenterol 1997; 24:40-2. [PMID: 9013350 DOI: 10.1097/00004836-199701000-00009] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A 54-year-old man with chronic hepatitis C virus (HCV) developed quadrihemianopsia caused by lacunar brain infarction. Extensive evaluation revealed high titers of anticardiolipin antibodies (ACA). Following interferon treatment (6 x 10(6), three times a week for 2 months and 3 x 10(6) for another 7 months), liver transaminase levels decreased to normal, HCV RNA in blood was no longer detectable, concomitantly with the disappearance of the ACA. The patient remained clinically stable without evidence for either HCV activity (RNA) or ACA or further thromboembolic events.
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Affiliation(s)
- S D Malnick
- Department of Internal Medicine C, Kaplan Hospital, Rehovot, Israel
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Affiliation(s)
- P D King
- Division of Gastroenterology, University of Missouri-Columbia School of Medicine 65212, USA
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Allison MC, Mills PR. Screening asymptomatic people at high risk for hepatitis C. The case against. BMJ (CLINICAL RESEARCH ED.) 1996; 312:1349-50. [PMID: 8646053 PMCID: PMC2350998 DOI: 10.1136/bmj.312.7042.1349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Abstract
Hepatitis C virus (HCV) infection is associated with a variable disease course and response to therapy. Some infected patients may develop little or no disease for 30 to 40 years, whereas others will develop cirrhosis within 5 to 10 years. Both host and viral factors influence the rate of disease progression. The management of patients is determined by the severity of their disease assessed by liver biopsy. Those with mild hepatitis without fibrosis do not require treatment but should undergo liver biopsy every 3 years. Patients with mild hepatitis with fibrosis, or with moderate or severe hepatitis with or without fibrosis, should be offered treatment. Interferon-alpha (IFN alpha) is currently the only licensed treatment for HCV infection. Although initial response rates to IFN alpha are high, over half the patients relapse and a sustained response is achieved in only 10 to 35% of patients. Higher doses of IFN alpha and a longer treatment duration are associated with better response rates. Treatment options for those who fail to respond to IFN alpha include a second course of IFN alpha at a higher dose or IFN alpha in combination with ribavirin, phlebotomy or ursodeoxycholic acid. At present, however, there are insufficient data to routinely recommend any of these options.
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Affiliation(s)
- H C Thomas
- Academic Department of Medicine, Imperial College School of Medicine, St Mary's Hospital, London, England
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