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El-Garem H, Mohey M, Ghaith D, Abou El-Soud NH, AbdAllah M, Omar H, Elsharkawy A, Kamal W, Cordie A, Esmat G. Liver stiffness reduction and serum fibrosis score improvement following sofosbuvir-based therapy of HCV/HIV co-infected patients. J Adv Res 2019. [DOI: 10.1016/j.jare.2019.02.021] [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: 11/29/2022] Open
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Waked I, Esmat G, Fouad R, Allam N, Hassany M, Mohey M, Shiha G, Soliman R, Qaqish RB, Hall C, Alami NN, Kopecky-Bromberg S, Mobashery N. Change in the hepatic profile of hepatitis C virus genotype 4-infected patients with compensated cirrhosis receiving ombitasvir, paritaprevir, and ritonavir plus ribavirin: A subanalysis of the AGATE-II study. J Med Virol 2018; 90:1739-1744. [PMID: 29900553 PMCID: PMC6767547 DOI: 10.1002/jmv.25243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/27/2018] [Indexed: 01/08/2023]
Abstract
In AGATE-II, treatment with ombitasvir coformulated with paritaprevir/ritonavir plus ribavirin (RBV) in Egyptians infected with hepatitis C virus genotype 4 resulted in high rates of sustained virologic response at post-treatment week 12. This subanalysis examined the effects of treatment in AGATE-II on liver biomarkers in patients with compensated cirrhosis. AGATE-II was a phase 3, open-label, partly randomized trial of ombitasvir/paritaprevir/ritonavir with weight-based RBV daily once in treatment-naive or treatment-experienced patients. Patients without cirrhosis received treatment for 12 weeks and patients with compensated cirrhosis were randomized 1:1 to the same regimen for either 12 or 24 weeks. Sixty patients with compensated cirrhosis were randomized to treatment for 12 weeks (n = 31) or 24 weeks (n = 29). In the 12-week arm, significant improvements were observed in biomarkers of liver injury (alanine aminotransferase: -53.7 U/L, P < 0.001; aspartate aminotransferase: -35.9 U/L, P < 0.001) and liver fibrosis (aspartate aminotransferase to platelet ratio index: -0.987, P < 0.001; fibrosis-4 index: -1.165, P < 0.001). Similar results were reported in the 24-week arm. Treatment with ombitasvir/paritaprevir/ritonavir plus RBV in hepatitis C virus genotype, 4-infected Egyptians with compensated cirrhosis resulted in improvements in certain biomarkers of liver synthetic function, injury, and fibrosis, independent of treatment duration.
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Affiliation(s)
- Imam Waked
- National Liver Institute, Menoufiya, Egypt
| | | | | | | | - Mohamed Hassany
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | | | - Gamal Shiha
- Mansoura University and Egyptian Liver Research Institute and Hospital, (ELRIAH), Mansoura, Egypt
| | - Reham Soliman
- Mansoura University and Egyptian Liver Research Institute and Hospital, (ELRIAH), Mansoura, Egypt
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Gamil M, Alboraie M, El-Sayed M, Elsharkawy A, Asem N, Elbaz T, Mohey M, Abbas B, Mehrez M, Esmat G. Novel scores combining AFP with non-invasive markers for prediction of liver fibrosis in chronic hepatitis C patients. J Med Virol 2018; 90:1080-1086. [PMID: 29315641 DOI: 10.1002/jmv.25026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 05/15/2017] [Revised: 12/09/2017] [Accepted: 12/10/2017] [Indexed: 12/25/2022]
Abstract
Serum levels of alpha-fetoprotein (AFP) were reported to increase in patients with significant or advanced hepatic fibrosis. Combination of non-invasive tests decreases the use of liver biopsy in large proportion of chronic HCV patients. The aim of the study was to compare and combine AFP with commonly used non-invasive fibrosis tests in novel scores for prediction of different stages of hepatic fibrosis. Six hundred and fifty two treatment naïve chronic hepatitis C patients were enrolled. Demographic data, basic pre-treatment laboratory tests including complete blood count (CBC), liver biochemical profile and renal functions test, international normalized ratio (INR) in addition to AFP, liver stiffness measurement (LSM) by Fibroscan and liver biopsies were retrospectively analyzed. AST to Platelet Ratio Index (APRI) and FIB-4 scores were calculated. Different predictive models using multivariate logistic regression analysis were generated and presented in equations (scores) composed of a combination of AFP, LSM plus FIB-4/APRI scores. AFP was correlating significantly with LSM, FIB-4, and APRI scores. Areas under receiver operating characteristic curves (AUROCs) for predicting significant hepatic fibrosis, advanced hepatic fibrosis, and cirrhosis were 0.897, 0.931, and 0.955, respectively, for equations (scores) containing AFP, LSM, and FIB-4. AUROCs for predicting significant hepatic fibrosis, advanced hepatic fibrosis and cirrhosis were 0.897, 0.929, and 0.959, respectively, for equations (scores) containing AFP, LSM, and APRI. The study shows that combining AFP to serum biomarkers and LSM increases their diagnostic performance for prediction of different stages of liver fibrosis.
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Affiliation(s)
- Mohamed Gamil
- National Hepatology and Tropical Medicine Research institute, Cairo, Egypt
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohammad El-Sayed
- Department of Endemic Medicine and Hepatology, Cairo University, Cairo, Egypt
| | - Aisha Elsharkawy
- Department of Endemic Medicine and Hepatology, Cairo University, Cairo, Egypt
| | - Noha Asem
- Department of Public Health and Community Medicine, Cairo University, Cairo, Egypt
| | - Tamer Elbaz
- Department of Endemic Medicine and Hepatology, Cairo University, Cairo, Egypt
| | - Mohammad Mohey
- Department of Endemic Medicine and Hepatology, Cairo University, Cairo, Egypt
| | | | - Mai Mehrez
- National Hepatology and Tropical Medicine Research institute, Cairo, Egypt
| | - Gamal Esmat
- Department of Endemic Medicine and Hepatology, Cairo University, Cairo, Egypt
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Elsharkawy A, Eletreby R, Fouad R, Soliman Z, Abdallah M, Negm M, Mohey M, Esmat G. Impact of different sofosbuvir based treatment regimens on the biochemical profile of chronic hepatitis C genotype 4 patients. Expert Rev Gastroenterol Hepatol 2017; 11:773-778. [PMID: 28480808 DOI: 10.1080/17474124.2017.1326816] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND Huge efforts have been made to control chronic HCV in Egypt with introduction of Direct-Acting Antivirals (DAAs). Current study aims at evaluating effect of various DAA regimens on liver biochemical profile and haematological indices during treatment. METHODS 272 patients with chronic HCV genotype 4 treated by different DAA regimens (SOF/RBV, SOF/DAC ± RBV, SOF/SIM) for a duration of 12 or 24 weeks in Kasr Alainy Viral Hepatitis Center, Cairo University were followed up for serum bilirubin (BIL), albumin (ALB), alanine transaminase (ALT), aspartate aminotransferase (AST), prothrombin concentration, international normalized ratio (INR), and CBC at baseline, week-4 and end of treatment. RESULTS Mean age was 54 years. Males comprised 64.7%, 72.4% were treatment-naïve, 39% were cirrhotic. Overall SVR12 rate was (93.4%). With all regimens, ALT and AST declined after treatment. In cirrhotics, there was a rise in BIL and INR; with no change in ALB and a decrease in White blood cells. Drop in Hemoglobin and platelets in cirrhotic patients were noted with SOF/RBV, while SOF/SIM showed rise in BIL. CONCLUSION DAAs are safe and effective in genotype 4 chronic HCV patients. It improves liver necro-inflammatory markers in cirrhotics and non-cirrhotics. Cirrhotic patients require careful observation being more vulnerable for treatment related complications.
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Affiliation(s)
- Aisha Elsharkawy
- a Endemic Medicine and Hepatogastroentrology Department, Faculty of medicine , Cairo University , Cairo , Egypt
| | - Rasha Eletreby
- a Endemic Medicine and Hepatogastroentrology Department, Faculty of medicine , Cairo University , Cairo , Egypt
| | - Rabab Fouad
- a Endemic Medicine and Hepatogastroentrology Department, Faculty of medicine , Cairo University , Cairo , Egypt
| | - Zeinab Soliman
- a Endemic Medicine and Hepatogastroentrology Department, Faculty of medicine , Cairo University , Cairo , Egypt
| | - Mohamed Abdallah
- b Medical research division , National research Centre , Cairo , Egypt
| | - Mohamed Negm
- c Kasr Al-Ainy Viral Hepatitis Center, Faculty of medicine , Cairo University , Cairo , Egypt
| | - Mohammad Mohey
- a Endemic Medicine and Hepatogastroentrology Department, Faculty of medicine , Cairo University , Cairo , Egypt
| | - Gamal Esmat
- a Endemic Medicine and Hepatogastroentrology Department, Faculty of medicine , Cairo University , Cairo , Egypt
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El-Khlousy M, Rahman EA, Mostafa S, Bassam A, Elgawad HA, Elnasr MS, Mohey M, Ghaith D. Study of the clinical relevance of Helicobacter pylori virulence genes to gastric diseases among Egyptian patients. Arab J Gastroenterol 2016; 17:90-4. [PMID: 27344093 DOI: 10.1016/j.ajg.2016.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 04/24/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND STUDY AIMS Helicobacter pylori infection is common in Egypt. It has been associated with gastritis, ulcers and it is a risk factor for gastric cancer. We aimed to study the correlation between the presence of H. pylori virulence factors and the histopathological and endoscopic findings in gastric biopsies. PATIENTS AND METHODS Gastric biopsies from thirty seven patients scheduled for diagnostic endoscopy in Cairo University hospital were included in the study. All gastric biopsies were subjected to histopathological examination and PCR assay for detection of 16S rRNA gene to diagnose H. pylori infection, detection of H. pylori virulence factors by PCR for cagA and vacA genotypes and serological analysis of H. pylori (cagA, vacA, P25, and P19) IgG antibodies by immunoblot assay were done. RESULTS H. pylori infection was detected in 23 (62.2%) cases by histopathology while 28/37 (75.7%) were positive for H. pylori 16S rRNA gene by PCR. By PCR seventeen samples out of 37 (45.9%) were positive for cagA gene and five (13.5%) for cag empty site gene. CONCLUSION The most common vacA genotype identified was vacA s2m2 genotype in 10 (27.02%). No statistical correlation was found between IgG antibodies against different antigens of H. pylori virulence factors (cagA, vacA, p25, and p19) and the degree of gastritis except for IgG antibodies against the UreA antigen.
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Affiliation(s)
- Mona El-Khlousy
- Clinical and Chemical Pathology Department, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Eiman A Rahman
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sally Mostafa
- Clinical and Chemical Pathology Department, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Amira Bassam
- Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba A Elgawad
- Clinical and Chemical Pathology Department, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Mohamed S Elnasr
- Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohammad Mohey
- Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Doaa Ghaith
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Shehab H, Elattar I, Elbaz T, Mohey M, Esmat G. CUFA algorithm: assessment of liver fibrosis using routine laboratory data. J Viral Hepat 2014; 21:956-64. [PMID: 24989248 DOI: 10.1111/jvh.12270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 02/12/2014] [Accepted: 03/23/2014] [Indexed: 12/28/2022]
Abstract
Staging of liver fibrosis is an integral part of the management of HCV. Liver biopsy is hampered by its invasiveness and possibility of sampling error. Current noninvasive methods are disadvantaged by their cost and complexity. In this study, we aimed at developing a noninvasive method for the staging of liver fibrosis based only on routine laboratory tests and clinical data. Basic clinical and laboratory data and liver biopsies were collected from 994 patients presenting for the evaluation of HCV. Logistic regression was used to create a model predictive of fibrosis stages. A sequential test was then developed by combining our new model with APRI. In the training set (497) a model was created by logistic regression for the prediction of significant fibrosis (≥F2), it included platelets, AST and age (PLASA). The areas under the curve (AUC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 0.753, 66.8, 71.4, 69.8, 68.4, respectively, while in the validation set (497), they were 0.777, 66.7, 72.8, 68.6 and 71, respectively. These were the best performance indicators when compared to APRI, FIB-4, King's score, platelets, fibrosis index, age-platelet index and Lok index in the same set of patients. A sequential test was then developed including APRI followed by PLASA [Cairo University Fibrosis Assessment (CUFA) algorithm], this allowed saving 20% and 34% of liver biopsies for patients being tested for significant fibrosis and cirrhosis, respectively. In conclusion, the CUFA algorithms at no cost allow saving a significant proportion of patients from performing a liver biopsy or a more complex costly test. These algorithms could be used as the first step in the assessment of liver fibrosis before embarking on the more costly advanced serum markers, Fibroscan or liver biopsy.
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Affiliation(s)
- H Shehab
- Department of Endemic medicine, Hepatology Division, Faculty of medicine, Cairo University, Cairo, Egypt
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