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Serdarova M, Dimova R, Chakarova N, Grozeva G, Todorova A, Tsarkova P, Marinova C, Popov D, Mateva L, Tankova T. Metabolic determinants of NAFLD in adults with type 1 diabetes. Diabetes Res Clin Pract 2022; 186:109819. [PMID: 35248654 DOI: 10.1016/j.diabres.2022.109819] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/05/2022] [Accepted: 02/28/2022] [Indexed: 12/12/2022]
Abstract
AIM To assess the main metabolic determinants of non-alcoholic fatty liver disease (NAFLD) in adult patients with type 1 diabetes (T1D). METHODS 115 patients with T1D were divided into 4 groups according to NAFLD grade. NAFLD was diagnosed via transient elastography when CAP > 233 dB/m. Body composition was evaluated by Inbody720, Biospace. Serum lipids, liver enzymes, uric acid, creatinine, hsCRP and HbA1c were evaluated at fasting. RESULTS The overall prevalence of NAFLD was 47% (n = 54). In the subgroup with BMI > 25 kg/m2 NAFLD prevalence was 66%; and positive family history of type 2 diabetes brought the risk up to 76%. 37% of the lean individuals also had NAFLD. HbA1c > 7% doubled the risk of NAFLD. Waist circumference > 82.5 cm was independently related to NAFLD, accounting for 24% of its variation in females. Accumulation of two and three metabolic syndrome (MetS) components, besides hyperglycemia, increased the risk of NAFLD by 14% (p < 0.0001) and 6% (p = 0.024), respectively. Lean NAFLD correlated with total insulin dose; NAFLD in overweight T1D patients correlated with triglycerides. CONCLUSIONS NAFLD is highly prevalent in adults with T1D and obesity or other metabolic derangements and might be independently related to poor long-term glycemic control and waist circumference in females.
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Affiliation(s)
- M Serdarova
- Department of Endocrinology, Medical University of Sofia, Bulgaria.
| | - R Dimova
- Department of Endocrinology, Medical University of Sofia, Bulgaria
| | - N Chakarova
- Department of Endocrinology, Medical University of Sofia, Bulgaria
| | - G Grozeva
- Department of Endocrinology, Medical University of Sofia, Bulgaria
| | - A Todorova
- Department of Endocrinology, Medical University of Sofia, Bulgaria
| | - P Tsarkova
- Department of Endocrinology, Medical University of Sofia, Bulgaria
| | - C Marinova
- Department of Internal Diseases, Medical University of Sofia, Bulgaria
| | - D Popov
- Department of Internal Diseases, Medical University of Sofia, Bulgaria
| | - L Mateva
- Department of Internal Diseases, Medical University of Sofia, Bulgaria
| | - T Tankova
- Department of Endocrinology, Medical University of Sofia, Bulgaria
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Francque SM, Bedossa P, Ratziu V, Anstee QM, Bugianesi E, Sanyal AJ, Loomba R, Harrison SA, Balabanska R, Mateva L, Lanthier N, Alkhouri N, Moreno C, Schattenberg JM, Stefanova-Petrova D, Vonghia L, Rouzier R, Guillaume M, Hodge A, Romero-Gómez M, Huot-Marchand P, Baudin M, Richard MP, Abitbol JL, Broqua P, Junien JL, Abdelmalek MF. A Randomized, Controlled Trial of the Pan-PPAR Agonist Lanifibranor in NASH. N Engl J Med 2021; 385:1547-1558. [PMID: 34670042 DOI: 10.1056/nejmoa2036205] [Citation(s) in RCA: 250] [Impact Index Per Article: 83.3] [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: 11/19/2022]
Abstract
BACKGROUND Management of nonalcoholic steatohepatitis (NASH) is an unmet clinical need. Lanifibranor is a pan-PPAR (peroxisome proliferator-activated receptor) agonist that modulates key metabolic, inflammatory, and fibrogenic pathways in the pathogenesis of NASH. METHODS In this phase 2b, double-blind, randomized, placebo-controlled trial, patients with noncirrhotic, highly active NASH were randomly assigned in a 1:1:1 ratio to receive 1200 mg or 800 mg of lanifibranor or placebo once daily for 24 weeks. The primary end point was a decrease of at least 2 points in the SAF-A score (the activity part of the Steatosis, Activity, Fibrosis [SAF] scoring system that incorporates scores for ballooning and inflammation) without worsening of fibrosis; SAF-A scores range from 0 to 4, with higher scores indicating more-severe disease activity. Secondary end points included resolution of NASH and regression of fibrosis. RESULTS A total of 247 patients underwent randomization, of whom 103 (42%) had type 2 diabetes mellitus and 188 (76%) had significant (moderate) or advanced fibrosis. The percentage of patients who had a decrease of at least 2 points in the SAF-A score without worsening of fibrosis was significantly higher among those who received the 1200-mg dose, but not among those who received the 800-mg dose, of lanifibranor than among those who received placebo (1200-mg dose vs. placebo, 55% vs. 33%, P = 0.007; 800-mg dose vs. placebo, 48% vs. 33%, P = 0.07). The results favored both the 1200-mg and 800-mg doses of lanifibranor over placebo for resolution of NASH without worsening of fibrosis (49% and 39%, respectively, vs. 22%), improvement in fibrosis stage of at least 1 without worsening of NASH (48% and 34%, respectively, vs. 29%), and resolution of NASH plus improvement in fibrosis stage of at least 1 (35% and 25%, respectively, vs. 9%). Liver enzyme levels decreased and the levels of the majority of lipid, inflammatory, and fibrosis biomarkers improved in the lanifibranor groups. The dropout rate for adverse events was less than 5% and was similar across the trial groups. Diarrhea, nausea, peripheral edema, anemia, and weight gain occurred more frequently with lanifibranor than with placebo. CONCLUSIONS In this phase 2b trial involving patients with active NASH, the percentage of patients who had a decrease of at least 2 points in the SAF-A score without worsening of fibrosis was significantly higher with the 1200-mg dose of lanifibranor than with placebo. These findings support further assessment of lanifibranor in phase 3 trials. (Funded by Inventiva Pharma; NATIVE ClinicalTrials.gov number, NCT03008070.).
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Affiliation(s)
- Sven M Francque
- From Antwerp University Hospital and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (S.M.F., L.V.), and Service d'Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (N.L.) and Cliniques Universitaires de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles (C.M.), Brussels - all in Belgium; the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (P. Bedossa, Q.M.A.); Pitie-Salpétriêre Hospital, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris (V.R.), Centre Hospitalier Universitaire Rangueil, Toulouse (M.G.), and Inventiva Pharma, Daix (P.H.-M., M.B., M.-P.R., J.-L.A., P. Broqua, J.-L.J.) - all in France; the Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy (E.B.); Virginia Commonwealth University, Richmond (A.J.S.); the University of California San Diego, La Jolla (R.L.); Pinnacle Clinical Research, San Antonio, TX (S.A.H.); Acibadem City Clinic Tokuda Hospital (R.B.), University Hospital "St. Ivan Rilski," Medical University-Sofia (L.M.), and Diagnostic Consultation Center Alexandrovska (D.S.-P.) - all in Sofia, Bulgaria; Arizona Liver Health, Phoenix (N.A.); Metabolic Liver Research Program, Department of Medicine, University Medical Center, Mainz, Germany (J.M.S.); Cap Research, Quatre Bornes, Mauritius (R.R.); Monash Medical Centre, Clayton, VIC, Australia (A.H.); Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain (M.R.-G.); and Duke University Medical Center, Durham, NC (M.F.A.)
| | - Pierre Bedossa
- From Antwerp University Hospital and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (S.M.F., L.V.), and Service d'Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (N.L.) and Cliniques Universitaires de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles (C.M.), Brussels - all in Belgium; the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (P. Bedossa, Q.M.A.); Pitie-Salpétriêre Hospital, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris (V.R.), Centre Hospitalier Universitaire Rangueil, Toulouse (M.G.), and Inventiva Pharma, Daix (P.H.-M., M.B., M.-P.R., J.-L.A., P. Broqua, J.-L.J.) - all in France; the Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy (E.B.); Virginia Commonwealth University, Richmond (A.J.S.); the University of California San Diego, La Jolla (R.L.); Pinnacle Clinical Research, San Antonio, TX (S.A.H.); Acibadem City Clinic Tokuda Hospital (R.B.), University Hospital "St. Ivan Rilski," Medical University-Sofia (L.M.), and Diagnostic Consultation Center Alexandrovska (D.S.-P.) - all in Sofia, Bulgaria; Arizona Liver Health, Phoenix (N.A.); Metabolic Liver Research Program, Department of Medicine, University Medical Center, Mainz, Germany (J.M.S.); Cap Research, Quatre Bornes, Mauritius (R.R.); Monash Medical Centre, Clayton, VIC, Australia (A.H.); Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain (M.R.-G.); and Duke University Medical Center, Durham, NC (M.F.A.)
| | - Vlad Ratziu
- From Antwerp University Hospital and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (S.M.F., L.V.), and Service d'Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (N.L.) and Cliniques Universitaires de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles (C.M.), Brussels - all in Belgium; the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (P. Bedossa, Q.M.A.); Pitie-Salpétriêre Hospital, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris (V.R.), Centre Hospitalier Universitaire Rangueil, Toulouse (M.G.), and Inventiva Pharma, Daix (P.H.-M., M.B., M.-P.R., J.-L.A., P. Broqua, J.-L.J.) - all in France; the Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy (E.B.); Virginia Commonwealth University, Richmond (A.J.S.); the University of California San Diego, La Jolla (R.L.); Pinnacle Clinical Research, San Antonio, TX (S.A.H.); Acibadem City Clinic Tokuda Hospital (R.B.), University Hospital "St. Ivan Rilski," Medical University-Sofia (L.M.), and Diagnostic Consultation Center Alexandrovska (D.S.-P.) - all in Sofia, Bulgaria; Arizona Liver Health, Phoenix (N.A.); Metabolic Liver Research Program, Department of Medicine, University Medical Center, Mainz, Germany (J.M.S.); Cap Research, Quatre Bornes, Mauritius (R.R.); Monash Medical Centre, Clayton, VIC, Australia (A.H.); Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain (M.R.-G.); and Duke University Medical Center, Durham, NC (M.F.A.)
| | - Quentin M Anstee
- From Antwerp University Hospital and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (S.M.F., L.V.), and Service d'Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (N.L.) and Cliniques Universitaires de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles (C.M.), Brussels - all in Belgium; the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (P. Bedossa, Q.M.A.); Pitie-Salpétriêre Hospital, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris (V.R.), Centre Hospitalier Universitaire Rangueil, Toulouse (M.G.), and Inventiva Pharma, Daix (P.H.-M., M.B., M.-P.R., J.-L.A., P. Broqua, J.-L.J.) - all in France; the Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy (E.B.); Virginia Commonwealth University, Richmond (A.J.S.); the University of California San Diego, La Jolla (R.L.); Pinnacle Clinical Research, San Antonio, TX (S.A.H.); Acibadem City Clinic Tokuda Hospital (R.B.), University Hospital "St. Ivan Rilski," Medical University-Sofia (L.M.), and Diagnostic Consultation Center Alexandrovska (D.S.-P.) - all in Sofia, Bulgaria; Arizona Liver Health, Phoenix (N.A.); Metabolic Liver Research Program, Department of Medicine, University Medical Center, Mainz, Germany (J.M.S.); Cap Research, Quatre Bornes, Mauritius (R.R.); Monash Medical Centre, Clayton, VIC, Australia (A.H.); Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain (M.R.-G.); and Duke University Medical Center, Durham, NC (M.F.A.)
| | - Elisabetta Bugianesi
- From Antwerp University Hospital and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (S.M.F., L.V.), and Service d'Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (N.L.) and Cliniques Universitaires de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles (C.M.), Brussels - all in Belgium; the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (P. Bedossa, Q.M.A.); Pitie-Salpétriêre Hospital, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris (V.R.), Centre Hospitalier Universitaire Rangueil, Toulouse (M.G.), and Inventiva Pharma, Daix (P.H.-M., M.B., M.-P.R., J.-L.A., P. Broqua, J.-L.J.) - all in France; the Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy (E.B.); Virginia Commonwealth University, Richmond (A.J.S.); the University of California San Diego, La Jolla (R.L.); Pinnacle Clinical Research, San Antonio, TX (S.A.H.); Acibadem City Clinic Tokuda Hospital (R.B.), University Hospital "St. Ivan Rilski," Medical University-Sofia (L.M.), and Diagnostic Consultation Center Alexandrovska (D.S.-P.) - all in Sofia, Bulgaria; Arizona Liver Health, Phoenix (N.A.); Metabolic Liver Research Program, Department of Medicine, University Medical Center, Mainz, Germany (J.M.S.); Cap Research, Quatre Bornes, Mauritius (R.R.); Monash Medical Centre, Clayton, VIC, Australia (A.H.); Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain (M.R.-G.); and Duke University Medical Center, Durham, NC (M.F.A.)
| | - Arun J Sanyal
- From Antwerp University Hospital and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (S.M.F., L.V.), and Service d'Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (N.L.) and Cliniques Universitaires de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles (C.M.), Brussels - all in Belgium; the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (P. Bedossa, Q.M.A.); Pitie-Salpétriêre Hospital, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris (V.R.), Centre Hospitalier Universitaire Rangueil, Toulouse (M.G.), and Inventiva Pharma, Daix (P.H.-M., M.B., M.-P.R., J.-L.A., P. Broqua, J.-L.J.) - all in France; the Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy (E.B.); Virginia Commonwealth University, Richmond (A.J.S.); the University of California San Diego, La Jolla (R.L.); Pinnacle Clinical Research, San Antonio, TX (S.A.H.); Acibadem City Clinic Tokuda Hospital (R.B.), University Hospital "St. Ivan Rilski," Medical University-Sofia (L.M.), and Diagnostic Consultation Center Alexandrovska (D.S.-P.) - all in Sofia, Bulgaria; Arizona Liver Health, Phoenix (N.A.); Metabolic Liver Research Program, Department of Medicine, University Medical Center, Mainz, Germany (J.M.S.); Cap Research, Quatre Bornes, Mauritius (R.R.); Monash Medical Centre, Clayton, VIC, Australia (A.H.); Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain (M.R.-G.); and Duke University Medical Center, Durham, NC (M.F.A.)
| | - Rohit Loomba
- From Antwerp University Hospital and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (S.M.F., L.V.), and Service d'Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (N.L.) and Cliniques Universitaires de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles (C.M.), Brussels - all in Belgium; the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (P. Bedossa, Q.M.A.); Pitie-Salpétriêre Hospital, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris (V.R.), Centre Hospitalier Universitaire Rangueil, Toulouse (M.G.), and Inventiva Pharma, Daix (P.H.-M., M.B., M.-P.R., J.-L.A., P. Broqua, J.-L.J.) - all in France; the Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy (E.B.); Virginia Commonwealth University, Richmond (A.J.S.); the University of California San Diego, La Jolla (R.L.); Pinnacle Clinical Research, San Antonio, TX (S.A.H.); Acibadem City Clinic Tokuda Hospital (R.B.), University Hospital "St. Ivan Rilski," Medical University-Sofia (L.M.), and Diagnostic Consultation Center Alexandrovska (D.S.-P.) - all in Sofia, Bulgaria; Arizona Liver Health, Phoenix (N.A.); Metabolic Liver Research Program, Department of Medicine, University Medical Center, Mainz, Germany (J.M.S.); Cap Research, Quatre Bornes, Mauritius (R.R.); Monash Medical Centre, Clayton, VIC, Australia (A.H.); Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain (M.R.-G.); and Duke University Medical Center, Durham, NC (M.F.A.)
| | - Stephen A Harrison
- From Antwerp University Hospital and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (S.M.F., L.V.), and Service d'Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (N.L.) and Cliniques Universitaires de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles (C.M.), Brussels - all in Belgium; the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (P. Bedossa, Q.M.A.); Pitie-Salpétriêre Hospital, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris (V.R.), Centre Hospitalier Universitaire Rangueil, Toulouse (M.G.), and Inventiva Pharma, Daix (P.H.-M., M.B., M.-P.R., J.-L.A., P. Broqua, J.-L.J.) - all in France; the Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy (E.B.); Virginia Commonwealth University, Richmond (A.J.S.); the University of California San Diego, La Jolla (R.L.); Pinnacle Clinical Research, San Antonio, TX (S.A.H.); Acibadem City Clinic Tokuda Hospital (R.B.), University Hospital "St. Ivan Rilski," Medical University-Sofia (L.M.), and Diagnostic Consultation Center Alexandrovska (D.S.-P.) - all in Sofia, Bulgaria; Arizona Liver Health, Phoenix (N.A.); Metabolic Liver Research Program, Department of Medicine, University Medical Center, Mainz, Germany (J.M.S.); Cap Research, Quatre Bornes, Mauritius (R.R.); Monash Medical Centre, Clayton, VIC, Australia (A.H.); Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain (M.R.-G.); and Duke University Medical Center, Durham, NC (M.F.A.)
| | - Rozalina Balabanska
- From Antwerp University Hospital and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (S.M.F., L.V.), and Service d'Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (N.L.) and Cliniques Universitaires de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles (C.M.), Brussels - all in Belgium; the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (P. Bedossa, Q.M.A.); Pitie-Salpétriêre Hospital, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris (V.R.), Centre Hospitalier Universitaire Rangueil, Toulouse (M.G.), and Inventiva Pharma, Daix (P.H.-M., M.B., M.-P.R., J.-L.A., P. Broqua, J.-L.J.) - all in France; the Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy (E.B.); Virginia Commonwealth University, Richmond (A.J.S.); the University of California San Diego, La Jolla (R.L.); Pinnacle Clinical Research, San Antonio, TX (S.A.H.); Acibadem City Clinic Tokuda Hospital (R.B.), University Hospital "St. Ivan Rilski," Medical University-Sofia (L.M.), and Diagnostic Consultation Center Alexandrovska (D.S.-P.) - all in Sofia, Bulgaria; Arizona Liver Health, Phoenix (N.A.); Metabolic Liver Research Program, Department of Medicine, University Medical Center, Mainz, Germany (J.M.S.); Cap Research, Quatre Bornes, Mauritius (R.R.); Monash Medical Centre, Clayton, VIC, Australia (A.H.); Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain (M.R.-G.); and Duke University Medical Center, Durham, NC (M.F.A.)
| | - Lyudmila Mateva
- From Antwerp University Hospital and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (S.M.F., L.V.), and Service d'Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (N.L.) and Cliniques Universitaires de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles (C.M.), Brussels - all in Belgium; the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (P. Bedossa, Q.M.A.); Pitie-Salpétriêre Hospital, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris (V.R.), Centre Hospitalier Universitaire Rangueil, Toulouse (M.G.), and Inventiva Pharma, Daix (P.H.-M., M.B., M.-P.R., J.-L.A., P. Broqua, J.-L.J.) - all in France; the Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy (E.B.); Virginia Commonwealth University, Richmond (A.J.S.); the University of California San Diego, La Jolla (R.L.); Pinnacle Clinical Research, San Antonio, TX (S.A.H.); Acibadem City Clinic Tokuda Hospital (R.B.), University Hospital "St. Ivan Rilski," Medical University-Sofia (L.M.), and Diagnostic Consultation Center Alexandrovska (D.S.-P.) - all in Sofia, Bulgaria; Arizona Liver Health, Phoenix (N.A.); Metabolic Liver Research Program, Department of Medicine, University Medical Center, Mainz, Germany (J.M.S.); Cap Research, Quatre Bornes, Mauritius (R.R.); Monash Medical Centre, Clayton, VIC, Australia (A.H.); Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain (M.R.-G.); and Duke University Medical Center, Durham, NC (M.F.A.)
| | - Nicolas Lanthier
- From Antwerp University Hospital and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (S.M.F., L.V.), and Service d'Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (N.L.) and Cliniques Universitaires de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles (C.M.), Brussels - all in Belgium; the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (P. Bedossa, Q.M.A.); Pitie-Salpétriêre Hospital, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris (V.R.), Centre Hospitalier Universitaire Rangueil, Toulouse (M.G.), and Inventiva Pharma, Daix (P.H.-M., M.B., M.-P.R., J.-L.A., P. Broqua, J.-L.J.) - all in France; the Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy (E.B.); Virginia Commonwealth University, Richmond (A.J.S.); the University of California San Diego, La Jolla (R.L.); Pinnacle Clinical Research, San Antonio, TX (S.A.H.); Acibadem City Clinic Tokuda Hospital (R.B.), University Hospital "St. Ivan Rilski," Medical University-Sofia (L.M.), and Diagnostic Consultation Center Alexandrovska (D.S.-P.) - all in Sofia, Bulgaria; Arizona Liver Health, Phoenix (N.A.); Metabolic Liver Research Program, Department of Medicine, University Medical Center, Mainz, Germany (J.M.S.); Cap Research, Quatre Bornes, Mauritius (R.R.); Monash Medical Centre, Clayton, VIC, Australia (A.H.); Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain (M.R.-G.); and Duke University Medical Center, Durham, NC (M.F.A.)
| | - Naim Alkhouri
- From Antwerp University Hospital and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (S.M.F., L.V.), and Service d'Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (N.L.) and Cliniques Universitaires de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles (C.M.), Brussels - all in Belgium; the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (P. Bedossa, Q.M.A.); Pitie-Salpétriêre Hospital, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris (V.R.), Centre Hospitalier Universitaire Rangueil, Toulouse (M.G.), and Inventiva Pharma, Daix (P.H.-M., M.B., M.-P.R., J.-L.A., P. Broqua, J.-L.J.) - all in France; the Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy (E.B.); Virginia Commonwealth University, Richmond (A.J.S.); the University of California San Diego, La Jolla (R.L.); Pinnacle Clinical Research, San Antonio, TX (S.A.H.); Acibadem City Clinic Tokuda Hospital (R.B.), University Hospital "St. Ivan Rilski," Medical University-Sofia (L.M.), and Diagnostic Consultation Center Alexandrovska (D.S.-P.) - all in Sofia, Bulgaria; Arizona Liver Health, Phoenix (N.A.); Metabolic Liver Research Program, Department of Medicine, University Medical Center, Mainz, Germany (J.M.S.); Cap Research, Quatre Bornes, Mauritius (R.R.); Monash Medical Centre, Clayton, VIC, Australia (A.H.); Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain (M.R.-G.); and Duke University Medical Center, Durham, NC (M.F.A.)
| | - Christophe Moreno
- From Antwerp University Hospital and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (S.M.F., L.V.), and Service d'Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (N.L.) and Cliniques Universitaires de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles (C.M.), Brussels - all in Belgium; the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (P. Bedossa, Q.M.A.); Pitie-Salpétriêre Hospital, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris (V.R.), Centre Hospitalier Universitaire Rangueil, Toulouse (M.G.), and Inventiva Pharma, Daix (P.H.-M., M.B., M.-P.R., J.-L.A., P. Broqua, J.-L.J.) - all in France; the Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy (E.B.); Virginia Commonwealth University, Richmond (A.J.S.); the University of California San Diego, La Jolla (R.L.); Pinnacle Clinical Research, San Antonio, TX (S.A.H.); Acibadem City Clinic Tokuda Hospital (R.B.), University Hospital "St. Ivan Rilski," Medical University-Sofia (L.M.), and Diagnostic Consultation Center Alexandrovska (D.S.-P.) - all in Sofia, Bulgaria; Arizona Liver Health, Phoenix (N.A.); Metabolic Liver Research Program, Department of Medicine, University Medical Center, Mainz, Germany (J.M.S.); Cap Research, Quatre Bornes, Mauritius (R.R.); Monash Medical Centre, Clayton, VIC, Australia (A.H.); Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain (M.R.-G.); and Duke University Medical Center, Durham, NC (M.F.A.)
| | - Jörn M Schattenberg
- From Antwerp University Hospital and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (S.M.F., L.V.), and Service d'Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (N.L.) and Cliniques Universitaires de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles (C.M.), Brussels - all in Belgium; the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (P. Bedossa, Q.M.A.); Pitie-Salpétriêre Hospital, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris (V.R.), Centre Hospitalier Universitaire Rangueil, Toulouse (M.G.), and Inventiva Pharma, Daix (P.H.-M., M.B., M.-P.R., J.-L.A., P. Broqua, J.-L.J.) - all in France; the Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy (E.B.); Virginia Commonwealth University, Richmond (A.J.S.); the University of California San Diego, La Jolla (R.L.); Pinnacle Clinical Research, San Antonio, TX (S.A.H.); Acibadem City Clinic Tokuda Hospital (R.B.), University Hospital "St. Ivan Rilski," Medical University-Sofia (L.M.), and Diagnostic Consultation Center Alexandrovska (D.S.-P.) - all in Sofia, Bulgaria; Arizona Liver Health, Phoenix (N.A.); Metabolic Liver Research Program, Department of Medicine, University Medical Center, Mainz, Germany (J.M.S.); Cap Research, Quatre Bornes, Mauritius (R.R.); Monash Medical Centre, Clayton, VIC, Australia (A.H.); Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain (M.R.-G.); and Duke University Medical Center, Durham, NC (M.F.A.)
| | - Diana Stefanova-Petrova
- From Antwerp University Hospital and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (S.M.F., L.V.), and Service d'Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (N.L.) and Cliniques Universitaires de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles (C.M.), Brussels - all in Belgium; the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (P. Bedossa, Q.M.A.); Pitie-Salpétriêre Hospital, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris (V.R.), Centre Hospitalier Universitaire Rangueil, Toulouse (M.G.), and Inventiva Pharma, Daix (P.H.-M., M.B., M.-P.R., J.-L.A., P. Broqua, J.-L.J.) - all in France; the Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy (E.B.); Virginia Commonwealth University, Richmond (A.J.S.); the University of California San Diego, La Jolla (R.L.); Pinnacle Clinical Research, San Antonio, TX (S.A.H.); Acibadem City Clinic Tokuda Hospital (R.B.), University Hospital "St. Ivan Rilski," Medical University-Sofia (L.M.), and Diagnostic Consultation Center Alexandrovska (D.S.-P.) - all in Sofia, Bulgaria; Arizona Liver Health, Phoenix (N.A.); Metabolic Liver Research Program, Department of Medicine, University Medical Center, Mainz, Germany (J.M.S.); Cap Research, Quatre Bornes, Mauritius (R.R.); Monash Medical Centre, Clayton, VIC, Australia (A.H.); Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain (M.R.-G.); and Duke University Medical Center, Durham, NC (M.F.A.)
| | - Luisa Vonghia
- From Antwerp University Hospital and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (S.M.F., L.V.), and Service d'Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (N.L.) and Cliniques Universitaires de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles (C.M.), Brussels - all in Belgium; the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (P. Bedossa, Q.M.A.); Pitie-Salpétriêre Hospital, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris (V.R.), Centre Hospitalier Universitaire Rangueil, Toulouse (M.G.), and Inventiva Pharma, Daix (P.H.-M., M.B., M.-P.R., J.-L.A., P. Broqua, J.-L.J.) - all in France; the Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy (E.B.); Virginia Commonwealth University, Richmond (A.J.S.); the University of California San Diego, La Jolla (R.L.); Pinnacle Clinical Research, San Antonio, TX (S.A.H.); Acibadem City Clinic Tokuda Hospital (R.B.), University Hospital "St. Ivan Rilski," Medical University-Sofia (L.M.), and Diagnostic Consultation Center Alexandrovska (D.S.-P.) - all in Sofia, Bulgaria; Arizona Liver Health, Phoenix (N.A.); Metabolic Liver Research Program, Department of Medicine, University Medical Center, Mainz, Germany (J.M.S.); Cap Research, Quatre Bornes, Mauritius (R.R.); Monash Medical Centre, Clayton, VIC, Australia (A.H.); Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain (M.R.-G.); and Duke University Medical Center, Durham, NC (M.F.A.)
| | - Régine Rouzier
- From Antwerp University Hospital and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (S.M.F., L.V.), and Service d'Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (N.L.) and Cliniques Universitaires de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles (C.M.), Brussels - all in Belgium; the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (P. Bedossa, Q.M.A.); Pitie-Salpétriêre Hospital, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris (V.R.), Centre Hospitalier Universitaire Rangueil, Toulouse (M.G.), and Inventiva Pharma, Daix (P.H.-M., M.B., M.-P.R., J.-L.A., P. Broqua, J.-L.J.) - all in France; the Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy (E.B.); Virginia Commonwealth University, Richmond (A.J.S.); the University of California San Diego, La Jolla (R.L.); Pinnacle Clinical Research, San Antonio, TX (S.A.H.); Acibadem City Clinic Tokuda Hospital (R.B.), University Hospital "St. Ivan Rilski," Medical University-Sofia (L.M.), and Diagnostic Consultation Center Alexandrovska (D.S.-P.) - all in Sofia, Bulgaria; Arizona Liver Health, Phoenix (N.A.); Metabolic Liver Research Program, Department of Medicine, University Medical Center, Mainz, Germany (J.M.S.); Cap Research, Quatre Bornes, Mauritius (R.R.); Monash Medical Centre, Clayton, VIC, Australia (A.H.); Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain (M.R.-G.); and Duke University Medical Center, Durham, NC (M.F.A.)
| | - Maeva Guillaume
- From Antwerp University Hospital and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (S.M.F., L.V.), and Service d'Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (N.L.) and Cliniques Universitaires de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles (C.M.), Brussels - all in Belgium; the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (P. Bedossa, Q.M.A.); Pitie-Salpétriêre Hospital, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris (V.R.), Centre Hospitalier Universitaire Rangueil, Toulouse (M.G.), and Inventiva Pharma, Daix (P.H.-M., M.B., M.-P.R., J.-L.A., P. Broqua, J.-L.J.) - all in France; the Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy (E.B.); Virginia Commonwealth University, Richmond (A.J.S.); the University of California San Diego, La Jolla (R.L.); Pinnacle Clinical Research, San Antonio, TX (S.A.H.); Acibadem City Clinic Tokuda Hospital (R.B.), University Hospital "St. Ivan Rilski," Medical University-Sofia (L.M.), and Diagnostic Consultation Center Alexandrovska (D.S.-P.) - all in Sofia, Bulgaria; Arizona Liver Health, Phoenix (N.A.); Metabolic Liver Research Program, Department of Medicine, University Medical Center, Mainz, Germany (J.M.S.); Cap Research, Quatre Bornes, Mauritius (R.R.); Monash Medical Centre, Clayton, VIC, Australia (A.H.); Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain (M.R.-G.); and Duke University Medical Center, Durham, NC (M.F.A.)
| | - Alexander Hodge
- From Antwerp University Hospital and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (S.M.F., L.V.), and Service d'Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (N.L.) and Cliniques Universitaires de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles (C.M.), Brussels - all in Belgium; the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (P. Bedossa, Q.M.A.); Pitie-Salpétriêre Hospital, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris (V.R.), Centre Hospitalier Universitaire Rangueil, Toulouse (M.G.), and Inventiva Pharma, Daix (P.H.-M., M.B., M.-P.R., J.-L.A., P. Broqua, J.-L.J.) - all in France; the Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy (E.B.); Virginia Commonwealth University, Richmond (A.J.S.); the University of California San Diego, La Jolla (R.L.); Pinnacle Clinical Research, San Antonio, TX (S.A.H.); Acibadem City Clinic Tokuda Hospital (R.B.), University Hospital "St. Ivan Rilski," Medical University-Sofia (L.M.), and Diagnostic Consultation Center Alexandrovska (D.S.-P.) - all in Sofia, Bulgaria; Arizona Liver Health, Phoenix (N.A.); Metabolic Liver Research Program, Department of Medicine, University Medical Center, Mainz, Germany (J.M.S.); Cap Research, Quatre Bornes, Mauritius (R.R.); Monash Medical Centre, Clayton, VIC, Australia (A.H.); Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain (M.R.-G.); and Duke University Medical Center, Durham, NC (M.F.A.)
| | - Manuel Romero-Gómez
- From Antwerp University Hospital and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (S.M.F., L.V.), and Service d'Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (N.L.) and Cliniques Universitaires de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles (C.M.), Brussels - all in Belgium; the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (P. Bedossa, Q.M.A.); Pitie-Salpétriêre Hospital, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris (V.R.), Centre Hospitalier Universitaire Rangueil, Toulouse (M.G.), and Inventiva Pharma, Daix (P.H.-M., M.B., M.-P.R., J.-L.A., P. Broqua, J.-L.J.) - all in France; the Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy (E.B.); Virginia Commonwealth University, Richmond (A.J.S.); the University of California San Diego, La Jolla (R.L.); Pinnacle Clinical Research, San Antonio, TX (S.A.H.); Acibadem City Clinic Tokuda Hospital (R.B.), University Hospital "St. Ivan Rilski," Medical University-Sofia (L.M.), and Diagnostic Consultation Center Alexandrovska (D.S.-P.) - all in Sofia, Bulgaria; Arizona Liver Health, Phoenix (N.A.); Metabolic Liver Research Program, Department of Medicine, University Medical Center, Mainz, Germany (J.M.S.); Cap Research, Quatre Bornes, Mauritius (R.R.); Monash Medical Centre, Clayton, VIC, Australia (A.H.); Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain (M.R.-G.); and Duke University Medical Center, Durham, NC (M.F.A.)
| | - Philippe Huot-Marchand
- From Antwerp University Hospital and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (S.M.F., L.V.), and Service d'Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (N.L.) and Cliniques Universitaires de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles (C.M.), Brussels - all in Belgium; the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (P. Bedossa, Q.M.A.); Pitie-Salpétriêre Hospital, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris (V.R.), Centre Hospitalier Universitaire Rangueil, Toulouse (M.G.), and Inventiva Pharma, Daix (P.H.-M., M.B., M.-P.R., J.-L.A., P. Broqua, J.-L.J.) - all in France; the Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy (E.B.); Virginia Commonwealth University, Richmond (A.J.S.); the University of California San Diego, La Jolla (R.L.); Pinnacle Clinical Research, San Antonio, TX (S.A.H.); Acibadem City Clinic Tokuda Hospital (R.B.), University Hospital "St. Ivan Rilski," Medical University-Sofia (L.M.), and Diagnostic Consultation Center Alexandrovska (D.S.-P.) - all in Sofia, Bulgaria; Arizona Liver Health, Phoenix (N.A.); Metabolic Liver Research Program, Department of Medicine, University Medical Center, Mainz, Germany (J.M.S.); Cap Research, Quatre Bornes, Mauritius (R.R.); Monash Medical Centre, Clayton, VIC, Australia (A.H.); Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain (M.R.-G.); and Duke University Medical Center, Durham, NC (M.F.A.)
| | - Martine Baudin
- From Antwerp University Hospital and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (S.M.F., L.V.), and Service d'Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (N.L.) and Cliniques Universitaires de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles (C.M.), Brussels - all in Belgium; the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (P. Bedossa, Q.M.A.); Pitie-Salpétriêre Hospital, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris (V.R.), Centre Hospitalier Universitaire Rangueil, Toulouse (M.G.), and Inventiva Pharma, Daix (P.H.-M., M.B., M.-P.R., J.-L.A., P. Broqua, J.-L.J.) - all in France; the Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy (E.B.); Virginia Commonwealth University, Richmond (A.J.S.); the University of California San Diego, La Jolla (R.L.); Pinnacle Clinical Research, San Antonio, TX (S.A.H.); Acibadem City Clinic Tokuda Hospital (R.B.), University Hospital "St. Ivan Rilski," Medical University-Sofia (L.M.), and Diagnostic Consultation Center Alexandrovska (D.S.-P.) - all in Sofia, Bulgaria; Arizona Liver Health, Phoenix (N.A.); Metabolic Liver Research Program, Department of Medicine, University Medical Center, Mainz, Germany (J.M.S.); Cap Research, Quatre Bornes, Mauritius (R.R.); Monash Medical Centre, Clayton, VIC, Australia (A.H.); Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain (M.R.-G.); and Duke University Medical Center, Durham, NC (M.F.A.)
| | - Marie-Paule Richard
- From Antwerp University Hospital and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (S.M.F., L.V.), and Service d'Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (N.L.) and Cliniques Universitaires de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles (C.M.), Brussels - all in Belgium; the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (P. Bedossa, Q.M.A.); Pitie-Salpétriêre Hospital, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris (V.R.), Centre Hospitalier Universitaire Rangueil, Toulouse (M.G.), and Inventiva Pharma, Daix (P.H.-M., M.B., M.-P.R., J.-L.A., P. Broqua, J.-L.J.) - all in France; the Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy (E.B.); Virginia Commonwealth University, Richmond (A.J.S.); the University of California San Diego, La Jolla (R.L.); Pinnacle Clinical Research, San Antonio, TX (S.A.H.); Acibadem City Clinic Tokuda Hospital (R.B.), University Hospital "St. Ivan Rilski," Medical University-Sofia (L.M.), and Diagnostic Consultation Center Alexandrovska (D.S.-P.) - all in Sofia, Bulgaria; Arizona Liver Health, Phoenix (N.A.); Metabolic Liver Research Program, Department of Medicine, University Medical Center, Mainz, Germany (J.M.S.); Cap Research, Quatre Bornes, Mauritius (R.R.); Monash Medical Centre, Clayton, VIC, Australia (A.H.); Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain (M.R.-G.); and Duke University Medical Center, Durham, NC (M.F.A.)
| | - Jean-Louis Abitbol
- From Antwerp University Hospital and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (S.M.F., L.V.), and Service d'Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (N.L.) and Cliniques Universitaires de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles (C.M.), Brussels - all in Belgium; the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (P. Bedossa, Q.M.A.); Pitie-Salpétriêre Hospital, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris (V.R.), Centre Hospitalier Universitaire Rangueil, Toulouse (M.G.), and Inventiva Pharma, Daix (P.H.-M., M.B., M.-P.R., J.-L.A., P. Broqua, J.-L.J.) - all in France; the Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy (E.B.); Virginia Commonwealth University, Richmond (A.J.S.); the University of California San Diego, La Jolla (R.L.); Pinnacle Clinical Research, San Antonio, TX (S.A.H.); Acibadem City Clinic Tokuda Hospital (R.B.), University Hospital "St. Ivan Rilski," Medical University-Sofia (L.M.), and Diagnostic Consultation Center Alexandrovska (D.S.-P.) - all in Sofia, Bulgaria; Arizona Liver Health, Phoenix (N.A.); Metabolic Liver Research Program, Department of Medicine, University Medical Center, Mainz, Germany (J.M.S.); Cap Research, Quatre Bornes, Mauritius (R.R.); Monash Medical Centre, Clayton, VIC, Australia (A.H.); Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain (M.R.-G.); and Duke University Medical Center, Durham, NC (M.F.A.)
| | - Pierre Broqua
- From Antwerp University Hospital and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (S.M.F., L.V.), and Service d'Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (N.L.) and Cliniques Universitaires de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles (C.M.), Brussels - all in Belgium; the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (P. Bedossa, Q.M.A.); Pitie-Salpétriêre Hospital, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris (V.R.), Centre Hospitalier Universitaire Rangueil, Toulouse (M.G.), and Inventiva Pharma, Daix (P.H.-M., M.B., M.-P.R., J.-L.A., P. Broqua, J.-L.J.) - all in France; the Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy (E.B.); Virginia Commonwealth University, Richmond (A.J.S.); the University of California San Diego, La Jolla (R.L.); Pinnacle Clinical Research, San Antonio, TX (S.A.H.); Acibadem City Clinic Tokuda Hospital (R.B.), University Hospital "St. Ivan Rilski," Medical University-Sofia (L.M.), and Diagnostic Consultation Center Alexandrovska (D.S.-P.) - all in Sofia, Bulgaria; Arizona Liver Health, Phoenix (N.A.); Metabolic Liver Research Program, Department of Medicine, University Medical Center, Mainz, Germany (J.M.S.); Cap Research, Quatre Bornes, Mauritius (R.R.); Monash Medical Centre, Clayton, VIC, Australia (A.H.); Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain (M.R.-G.); and Duke University Medical Center, Durham, NC (M.F.A.)
| | - Jean-Louis Junien
- From Antwerp University Hospital and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (S.M.F., L.V.), and Service d'Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (N.L.) and Cliniques Universitaires de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles (C.M.), Brussels - all in Belgium; the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (P. Bedossa, Q.M.A.); Pitie-Salpétriêre Hospital, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris (V.R.), Centre Hospitalier Universitaire Rangueil, Toulouse (M.G.), and Inventiva Pharma, Daix (P.H.-M., M.B., M.-P.R., J.-L.A., P. Broqua, J.-L.J.) - all in France; the Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy (E.B.); Virginia Commonwealth University, Richmond (A.J.S.); the University of California San Diego, La Jolla (R.L.); Pinnacle Clinical Research, San Antonio, TX (S.A.H.); Acibadem City Clinic Tokuda Hospital (R.B.), University Hospital "St. Ivan Rilski," Medical University-Sofia (L.M.), and Diagnostic Consultation Center Alexandrovska (D.S.-P.) - all in Sofia, Bulgaria; Arizona Liver Health, Phoenix (N.A.); Metabolic Liver Research Program, Department of Medicine, University Medical Center, Mainz, Germany (J.M.S.); Cap Research, Quatre Bornes, Mauritius (R.R.); Monash Medical Centre, Clayton, VIC, Australia (A.H.); Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain (M.R.-G.); and Duke University Medical Center, Durham, NC (M.F.A.)
| | - Manal F Abdelmalek
- From Antwerp University Hospital and the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp (S.M.F., L.V.), and Service d'Hépato-Gastroentérologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (N.L.) and Cliniques Universitaires de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles (C.M.), Brussels - all in Belgium; the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (P. Bedossa, Q.M.A.); Pitie-Salpétriêre Hospital, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris (V.R.), Centre Hospitalier Universitaire Rangueil, Toulouse (M.G.), and Inventiva Pharma, Daix (P.H.-M., M.B., M.-P.R., J.-L.A., P. Broqua, J.-L.J.) - all in France; the Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy (E.B.); Virginia Commonwealth University, Richmond (A.J.S.); the University of California San Diego, La Jolla (R.L.); Pinnacle Clinical Research, San Antonio, TX (S.A.H.); Acibadem City Clinic Tokuda Hospital (R.B.), University Hospital "St. Ivan Rilski," Medical University-Sofia (L.M.), and Diagnostic Consultation Center Alexandrovska (D.S.-P.) - all in Sofia, Bulgaria; Arizona Liver Health, Phoenix (N.A.); Metabolic Liver Research Program, Department of Medicine, University Medical Center, Mainz, Germany (J.M.S.); Cap Research, Quatre Bornes, Mauritius (R.R.); Monash Medical Centre, Clayton, VIC, Australia (A.H.); Virgen del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain (M.R.-G.); and Duke University Medical Center, Durham, NC (M.F.A.)
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Lopes H, Baptista-Leite R, Franco D, Kundurzhiev T, Mateva L, Jelev D, Simonova M. Fighting Hepatitis C in a COVID-19 ecosystem. Public health policies are needed more than ever. J Gastrointestin Liver Dis 2020; 29:692-693. [PMID: 33331350 DOI: 10.15403/jgld-2794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/01/2020] [Indexed: 11/01/2022]
Affiliation(s)
- Henrique Lopes
- Public Health Unit, Institute of Health Sciences, Catholic University of Portugal, Lisbon, Portugal.
| | - Ricardo Baptista-Leite
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Institute of Health Sciences, Catholic University of Portugal, Lisbon, Portugal.
| | - Diogo Franco
- Public Health Unit, Institute of Health Sciences, Catholic University of Portugal, Lisbon, Portugal.
| | - Todor Kundurzhiev
- Biostatistics and Medical Informatics, Department of Occupational Medicine. Faculty of Public Health, Medical University, Sofia. Bulgaria.
| | - Lyudmila Mateva
- Clinic of Gastroenterology, St. Ivan Rilski University Hospital, Chair of Internal Medicine, Faculty of Medicine, Medical University, Sofia. Bulgaria.
| | - Dejan Jelev
- Clinic of Gastroenterology, St. Ivan Rilski University Hospital, Chair of Internal Medicine, Faculty of Medicine, Medical University, Sofia. Bulgaria.
| | - Marieta Simonova
- Clinic of Gastroenterology, Department of Gastroenterology, HPB Surgery and Transplantology, Military Medical Academy, Sofia, Bulgaria.
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4
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Yordanova I, Pavlova Z, Kirov A, Todorov T, Alexiev A, Sarafov S, Mateva L, Chamova T, Gospodinova M, Mitev V, Tournev I, Todorova A. Monoallelic expression of the TTR gene as a contributor to the age at onset and penetrance of TTR-related amyloidosis. Gene 2019; 705:16-21. [PMID: 30981840 DOI: 10.1016/j.gene.2019.04.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 11/18/2022]
Abstract
TTR-related amyloidosis (ATTR) is manifested in two allelic forms: familial amyloid polyneuropathy (TTR-FAP) and cardiomyopathy (TTR-FAC), both caused by mutations in the TTR gene. The most prevalent mutation in Bulgaria is p.Glu89Gln. Markedly different age at onset and disease penetrance is noticed in Bulgarian p.Glu89Gln cases even in a single family or between genetically identical twins. The present study aimed to evaluate the transcription profile of the TTR gene in order to better understand the difference in disease onset and penetrance. Six p.Glu89Gln positive families were selected from our registry, based on intrafamilial differences in disease onset and penetrance. Plasma and urine specimens were collected from 13 patients and subjected to transcription analysis. Both mutant and wild type transcripts were visualized in a mixed transcription profile, which is the traditional model of autosomal gene expression. The results from a relative quantification of the mutant versus wild type transcript showed presence of the mutant transcript between 0.14 and 1.14 times against the wild type. In addition, monoallelic expression signature was also detected. Based on our results we propose a model of natural selection, which includes age-related allele exclusion or suppression: predominant expression of a wild type (at an early age) and mutant (at the process of ageing) alleles. The intrafamilial differences in disease onset and penetrance need to be considered in genetic counselling and in follow-up of mutation carriers.
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Affiliation(s)
- Iglika Yordanova
- Genetic Medico-Diagnostic Laboratory Genica, Sofia, Bulgaria; IMDL Genome Center "Bulgaria", Sofia, Bulgaria
| | - Zornitza Pavlova
- IMDL Genome Center "Bulgaria", Sofia, Bulgaria; Department of Medical Chemistry and Biochemistry, Medical University Sofia, Sofia, Bulgaria
| | | | - Tihomir Todorov
- Genetic Medico-Diagnostic Laboratory Genica, Sofia, Bulgaria; IMDL Genome Center "Bulgaria", Sofia, Bulgaria
| | - Assen Alexiev
- Clinic of Gastroenterology, University Hospital "St. Ivan Rilski", Medical University-Sofia, Bulgaria
| | - Stayko Sarafov
- Clinic of Nervous Diseases, University Hospital "Alexandrovska", Department of Neurology, Medical University Sofia, Sofia, Bulgaria
| | - Lyudmila Mateva
- Clinic of Gastroenterology, University Hospital "St. Ivan Rilski", Medical University-Sofia, Bulgaria
| | - Teodora Chamova
- Clinic of Nervous Diseases, University Hospital "Alexandrovska", Department of Neurology, Medical University Sofia, Sofia, Bulgaria
| | | | - Vanyo Mitev
- Department of Medical Chemistry and Biochemistry, Medical University Sofia, Sofia, Bulgaria
| | - Ivailo Tournev
- Clinic of Nervous Diseases, University Hospital "Alexandrovska", Department of Neurology, Medical University Sofia, Sofia, Bulgaria; Department for Cognitive Science and Psychology, New Bulgarian University, Sofia, Bulgaria
| | - Albena Todorova
- Genetic Medico-Diagnostic Laboratory Genica, Sofia, Bulgaria; IMDL Genome Center "Bulgaria", Sofia, Bulgaria; Department of Medical Chemistry and Biochemistry, Medical University Sofia, Sofia, Bulgaria
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5
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Maaroufi A, Vince A, Himatt SM, Mohamed R, Fung J, Opare-Sem O, Workneh A, Njouom R, Al Ghazzawi I, Abdulla M, Kaliaskarova KS, Owusu-Ofori S, Abdelmageed MK, Adda D, Akin O, Al Baqali A, Al Dweik N, Al Ejji K, Al Kaabi S, Al Naamani K, Al Qamish J, Al Sadadi M, Al Salman J, AlBadri M, Al-Busafi SA, Al-Romaihi HE, Ampofo W, Antonov K, Anyaike C, Arome F, Bane A, Blach S, Borodo MM, Brandon SM, Bright B, Butt MT, Cardenas I, Chan HLY, Chen CJ, Chen DS, Chen PJ, Chien RN, Chuang WL, Cuellar D, Derbala M, Elbardiny AA, Estes C, Farag E, Gamkrelidze I, Garcia V, Genov J, Ghandour Z, Ghuloom M, Gomez B, Gunter J, Habeeb J, Hajelssedig O, Hamoudi W, Hrstic I, Hu CC, Huang CF, Hui YT, Jahis R, Jelev D, John AK, Kamel Y, Kao JH, Khamis J, Khattabi H, Khoudri I, Konysbekova A, Kotzev I, Lai MS, Lao WC, Layden J, Lee MH, Lesi O, Li M, Lo A, Loo CK, Lukšić B, Malu AO, Mateva L, Mitova R, Morović M, Murphy K, Mustapha B, Nde H, Nersesov A, Ngige E, Njoya O, Nonković D, Obekpa S, Oguche S, Okolo EE, Omede O, Omuemu C, Ondoa P, Phillips RO, Prokopenko YN, Razavi H, Razavi-Shearer D, Redae B, Reic T, Rinke de Wit T, Rios C, Robbins S, Roberts LR, Sanad SJ, Schmelzer JD, Sharma M, Simonova M, Su TH, Sultan K, Tan SS, Tchernev K, Tsang OTY, Tsang S, Tzeuton C, Ugoeze S, Uzochukwu B, Vi R, Wani HU, Wong VWS, Yacoub R, Yesmembetov KI, Youbi M, Yuen MF, Razavi-Shearer K. Historical epidemiology of hepatitis C virus in select countries-volume 4. J Viral Hepat 2017; 24 Suppl 2:8-24. [PMID: 29105285 DOI: 10.1111/jvh.12762] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 06/19/2017] [Accepted: 07/03/2017] [Indexed: 12/11/2022]
Abstract
Due to the introduction of newer, more efficacious treatment options, there is a pressing need for policy makers and public health officials to develop or adapt national hepatitis C virus (HCV) control strategies to the changing epidemiological landscape. To do so, detailed, country-specific data are needed to characterize the burden of chronic HCV infection. In this study of 17 countries, a literature review of published and unpublished data on HCV prevalence, viraemia, genotype, age and gender distribution, liver transplants and diagnosis and treatment rates was conducted, and inputs were validated by expert consensus in each country. Viraemic prevalence in this study ranged from 0.2% in Hong Kong to 2.4% in Taiwan, while the largest viraemic populations were in Nigeria (2 597 000 cases) and Taiwan (569 000 cases). Diagnosis, treatment and liver transplant rates varied widely across the countries included in this analysis, as did the availability of reliable data. Addressing data gaps will be critical for the development of future strategies to manage and minimize the disease burden of hepatitis C.
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Affiliation(s)
- A Maaroufi
- National Institute of Health Administration, Rabat, Morocco
| | - A Vince
- Medical School University of Zagreb, University Hospital of Infectious Diseases Zagreb, Zagreb, Croatia
| | - S M Himatt
- Ministry of Public Health Qatar, Doha, Qatar
| | - R Mohamed
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - J Fung
- Department of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - O Opare-Sem
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - A Workneh
- Non-Communicable Diseases Programme, World Health Organization, Addis Ababa, Ethiopia.,Federal Ministry of Health, Addis Ababa, Ethiopia
| | - R Njouom
- Virology Department, Centre Pasteur of Cameroon, Yaounde, Cameroon
| | - I Al Ghazzawi
- GI and Hepatology Department, Jordan Royal Medical Services, Amman, Jordan
| | - M Abdulla
- Salmaniya Medical Complex, Manama, Bahrain
| | - K S Kaliaskarova
- Ministry of Healthcare and Social Development of the Republic of Kazakhstan, Astana, Kazakhstan.,Republican Coordination Center for Hepatology and Gastroenterology, Astana, Kazakhstan
| | | | | | - D Adda
- Civil Society Network on Hepatitis, Abuja, Nigeria.,Chagro-Care Trust (CCT), Jalingo, Nigeria
| | - O Akin
- Federal Ministry of Health, Abuja, Nigeria
| | - A Al Baqali
- Al Kindi Specialised Hospital, Manama, Bahrain
| | - N Al Dweik
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - K Al Ejji
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - S Al Kaabi
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - K Al Naamani
- Division of Gastroenterology and Hepatology, Department of Medicine, Armed Forces Hospital, Muscat, Oman
| | - J Al Qamish
- Gastroenterolgy Clinic, IBN Al-Nafees Hospital, Manama, Bahrain
| | | | | | - M AlBadri
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - S A Al-Busafi
- Division of Gastroenterology, Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - W Ampofo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - K Antonov
- University Hospital "St. Ivan Rilski", Sofia, Bulgaria
| | - C Anyaike
- Federal Ministry of Health, Abuja, Nigeria
| | - F Arome
- Advocacy for the Prevention of Hepatitis in Nigeria, Jos, Nigeria
| | - A Bane
- Gastroenterology and Hepatology, Addis Ababa University Medical School, Addis Ababa, Ethiopia.,Ethiopian Gastroenterological Association, Addis Ababa, Ethiopia
| | - S Blach
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - M M Borodo
- Aminu Kano Teaching Hospital, Kano, Nigeria.,Bayero University, Kano, Nigeria
| | - S M Brandon
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - B Bright
- LiveWell Initiative (LWI), Lagos, Nigeria
| | - M T Butt
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - I Cardenas
- Communicable Diseases Division, Ministry of Health and Social Protection, Bogota, Colombia
| | - H L Y Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China.,Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | | | - D S Chen
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - P J Chen
- National Taiwan University, Taipei, Taiwan
| | - R N Chien
- Liver Research Unit, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - W L Chuang
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - D Cuellar
- Department of Epidemiology and Demography, Ministry of Health and Social Protection, Bogota, Colombia
| | - M Derbala
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - C Estes
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - E Farag
- Ministry of Public Health Qatar, Doha, Qatar
| | - I Gamkrelidze
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - V Garcia
- Ministry of Public Health, Santo Domingo, Dominican Republic
| | - J Genov
- University Hospital "Queen Joanna", Sofia, Bulgaria
| | - Z Ghandour
- BDF Hospital, Royal Medical Services, Riffa, Bahrain
| | - M Ghuloom
- Salmaniya Medical Complex, Manama, Bahrain
| | - B Gomez
- Pan American Health Organization, Washington, DC, USA
| | - J Gunter
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - J Habeeb
- Salmaniya Medical Complex, Manama, Bahrain
| | - O Hajelssedig
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - W Hamoudi
- Department of Gastroenterology & Hepatology, Al Bashir Hospital, Amman, Jordan.,Jordan Ministry of Health, Amman, Jordan
| | - I Hrstic
- General Hospital Pula, Pula, Croatia
| | - C C Hu
- Liver Research Unit, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - C F Huang
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Y T Hui
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, SAR, China
| | - R Jahis
- Disease Control Division, Ministry of Health, Putrajaya, Malaysia
| | - D Jelev
- University Hospital "St. Ivan Rilski", Sofia, Bulgaria
| | - A K John
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Y Kamel
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Department of Medicine, Miniya University, Minya, Egypt
| | - J H Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - J Khamis
- Salmaniya Medical Complex, Manama, Bahrain
| | - H Khattabi
- Eastern Mediterranean Regional Office, World Health Organization, Cairo, Egypt
| | - I Khoudri
- National Institute of Health Administration, Rabat, Morocco
| | - A Konysbekova
- Republican Diagnostic Center, Astana, Kazakhstan.,University Medical Center, Astana, Kazakhstan
| | - I Kotzev
- University Hospital "St. Marina", Varna, Bulgaria
| | - M S Lai
- Department of Medicine, North District Hospital, Hong Kong, SAR, China
| | - W C Lao
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, SAR, China
| | - J Layden
- Department of Public Health Sciences, Loyola University Chicago, Chicago, IL, USA
| | - M H Lee
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - O Lesi
- University of Lagos, Lagos, Nigeria.,Lagos University Teaching Hospital, Lagos, Nigeria
| | - M Li
- Division of Gastroenterology and Hepatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, SAR, China
| | - A Lo
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - C K Loo
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, SAR, China
| | - B Lukšić
- Clinical Department of Infectious Diseases, Split University Hospital and Split University Medical School, Split, Croatia
| | - A O Malu
- Benue State University Teaching Hospital, Makurdi, Nigeria
| | - L Mateva
- University Hospital "St. Ivan Rilski", Sofia, Bulgaria
| | - R Mitova
- University Hospital "Queen Joanna", Sofia, Bulgaria
| | - M Morović
- Department of Infectious Diseases, Zadar General Hospital, Zadar, Croatia
| | - K Murphy
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | | | - H Nde
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - A Nersesov
- National Research Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan
| | - E Ngige
- Federal Ministry of Health, Abuja, Nigeria
| | - O Njoya
- Research Laboratory on Viral Hepatitis & Health Communication, Faculty of Medicine, University of Yaoundé, Yaoundé, Cameroon
| | - D Nonković
- Department of Epidemiology, Institute of Public Health, County of Dalmatia, Split, Croatia
| | - S Obekpa
- Advocacy for the Prevention of Hepatitis in Nigeria, Jos, Nigeria.,Benue State University Teaching Hospital, Makurdi, Nigeria
| | - S Oguche
- Department of Pediatrics, University of Jos, Jos, Nigeria.,Department of Medicine, University of Jos, Jos, Nigeria.,Jos University Teaching Hospital, Jos, Nigeria
| | - E E Okolo
- Beacon Youth Initiative, Lafia, Nigeria
| | - O Omede
- Federal Ministry of Health, Abuja, Nigeria
| | - C Omuemu
- University of Benin, Benin City, Nigeria
| | - P Ondoa
- Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands.,African Society of Laboratory Medicine, Addis Ababa, Ethiopia
| | - R O Phillips
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Y N Prokopenko
- Republican Coordination Center for Hepatology and Gastroenterology, Astana, Kazakhstan
| | - H Razavi
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | | | - B Redae
- Ethiopian Gastroenterological Association, Addis Ababa, Ethiopia.,St. Paul's Hospital Millennium College, Addis Ababa, Ethiopia
| | - T Reic
- European Liver Patients Association, Sint-Truiden, Belgium
| | - T Rinke de Wit
- PharmAccess Foundation, Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - C Rios
- Department of Health Promotion and Disease Prevention, Ministry of Health and Social Protection, Bogota, Colombia
| | - S Robbins
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - L R Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - S J Sanad
- BDF Hospital, Royal Medical Services, Riffa, Bahrain
| | - J D Schmelzer
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - M Sharma
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - M Simonova
- Clinic of Gastroenterology, Military Medical Academy, Sofia, Bulgaria
| | - T H Su
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - K Sultan
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - S S Tan
- Department of Hepatology, Selayang Hospital, Selangor, Malaysia
| | | | - O T Y Tsang
- Department of Medicine and Geriatrics, Princess Margaret Hospital Authority, Hong Kong, SAR, China
| | - S Tsang
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong, SAR, China
| | - C Tzeuton
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - S Ugoeze
- Federal Medical Centre, Jalingo, Nigeria
| | - B Uzochukwu
- Institute of Public Health, University of Nigeria, Nsukka, Nigeria
| | - R Vi
- Republican Coordination Center for Hepatology and Gastroenterology, Astana, Kazakhstan.,International HepatoTransplant Group, Astana, Kazakhstan
| | - H U Wani
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - V W S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - R Yacoub
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - K I Yesmembetov
- National Scientific Center of Oncology and Transplantology, Astana, Kazakhstan
| | - M Youbi
- National Institute of Health Administration, Rabat, Morocco
| | - M F Yuen
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, SAR, China
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6
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Chan HLY, Chen CJ, Omede O, Al Qamish J, Al Naamani K, Bane A, Tan SS, Simonova M, Cardenas I, Derbala M, Akin O, Phillips RO, Abdelmageed MK, Abdulla M, Adda D, Al Baqali A, Al Dweik N, Al Ejji K, Al Ghazzawi I, Al Kaabi S, Al Sadadi M, Al Salman J, AlBadri M, Al-Busafi SA, Al-Romaihi HE, Ampofo W, Antonov K, Anyaike C, Arome F, Blach S, Borodo MM, Brandon SM, Bright B, Butt MT, Chen DS, Chen PJ, Chien RN, Chuang WL, Cuellar D, Elbardiny AA, Estes C, Farag E, Fung J, Gamkrelidze I, Garcia V, Genov J, Ghandour Z, Ghuloom M, Gomez B, Gunter J, Habeeb J, Hajelssedig O, Hamoudi W, Himatt SM, Hrstic I, Hu CC, Huang CF, Hui YT, Jahis R, Jelev D, John AK, Kaliaskarova KS, Kamel Y, Kao JH, Khamis J, Khattabi H, Khoudri I, Konysbekova A, Kotzev I, Lai MS, Lao WC, Layden J, Lee MH, Lesi O, Li M, Lo A, Loo CK, Lukšić B, Maaroufi A, Malu AO, Mateva L, Mitova R, Mohamed R, Morović M, Murphy K, Mustapha B, Nersesov A, Ngige E, Njouom R, Njoya O, Nonković D, Obekpa S, Oguche S, Okolo EE, Omuemu C, Ondoa P, Opare-Sem O, Owusu-Ofori S, Prokopenko YN, Razavi H, Razavi-Shearer D, Razavi-Shearer K, Redae B, Reic T, Rinke de Wit T, Rios C, Robbins S, Roberts LR, Sanad SJ, Schmelzer JD, Sharma M, Su TH, Sultan K, Tchernev K, Tsang OTY, Tsang S, Tzeuton C, Ugoeze S, Uzochukwu B, Vi R, Vince A, Wani HU, Wong VWS, Workneh A, Yacoub R, Yesmembetov KI, Youbi M, Yuen MF, Nde H. The present and future disease burden of hepatitis C virus infections with today's treatment paradigm: Volume 4. J Viral Hepat 2017; 24 Suppl 2:25-43. [PMID: 29105283 DOI: 10.1111/jvh.12760] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 06/19/2017] [Accepted: 07/03/2017] [Indexed: 12/13/2022]
Abstract
Factors influencing the morbidity and mortality associated with viremic hepatitis C virus (HCV) infection change over time and place, making it difficult to compare reported estimates. Models were developed for 17 countries (Bahrain, Bulgaria, Cameroon, Colombia, Croatia, Dominican Republic, Ethiopia, Ghana, Hong Kong, Jordan, Kazakhstan, Malaysia, Morocco, Nigeria, Qatar and Taiwan) to quantify and characterize the viremic population as well as forecast the changes in the infected population and the corresponding disease burden from 2015 to 2030. Model inputs were agreed upon through expert consensus, and a standardized methodology was followed to allow for comparison across countries. The viremic prevalence is expected to remain constant or decline in all but four countries (Ethiopia, Ghana, Jordan and Oman); however, HCV-related morbidity and mortality will increase in all countries except Qatar and Taiwan. In Qatar, the high-treatment rate will contribute to a reduction in total cases and HCV-related morbidity by 2030. In the remaining countries, however, the current treatment paradigm will be insufficient to achieve large reductions in HCV-related morbidity and mortality.
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Affiliation(s)
- H L Y Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China.,Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | | | - O Omede
- Federal Ministry of Health, Abuja, Nigeria
| | - J Al Qamish
- Gastroenterolgy Clinic, IBN Al-Nafees Hospital, Manama, Bahsrain
| | - K Al Naamani
- Division of Gastroenterology and Hepatology, Department of Medicine, Armed Forces Hospital, Muscat, Oman
| | - A Bane
- Gastroenterology and Hepatology, Addis Ababa University Medical School, Addis Ababa, Ethiopia.,Ethiopian Gastroenterological Association, Addis Ababa, Ethiopia
| | - S S Tan
- Department of Hepatology, Selayang Hospital, Selangor, Malaysia
| | - M Simonova
- Clinic of Gastroenterology, Military Medical Academy, Sofia, Bulgaria
| | - I Cardenas
- Communicable Diseases Division, Ministry of Health and Social Protection, Bogota, Colombia
| | - M Derbala
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - O Akin
- Federal Ministry of Health, Abuja, Nigeria
| | - R O Phillips
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - M Abdulla
- Salmaniya Medical Complex, Manama, Bahrain
| | - D Adda
- Civil Society Network on Hepatitis, Abuja, Nigeria.,Chagro-Care Trust (CCT), Jalingo, Nigeria
| | - A Al Baqali
- Al Kindi Specialised Hospital, Manama, Bahrain
| | - N Al Dweik
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - K Al Ejji
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - I Al Ghazzawi
- GI and Hepatology Department, Jordan Royal Medical Services, Amman, Jordan
| | - S Al Kaabi
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | | | - M AlBadri
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - S A Al-Busafi
- Division of Gastroenterology, Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - W Ampofo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - K Antonov
- University Hospital "St. Ivan Rilski", Sofia, Bulgaria
| | - C Anyaike
- Federal Ministry of Health, Abuja, Nigeria
| | - F Arome
- Advocacy for the Prevention of Hepatitis in Nigeria, Jos, Nigeria
| | - S Blach
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - M M Borodo
- Aminu Kano Teaching Hospital, Kano, Nigeria.,Bayero University, Kano, Nigeria
| | - S M Brandon
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - B Bright
- LiveWell Initiative (LWI), Lagos, Nigeria
| | - M T Butt
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - D S Chen
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - P J Chen
- National Taiwan University, Taipei, Taiwan
| | - R N Chien
- Liver Research Unit, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - W L Chuang
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - D Cuellar
- Department of Epidemiology and Demography, Ministry of Health and Social Protection, Bogota, Colombia
| | | | - C Estes
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - E Farag
- Ministry of Public Health Qatar, Doha, Qatar
| | - J Fung
- Department of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - I Gamkrelidze
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - V Garcia
- Ministry of Public Health, Santo Domingo, Dominican Republic
| | - J Genov
- University Hospital "Queen Joanna", Sofia, Bulgaria
| | - Z Ghandour
- BDF Hospital, Royal Medical Services, Riffa, Bahrain
| | - M Ghuloom
- Salmaniya Medical Complex, Manama, Bahrain
| | - B Gomez
- Pan American Health Organization, Washington, DC, USA
| | - J Gunter
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - J Habeeb
- Salmaniya Medical Complex, Manama, Bahrain
| | - O Hajelssedig
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - W Hamoudi
- Department of Gastroenterology & Hepatology, Al Bashir Hospital, Amman, Jordan.,Jordan Ministry of Health, Amman, Jordan
| | - S M Himatt
- Ministry of Public Health Qatar, Doha, Qatar
| | - I Hrstic
- General Hospital Pula, Pula, Croatia
| | - C C Hu
- Liver Research Unit, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - C F Huang
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Y T Hui
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, SAR, China
| | - R Jahis
- Disease Control Division, Ministry of Health, Putrajaya, Malaysia
| | - D Jelev
- University Hospital "St. Ivan Rilski", Sofia, Bulgaria
| | - A K John
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - K S Kaliaskarova
- Ministry of Healthcare and Social Development of the Republic of Kazakhstan, Astana, Kazakhstan.,Republican Coordination Center for Hepatology and Gastroenterology, Astana, Kazakhstan
| | - Y Kamel
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Department of Medicine, Miniya University, Minya, Egypt
| | - J H Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - J Khamis
- Salmaniya Medical Complex, Manama, Bahrain
| | - H Khattabi
- Eastern Mediterranean Regional Office, World Health Organization, Cairo, Egypt
| | - I Khoudri
- Department of Epidemiology and Disease Control, Ministry of Health, Rabat, Morocco
| | - A Konysbekova
- Republican Diagnostic Center, Astana, Kazakhstan.,University Medical Center, Astana, Kazakhstan
| | - I Kotzev
- University Hospital "St. Marina", Varna, Bulgaria
| | - M S Lai
- Department of Medicine, North District Hospital, Hong Kong, SAR, China
| | - W C Lao
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, SAR, China
| | - J Layden
- Department of Public Health Sciences, Loyola University Chicago, Chicago, IL, USA
| | - M H Lee
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - O Lesi
- University of Lagos, Lagos, Nigeria.,Lagos University Teaching Hospital, Lagos, Nigeria
| | - M Li
- Division of Gastroenterology and Hepatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, SAR, China
| | - A Lo
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - C K Loo
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, SAR, China
| | - B Lukšić
- Clinical Department of Infectious Diseases, Split University Hospital and Split University Medical School, Split, Croatia
| | - A Maaroufi
- Department of Epidemiology and Disease Control, Ministry of Health, Rabat, Morocco
| | - A O Malu
- Benue State University Teaching Hospital, Makurdi, Nigeria
| | - L Mateva
- University Hospital "St. Ivan Rilski", Sofia, Bulgaria
| | - R Mitova
- University Hospital "Queen Joanna", Sofia, Bulgaria
| | - R Mohamed
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - M Morović
- Department of Infectious Diseases, Zadar General Hospital, Zadar, Croatia
| | - K Murphy
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | | | - A Nersesov
- National Research Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan
| | - E Ngige
- Federal Ministry of Health, Abuja, Nigeria
| | - R Njouom
- Virology Department, Centre Pasteur of Cameroon, Yaounde, Cameroon
| | - O Njoya
- Research Laboratory on Viral Hepatitis & Health Communication, Faculty of Medicine, University of Yaoundé, Yaoundé, Cameroon
| | - D Nonković
- Department of Epidemiology, Institute of Public Health, County of Dalmatia, Split, Croatia
| | - S Obekpa
- Advocacy for the Prevention of Hepatitis in Nigeria, Jos, Nigeria.,Benue State University Teaching Hospital, Makurdi, Nigeria
| | - S Oguche
- Department of Pediatrics, University of Jos, Jos, Nigeria.,Department of Medicine, University of Jos, Jos, Nigeria.,Jos University Teaching Hospital, Jos, Nigeria
| | - E E Okolo
- Beacon Youth Initiative, Lafia, Nigeria
| | - C Omuemu
- University of Benin, Benin City, Nigeria
| | - P Ondoa
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.,African Society of Laboratory Medicine, Addis Ababa, Ethiopia
| | - O Opare-Sem
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Y N Prokopenko
- Republican Coordination Center for Hepatology and Gastroenterology, Astana, Kazakhstan
| | - H Razavi
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | | | | | - B Redae
- Ethiopian Gastroenterological Association, Addis Ababa, Ethiopia.,St. Paul's Hospital Millennium College, Addis Ababa, Ethiopia
| | - T Reic
- European Liver Patients Association, Sint-Truiden, Belgium
| | - T Rinke de Wit
- PharmAccess Foundation, Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - C Rios
- Department of Health Promotion and Disease Prevention, Ministry of Health and Social Protection, Bogota, Colombia
| | - S Robbins
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - L R Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - S J Sanad
- BDF Hospital, Royal Medical Services, Riffa, Bahrain
| | - J D Schmelzer
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - M Sharma
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - T H Su
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - K Sultan
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - O T Y Tsang
- Department of Medicine and Geriatrics, Princess Margaret Hospital Authority, Hong Kong, SAR, China
| | - S Tsang
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong, SAR, China
| | - C Tzeuton
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - S Ugoeze
- Federal Medical Centre, Jalingo, Nigeria
| | - B Uzochukwu
- Institute of Public Health, University of Nigeria, Nsukka, Nigeria
| | - R Vi
- Republican Coordination Center for Hepatology and Gastroenterology, Astana, Kazakhstan.,International HepatoTransplant Group, Astana, Kazakhstan
| | - A Vince
- Medical School University of Zagreb, University Hospital of Infectious Diseases Zagreb, Zagreb, Croatia
| | - H U Wani
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - V W S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - A Workneh
- Non-Communicable Diseases Programme, World Health Organization, Addis Ababa, Ethiopia.,Federal Ministry of Health, Addis Ababa, Ethiopia
| | - R Yacoub
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - K I Yesmembetov
- National Scientific Center of Oncology and Transplantology, Astana, Kazakhstan
| | - M Youbi
- Department of Epidemiology and Disease Control, Ministry of Health, Rabat, Morocco
| | - M F Yuen
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, SAR, China
| | - H Nde
- Center for Disease Analysis (CDA), Lafayette, CO, USA
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7
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Chen DS, Hamoudi W, Mustapha B, Layden J, Nersesov A, Reic T, Garcia V, Rios C, Mateva L, Njoya O, Al-Busafi SA, Abdelmageed MK, Abdulla M, Adda D, Akin O, Al Baqali A, Al Dweik N, Al Ejji K, Al Ghazzawi I, Al Kaabi S, Al Naamani K, Al Qamish J, Al Sadadi M, Al Salman J, AlBadri M, Al-Romaihi HE, Ampofo W, Antonov K, Anyaike C, Arome F, Bane A, Blach S, Borodo MM, Brandon SM, Bright B, Butt MT, Cardenas I, Chan HLY, Chen CJ, Chen PJ, Chien RN, Chuang WL, Cuellar D, Derbala M, Elbardiny AA, Estes C, Farag E, Fung J, Gamkrelidze I, Genov J, Ghandour Z, Ghuloom M, Gomez B, Gunter J, Habeeb J, Hajelssedig O, Himatt SM, Hrstic I, Hu CC, Huang CF, Hui YT, Jahis R, Jelev D, John AK, Kaliaskarova KS, Kamel Y, Kao JH, Khamis J, Khattabi H, Khoudri I, Konysbekova A, Kotzev I, Lai MS, Lao WC, Lee MH, Lesi O, Li M, Lo A, Loo CK, Lukšić B, Maaroufi A, Malu AO, Mitova R, Mohamed R, Morović M, Murphy K, Nde H, Ngige E, Njouom R, Nonković D, Obekpa S, Oguche S, Okolo EE, Omede O, Omuemu C, Ondoa P, Opare-Sem O, Owusu-Ofori S, Phillips RO, Prokopenko YN, Razavi H, Razavi-Shearer D, Razavi-Shearer K, Redae B, Rinke de Wit T, Robbins S, Roberts LR, Sanad SJ, Sharma M, Simonova M, Su TH, Sultan K, Tan SS, Tchernev K, Tsang OTY, Tsang S, Tzeuton C, Ugoeze S, Uzochukwu B, Vi R, Vince A, Wani HU, Wong VWS, Workneh A, Yacoub R, Yesmembetov KI, Youbi M, Yuen MF, Schmelzer JD. Strategies to manage hepatitis C virus infection disease burden-Volume 4. J Viral Hepat 2017; 24 Suppl 2:44-63. [PMID: 29105286 DOI: 10.1111/jvh.12759] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 06/19/2017] [Accepted: 07/03/2017] [Indexed: 01/03/2023]
Abstract
The hepatitis C virus (HCV) epidemic was forecasted through 2030 for 17 countries in Africa, Asia, Europe, Latin America and the Middle East, and interventions for achieving the Global Health Sector Strategy on viral hepatitis targets-"WHO Targets" (65% reduction in HCV-related deaths, 90% reduction in new infections and 90% of infections diagnosed by 2030) were considered. Scaling up treatment and diagnosis rates over time would be required to achieve these targets in all but one country, even with the introduction of high SVR therapies. The scenarios developed to achieve the WHO Targets in all countries studied assumed the implementation of national policies to prevent new infections and to diagnose current infections through screening.
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Affiliation(s)
- D S Chen
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - W Hamoudi
- Department of Gastroenterology & Hepatology, Al Bashir Hospital, Amman, Jordan.,Jordan Ministry of Health, Amman, Jordan
| | | | - J Layden
- Department of Public Health Sciences, Loyola University Chicago, Chicago, IL, USA
| | - A Nersesov
- National Research Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan
| | - T Reic
- European Liver Patients Association, Sint-Truiden, Belgium
| | - V Garcia
- Ministry of Public Health, Santo Domingo, Dominican Republic
| | - C Rios
- Department of Health Promotion and Disease Prevention, Ministry of Health and Social Protection, Bogota, Colombia
| | - L Mateva
- University Hospital "St. Ivan Rilski", Sofia, Bulgaria
| | - O Njoya
- Research Laboratory on Viral Hepatitis & Health Communication, Faculty of Medicine, University of Yaoundé, Yaoundé, Cameroon
| | - S A Al-Busafi
- Division of Gastroenterology, Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - M Abdulla
- Salmaniya Medical Complex, Manama, Bahrain
| | - D Adda
- Civil Society Network on Hepatitis, Abuja, Nigeria.,Chagro-Care Trust (CCT), Jalingo, Nigeria
| | - O Akin
- Federal Ministry of Health, Abuja, Nigeria
| | - A Al Baqali
- Al Kindi Specialised Hospital, Manama, Bahrain
| | - N Al Dweik
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - K Al Ejji
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - I Al Ghazzawi
- GI and Hepatology Department, Jordan Royal Medical Services, Amman, Jordan
| | - S Al Kaabi
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - K Al Naamani
- Division of Gastroenterology and Hepatology, Department of Medicine, Armed Forces Hospital, Muscat, Oman
| | - J Al Qamish
- Gastroenterolgy Clinic, IBN Al-Nafees Hospital, Manama, Bahrain
| | | | | | - M AlBadri
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - W Ampofo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - K Antonov
- University Hospital "St. Ivan Rilski", Sofia, Bulgaria
| | - C Anyaike
- Federal Ministry of Health, Abuja, Nigeria
| | - F Arome
- Advocacy for the Prevention of Hepatitis in Nigeria, Jos, Nigeria
| | - A Bane
- Gastroenterology and Hepatology, Addis Ababa University Medical School, Addis Ababa, Ethiopia.,Ethiopian Gastroenterological Association, Addis Ababa, Ethiopia
| | - S Blach
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - M M Borodo
- Aminu Kano Teaching Hospital, Kano, Nigeria.,Bayero University, Kano, Nigeria
| | - S M Brandon
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - B Bright
- LiveWell Initiative (LWI), Lagos, Nigeria
| | - M T Butt
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - I Cardenas
- Communicable Diseases Division, Ministry of Health and Social Protection, Bogota, Colombia
| | - H L Y Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.,Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | | | - P J Chen
- National Taiwan University, Taipei, Taiwan
| | - R N Chien
- Liver Research Unit, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - W L Chuang
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - D Cuellar
- Department of Epidemiology and Demography, Ministry of Health and Social Protection, Bogota, Colombia
| | - M Derbala
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - C Estes
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - E Farag
- Ministry of Public Health Qatar, Doha, Qatar
| | - J Fung
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - I Gamkrelidze
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - J Genov
- University Hospital "Queen Joanna", Sofia, Bulgaria
| | - Z Ghandour
- BDF Hospital, Royal Medical Services, Riffa, Bahrain
| | - M Ghuloom
- Salmaniya Medical Complex, Manama, Bahrain
| | - B Gomez
- Pan American Health Organization, Washington, DC, USA
| | - J Gunter
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - J Habeeb
- Salmaniya Medical Complex, Manama, Bahrain
| | - O Hajelssedig
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - S M Himatt
- Ministry of Public Health Qatar, Doha, Qatar
| | - I Hrstic
- General Hospital Pula, Pula, Croatia
| | - C C Hu
- Liver Research Unit, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - C F Huang
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Y T Hui
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
| | - R Jahis
- Disease Control Division, Ministry of Health, Putrajaya, Malaysia
| | - D Jelev
- University Hospital "St. Ivan Rilski", Sofia, Bulgaria
| | - A K John
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - K S Kaliaskarova
- Ministry of Healthcare and Social Development of the Republic of Kazakhstan, Astana, Kazakhstan.,Republican Coordination Center for Hepatology and Gastroenterology, Astana, Kazakhstan
| | - Y Kamel
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Department of Medicine, Miniya University, Minya, Egypt
| | - J H Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - J Khamis
- Salmaniya Medical Complex, Manama, Bahrain
| | - H Khattabi
- Eastern Mediterranean Regional Office, World Health Organization, Cairo, Egypt
| | - I Khoudri
- Department of Epidemiology and Disease Control, Ministry of Health, Rabat, Morocco
| | - A Konysbekova
- Republican Diagnostic Center, Astana, Kazakhstan.,University Medical Center, Astana, Kazakhstan
| | - I Kotzev
- University Hospital "St. Marina", Varna, Bulgaria
| | - M S Lai
- Department of Medicine, North District Hospital, Hong Kong, China
| | - W C Lao
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - M H Lee
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - O Lesi
- University of Lagos, Lagos, Nigeria.,Lagos University Teaching Hospital, Lagos, Nigeria
| | - M Li
- Division of Gastroenterology and Hepatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, China
| | - A Lo
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - C K Loo
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, China
| | - B Lukšić
- Clinical Department of Infectious Diseases, Split University Hospital and Split University Medical School, Split, Croatia
| | - A Maaroufi
- Department of Epidemiology and Disease Control, Ministry of Health, Rabat, Morocco
| | - A O Malu
- Benue State University Teaching Hospital, Makurdi, Nigeria
| | - R Mitova
- University Hospital "Queen Joanna", Sofia, Bulgaria
| | - R Mohamed
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - M Morović
- Department of Infectious Diseases, Zadar General Hospital, Zadar, Croatia
| | - K Murphy
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - H Nde
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - E Ngige
- Federal Ministry of Health, Abuja, Nigeria
| | - R Njouom
- Virology Department, Centre Pasteur of Cameroon, Yaounde, Cameroon
| | - D Nonković
- Department of Epidemiology, Institute of Public Health, Split, Croatia
| | - S Obekpa
- Advocacy for the Prevention of Hepatitis in Nigeria, Jos, Nigeria.,Benue State University Teaching Hospital, Makurdi, Nigeria
| | - S Oguche
- Department of Pediatrics, University of Jos, Jos, Nigeria.,Department of Medicine, University of Jos, Jos, Nigeria.,Jos University Teaching Hospital, Jos, Nigeria
| | - E E Okolo
- Beacon Youth Initiative, Lafia, Nigeria
| | - O Omede
- Federal Ministry of Health, Abuja, Nigeria
| | - C Omuemu
- University of Benin, Benin City, Nigeria
| | - P Ondoa
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.,African Society of Laboratory Medicine, Addis Ababa, Ethiopia
| | - O Opare-Sem
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - R O Phillips
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Y N Prokopenko
- Republican Coordination Center for Hepatology and Gastroenterology, Astana, Kazakhstan
| | - H Razavi
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | | | | | - B Redae
- Ethiopian Gastroenterological Association, Addis Ababa, Ethiopia.,St. Paul's Hospital Millennium College, Addis Ababa, Ethiopia
| | - T Rinke de Wit
- PharmAccess Foundation, Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
| | - S Robbins
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - L R Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - S J Sanad
- BDF Hospital, Royal Medical Services, Riffa, Bahrain
| | - M Sharma
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - M Simonova
- Clinic of Gastroenterology, Military Medical Academy, Sofia, Bulgaria
| | - T H Su
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - K Sultan
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - S S Tan
- Department of Hepatology, Selayang Hospital, Selangor, Malaysia
| | | | - O T Y Tsang
- Department of Medicine and Geriatrics, Princess Margaret Hospital Authority, Hong Kong, SAR China
| | - S Tsang
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong, China
| | - C Tzeuton
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - S Ugoeze
- Federal Medical Centre, Jalingo, Nigeria
| | - B Uzochukwu
- Institute of Public Health, University of Nigeria, Nsukka, Nigeria
| | - R Vi
- Republican Coordination Center for Hepatology and Gastroenterology, Astana, Kazakhstan.,International HepatoTransplant Group, Astana, Kazakhstan
| | - A Vince
- Medical School University of Zagreb, University Hospital of Infectious Diseases Zagreb, Zagreb, Croatia
| | - H U Wani
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - V W S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - A Workneh
- Non-Communicable Diseases Programme, World Health Organization, Addis Ababa, Ethiopia.,Federal Ministry of Health, Addis Ababa, Ethiopia
| | - R Yacoub
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - K I Yesmembetov
- National Scientific Center of Oncology and Transplantation, Astana, Kazakhstan
| | - M Youbi
- Department of Epidemiology and Disease Control, Ministry of Health, Rabat, Morocco
| | - M F Yuen
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - J D Schmelzer
- Center for Disease Analysis (CDA), Lafayette, CO, USA
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8
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Ivanova R, Valkov I, Marinova T, Alexiev A, Antonov K, Mateva L. Cardiometabolic risk factors and carotid intima media thickness in patients with chronic hepatitis C. Atherosclerosis 2017. [DOI: 10.1016/j.atherosclerosis.2017.06.863] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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9
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Valkov I, Ivanova R, Alexiev A, Antonov K, Mateva L. Association of Serum Lipids with Hepatic Steatosis, Stage of Liver Fibrosis and Viral Load in Chronic Hepatitis C. J Clin Diagn Res 2017; 11:OC15-OC20. [PMID: 28969178 DOI: 10.7860/jcdr/2017/28609.10459] [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] [Received: 03/23/2017] [Accepted: 06/19/2017] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Hepatitis C Virus (HCV) relies on host lipids for its life cycle contributing to lipid abnormalities and hepatic steatosis. Disease progression is influenced by viral factors interacting with host immune and metabolic pathways. The significance of serum lipids for Chronic Hepatitis C (CHC) assessment is not clearly established yet. AIM Our aim was to investigate serum lipids' association with stage of liver fibrosis, steatosis and genotypes in patients with CHC. MATERIALS AND METHODS A total of 112 CHC patients (54 male, 58 female, aged 48.6±13.7 years) were studied - 98 genotype 1 (G1) and 14 genotype 3 (G3). Liver cirrhosis (F4) was diagnosed in 31 cases. Steatosis was present in 75 of all patients on ultrasound. Liver biopsy was done in 65 patients and histology showed steatosis in 28, stages of fibrosis (F1-F3) in 56 and F4 in 9 patients (METAVIR). Laboratory panel included complete blood count, liver tests and serum lipid levels (mmol/l) with Friedewald equation estimations. Indirect noninvasive fibrosis scores FIB-4, Aspartate aminotransferase to Platelet Ratio Index (APRI) and Forns index were calculated. HCV RNA was quantified by RT-PCR. Statistical analysis included Spearman's rho, Mann-Whitney U test, Receiver Operating Characteristic (ROC) curve. RESULTS Total Cholesterol (TCh) (p=0.002) and Low-Density Lipoprotein (LDL) (p=0.003) in G1 patients were higher when steatosis was present. TCh (p<0.001), High-Density Lipoprotein (HDL) (p=0.018) and LDL (p=0.003) were lower in G1 F4 compared with F1-F3 patients. Triglyceride (TG) levels correlated with FIB-4 (r=0.364, p=0.029), APRI (r=0.333, p=0.047) and Forns index (r=0.423, p=0.010) in G1 patients without steatosis. TG to LDL ratio (TG/LDL) (p=0.001) was higher in F4 than in F1-F3 patients. TG/LDL ratio predicted the presence of F4 in G1 patients without steatosis by an area under the ROC curve 0.900 (p<0.001). TG/LDL ratio > 0.52 was highly specific for F4 without steatosis. Specificity dropped to 76% when steatosis was present. TG/LDL < 0.32 negatively predicted liver cirrhosis. HCV RNA correlated with TG levels (r=0.330, p=0.009) in G1 patients with steatosis and with histological percent of fatty hepatocytes (r=0.585, p=0.028) in G3 patients. CONCLUSION Lipid levels in CHC G1 patients depend on the presence of steatosis and cirrhosis. HCV RNA is associated with TG levels in G1 patients with steatosis, but not in G3 patients. In cirrhotic CHC G1 patients cholesterol is low with relatively increased TG. TG/LDL ratio is a potential marker of liver cirrhosis in CHC G1 patients.
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Affiliation(s)
- Ivan Valkov
- Resident and PhD Student, Clinic of Gastroenterology, University Hospital "St.Ivan Rilski", Medical University-Sofia, Bulgaria
| | - Radina Ivanova
- Associate Professor, Laboratory of Clinical Pathology, University Hospital "St.Ivan Rilski", Medical University-Sofia, Bulgaria
| | - Assen Alexiev
- Professor, Clinic of Gastroenterology, University Hospital "St.Ivan Rilski", Medical University-Sofia, Bulgaria
| | - Krasimir Antonov
- Professor, Clinic of Gastroenterology, University Hospital "St.Ivan Rilski", Medical University-Sofia, Bulgaria
| | - Lyudmila Mateva
- Professor, Head of Clinic of Gastroenterology, University Hospital "St.Ivan Rilski", Medical University-Sofia, Bulgaria
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10
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Valkov I, Ivanova R, Marinova C, Alexiev A, Antonov K, Jelev D, Ivanova RS, Mateva L. A Comparative Analysis of Serum Lipids in Patients with Chronic Hepatitis C, Nonalcoholic Fatty Liver Disease and Healthy Controls. Acta Medica Bulgarica 2017. [DOI: 10.1515/amb-2017-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Abstract
Serum lipids abnormalities are widespread among patients with chronic hepatitis C (CHC), but the impact of concomitant hepatic steatosis [steatosis, nonalcoholic steatosis (NAS)], as well as distinctions between it and nonalcoholic fatty liver disease (NAFLD) are not well established yet. The aim of the study was to assess and compare the serum lipids in patients with genotype 1 CHC with and without steatosis, those with NAFLD, and healthy controls (HC). A total of 1010 subjects were included in this study: 366 CHC genotype 1 patients with steatosis (n = 227) and without steatosis (n = 139), 403 NAFLD patients, and 241 HC without fatty liver or other disease, matched for age and gender. Serum lipids, body mass index (BMI), components of metabolic syndrome (MS), and serum insulin levels were evaluated. In addition serum lipoprotein (a) [Lp(a)] levels were studied in 112 CHC and 80 NAFLD patients. The mean levels of total cholesterol, LDL-cholesterol and triglycerides (Tg) were higher and the mean levels of HDL-cholesterol were lower in all patients with steatosis (CHC and NAFLD) than in CHC cases without steatosis (p < 0.05 and p = 0.001, resp.). Higher prevalence and severity of lipid abnormalities, including Lp(a), were observed in patients with NAFLD than in those with CHC (p < 0.001). No difference was found between CHC patients without steatosis and HC. Higher prevalence and grade of glucose metabolic abnormalities were also observed in patients with NAFLD and CHC with steatosis than in cases without steatosis (p < 0.05 and p = 0.001, resp.). Lipid and glucose metabolic abnormalities in patients with CHC were dependent on steatosis. CHC with steatosis and NAFLD were associated with insulin resistant type dyslipidemia, with total cholesterol and LDL-cholesterol being generally lower in CHC.
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Affiliation(s)
- I. Valkov
- Clinic of Gastroenterology , University Hospital Sv. Ivan Rilski , Medical University – Sofia
- Department of Internal Diseases , Faculty of Medicine , Medical University – Sofia
| | - R. Ivanova
- Clinic of Cardiology , University Hospital Alexandrovska , Medical University – Sofia
- Department of Internal Diseases , Faculty of Medicine , Medical University – Sofia
| | - C. Marinova
- Clinic of Gastroenterology , University Hospital Sv. Ivan Rilski , Medical University – Sofia
- Department of Internal Diseases , Faculty of Medicine , Medical University – Sofia
| | - A. Alexiev
- Clinic of Gastroenterology , University Hospital Sv. Ivan Rilski , Medical University – Sofia
- Department of Internal Diseases , Faculty of Medicine , Medical University – Sofia
| | - K. Antonov
- Clinic of Gastroenterology , University Hospital Sv. Ivan Rilski , Medical University – Sofia
- Department of Internal Diseases , Faculty of Medicine , Medical University – Sofia
| | - D. Jelev
- Clinic of Gastroenterology , University Hospital Sv. Ivan Rilski , Medical University – Sofia
- Department of Internal Diseases , Faculty of Medicine , Medical University – Sofia
| | - R. S. Ivanova
- Laboratory of Clinical Pathology , University Hospital Sv. Ivan Rilski , Medical University – Sofia
- Clinical Center of Endocrinology and Gerontology , Faculty of Medicine , Medical University – Sofia
| | - L. Mateva
- Clinic of Gastroenterology , University Hospital Sv. Ivan Rilski , Medical University – Sofia
- Department of Internal Diseases , Faculty of Medicine , Medical University – Sofia
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Krauwinkel W, Noukens J, van Dijk J, Popa S, Ouatas T, de Vries M, Phung D, Gibbons J, Mordenti J, Mateva L. A comparison of the pharmacokinetics and safety of enzalutamide in subjects with hepatic impairment and matched healthy subjects. J Clin Pharm Ther 2017; 42:268-275. [PMID: 28251667 DOI: 10.1111/jcpt.12503] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 08/17/2016] [Accepted: 01/04/2017] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Enzalutamide is an androgen receptor inhibitor approved for treatment of metastatic castration-resistant prostate cancer. Enzalutamide is highly protein bound and eliminated primarily by hepatic metabolism; therefore, it is important to understand whether enzalutamide pharmacokinetics is altered by hepatic impairment. METHODS Pharmacokinetic data were obtained from two non-randomized, open-label, single-dose, phase 1 studies conducted in patients with mild (Child-Pugh class A, n = 6) or moderate (Child-Pugh class B, n = 8) hepatic impairment (NCT01901133) or severe (Child-Pugh class C, n = 8) hepatic impairment (NCT02138162) and their corresponding matched healthy controls; data from both studies are presented here. Subjects with hepatic impairment had liver cirrhosis (n = 19) or chronic hepatitis (n = 3). All subjects received a single oral dose of 160 mg enzalutamide under fasting conditions, with blood samples collected predose and up to 49 days post-dose. RESULTS AND DISCUSSION Exposure to enzalutamide active moieties, based on the area under the curve of the sum of enzalutamide and N-desmethyl enzalutamide (an active metabolite with similar potency to enzalutamide), increased by 13%, 18% and 4% in subjects with mild, moderate and severe hepatic impairment, respectively, relative to matched controls. Compared with healthy controls, the mean maximum plasma concentration for enzalutamide active moieties was 24% higher in subjects with mild hepatic impairment and 11% and 41% lower in subjects with moderate and severe hepatic impairment, respectively. Enzalutamide was generally well tolerated, with no clinically significant trends in abnormal laboratory findings, vital signs or electrocardiograms. WHAT IS NEW AND CONCLUSIONS No major differences in single-dose pharmacokinetics were observed in subjects with hepatic impairment vs. matched healthy controls. Therefore, these studies indicate that no initial dose adjustment is necessary when administering enzalutamide to patients with hepatic impairment.
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Affiliation(s)
| | - J Noukens
- Kinesis Pharma BV, Breda, The Netherlands
| | - J van Dijk
- Astellas Pharma Europe, Leiden, The Netherlands
| | - S Popa
- ARENSIA Exploratory Medicine, Republican Clinical Hospital, Chisinau, Moldova
| | - T Ouatas
- Astellas Pharma Europe, Leiden, The Netherlands
| | - M de Vries
- Astellas Pharma Europe, Leiden, The Netherlands
| | - D Phung
- Astellas Pharma Europe, Leiden, The Netherlands
| | - J Gibbons
- Medivation, Inc., (Medivation was acquired by Pfizer, Inc. in September 2016), San Francisco, CA, USA
| | - J Mordenti
- Medivation, Inc., (Medivation was acquired by Pfizer, Inc. in September 2016), San Francisco, CA, USA
| | - L Mateva
- Gastroenterology Clinic, University Hospital St. Ivan Rilski, Medical University Sofia, COMAC Medical Ltd, Sofia, Bulgaria
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12
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Ivanova R, Marinova C, Alexiev A, Mateva L. Cardiometabolic risk factors in young v/s middle-aged patients with nonalcoholic fatty liver disease. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.748] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Ivanova R, Valkov I, Marinova C, Alexiev A, Antonov K, Jelev D, Mateva L. Comparative analysis of serum lipids in patients with chronic hepatitis C, nonalcoholic fatty liver disease, and healthy controls. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.751] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Groenendaal-van de Meent D, Adel MD, Noukens J, Rijnders S, Krebs-Brown A, Mateva L, Alexiev A, Schaddelee M. Effect of Moderate Hepatic Impairment on the Pharmacokinetics and Pharmacodynamics of Roxadustat, an Oral Hypoxia-Inducible Factor Prolyl Hydroxylase Inhibitor. Clin Drug Investig 2016; 36:743-751. [PMID: 27352308 PMCID: PMC4987405 DOI: 10.1007/s40261-016-0422-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Roxadustat is a hypoxia-inducible factor prolyl hydroxylase inhibitor in phase III development for the treatment of anaemia associated with chronic kidney disease. This study evaluated the effects of moderate hepatic impairment on roxadustat pharmacokinetics, pharmacodynamics and tolerability. METHODS This was an open-label study in which eight subjects with moderate hepatic impairment (liver cirrhosis Child-Pugh score 7-9) and eight subjects with normal hepatic function (matched for body mass index, age and sex) received a single oral 100 mg roxadustat dose under fasted conditions. Blood samples were collected until 144 h post-dose in subjects with moderate hepatic impairment and until 96 h post-dose in subjects with normal hepatic function. RESULTS In subjects with moderate hepatic impairment, area under the concentration-time curve (AUC) from the time of drug administration to infinity (AUC∞) and observed maximum concentration (C max) were 23 % higher [geometric least-squares mean ratio (GMR) 123 %; 90 % CI 86.1-175] and 16 % lower (GMR 83.6 %; 90 % CI 67.5-104), respectively, than in subjects with normal hepatic function. Mean terminal half-life (t ½) appeared to be longer (17.7 vs. 12.8 h) in subjects with moderate hepatic impairment, however intersubject variability on apparent total systemic clearance after single oral dosing (CL/F), apparent volume of distribution at equilibrium after oral administration (V z/F) and t ½ was approximately twofold higher. Erythropoietin (EPO) baseline-corrected AUC from administration to the last measurable EPO concentration (AUCE,last) and maximum effect (E max) were 31 % (GMR 68.95 %; 90 % CI 29.29-162.29) and 48 % (GMR 52.29 %; 90 % CI 28.95-94.46) lower, respectively, than in subjects with normal hepatic function. The single oral roxadustat dose was generally well tolerated. CONCLUSIONS This study demonstrated the effect of moderate hepatic impairment on the pharmacokinetics and pharmacodynamics of roxadustat relative to subjects with normal hepatic function. These differences are not expected to be of clinical significance.
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Affiliation(s)
| | | | | | | | | | - Lyudmila Mateva
- Gastroenterology Clinic, University Hospital St Ivan Rilski, Medical University-Sofia, COMAC Medical Ltd, Sofia, Bulgaria
| | - Assen Alexiev
- Gastroenterology Clinic, University Hospital St Ivan Rilski, Medical University-Sofia, COMAC Medical Ltd, Sofia, Bulgaria
| | - Marloes Schaddelee
- Astellas Pharma Europe B.V., Leiden, The Netherlands.
- Business Development, Transaction Execution Group, Astellas Pharma Inc., Sylviusweg 62, PO Box 344, 2300 AH, Leiden, The Netherlands.
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15
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Krastev Z, Jelev D, Antonov K, Petkova T, Atanasova E, Zheleva N, Tomov B, Boyanova Y, Mateva L. Ombitasvir, paritaprevir, ritonavir, dasabuvir and ribavirin in cirrhosis after complete destruction of hepatocellular carcinoma. World J Gastroenterol 2016; 22:2630-2635. [PMID: 26937151 PMCID: PMC4768209 DOI: 10.3748/wjg.v22.i8.2630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/21/2015] [Accepted: 12/16/2015] [Indexed: 02/06/2023] Open
Abstract
We observed a sustained viral response (SVR) of ombitasvir/paritaprevir/ritonavir, dasabuvir and ribavirin therapy, for 12 wk, in two cases with compensated liver cirrhosis and fully destroyed early hepatocellular carcinoma (HCC). Patients were infected with hepatitis C virus (HCV) genotype 1b and were previous null responders/relapsers to interferon-alpha/ribavirin (IFN/RBV). There was a rapid suppression of HCV RNA to undetectable levels within the first two treatment weeks. SVR was achieved even after marked reduction of the RBV dose. The treatment was well tolerated. Both subjects experienced worsening of liver disease during therapy, in different patterns: severe, transient, predominantly direct hyperbilirubinemia without cytolysis (case 1) or progressive increase of aminotransferases (grade 4) without severe hyperbilirubinemia (case 2). Adverse events spontaneously resolved. The patients remained in a good clinical condition without hepatic decompensation. There was no re-occurrence of HCC. This is the first report for treatment of HCV cirrhosis after complete HCC destruction.
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Abstract
Actinomycosis is a rare subacute or chronic, endogenous infection mainly by Actinomyces species, showing low virulence through fimbriae and biofilms. Cervicofacial, thoracic, abdominal, pelvic and sometimes cerebral, laryngeal, urinary and other regions can be affected. Actinomycosis mimics other diseases, often malignancy. Disease risk in immunocompromised subjects needs clarification. Diagnosis is often delayed and 'sulfur granules' are helpful but nonspecific. Culture requires immediate specimen transport and prolonged anaerobic incubation. Imaging, histology, cytology, matrix-assisted laser desorption ionization time-of-flight mass spectrometry and molecular methods improve the diagnosis. Actinomycetes are β-lactam susceptible, occasionally resistant. Treatment includes surgery and/or long-term parenteral then oral antibiotics, but some 1-4-week regimens or oral therapy alone were curative. For prophylaxis, oral hygiene and regular intrauterine device replacement are important.
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Affiliation(s)
- Lyudmila Boyanova
- Department of Medical Microbiology, Medical University of Sofia, Bulgaria
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17
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Dzekova-Vidimliski P, Nikolov IG, Matevska-Geshkovska N, Boyanova Y, Nikolova N, Romanciuc G, Dumitrascu D, Caloska-Ivanova V, Joksimovic N, Antonov K, Mateva L, Rostaing L, Dimovski A, Sikole A. Genetic predictors of the response to the treatment of hepatitis C virus infection. Bosn J Basic Med Sci 2015; 15:55-9. [PMID: 26614853 PMCID: PMC4690443 DOI: 10.17305/bjbms.2015.632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/08/2015] [Accepted: 09/09/2015] [Indexed: 02/06/2023] Open
Abstract
The genome-wide association studies have identified a strong association between interleukin 28B (IL28B) gene polymorphisms and the response to treatment in patients with hepatitis C virus (HCV) infection. The aim of the study was to evaluate the association between three most widely studied IL28B gene polymorphisms and the response to antiviral treatment of chronic hepatitis C. We performed the genotyping of the three IL28B gene polymorphisms: rs12979860, rs8099917, and rs12980275 in 72 Caucasian patients with chronic hepatitis C, previously treated with the combination therapy of pegylated interferon alpha (PEGIFN α) and ribavirin (RBV). The patients included in the study had finished the treatment regimen at least 6 months before enrolling in the study. We used the sustained viral response (SVR) for the evaluation of the effectiveness of the antiviral treatment, and it was tested with an assay with a sensitivity of 20 IU/mL. An SVR was achieved in 59.7% (43/72) of the treated patients. The three IL28B gene polymorphisms (CC genotype of rs12979860, TT genotype of rs8099917, and AA genotype of rs12980275) were associated with the SVR (p=0.029, p=0.016, and p=0.028, respectively) in the study patients with chronic hepatitis C treated with the combination therapy of PEGIFN α and RBV. The association of IL28B gene polymorphisms with the treatment response points to the possibility of personalized medicine for the treatment of HCV infection.
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Nikolova N, Jelev D, Antonov K, Mateva L, Krastev Z. The decrease of HBsAg during nucleos(t)ide analogues (NUC) therapy in Bulgarian patients. BIOTECHNOL BIOTEC EQ 2015. [DOI: 10.1080/13102818.2015.1036773] [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: 10/23/2022] Open
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Ivanova R, Petrova J, Marinova C, Alexiev A, Mateva L. Impact of newly diagnosed diabetes mellitus type 2 on cardiometabolic risk factors and carotid intima media thickness in patients with nonalcoholic fatty liver disease. Atherosclerosis 2015. [DOI: 10.1016/j.atherosclerosis.2015.04.885] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Groenendaal−van de Meent D, den Adel M, Noukens J, Rijnders S, Krebs-Brown A, Mateva L, Alexiev A, Schaddelee M. FP390MODERATE HEPATIC IMPAIRMENT HAS ONLY A MINOR IMPACT ON THE PHARMACOKINETICS OF ROXADUSTAT, AN ORAL HYPOXIA-INDUCIBLE FACTOR PROLYL-HYDROXYLASE INHIBITOR. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv176.14] [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: 11/13/2022] Open
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Ivanova R, Gospodinova M, Petrova J, Alexiev A, Denchev S, Mateva L. Cardiovascular risk factors in nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.05.715] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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de Mey C, Mateva L, Krastev Z, Sachse R, Wood N, Malhotra B. Effects of hepatic dysfunction on the single-dose pharmacokinetics of fesoterodine. J Clin Pharmacol 2010; 51:397-405. [PMID: 20371737 DOI: 10.1177/0091270010365547] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [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
Fesoterodine, a new antimuscarinic for the treatment of overactive bladder, is rapidly and extensively hydrolyzed by nonspecific esterases to its principal active moiety, 5-hydroxymethyl tolterodine (5-HMT). The elimination of 5-HMT involves metabolism and renal excretion. The plasma and urinary pharmacokinetics of 5-HMT and its inactive carboxy (SPM 5509), N-desisopropyl (SPM 7789), and carboxy-N-desisopropyl (SPM 7790) metabolites were investigated after a single oral dose of 8 mg of fesoterodine in 8 male subjects with moderate hepatic cirrhosis (Child-Turcotte-Pugh class B) and 8 matched healthy controls. The estimated mean ratios (95% confidence interval) of the area under the curve extrapolated to infinity after dosing (AUC(0-∞)), cumulative urinary excretion up to 48 hours after dosing (Ae(0-48)), maximum observed concentration (C(max)), and apparent terminal disposition half-life (t(1/2)) of 5-HMT for cirrhotic and healthy subjects were 2.2 (1.5-3.1), 2.5 (1.7-3.8), 1.4 (1.0-1.9), and 1.1 (0.8-1.3), respectively. In subjects with hepatic cirrhosis, AUC(0-∞) and Ae(0-48) of 5-HMT increased approximately 2-fold; the increase in C(max) was smaller, and t(1/2) was unaffected. AUC and C(max) of the inactive carboxy metabolites, SPM 5509 and SPM 7790, were reduced reciprocally by about 50%, whereas exposure to the dealkylated metabolite, SPM 7789, increased about 2-fold. Fesoterodine 8 mg was equally well tolerated in both groups. The results indicate that moderate hepatic cirrhosis reduces 5-HMT clearance, with an apparent effect on the carboxylation pathway and not on dealkylation.
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Affiliation(s)
- Christian de Mey
- Applied Clinical Pharmacology Services, Philippsring 11, D-55252, Mainz-Kastel, Germany.
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Petkova I, Mateva L, Beniozef D, Petrov K, Thorn W. Sodium pyruvate infusions in patients with alcoholic liver disease. Preliminary report. Acta Physiol Pharmacol Bulg 2002; 25:103-8. [PMID: 11688547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Pyruvate has been shown to benefit cellular energy metabolism and to reduce free radical formation. Concerning gastrointestinal side effects of orally administered sodium pyruvate, in this pilot study we investigated the therapeutic effectiveness of sodium pyruvate infusions in patients with alcoholic liver disease (ALD). Fifteen patients with ALD received sodium pyruvate infusions for: (1) 10 days (54-86.4 g pyruvate daily, 150-180 mg/min., 6-8 h); and (2) 15 days (50-54 g daily, 100 mg/min., 6 h). Sodium pyruvate treatment resulted in significantly decreased serum AST (p<0.03), ALT (p<0.03), AP (p<0.004), GGT (p<0.05), and total bilirubin (p<0.04). Improvement of liver function was also evident from the significantly decreased Combined Clinical and Laboratory Index (from 6.50+/-0.71, to 3.92+/-0.84, p<0.001), and Liver Damage Score (from 3.83+/-0.71 to 2.75+/-0.58, p<0.01). The two therapy schedules used showed similar results. Unchanged serum pyruvate, lactate, and glucose confirmed the good utilization of pyruvate. Tolerance of sodium pyruvate treatment was very good in 26.09% and good in 68.94% of the observations. Our results showed good therapeutic effectiveness and good tolerance of sodium pyruvate infusions in patients with ALD. This is possibly due to the rapid gain of ATP and GTP, required to redress defective cells, and to antioxidant action of pyruvate.
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Affiliation(s)
- I Petkova
- Department of Pathophysiology, Medical University, Sofia, Bulgaria.
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Krastev Z, Vladimirov B, Mateva L, Alexiev A. Quantitative assessment of severity of biliary tract infection. Hepatogastroenterology 1996; 43:792-5. [PMID: 8884291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND/AIMS It is very important for physicians to evaluate the severity of the biliary infection. At the moment, there is no useful quantitative system. In this study, we propose a scoring system for assessing the severity of biliary infections and evaluation of the efficacy of antibacterial and endoscopic treatments. MATERIALS AND METHODS We created a biliary tract infection score (BTIS) including local physical and ultrasound findings, signs of inflammation and hepatobiliary involvement. The BTIS was calculated in 317 patients: group I-155 pts with cholecystitis and cholangitis, treated only by antibiotics and group II-162 pts with acute cholangitis treated by endoscopic procedures. RESULTS The BTIS allowed the differentiation of the severity of biliary infections: 15.50 +/- 0.52 in acute cholangitis group and 5.77 +/- 2.79 in group I (p < 0.001). The BTIS significantly decreased after antibacterial therapy (excluding only the cefotiam subgroup) and in endoscopicaly treated patients. CONCLUSIONS The BTIS is a combination of simple, reliable, acceptable and low cost parameters, reflecting the principal pathological processes and degree of abnormalities. A BTIS facilitated the assessment of severity of biliary infection and comparison of the results of various methods of treatment.
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Affiliation(s)
- Z Krastev
- Clinic of Gastroenterology, St.I. Rilski University Hospital, Sofia, Bulgaria
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Krastev Z, Mateva L, Danev S, Nikolov R. Clinical meaning of GGT activity in follow-up of patients with alcohol-related liver injury and cholestasis. Ital J Gastroenterol 1992; 24:185-7. [PMID: 1350934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
The dynamics of GGT was investigated in three groups of patients after removing some primary causes of GGT increase. Group A included 34 patients with alcohol-related liver disease, group B included 16 patients with alcoholic liver injury and cholestasis, caused by concomitant alcoholic pancreatitis and group C included 17 patients with extrahepatic cholestasis, caused by choledocholithiasis. Follow-up assays of GGT were performed on the 7th, 14th and 30th days. Our results showed that the dynamics of GGT was more rapid after removing the cause for cholestasis than in stopping alcohol consumption in patients with chronic liver diseases. On the 14th day more than a 50% decrease in GGT activity was noted in 20% of the patients from groups A and B and in almost all cases from group C. On the 30th day, the reference range of GGT was not attained by any of the patients with liver disease nor in five patients from group C. No significant correlation was found between the severity of liver damage and the extent of GGT increase at the beginning and at the end of the follow-up period.
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Affiliation(s)
- Z Krastev
- Clinic of Gastroenterology, Medical Academy, Sofia, Bulgaria
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