Efficacy of adding metformin to pegylated interferon and ribavirin in treatment naive patients with chronic hepatitis C: a randomized double-blind controlled trial

Evidence indicates that insulin resistance results in poor sustained viral response [SVR] in patients with chronic hepatitis C [CHC]. Metformin is an oral hypoglycemic agent which improves insulin resistance. We sought to determine if the addition of metformin to the treatment regimen could improve SVR in treatment-naïve CHC patients in a randomized, double-blind, placebo-controlled trial. We randomized 140 consecutive CHC patients to receive either metformin 500 mg three times a day or placebo in addition to pegylated interferon [PEG-IFN] and ribavirin [RBV]. Only treatment-naïve subjects aged between 15 and 65 years of age were included. SVR was defined as no detectable HCV RNA six months after the end of treatment. Subjects who received at least one dose of PEG-IFN were included in the final analysis. The SVR rate in the metformin group was 75% versus 79% in controls [intention-to-treat] which was not significantly different. Also, the difference between the placebo and metformin group was not significant in subsets of different genotypes or those with homeostasis model assessment of insulin resistance [HOMA-IR] levels greater than 2 or body mass index greater than 25. The most common complaint was gastrointestinal discomfort [13% in metformin group versus 4% in controls; p=0.002] that lead to discontinuation of metformin in 8 participants. Although triple therapy with metformin, PEG-IFN and RBV is relatively well tolerated, the addition of metformin did not significantly improve viral response in CHC patients.

Exacerbation of skin lesions in a 50 year old man with psoriasis during treatment by pegylated interferon

Chronic hepatitis C might lead to several immunological dysfunctions. Studies have shown a positive association between hepatitis C virus [HCV] infection and psoriasis. These results suggest that the infection may be one of the triggering factors for the development or exacerbation of psoriasis. Here, we present a case of chronic HCV infection with psoriasis who developed exacerbation of skin lesions during therapy with peginterferon alpha-2a plus ribavirin. We discuss the management, course and results of HCV treatment in this patient

Bell's palsy associated with chronic HCV infection before and during peginterferon alfa and ribavirin therapy

Neuropsychiatric side effects of peginterferon-alpha [EG-IFN-alpha] therapy consist of a large spectrum of symptoms. Organic personality syndrome, organic affective syndrome, psychotic manifestations and seizures are more common side effects of PEG-IFN-alpha whereas cranial neuropathy and movement disorders are less common. Bell's palsy is often idiopathic, but has been linked to some viral infections, particularly with herpes viruses. Other infections, such as human immunodeficiency virus infection and Lyme disease, may also lead to idiopathic facial paralysis. Neither acute nor chronic Hepatitis C infection has been implicated previously in Bell's palsy, but PEG-IFN- alpha may play a role. Two patients with CHC who developed Bell's palsy before and during treatment with PEG-IFN- alpha and Ribavirin are presented here

case report of cyclic neutropenia associated with pyoderma gangrenosum

We present a 24-year-old female referred with non-healing wound of a few days duration on anterior aspect of her right foreleg. Biopsy of the wound was reported to be pyoderma gangrenosum on pathologic report. Further work up of the patient for high grade fever and occasional leukopenias revealed the diagnosis of cyclic neutropenia. Treatment with granulocyte colony-stimulating factor [G-CSF] resulted in patient's neutrophil counts correction and dramatic improvement in healing of her lower extremity wound

Pegaferon in hepatitis C: results of a multicenter study

Chronic hepatitis C [CHC] is a major contributor to cirrhosis and hepatocellular carcinoma and major global public health problem that causes mortality in both developed and developing countries. For the past decade, treatment with pegylated interferon [peg interferon alpha] ribavirin [RBV] has been associated with rates of sustained virologic response of /= 800,000 IU/ml before starting treatment. "As-treated analysis" indicated that a total of 168 [77.8%] patients achieved sustained viral response [SVR, undetectable plasma HCV RNA 24 weeks after the last planned dose of study treatment]. This study, with a larger number of participants, confirms the results of a previous study by the authors that Pegaferon, a PEG-IFN alpha 2a locally produced in Iran, is effective in treatment-na‹ve CHC patients

Rapid low-cost detection of hepatitis C virus RNA in HCV-infected patients by real-time RT-PCR using SYBR green I

We intend to design and validate a low-cost assay for the detection of hepatitis C virus [HCV] RNA using rapid-cycle RT-PCR. The procedure is performed in a closed system with little risk of contamination allowing PCR and product identification to be performed within one or two hours. A SYBR Green-based real-time RT-PCR for rapid detection of HCV. Amplicon synthesis was monitored continuously by SYBR Green I, which binds to double stranded DMA during PCR. The PCR products were identified by melting curve analysis. Standard sera with known concentrations of HCV RNA and 150 clinical samples were used to validate our assay. The minimum detection level of our assay was less than 50 ID/mL. The results on 100 plasma samples were comparable with commercial assays. This method is useful for rapid qualitative detection of HCV infection and particularly suitable for routine diagnostic applications

Seroprevalence of toxoplasmosis in HIV+/AIDS patients in Iran

Toxoplasma gondii has arisen as an important opportunistic agent especially in the central nervous system and in advanced HIV disease can cause significant morbidity and mortality. This study was carried out to determine the seroprevalence of toxoplasmosis among HIV-positive patients in Iran. Blood samples were collected from 201 HIV-positive patients and anti-toxoplasma antibodies were detected by using conventional ELISA. An antibody titer of >3 IU/ml was considered positive. The majority of studied patients were male [male to female ratio: 5 to 1] with the mean age of 36 +/- 1 yrs. The seroprevalence of toxoplasmosis in HIV-positive patients was 49.75%. The mean CD4 count in HIV patients with positive toxoplasma serology was 332.5 +/- 22.4 cells/micro l. Only 1% of the patients had IgM anti-toxoplasma antibodies and 10% of the patients had clinical toxoplasma encephalitis. The mean CD4 count in this group was 66.4 +/- 15.5 cells/micro l and there was a significant association between CD4 count and rate of toxoplasma encephalitis [P<0.001]. Previous reports suggested that toxoplasma encephalitis could be prevented by appropriate chemoprophylaxis. In view of the relatively high prevalence of toxoplasma infection found among the HIV-infected patients in our study, we suggest that routine screening for toxoplasma should be undertaken for all HIV-infected patients in Iran

Hepatitis-C and hepatitis-B co-infections in patients with human immunodeficiency virus in Tehran, Iran

We carried out a study to determine the seroprevalence of HBV and HCV infections in HIV positive patients at a main referral center for HIV/AIDS in Iran. Serum samples from 201 HIV positive patients referring to a referral center for HIV/AIDS were analyzed for the presence of some hepatitis B [HBsAg, anti-HBc, anti-HBs] and Hepatitis C [anti-HCV] markers, during 2004- 2005. HBsAg was positive in 27 patients [13.4%], anti-HBc was positive in 60 patients [29.8%] and anti-HBs in 23 patients [11.4%]. Anti-HCV Ab was positive in 135 of 201 [67.2%]. HBV and HCV coinfection was observed in 73 of 201 [36.3%]. The maximum prevalence of HBV-HIV and HCV-HIV coinfections were seen in intravenous drug users; 61.2% and 85.1%, respectively [P<0.0001]. The minimum prevalence of HBV-HIV and HCV-HIV were seen in HIV patients wife [HIV+ patients who were infected by monogamous sexual contact with their HIV positive husband] both of them were 8% [P<0.0001]. This study showed that HBV-HIV and HCV-HIV coinfections are significant in patients with HIV/AIDS in Iran. A greater relevance was observed in the association between HCV and HIV. This study suggests that it is necessary to investigate risk factors and risk groups for these infections in Iran

Assessing the prevalence of HIV among Afghan immigrants in Iran through rapid HIV testing in the field

Throughout the world, many migrant and mobile populations are at elevated risk for HIV. Iran has a large immigrant population from neighboring Afghanistan; however, few data exist on the prevalence of HIV in this community. In 2008, we conducted a study to assess the presence of HIV infection among 477 immigrants in a town to the northeast of Tehran using a rapid test in the field. HIV prevalence was 0.2% [95% CI 0.005-1.2] with one person HIV-positive. We recommend periodic HIV sero-surveillance with detailed behavioral measures for this population in the future

Cytomegalovirus co-infection in patients with human immunodeficiency virus in Iran

Serum samples from 201 HIV positive patients were collected to determine the seroprevalence of CMV infection in Iranian HIV infected patients during March 2004 until March 2005 using conventional ELISA kits. An antibody level of>1.1 Iu/ml was considered positive. The seroprevalence of CMV infection was 94%.The maximum prevalence of CMV antibody was seen in patients with unsafe sex and IDUs. Prevalence of CMV was much higher in patients with low socioeconomic status and low level of education. 83% of patients with CD4<100 were CMV seropositive. Our study showed that a significantly high prevalence of CMV in HIV positive patients in Iran. By increasing the level of education and socioeconomic status the prevalence of CMV infection decreased

Expansion of CD4+CD25+FoxP3+ regulatory T cells in chronic hepatitis C virus infection

Regulatory T cells [Tregs] have been involved in impaired immunity and may have a pivotal role in persistence of viral infections. To develop a simple and reliable in-house three color flow cytometery of peripheral blood to understand the role of HCV infection in the increase of Tregs. The level of naturally occurring CD4+ CD25+ FoxP3+ regulatory T cells [nTregs] in 20 chronically infected with hepatitis C virus [HCV] patients was compared to those of 15 healthy individuals by flowcytometry. In a different approach we performed permeabilization and intracellular staining before surface staining which allows the preservation of the surface molecules in the combined detection process and results in the normal frequency of nTregs in blood. Using the optimized method, it was shown that a significantly higher proportion of nTregs in the total CD4+ T cell population was seen in the peripheral blood of chronic HCV patients [0.83 +/- 0.21%, p=0.05] as compared to controls [0.26 +/- 0.1, p=0.05]. Conclusions: In accordance with other studies, we showed that HCV infection induces a dramatic increase in Tregs, which might contribute to the immune response failure during HCV infection

cross-sectional study of anemia in human immunodeficiency virus-infected patients in Iran

Anemia is a frequent complication of infection with human immunodeficiency virus [HIV]. The causes of HIV-related anemia are multifactorial. This study was conducted to evaluate the factors associated with anemia in HIV-infected patients. A total of 642 patients with HIV/AIDS attending the HIV Clinic at Imam Khomeini Hospital in Tehran, Iran enrolled in this study. A detailed history and physical examination was done for all the patients. Investigations included CD4+ count, hemoglobin concentration, and red blood cells morphology. Among HIV-infected patients, 87% were males. The mean duration of antiretroviral therapy was 17.9 +/- 9.2 months. The mean [ +/- SD] hemoglobin level was 12.9 +/- 2.31 mg/dL. Evaluation of red blood cell morphology showed macrocytosis in 11%, normocytosis plus normochromia in 41.1%, and microcytosis plus hypochromia in 47.9% of the patients. The prevalence of anemia [defined as hemoglobin<10 mg/dL] was 10.3%. Anemia was positively associated with female sex [OR = 3.01], CD4 level [CD4 count of <200] [OR=3.49], and antituberculous drug administration [OR=4.57]. Female sex, stage of HIV infection, and antituberculous drug use were the most important factors associated with anemia in HIV-infected patients in our study