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Álvarez-Ossorio MJ, Sarmento E Castro R, Granados R, Macías J, Morano-Amado LE, Ríos MJ, Merino D, Álvarez EN, Collado A, Pérez-Pérez M, Téllez F, Martín JM, Méndez J, Pineda JA, Neukam K. Impact of interferon-free regimens on the glomerular filtration rate during treatment of chronic hepatitis C in a real-life cohort. J Viral Hepat 2018; 25:699-706. [PMID: 29377515 DOI: 10.1111/jvh.12867] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 12/20/2017] [Indexed: 01/09/2023]
Abstract
Little data are available on renal toxicity exerted by direct-acting antivirals (DAAs) in real life. The aim of this study was to assess the impact of direct-acting antivirals against hepatitis C virus infection currently used in Spain and Portugal on the estimated glomerular filtration rate (eGFR) in clinical practise. From an international, prospective multicohort study, patients treated with DAAs for at least 12 weeks and with eGFR ≥30 mL/min per 1.73 m2 at baseline were selected. eGFR was determined using the CKD-EPI formula. A total of 1131 patients were included; 658 (58%) were HIV/HCV-coinfected patients. Among the 901 patients treated for 12 weeks, median (interquartile range) eGFR was 100 (87-107) at baseline vs 97 (85-105) mL/min per 1.73 m2 at week 12 of follow-up (FU12) post-treatment (P < .001). For HIV-coinfected subjects who received tenofovir plus a ritonavir-boosted HIV protease inhibitor (PI/r), baseline vs FU12 eGFR were 104 (86-109) vs 104 (91-110) mL/min per 1.73 m2 (P = .913). Among subjects receiving ombitasvir/paritaprevir with or without dasabuvir, eGFR did not show any significant change. Of 1100 subjects with eGFR >60 mL/min per 1.73 m2 at baseline, 22 (2%) had eGFR <60 mL/min per 1.73 m2 at FU12, but none presented with eGFR <30 mL/min per 1.73 m2 . In conclusion, eGFR slightly declines during therapy with all-oral DAAs and this effect persists up to 12 weeks after stopping treatment in subjects with normal to moderately impaired renal function, regardless of HIV status. Concomitant use of tenofovir plus PI/r does not seem to have an impact on eGFR.
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Affiliation(s)
- M J Álvarez-Ossorio
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | | | - R Granados
- Unit of Infectious Diseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
| | - J Macías
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | - L E Morano-Amado
- Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | - M J Ríos
- Unit of Infectious Diseases, Hospital Universitario Virgen Macarena, Seville, Spain
| | - D Merino
- Unit of Infectious Diseases, Complejo Hospitalario Universitario de Huelva, Huelva, Spain
| | - E N Álvarez
- Infectious Diseases Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - A Collado
- Infectious Diseases Unit, Hospital Universitario Torrecárdenas, Almeria, Spain
| | - M Pérez-Pérez
- Unit of Infectious Diseases, Hospital La Línea, AGS Campo de Gibraltar, Cadiz, Spain
| | - F Téllez
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Puerto Real, Instituto de Investigación e Innovación en Ciencias Biomédicas de la Provincia de Cádiz (INiBICA), Puerto Real, Spain
| | - J M Martín
- Unit of Infectious Diseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
| | - J Méndez
- Unit of Infectious Diseases, Centro Hospitalar do Porto, Porto, Portugal
| | - J A Pineda
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | - K Neukam
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain.,Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
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2
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Renner A, Neukam K, RÖsner T, Elert O, Lange V. Pumpless Extracorporeal Lung Assist as Supportive Therapy in a Patient with Diffuse Alveolar Hemorrhage. Int J Artif Organs 2018; 31:279-81. [DOI: 10.1177/039139880803100313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Our 18-year old female patient suffered from microscopic polyangiitis. After invasive diagnostics, a diffuse alveolar hemorrhage occurred, leading to acute lung failure. In spite of differential ventilation, respiratory insufficiency and lactate-acidosis increased quickly. Due to the massive hemorrhage, a pumpless extracorporeal lung assist was implanted and, after six hours, low-dose heparinization was started. In response to this therapy, hypercapnia and acidosis improved quickly and were completely eliminated within 24 hours. Simultaneously, treatment with prednisolon and cyclophosphamid was started. After 7 days, the patient's conditions allowed weaning from the pumpless extracorporeal lung assist and after 9 days she was extubated. In conclusion, the pumpless lung assist was shown to be a very practical option to treat the most serious forms of hypercapnia, especially for patients disposed to diffuse bleeding.
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Affiliation(s)
- A. Renner
- Clinic and Polyclinic of Cardiothoracic Surgery, University of Wuerzburg, Wuerzburg - Germany
| | - K. Neukam
- Clinic and Polyclinic of Cardiothoracic Surgery, University of Wuerzburg, Wuerzburg - Germany
| | - T. RÖsner
- Clinic and Polyclinic of Cardiothoracic Surgery, University of Wuerzburg, Wuerzburg - Germany
| | - O. Elert
- Clinic and Polyclinic of Cardiothoracic Surgery, University of Wuerzburg, Wuerzburg - Germany
| | - V. Lange
- Clinic and Polyclinic of Cardiothoracic Surgery, University of Wuerzburg, Wuerzburg - Germany
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3
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Neukam K, Ridruejo E, Pérez P, Campos RH, Martínez AP, Di Lello FA. Prevalence of hepatitis C virus infection according to the year of birth: identification of risk groups. Eur J Clin Microbiol Infect Dis 2017; 37:247-254. [PMID: 29076048 DOI: 10.1007/s10096-017-3123-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 10/12/2017] [Indexed: 12/18/2022]
Abstract
Hepatitis C virus (HCV) screening according to the year of birth is recommended is some countries based on epidemiological data. The aim of this study was to analyze anti-HCV prevalence among people born between 1905 and 2015 in Argentina. Patients attending a tertiary care hospital in Buenos Aires, Argentina, from 2001 to 2015, who had a determination of anti-HCV, were included. Of 22,079 patients analyzed, 1,152 (5.2%; 95% confidence interval [CI]: 4.9%-5.5%) patients showed positive anti-HCV and 729 (3.3%; 95% CI: 3.1%-3.5%) patients showed detectable viremia. Three risk groups were identified (HCV prevalence): low-risk group-outpatient clinics/emergencies (2.8%); intermediate-risk group-in-patients (8%); and high-risk group-dialysis/transplants (27.2%). In the low-risk group, being born in 1973 or before was identified as a cut-off value for the risk of anti-HCV acquisition (area under the receiver-operator characteristic curve: 75.1 [95% asymptotic CI: 0.732-0.770; p < 0.001]). Ninety-one patients born after 1973 (0.8%) showed positive anti-HCV versus 457 individuals born in 1973 or before (5.8%), p < 0.001. In this group, positive anti-HCV was observed in 252 females (2.1%) and 296 males (4.1%), p < 0.001. In a multivariate analysis adjusted for gender, alanine-aminotransferase levels and HIV coinfection, being born in 1973 or before was independently identified as a risk for positive anti-HCV (adjusted odds ratio: 14.234 [95% CI: 9.993-20.277]; p < 0.001). People born in 1973 or before without other risk factors should be included in screening programs to link the highest possible number of HCV-infected patients to appropriate care and treatment.
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Affiliation(s)
- K Neukam
- Cátedra de Virología, Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Junín 956, 4° piso, 1113, Ciudad de Buenos Aires, Argentina. .,Unit of Infectious Diseases, Microbiology and Preventive Medicine, Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Avda Manuel Siurot s/n, 41013, Seville, Spain.
| | - E Ridruejo
- Hepatology Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno "CEMIC", Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - P Pérez
- Cátedra de Virología, Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Junín 956, 4° piso, 1113, Ciudad de Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - R H Campos
- Cátedra de Virología, Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Junín 956, 4° piso, 1113, Ciudad de Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - A P Martínez
- Virology Section, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno "CEMIC", Buenos Aires, Argentina
| | - F A Di Lello
- Cátedra de Virología, Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Junín 956, 4° piso, 1113, Ciudad de Buenos Aires, Argentina. .,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.
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4
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Macías J, Real LM, Rivero-Juárez A, Merchante N, Camacho A, Neukam K, Rivero A, Mancebo M, Pineda JA. Changes in liver steatosis evaluated by transient elastography with the controlled attenuation parameter in HIV-infected patients. HIV Med 2017; 17:766-773. [PMID: 27028546 DOI: 10.1111/hiv.12384] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVES There are scant data on the progression of hepatic steatosis (HS) in HIV infection. We therefore evaluated changes in HS over time in HIV-infected patients using the controlled attenuation parameter (CAP). METHODS A prospective cohort of 326 HIV-infected patients was included in this study. All patients underwent a CAP measurement. Changes in steatosis were evaluated by calculating the median (Q1-Q3) difference between baseline and 12-month CAP values. RESULTS The median (Q1-Q3) CAP was 221 (196-252) dB/m at baseline and 224 (198-257) dB/m at the 12-month visit (P = 0.617). Significant steatosis, that is, CAP ≥ 238 dB/m, was observed in 76 individuals (37%) at baseline and in 80 (39%) at the 12-month visit (P = 0.683). The following variables were associated with ΔCAP: plasma HIV RNA [< 50 vs. ≥ 50 HIV-1 RNA copies/mL: median (Q1-Q3) ΔCAP, 4 (-21, 27) vs. -21 (-49, 4) dB/m, respectively; P = 0.024]; body mass index (BMI) [no increase vs. increase: -13 (-40, 4) vs. 14 (-6, 32) dB/m, respectively; P < 0.001]; triglycerides [no increase vs. increase: -1 (-30, 22) vs. 15 (-3, 40) dB/m, respectively; P = 0.001]; fasting plasma glucose [not impaired vs. impaired: -4 (-31, 16) vs. 30 (15, 49) dB/m, respectively; P < 0.001]; and raltegravir [no vs. yes: 5 (-20, 29) vs. -11 (-37.5, 15) dB/m, respectively; P = 0.018]. The only factor independently associated with ΔCAP was BMI [B (standard error): 9.03 (1.9); P < 0.001]. CONCLUSIONS Increases in CAP values over a period of 12 months in HIV-infected patients were strongly associated with elevations in BMI. Other metabolic factors and antiretroviral drugs were not predictors of CAP changes independent of BMI.
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Affiliation(s)
- J Macías
- Infectious Diseases and Microbiology Unit, Valme University Hospital, Seville, Spain. .,Institute of Biomedicine from Seville (IBiS), Seville, Spain.
| | - L M Real
- Infectious Diseases and Microbiology Unit, Valme University Hospital, Seville, Spain.,Institute of Biomedicine from Seville (IBiS), Seville, Spain
| | - A Rivero-Juárez
- Infectious Diseases Unit, Institute Maimónides of Biomedical Research from Cordoba, Cordoba, Spain
| | - N Merchante
- Infectious Diseases and Microbiology Unit, Valme University Hospital, Seville, Spain.,Institute of Biomedicine from Seville (IBiS), Seville, Spain
| | - A Camacho
- Infectious Diseases Unit, Institute Maimónides of Biomedical Research from Cordoba, Cordoba, Spain
| | - K Neukam
- Infectious Diseases and Microbiology Unit, Valme University Hospital, Seville, Spain.,Institute of Biomedicine from Seville (IBiS), Seville, Spain
| | - A Rivero
- Infectious Diseases Unit, Institute Maimónides of Biomedical Research from Cordoba, Cordoba, Spain
| | - M Mancebo
- Infectious Diseases and Microbiology Unit, Valme University Hospital, Seville, Spain.,Institute of Biomedicine from Seville (IBiS), Seville, Spain
| | - J A Pineda
- Infectious Diseases and Microbiology Unit, Valme University Hospital, Seville, Spain
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5
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Pineda JA, Morano-Amado LE, Granados R, Macías J, Téllez F, García-Deltoro M, Ríos MJ, Collado A, Delgado-Fernández M, Suárez-Santamaría M, Serrano M, Miralles-Álvarez C, Neukam K. Week 4 response predicts sustained virological response to all-oral direct-acting antiviral-based therapy in cirrhotic patients with hepatitis C virus genotype 3 infection. Clin Microbiol Infect 2017; 23:409.e5-409.e8. [PMID: 28137633 DOI: 10.1016/j.cmi.2016.12.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/29/2016] [Accepted: 12/31/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to determine the predictive capacity of response at treatment week (TW) 4 for the achievement of sustained virological response 12 weeks after the scheduled end of therapy date (SVR12) to treatment against hepatitis C virus (HCV) genotype 3 (GT3) infection with all-oral direct-acting antiviral (DAA) -based regimens. PATIENTS AND METHODS From a prospective multicohort study, HCV GT3-infected patients who completed a course of currently recommended DAA-based therapy at 33 Spanish hospitals and who had reached the SVR12 evaluation time-point were selected. TW4 HCV-RNA levels were categorized as target-not-detected (TND), below the lower limit of quantification (LLOQTD) and ≥LLOQ. RESULTS A total of 123 patients were included, 86 (70%) received sofosbuvir/ daclatasvir±ribavirin, 27 (22%) received sofosbuvir/ ledipasvir/ ribavirin and 10 (8.1%) received sofosbuvir/ ribavirin, respectively. In all, 114 (92.7%) of the 123 patients presented SVR12 in an on-treatment approach, but nine (7.3%) patients relapsed, all of them had presented cirrhosis at baseline. In those who achieved TND, LLOQTD and ≥LLOQ, SVR12 was observed in 81/83 (98%; 95% CI 91.5%-99.7%), 24/28 (85.7%; 95% CI 67.3%-96%) and 9/12 (75%; 95% CI 42.8%-94.5%), respectively; p(linear association) 0.001. Corresponding numbers for subjects with cirrhosis were: 52/54 (96.3%; 95% CI 87.3%-95.5%), 14/18 (77.8%; 95% CI 52.4%-93.6%) and 7/10 (70%; 95% CI 34.8%-93.3%); p 0.004. CONCLUSIONS TW4-response indicates the probability of achieving SVR12 to currently used DAA-based therapy in HCV genotype 3-infected individuals with cirrhosis. This finding may be useful to tailor treatment strategy in this setting.
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Affiliation(s)
- J A Pineda
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | - L E Morano-Amado
- Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | - R Granados
- Unit of Infectious Diseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
| | - J Macías
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain; Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - F Téllez
- Unit of Infectious Diseases and Microbiology, Hospital La Línea, AGS Campo de Gibraltar, La Linea de la Concepcion, Spain
| | - M García-Deltoro
- Unit of Infectious Diseases, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - M J Ríos
- Unit of Infectious Diseases, Hospital Virgen Macarena, Seville, Spain
| | - A Collado
- Unit of Infectious Diseases, Hospital Universitario Torrecárdenas, Almeria, Spain
| | | | - M Suárez-Santamaría
- Fundación Biomédica del Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | - M Serrano
- Unit of Infectious Diseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
| | - C Miralles-Álvarez
- Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | - K Neukam
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain; Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain.
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6
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Núñez-Torres R, Macías J, Rivero-Juarez A, Neukam K, Merino D, Téllez F, Merchante N, Gómez-Mateos J, Rivero A, Pineda JA, Real LM. Fat mass and obesity-associated gene variations are related to fatty liver disease in HIV-infected patients. HIV Med 2017; 18:546-554. [PMID: 28116842 DOI: 10.1111/hiv.12489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Fatty liver disease (FLD) is frequently observed in HIV-infected patients. Obesity and type 2 diabetes mellitus (T2DM) are strongly associated with FLD. Because genetic variants within the fat mass and obesity-associated (FTO) gene have been associated with both pathologies, our aim was to evaluate the association of single nucleotide polymorphisms (SNPs) within the FTO, previously related to obesity or T2DM, with FLD in HIV-infected patients. METHODS FLD was defined as a value of the controlled attenuation parameter (CAP) ≥ 238 dB/m, obtained by transient elastography. Four SNPs within FTO intron 1 (rs11642841, rs8050136, rs9939609 and rs9940128) were genotyped in 421 individuals using a custom Golden Gate protocol. The results were replicated in a validation sample consisting of a further 206 HIV-infected patients. Multivariate logistic regression analyses were conducted in the entire population. RESULTS Three SNPs (rs8050136, rs9939609 and rs9940128) were associated with FLD, with rs9940128 showing the strongest association. This polymorphism also showed an association with FLD in the validation sample. In total, rs9940128 was genotyped in 627 HIV-infected patients, including 267 (42.6%) FLD-diagnosed individuals. The frequency of FLD among rs9940128 AA carriers was 55.7% (63 of 113 individuals) and that in patients without this genotype was 39.7% (204 of 514 individuals) [P = 0.009; adjusted odds ratio 1.88; 95% confidence interval (CI) 1.17-3.01]. CONCLUSIONS Variations within FTO may be predictors of FLD in HIV-infected patients independently of metabolic factors.
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Affiliation(s)
- R Núñez-Torres
- Unit of Infectious Diseases and Microbiology, Valme University Hospital, Seville, Spain
| | - J Macías
- Unit of Infectious Diseases and Microbiology, Valme University Hospital, Seville, Spain.,Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - A Rivero-Juarez
- Unit of Infectious Diseases, Reina Sofía University Hospital, Córdoba, Spain.,Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBC), University of Córdoba, Córdoba, Spain
| | - K Neukam
- Unit of Infectious Diseases and Microbiology, Valme University Hospital, Seville, Spain.,Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - D Merino
- Unit of Infectious Diseases, Huelva University Hospital, Huelva, Spain
| | - F Téllez
- Unit of Infectious Diseases, La Línea de la Concepción Hospital, Cadiz, Spain
| | - N Merchante
- Unit of Infectious Diseases and Microbiology, Valme University Hospital, Seville, Spain.,Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - J Gómez-Mateos
- Unit of Infectious Diseases and Microbiology, Valme University Hospital, Seville, Spain.,Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - A Rivero
- Unit of Infectious Diseases, Reina Sofía University Hospital, Córdoba, Spain
| | - J A Pineda
- Unit of Infectious Diseases and Microbiology, Valme University Hospital, Seville, Spain
| | - L M Real
- Unit of Infectious Diseases and Microbiology, Valme University Hospital, Seville, Spain.,Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
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7
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Neukam K, Morano-Amado LE, Rivero-Juárez A, Macías J, Granados R, Romero-Palacios A, Márquez M, Merino D, Ortega E, Alados-Arboledas JC, Cucurull J, Omar M, Ryan-Murua P, Pineda JA. Liver stiffness predicts the response to direct-acting antiviral-based therapy against chronic hepatitis C in cirrhotic patients. Eur J Clin Microbiol Infect Dis 2016; 36:853-861. [PMID: 28004322 DOI: 10.1007/s10096-016-2871-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 12/07/2016] [Indexed: 12/21/2022]
Abstract
The purpose of this investigation was to evaluate the impact of liver stiffness (LS) on the response to direct-acting antiviral (DAA)-based therapy against hepatitis C virus (HCV) infection in cirrhotic patients. Those patients included in two Spanish prospective cohorts of patients receiving therapy based on at least one DAA, who showed a baseline LS ≥ 12.5 kPa and who had reached the scheduled time point for sustained virological response evaluation 12 weeks after completing therapy (SVR12) were analysed. Pegylated interferon/ribavirin-based therapy plus an HCV NS3/4A protease inhibitor (PR-PI group) was administered to 198 subjects, while 146 received interferon-free regimens (IFN-free group). The numbers of patients with SVR12 according to an LS < 21 kPa versus ≥21 kPa were 59/99 (59.6%) versus 46/99 (46.5%) in the PR-PI group (p = 0.064) and 41/43 (95.3%) versus 90/103 (87.4%) in the IFN-free group (p = 0.232). Corresponding figures for the relapse rates in those who presented end-of-treatment response (ETR) were 3/62 (4.8%) versus 10/56 (17.9%, p = 0.024) and 1/42 (2.4%) versus 8/98 (8.2%, p = 0.278), respectively. In a multivariate analysis adjusted for age, sex and use of interferon, a baseline LS ≥ 21 kPa was identified as an independent predictor of relapse [adjusted odds ratio, AOR (95% confidence interval, CI): 4.228 (1.344-13.306); p = 0.014] in those patients with ETR. LS above 21 kPa is associated with higher rates of relapse to DAA-based therapy in HCV-infected patients with cirrhosis in clinical practice. LS could help us to tailor the duration and composition of DAA-based combinations in cirrhotic subjects, in order to minimise the likelihood of relapse.
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Affiliation(s)
- K Neukam
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain.
| | - L E Morano-Amado
- Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | - A Rivero-Juárez
- Unit of Infectious Diseases, Hospital Universitario Reina Sofía, Maimónides Institute of Biomedical Investigation of Cordoba (IMIBIC), University of Cordoba, Cordoba, Spain
| | - J Macías
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | - R Granados
- Unit of Infectious Diseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
| | - A Romero-Palacios
- Unit of Infectious Diseases, Hospital Universitario Puerto Real, Puerto Real, Spain
| | - M Márquez
- Unit of Infectious Diseases, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - D Merino
- Unit of Infectious Diseases, Complejo Hospitalario Universitario de Huelva, Huelva, Spain
| | - E Ortega
- Unit of Infectious Diseases, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - J C Alados-Arboledas
- Unit of Infectious Diseases and Microbiology, AGS Norte de Cádiz, Jerez de la Frontera, Spain
| | - J Cucurull
- Service of Internal Medicine, Hospital de Figueres-Fundació Salut Empordà, Figueres, Spain
| | - M Omar
- Unit of Infectious Diseases, Complejo Hospitalario de Jaén, Jaen, Spain
| | - P Ryan-Murua
- Internal Medicine Service, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - J A Pineda
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
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8
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Macías J, Monge P, Mancebo M, Merchante N, Neukam K, Real LM, Pineda JA. High frequency of potential interactions between direct-acting antivirals and concomitant therapy in HIV/hepatitis C virus-coinfected patients in clinical practice. HIV Med 2016; 18:445-451. [PMID: 27882706 DOI: 10.1111/hiv.12471] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The aim of the study was to analyse the frequency and degree of potential drug-drug interactions (DDIs) between direct-acting antivirals (DAAs) and concomitant medication used by HIV/hepatitis C virus (HCV)-coinfected patients, including antiretroviral therapy (ART) and other drugs. METHODS All patients with HIV infection and viraemic HCV genotype 1, 3 or 4 coinfection attending a tertiary care centre in Spain (November 2014 to November 2015) were included in the study. DDIs were classified as major, i.e. drugs should not be co-administered, or minor, i.e. close monitoring, dosage alteration or change in timing may be required if drugs are co-administered, following the http://www.hep-druginteractions.org database recommendations. RESULTS A total of 244 patients were included in the study, of whom 224 (92%) were previous injecting drug users. Major DDIs were found for: paritaprevir-r/ombitasvir plus dasabuvir (3D), in 60 (44%) of 138 individuals with genotype 1; paritaprevir-r/ombitasvir (2D), in 22 (37%) of 60 individuals with genotype 4; sofosbuvir/ledipasvir (SOF/LDV), in four (2%) of 198 patients with genotype 1 or 4; simeprevir (SMV) plus SOF, in 160 (81%) of 198 patients with genotype 1 or 4; daclatasvir (DCV) plus SOF, in seven (3%) of 244 patients with genotype 1, 3 or 4 (P < 0.001). Minor DDIs were found for: 3D, in 123 (89%) individuals with genotype 1; 2D, in 52 (87%) individuals with genotype 4; SOF/LDV, in 154 (78%) patients with genotype 1 or 4; SMV plus SOF, in 129 (65%) patients with genotype 1 or 4; DCV plus SOF, in 149 (61%) patients with genotype 1, 3 or 4 (P < 0.001). CONCLUSIONS Drug-drug interactions between DAAs and ART or other commonly prescribed medications are frequently found among HIV/HCV-coinfected patients. Potential major and minor DDIs are more frequent with 3D, 2D and SMV plus SOF regimens.
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Affiliation(s)
- J Macías
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Seville, Spain.,Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - P Monge
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Seville, Spain
| | - M Mancebo
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Seville, Spain
| | - N Merchante
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Seville, Spain.,Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - K Neukam
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Seville, Spain.,Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - L M Real
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Seville, Spain.,Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - J A Pineda
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Seville, Spain
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9
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Rivero-Juarez A, Gutierrez-Valencia A, Castaño M, Merino D, Neukam K, Ríos-Villegas MJ, Lopez-Ruz MA, Jiménez-Aguilar P, Marquez M, Collado A, Gomez-Vidal A, Hernandez-Quero J, Tellez F, Fernandez-Fuertes E, Rivero A, López-Cortés LF. Dimension of chronic hepatitis C virus in HIV-infected patients in the interferon-free era: an overview from south Spain. Eur J Clin Microbiol Infect Dis 2015; 34:2247-55. [PMID: 26342330 PMCID: PMC4607719 DOI: 10.1007/s10096-015-2476-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 08/20/2015] [Indexed: 02/08/2023]
Abstract
The implementation of hepatitis C (HCV) direct-acting antiviral drugs is prioritized in several populations in which its application provides the most immediate and impactful benefit. In this scenario, a precise knowledge of the situation of human immunodeficiency virus (HIV)/HCV chronic co-infection is required to adequately address this disease. This cross-sectional study was performed in 21 hospitals in Andalusia (Spain). The study population consisted of HIV-infected patients with an active HCV chronic infection who were not receiving HCV treatment at the time of inclusion. A total of 13,506 HIV-infected patients were included in the study. Of them, 2561 (18.9 %) presented chronic HCV infection. The majority of the patients included were on highly active antiretroviral therapy (HAART; 96.2 %), showed plasma levels with an undetectable HIV viral load (92.5 %), and had a good immunological status (median CD4+ cell count of 486 cells/mL). The HCV genotype distribution was as follows: 58.1 % were genotype 1, 1.1 % were genotype 2, 16.1 % were genotype 3, and 22.1 % were genotype 4 (2.6 % were missing data). In total, 24.8 % of the patients showed liver fibrosis stage F0-F1, 27.9 % showed stage F2, 16.7 % showed stage F3, and 21 % showed stage F4 (9.6 % were missing data). With regards to previous HCV treatment experiences, 68.05 % of the patients were naïve and 31.95 % had failed to respond to a previous treatment. The burden of HCV/HIV co-infected patients in our population was reported as one in five HIV-infected patients requiring HCV treatment. The implementation of extra resources to face this important health challenge is mandatory.
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Affiliation(s)
- A Rivero-Juarez
- Unidad Clínica de Enfermedades Infecciosas, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Hospital Universitario Reina Sofía, Avda. Menendez Pidal s/n, 14004, Cordoba, Spain.
| | - A Gutierrez-Valencia
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - M Castaño
- Unidad Clínica de Enfermedades Infecciosas, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - D Merino
- Unidad Clínica de Enfermedades Infecciosas, Complejo Hospitalario Universitario de Huelva, Huelva, Spain
| | - K Neukam
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario de Valme, Seville, Spain
| | - M J Ríos-Villegas
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain
| | - M A Lopez-Ruz
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - P Jiménez-Aguilar
- Unidad Clínica de Enfermedades Infecciosas, Hospital Universitario Puerto Real, Cádiz, Spain
| | - M Marquez
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Regional Universitario Virgen de la Victoria, Málaga, Spain
| | - A Collado
- Unidad Clínica de Enfermedades Infecciosas, Complejo Hospitalario Torrecárdenas, Almería, Spain
| | - A Gomez-Vidal
- Unidad Clínica de Enfermedades Infecciosas, Complejo Hospitalario de Jaén, Jaén, Spain
| | - J Hernandez-Quero
- Unidad Clínica de Enfermedades Infecciosas, Hospital Universitario San Cecilio, Granada, Spain
| | - F Tellez
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital La Línea, AGS Campo de Gibraltad, Cádiz, Spain
| | - E Fernandez-Fuertes
- Unidad Clínica de Enfermedades Infecciosas, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Hospital Universitario Reina Sofía, Avda. Menendez Pidal s/n, 14004, Cordoba, Spain
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
- Unidad Clínica de Enfermedades Infecciosas, Hospital Regional Universitario Carlos Haya, Málaga, Spain
- Unidad Clínica de Enfermedades Infecciosas, Complejo Hospitalario Universitario de Huelva, Huelva, Spain
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario de Valme, Seville, Spain
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Unidad Clínica de Enfermedades Infecciosas, Hospital Universitario Puerto Real, Cádiz, Spain
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Regional Universitario Virgen de la Victoria, Málaga, Spain
- Unidad Clínica de Enfermedades Infecciosas, Complejo Hospitalario Torrecárdenas, Almería, Spain
- Unidad Clínica de Enfermedades Infecciosas, Complejo Hospitalario de Jaén, Jaén, Spain
- Unidad Clínica de Enfermedades Infecciosas, Hospital Universitario San Cecilio, Granada, Spain
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital La Línea, AGS Campo de Gibraltad, Cádiz, Spain
- Unidad de Medicina Tropical, Hospital de Poniente, Almería, Spain
| | - A Rivero
- Unidad Clínica de Enfermedades Infecciosas, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Hospital Universitario Reina Sofía, Avda. Menendez Pidal s/n, 14004, Cordoba, Spain.
| | - L F López-Cortés
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
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10
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Monje-Agudo P, Castro-Iglesias A, Rivero-Juárez A, Martínez-Marcos F, Ortega-González E, Real LM, Pernas B, Merchante N, Cid P, Macías J, Merino MD, Rivero A, Mena A, Neukam K, Pineda JA. Impact of HIV infection on sustained virological response to treatment against hepatitis C virus with pegylated interferon plus ribavirin. Eur J Clin Microbiol Infect Dis 2015; 34:1929-36. [PMID: 26155784 DOI: 10.1007/s10096-015-2434-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 06/22/2015] [Indexed: 12/18/2022]
Abstract
It is commonly accepted that human immunodeficiency (HIV) coinfection negatively impacts on the rates of sustained virological response (SVR) to therapy with pegylated interferon plus ribavirin (PR). However, this hypothesis is derived from comparing different studies. The aim of this study was to determine the impact of HIV coinfection on SVR to PR in one single population. In a multicentric, prospective study conducted between 2000 and 2013, all previously naïve hepatitis C virus (HCV)-infected patients who started PR in five Spanish hospitals were analyzed. SVR was evaluated 24 weeks after the scheduled end of therapy. Of the 1046 patients included in this study, 413 (39%) were coinfected with HIV. Three hundred and forty-one (54%) HCV-monoinfected versus 174 (42%) HIV/HCV-coinfected patients achieved SVR (p < 0.001). The corresponding figures for undetectable HCV RNA at treatment week 4 were 86/181 (47%) versus 59/197 (30%), p < 0.001. SVR was observed in 149 (69%) HCV genotype 2/3-monoinfected subjects versus 91 (68%) HIV/HCV genotype 2/3-coinfected subjects (p = 0.785). In the HCV genotype 1/4-infected population, 188 (46%) monoinfected patients versus 82 (30%) with HIV coinfection (p < 0.001) achieved SVR. In this subgroup, absence of HIV coinfection was independently associated with higher SVR [adjusted odds ratio (95% confidence interval): 2.127 (1.135-3.988); p = 0.019] in a multivariate analysis adjusted for age, sex, baseline HCV RNA load, IL28B genotype, fibrosis stage, and type of pegylated interferon. HIV coinfection impacts on the rates of SVR to PR only in HCV genotype 1/4-infected patients, while it has no effect on SVR in the HCV genotype 2/3-infected subpopulation.
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Affiliation(s)
- P Monje-Agudo
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Avda de Bellavista s/n, 41014, Sevilla, Spain
| | - A Castro-Iglesias
- Clinical Virology Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidad de A Coruña, 15006, A Coruña, Spain
| | - A Rivero-Juárez
- Unit of Infectious Diseases, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - F Martínez-Marcos
- Unit of Infectious Diseases, Complejo Hospitalario de Huelva, Ronda Exterior Norte s/n, 21005, Huelva, Spain
| | - E Ortega-González
- Unit of Infectious Diseases, Consorcio Hospital General Universitario de Valencia, Av. Tres Cruces s/n, 46014, Valencia, Spain
| | - L M Real
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Avda de Bellavista s/n, 41014, Sevilla, Spain
| | - B Pernas
- Clinical Virology Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidad de A Coruña, 15006, A Coruña, Spain
| | - N Merchante
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Avda de Bellavista s/n, 41014, Sevilla, Spain
| | - P Cid
- Clinical Virology Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidad de A Coruña, 15006, A Coruña, Spain
| | - J Macías
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Avda de Bellavista s/n, 41014, Sevilla, Spain
| | - M D Merino
- Unit of Infectious Diseases, Complejo Hospitalario de Huelva, Ronda Exterior Norte s/n, 21005, Huelva, Spain
| | - A Rivero
- Unit of Infectious Diseases, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - A Mena
- Clinical Virology Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidad de A Coruña, 15006, A Coruña, Spain
| | - K Neukam
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Avda de Bellavista s/n, 41014, Sevilla, Spain.
| | - J A Pineda
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Avda de Bellavista s/n, 41014, Sevilla, Spain
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11
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Mira JA, Neukam K, López-Cortés LF, Rivero-Juárez A, Téllez F, Girón-González JA, de los Santos-Gil I, Ojeda-Burgos G, Merino D, Ríos-Villegas MJ, Collado A, Torres-Cornejo A, Macías J, Rivero A, Pérez-Pérez M, Pineda JA. Efficacy of and risk of bleeding during pegylated interferon plus ribavirin treatment in HIV/HCV-coinfected patients with pretreatment thrombocytopenia. Eur J Clin Microbiol Infect Dis 2015; 34:1879-84. [PMID: 26115631 DOI: 10.1007/s10096-015-2426-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 06/05/2015] [Indexed: 01/21/2023]
Abstract
The aim of this study was to assess the efficacy of and the risk of major bleeding during pegylated interferon (peg-IFN)/ribavirin (RBV) treatment among human immunodeficiency virus (HIV)/hepatitis C virus (HCV)-coinfected patients according to the pretreatment platelet count. Two hundred and seventy-four HCV/HIV-coinfected, previously naïve individuals with compensated cirrhosis enrolled in one Spanish prospective cohort who received peg-IFN/RBV were included in this study. The frequency of severe bleeding and sustained virological response (SVR) rate were compared between patients with a pretreatment platelet count ≤70,000/mm(3) and >70,000/mm(3), respectively. Sixty-one (22 %) patients had a baseline platelet count ≤70,000/mm(3). The median (Q1-Q3) pretreatment platelet count was 58,000 (49,000-65,000) cells/mm(3) in the platelet ≤70,000 group and 129,000 (102,500-166,000) cells/mm(3) in the platelet >70,000 group (p < 0.0001). Seventeen (28 %) subjects of the platelet ≤70,000 group and 71 (33 %) patients of the platelet >70,000 group achieved SVR (p = 0.4). Only 2 (3.2 %) patients in the platelet ≤70,000 group developed a severe hemorrhagic event, specifically esophageal variceal bleeding. The efficacy of therapy with peg-IFN/RBV in HIV/HCV-coinfected patients with low pretreatment platelet counts is comparable to that found in the overall subset of subjects with compensated cirrhosis. The frequency of severe hemorrhagic events related with this therapy is low in this population.
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Affiliation(s)
- J A Mira
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Avenida de Bellavista S/N, 41014, Sevilla, Spain
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12
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Schittenhelm C, Langer S, Tscholl D, Neukam K, Scheubel R. Therapie eines chronischen Pleuraempyems bei karnifizierender Aspergillose. Zentralbl Chir 2014. [DOI: 10.1055/s-0034-1389312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Caruz A, Neukam K, Rivero-Juárez A, Herrero R, Real LM, Camacho A, Barreiro P, Labarga P, Rivero A, Pineda JA. Association of low-density lipoprotein receptor genotypes with hepatitis C viral load. Genes Immun 2014; 15:16-24. [PMID: 24173146 DOI: 10.1038/gene.2013.56] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 09/26/2013] [Accepted: 09/27/2013] [Indexed: 01/03/2023]
Abstract
Several data suggest that low-density lipoprotein receptor (LDLR) is a co-receptor for hepatitis C virus (HCV). Soluble LDLR can inhibit HCV infectivity; greater plasma low-density lipoprotein levels are associated with treatment success; LDLR genotypes have a synergistic impact on the likelihood of achieving SVR with Peg-IFN plus RBV, as well as on viral kinetics after starting treatment. The objective of this study was to assess the impact of genetic polymorphisms in genes related to cholesterol synthesis and transport pathways on pre-treatment plasma HCV viral load (VL). A total of 442 patients infected with HCV and treatment naive were prospectively recruited. One hundred forty-four SNPs located in 40 genes from the cholesterol synthesis/transport and IL28B were genotyped and analyzed for genetic association with pre-treatment plasma HCV VL. SNPs rs1433099 and rs2569540 of LDLR showed association with plasma HCV VL (P=4 × 10(-4) and P=2 × 10(-3)) in patients infected with genotypes 1 and 4. A haplotype including the last three exons of LDLR showed association with the cutoff level of 600 000 IU ml(-1) VL for genotypes 1 and 4 (OR=0.27; P=8 × 10(-6)), as well as a quantitative VL (mean±s.d.: 6.19±0.9 vs CC+CG 5.58±1.1 logIU ml(-1), P=8 × 10(-5)). LDLR genotypes are a major genetic factor influencing HCV VL in patients infected with genotypes 1 and 4.
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Affiliation(s)
- A Caruz
- Immunogenetics Unit, Department of Experimental, Biology Faculty of Sciences, Universidad de Jaén, Jaén, Spain
| | - K Neukam
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - A Rivero-Juárez
- Unit of Infectious Diseases, Maimonides Institute for Biomedical Research (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, Spain
| | - R Herrero
- Immunogenetics Unit, Department of Experimental, Biology Faculty of Sciences, Universidad de Jaén, Jaén, Spain
| | - L M Real
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - A Camacho
- Unit of Infectious Diseases, Maimonides Institute for Biomedical Research (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, Spain
| | - P Barreiro
- Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain
| | - P Labarga
- Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain
| | - A Rivero
- Unit of Infectious Diseases, Maimonides Institute for Biomedical Research (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, Spain
| | - J A Pineda
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
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14
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Di Lello FA, Caruz A, Rallon NI, Rivero-Juarez A, Neukam K, Barreiro P, Camacho A, García-Rey S, Rivero A, Soriano V, Cifuentes C, Macias J, Pineda JA. Effects of the genetic pattern defined by low-density lipoprotein receptor and IL28B genotypes on the outcome of hepatitis C virus infection. Eur J Clin Microbiol Infect Dis 2013; 32:1427-35. [PMID: 23715768 DOI: 10.1007/s10096-013-1894-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 05/07/2013] [Indexed: 02/06/2023]
Abstract
The aim of this study was to assess the impact of the genetic pattern (GP) defined by the single nucleotide polymorphisms (SNPs) rs14158 of low-density lipoprotein receptor (LDLR) and rs12979860 of interleukin-28B (IL28B) genes on the outcome and features of hepatitis C virus (HCV) infection in patients with and without human immunodeficiency virus (HIV) coinfection. 314 HIV/HCV-coinfected and 109 HCV-monoinfected patients treated with pegylated interferon (Peg-IFN) plus ribavirin (RBV), as well as 51 patients with HCV spontaneous clearance (SC), were included. Variations in both SNPs were determined by the TaqMan polymerase chain reaction (PCR) assay. In the 286 patients chronically infected by HCV genotypes 1 or 4, both rs14158 CC and rs12979860 CC were associated with a higher rate of sustained virological response (SVR), and these effects were complementary in both HCV-monoinfected and HIV/HCV-coinfected patients. Thus, 24 % of patients with rs14158/rs12979860 TT-TC/TT-TC, 33 % with TT-TC/CC, 44.2 % with CC/TT-TC, and 75.8 % harboring CC/CC attained SVR (p < 0.001). SC was associated with the IL28B genotype (66.7 % CC in SC vs. 42.6 % among those with chronic infection, p < 0.001) but not with the LDLR genotype. There was no association between GP and the plasma level of alanine aminotransferase (ALT) or the presence of advanced fibrosis. There is a complementary effect between the IL28B and LDLR genotypes on the probability of achieving SVR after Peg-IFN/RBV therapy in patients with HCV 1 or 4. Thus, the predictive value of IL28B genotype is modulated by the LDLR genotype in both HCV-monoinfected and HIV/HCV-coinfected patients. This complementary effect of both genotypes is also observed on the plasma levels of low-density lipoprotein cholesterol (LDL-C).
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Affiliation(s)
- F A Di Lello
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Avenida de Bellavista s/n, 41014, Seville, Spain
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Neukam K, Almeida C, Caruz A, Rivero-Juarez A, Rallon NI, Di Lello FA, Herrero R, Camacho A, Benito JM, Macias J, Rivero A, Soriano V, Pineda JA. A model to predict the response to therapy against hepatitis C virus (HCV) including low-density lipoprotein receptor genotype in HIV/HCV-coinfected patients. J Antimicrob Chemother 2012; 68:915-21. [DOI: 10.1093/jac/dks488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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16
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Rivero-Juarez A, Mira JA, Camacho A, Neukam K, Perez-Camacho I, Caruz A, Macias J, Torre-Cisneros J, Pineda JA, Rivero A. Baseline risk factors for relapse in HIV/HCV co-infected patients treated with PEG-IFN/RBV. Infection 2012; 41:21-6. [DOI: 10.1007/s15010-012-0352-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 10/03/2012] [Indexed: 12/25/2022]
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17
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Neukam K, Nattermann J, Rallón N, Rivero A, Caruz A, Macías J, Vogel M, Benito J, Camacho A, Mira J, Schwarze-Zander C, Barreiro P, Martínez A, Rockstroh J, Soriano V, Pineda J. Different distributions of hepatitis C virus genotypes among HIV-infected patients with acute and chronic hepatitis C according to interleukin-28B genotype. HIV Med 2011; 12:487-93. [PMID: 21375685 DOI: 10.1111/j.1468-1293.2011.00912.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The C allele of the single nucleotide polymorphism rs12979860, located near the interleukin-28B (IL-28B) gene, has a strong impact on hepatitis C virus (HCV) treatment response, as well as on spontaneous viral clearance. In patients with chronic hepatitis C (CHC), genotype CC carriers harbour HCV genotype 3 more commonly than those with non-CC genotypes. The aim of this study was to compare the HCV genotype distributions, according to IL-28B genotype, in HIV-infected patients with CHC and those with acute hepatitis C (AHC). METHODS The rs12979860 genotype was determined by polymerase chain reaction (PCR) in two subpopulations of HIV-infected patients. The first consisted of 80 German patients with AHC. The second consisted of 476 patients with CHC, belonging to one German and two Spanish cohorts. RESULTS In the AHC group, 31 (81.6%) rs12979860 CC carriers were infected with HCV genotype 1 or 4 vs. 32 (76.2%) among non-CC carriers (P=0.948). In patients with CHC, among those with the CC genotype, 119 (54.6%) were infected with HCV genotype 1 or 4 and 99 (45.4%) with genotype 2 or 3, whereas in the subset with non-CC genotypes, 200 (77.5%) harboured HCV genotype 1 or 4 and 58 (22.5%) genotype 2 or 3 (P<0.001). CONCLUSIONS Among HIV-infected patients with CHC, those bearing the IL-28B genotype CC were more commonly infected with genotype 3 than subjects with non-CC genotypes, whereas in HIV-infected subjects with AHC this finding was not obtained. These results strongly suggest that the protective effect of the CC genotype against evolution to CHC is mainly exerted in patients infected with HCV genotype 1 or 4.
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Affiliation(s)
- K Neukam
- Unit of Infectious Diseases, Valme University Hospital, Seville, Spain
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Rivero-Juarez A, Mira JA, Perez-Camacho I, Macias J, Camacho A, Neukam K, Torre-Cisneros J, Merchante N, Pineda JA, Rivero A. Twelve week post-treatment follow-up predicts sustained virological response to pegylated interferon and ribavirin therapy in HIV/hepatitis C virus co-infected patients. J Antimicrob Chemother 2011; 66:1351-3. [DOI: 10.1093/jac/dkr091] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Macías J, Mira J, Gilabert I, Neukam K, Roldán C, Viloria M, Moro A, Pineda JA. Combined use of aspartate aminotransferase, platelet count and matrix metalloproteinase 2 measurements to predict liver fibrosis in HIV/hepatitis C virus-coinfected patients. HIV Med 2011; 12:14-21. [PMID: 20497249 DOI: 10.1111/j.1468-1293.2010.00836.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Noninvasive tests that can be used in place of liver biopsy to diagnose fibrosis have major limitations. They either leave a significant proportion of patients without a definitive diagnosis or produce inaccurate results. Moreover, the performance of these tests is lower in HIV/hepatitis C virus (HCV) coinfection. Against this background, we examined the utility of serum matrix metalloproteinase 2 (MMP-2) and tissue inhibitor of metalloproteinase 1 (TIMP-1) measurements in combination with routine clinical data to predict fibrosis in HIV/HCV-coinfected patients. METHODS Patients with a liver biopsy who had not received anti-HCV therapy were included in the study. A model including variables independently associated with fibrosis was constructed. Diagnostic accuracy was determined by measuring the area under the receiver operating characteristic curve (AUROC). Positive (PPV) and negative (NPV) predictive values were calculated. RESULTS Ninety patients were included in the study. Aspartate aminotransferase (AST), platelet count and MMP-2 were predictors of significant fibrosis (F≥2) and cirrhosis (F4). A score constructed using these variables yielded an AUROC of 0.76 for F≥2 and 0.88 for F4. Score cut-offs detected (value ≥3.5) and excluded (value ≤1.5) F≥2 with a PPV of 87% and an NPV of 88%. Thirty-one patients (34%) were correctly diagnosed using these cut-offs, with four (13%) incorrect classifications. Cirrhosis was excluded with a certainty of 98% and diagnosed with a probability of 83%. Two (17%) of 12 patients were misclassified as having cirrhosis. The AST to platelet count index and MMP-2 levels were sequentially applied to detect F≥2. Forty-one patients (46%) were identified with this approach, with six (15%) misclassifications. CONCLUSION MMP-2 levels can be used in combination with AST and platelet count to aid the diagnosis of liver fibrosis in HIV/HCV-coinfected patients.
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Affiliation(s)
- J Macías
- Unidad de Enfermedades Infecciosas, Hospital Universitario de Valme, Seville, Spain
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Neukam K, De Spirt S, Stahl W, Bejot M, Maurette JM, Tronnier H, Heinrich U. Supplementation of flaxseed oil diminishes skin sensitivity and improves skin barrier function and condition. Skin Pharmacol Physiol 2010; 24:67-74. [PMID: 21088453 DOI: 10.1159/000321442] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 09/10/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Skin sensitivity is a common problem in the Western population correlated with changes of skin properties like skin barrier function, hydration and skin physiology. Skin properties can be modulated by dietary fatty acids (FA), especially poly-unsaturated FA. The present study was performed to evaluate the effect of daily supplementation with flaxseed oil and safflowerseed oil on healthy volunteers with sensitive skin. METHODS The study was designed as a randomized, double-blind 12-week intervention with 2 female treatment groups (n = 13). Plasma FA profile, skin sensitivity, skin hydration, transepidermal water loss (TEWL) and skin surface were evaluated on day 0, week 6 and week 12. RESULTS Supplementation with flaxseed oil led to significant decreases in sensitivity (after nicotinate irritation), TEWL, skin roughness and scaling, while smoothness and hydration were increased. Concomitantly, the ratio of n-6/n-3 FA in plasma decreased. Upon supplementation with safflowerseed oil, only a significant improvement in skin roughness and hydration was observed; however, the effects were less pronounced and determined at a later point in time than with flaxseed oil. The plasma n-6/n-3 FA ratio increased. CONCLUSION The data provide evidence that daily intake of flaxseed oil modulates skin condition.
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Affiliation(s)
- K Neukam
- Institute of Biochemistry and Molecular Biology I, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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Labarga P, Vispo ME, Guardiola JM, Miralles C, Martín-Carbonero L, Portu J, Barreiro P, Miralles P, Morello J, Tellez MJ, Bancalero P, Asensi V, Rallón NI, Santos I, Morano L, Aguirrebengoa K, Rios MJ, Rubio R, Neukam K, González-Lahoz J, Soriano V. Sustained virological response in HIV/HCV co-infected patients without rapid virological response (RVR) on peginterferon-ribavirin therapy. J Int AIDS Soc 2010. [PMCID: PMC3112992 DOI: 10.1186/1758-2652-13-s4-p208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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22
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Macías J, Mallolas J, López-Cortés LF, Cartón JA, Domingo P, Moreno S, Iribarren JA, Neukam K, Rodrigo A, Jiménez-Expósito MJ, Pineda JA. Liver safety of two nucleoside analogs plus efavirenz, nevirapine or a ritonavir-boosted protease inhibitor in HIV/HCV-coinfected drug-naïve patients. J Int AIDS Soc 2010. [PMCID: PMC3113099 DOI: 10.1186/1758-2652-13-s4-p91] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Krannich JH, Endler D, Bohrer T, Neukam K, Leyh R, Aleksic I. Inhospital mental strain of patients with lung cancer. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bensch M, van Wijk R, Schimmer C, Krannich JH, Neukam K, Aleksic I, Toyka KV, Leyh R. Surgical and neurological outcome of thymectomy for myasthenia gravis. Thorac Cardiovasc Surg 2008. [DOI: 10.1055/s-2008-1037970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schimmer C, Bohrer T, Neukam K, Elert O, Leyh R. 18-FDG-PET versus mediastinoscopy in the staging of non-small cell lung cancer. Thorac Cardiovasc Surg 2008. [DOI: 10.1055/s-2008-1037765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bensch M, van Wijk R, Schimmer C, Krannich JH, Neukam K, Aleksic I, Toyka KV, Leyh R. Surgical outcome and survival after thymomectomy. Thorac Cardiovasc Surg 2008. [DOI: 10.1055/s-2008-1037766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schimmer C, Keith P, Neukam K, Beissert M, Leyh R. Large thoracic wall hematoma following sternal reconstruction with transversal plate fixation after deep sternal wound infection. Thorac Cardiovasc Surg 2007; 55:402-5. [PMID: 17721856 DOI: 10.1055/s-2007-965402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We present the case of a 53-year-old male patient with a rare complication of a thoracic wall hematoma following thoracic wall reconstruction with transverse plate fixation and pectoralis advancement flaps. The patient could be subsequently discharged after surgical re-placement and an uneventful would healing. This case marks one of two complications occurring in a series of six patients treated for deep sternal wound infection with a combination of vacuum-assisted therapy and plate fixation.
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Affiliation(s)
- C Schimmer
- Department of Heart Surgery, University Würzburg, Würzburg, Germany.
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Affiliation(s)
- H. Pauly
- Universitätslaboratorium, Würzburger
| | - K. Neukam
- Universitätslaboratorium, Würzburger
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Babin-Ebell J, Misoph M, Müllges W, Neukam K, Reese J, Elert O. Intraoperative embolus formation during cardiopulmonary bypass affects the release of S100B. Thorac Cardiovasc Surg 1999; 47:166-9. [PMID: 10443518 DOI: 10.1055/s-2007-1013134] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Intraoperative thromboembolism and the systemic inflammatory reaction are thought to play a role in causing cerebral dysfunction following cardiopulmonary bypass (CPB). Increased levels of S100B, an astroglial protein, have been linked to neuropsychological deficits after CPB. The present study investigated whether S100B release correlates with intraoperative embolus formation, thrombin formation, or the release of inflammatory parameters. METHODS 40 patients undergoing coronary artery bypass grafting were included. Blood samples were taken before, during, and after CPB, and levels of S100B, thrombin-antithrombin complex (TAT), complement C5a, and interleukin 8 were analysed. Embolus formation was assessed by Doppler ultrasound at the arterial line of CPB. RESULTS The release of S100B correlated with embolus count (r = 0.42; p = 0.009) and TAT formation (r = 0.71; p = 0.0001). The correlation of S100B with interleukin 8 (r = 0.58; p = 0.0001) was due to the dependence of both parameters on bypass time (r = 0.29; p = 0.075, partial correlation). A correlation of S100B with C5a formation could not be observed. CONCLUSIONS S100B release is related to embolus and thrombin formation during CPB, indicating that thrombofibrinous embolism is involved in perioperative brain damage. Inflammatory parameters (i.e. interleukin 8 and C5a) seem to have no influence on S100B release.
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Affiliation(s)
- J Babin-Ebell
- Department of Cardiothoracic Surgery, University Hospital, Würzburg, Germany
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Abstract
The application of a centrifugal pump might lead to a reduced release of tissue factor (TF) due to less blood cell damage. This could result in a decrease in activation of the extrinsic pathway of coagulation and embolus formation. In the present study, 60 patients undergoing coronary artery bypass grafting were randomly assigned to a centrifugal or a roller pump. Plasma concentrations of TF, thrombin-antithrombin complex (TAT), and prothrombin fragments F1 + 2 were investigated before, during, and after cardiopulmonary bypass (CPB). Embolus detection was performed at the arterial line of CPB and transcranially by Doppler ultrasound. The centrifugal pump group revealed a lower TF release (area under the curve during CPB) when compared with the roller pump group [5661 (696-10359) vs 12681 (6383-17538) microg x min/l; median (lower - upper quartiles); P = 0.009]. In contrast, TAT and F1 + 2 formation did not differ between the groups, and neither did the total embolus count of both Doppler systems. Embolus counts did not correlate with TAT or F1 + 2 formation. In conclusion, the reduction in TF release by the application of a centrifugal pump seems to have little consequence on total thrombin formation. Since the applied Doppler systems seem to detect mainly microbubbles, conclusions regarding differences between the two pumps in the formation of thrombofibrinous clots cannot be drawn.
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Affiliation(s)
- J Babin-Ebell
- Department of Cardiothoracic Surgery, University Hospital, Würzburg, Germany
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Neukam K, Babin-Ebell J, Hickethier T, Weigl A, Elert O. Microbubble Detektion während der extrakorporalen Zirkulation. Z Herz-, Thorax-, Gefäßchir 1997. [DOI: 10.1007/bf03042140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Grossmann R, Babin-Ebell J, Misoph M, Schwender S, Neukam K, Hickethier T, Elert O, Keller F. Changes in coagulation and fibrinolytic parameters caused by extracorporeal circulation. Heart Vessels 1996; 11:310-7. [PMID: 9248850 DOI: 10.1007/bf01747190] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
During cardiopulmonary bypass (CPB) mechanical stress and the contact of blood with artificial surfaces lead to the activation of pro- and anticoagulant systems and the complement cascade, and to changes in cellular components. This phenomenon causes the "postperfusion-syndrome", with leukocytosis, increased capillary permeability, accumulation of interstitial fluid, and organ dysfunction. In this study, we focused on the influence of the extracorporeal circulation, sternotomy, and heparin administration on the activation of coagulation and fibrinolysis. In 15 patients we investigated coagulation parameters before, during and post CPB, i.e., fibrinogen, antithrombin (AT) III, thrombin-antithrombin complex (TAT), prothrombin fragments F1 + 2 (F1 + 2), factor (F) XIIa, tissue factor (TF), and parameters of the fibrinolytic system, i.e., plasmin-antiplasmin-complex (PAP), D-dimer, tissue-plasminogen-activator (tPA), urokinase-type plasminogen activator (uPA), and plasminogen-activator inhibitor type 1 (PAI 1). The results demonstrate distinct alterations in the above mentioned parameters. Despite administration of a high dose of heparin (activated clotting time [ACT] > 450s) combined with a low dose of aprotinin, activation of the coagulation and fibrinolytic pathways was observed. We found this activation was mainly caused by CPB and not by sternotomy. The activation of coagulation was due to foreign surface contact (F XII => F XIIa) as well as to an effect of tissue factor release in the late phase of CPB. The enhanced fibrinolytic activity during CPB was, at least in part, caused by tPA and was followed by PAI 1 release.
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Affiliation(s)
- R Grossmann
- Central Laboratory, University Medical Centre, Würzburg, Germany
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Steinbrueckner BE, Steigerwald U, Keller F, Neukam K, Elert O, Babin-Ebell J. Centrifugal and roller pumps--are there differences in coagulation and fibrinolysis during and after cardiopulmonary bypass? Heart Vessels 1995; 10:46-53. [PMID: 7730247 DOI: 10.1007/bf01745077] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A number of hemostatic parameters reflecting the activation of coagulation and fibrinolysis were investigated in a prospective study of 24 patients undergoing cardiopulmonary bypass (CPB) during heart surgery. The patients were randomized to a group in which either a roller (group 1) or a centrifugal pump (group 2) was used. Blood samples were taken preoperatively, at the onset of and every 20 min during CPB, after the administration of protamine, and 4, 20, 44, and 68 h postoperatively. The groups did not differ significantly in hematocrit, fibrinogen, factor XIII, and antithrombin III. Significant differences in favor of group 2 during and after CPB were found in prothrombin fragment F1 + 2, plasmin-antiplasmin complex (PAP), thrombin-antithrombin complex (TAT), and D-dimer (F1 + 2 P < 0.01 after 80-min CPB, PAP P < 0.005 after 40-min CPB, TAT and D-dimer P < 0.05 after 100-min CPB, D-dimer and PAP P < 0.05 after protamine administration, TAT and F1 + 2 4 h after CPB). These findings indicate the activation of fibrinolysis preceding thrombin generation during cardiopulmonary bypass. In addition, we conclude that centrifugal blood pumping is beneficial in avoiding excessive activation of both coagulation and fibrinolysis.
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Neukam K. Fortschritte auf dem Gebiet der Galvanotechnik im Jahre 1913. Angew Chem Int Ed Engl 1914. [DOI: 10.1002/ange.191402710001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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