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Occult hepatitis C infection (OCI) is defined as HCV RNA not detected in serum or plasma but in hepatocytes and peripheral blood mononuclear cells (PBMCs). OCI exists in general population and voluntary blood donors, and its infectivity and risk of transmission by transfusion has been confirmed. HCV RNA in PBMCs could not be detected in plasma or serum by blood screening in transfusion services, neither by enzyme-linked immunosorbent assay nor by nucleic acid amplification testing. OCI has become a potential threat to transfusion safety, therefore effective detection technologies and transmission blocking strategies need to be further developed.
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OBJECTIVE：To com pare the efficacy and safety of 5 direct antiviral agents in the treatment of chronic hepatitis C infection as glecaprevir （GLE）/pibrentasvir（PIB），ledipasvir（LDV）/sofosbuvir（SOF），SOF/velpatasvir（VEL），elbasvir（EBR）/ grazoprevir（GZR）compound preparation and danoprevir （DNV）+ peginterferon combined with ribavirin （P/R）. METHODS ： Retrieved from PubMed ，Embase，Cochrane Library ，Web of Science ，CNKI，VIP，Wanfang database and other databases ，RCTs about 5 direct antiviral agents in the treatment of chronic hepatitis C infection were collected during the inception to Jun. 2020. After literature screening and data extraction ，the quality of included literatures were evaluated with bias risk evaluation tool recommended by Cochrane system evaluator manual 5.1.0. Meta-analysis was performed by using Stata 15.0 software. RESULTS ： A total of 48 RCTs with 12 227 patients in trial group were included. Results of Meta-analysis showed that the descending order of sustained virological response （SVR）rate was GLE/PIB ＞LDV/SOF＞SOF/VEL＞EBR/GZR＞DNV+P/R；weighted SVR rates of GLE/PIB，LDV/SOF，SOF/VEL and EBR/GZ were more than 95％. The incidence of any severe adverse event and adverse event in ascending order was EBR/GZR ＜GLE/PIB＜SOF/VEL＜LDV/SOF＜DNV+P/R. The incidence of nausea/vomiting in ascending order was GLE/PIB ＜LDV/SOF＜EBR/GZR＜SOF/VEL＜DNV+P/R. The incidence of rash in ascending order was LDV/SOF ＜ GLE/PIB＜SOF/VEL＜EBR/GZR＜DNV + P/R. The incidence of insomnia from low to high was GLE/PIB ＜EBR/GZR＜SOF/ VEL＜LDV/SOF＜DNV+P/R. CONCLUSIONS ：GLE/PIB，LDV/SOF，SOF/VEL and EBR/GZR have higher and similar effective rates in the treatment of chronic hepatitis C ，especially the weighted SVR rate of GLE/PIB is the best ，and the safety of EBR/GZR and GLE/PIB is relatively better.
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Aim: Approximately 3% of the world population is infected with Hepatitis C virus (HCV) which is the main cause of chronic liver disease. Blood transfusion is thought to be the leading cause of global epidemic of HCV. The envelope proteins E1 and E2 are involved in the early stages of the virus life cycle. These proteins have a major role in binding to receptors on the cell surface, fusion and integration of the virus into the host cell. Considering the potency of E1 and E2 in the development of diagnostic methods, the aim of our present study was co-expression of recombinant envelope proteins in eukaryotic HEK293 (human embryonic kidney) cells. Methods: The viral genomic RNA was used for cDNA (complementary DNA) synthesis. Isolation of HCV envelope proteins coding fragment was performed using cDNA and specific primers. The target gene was cloned into pcDNA3.1 expression vector, and transfected into HEK293 cells, an expression host. Accuracy of the cloning and expression was confirmed using PCR and Western blot analysis. Results: The isolation and cloning of the gene fragment encoding the E1 and E2 proteins was successful. Co-expression of these proteins was confirmed using monoclonal antibodies specific for each protein. Conclusion: This study showed that HEK293 host cell is suitable for the expression of hepatitis C virus E1 and E2 coding gene. These proteins can be used in numerous virological studies and detection of HCV infection.
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Background and Aim: Thrombocytopenia is a frequent problem in patients with post- hepatitis C (HCV) liver cirrhosis and also occurs in chronic HCV-infected patients without liver cirrhosis. The aim of this study was to evaluate the role of plasma thrombopoietin (TPO) in the occurrence of thrombocytopenia in both conditions. Method: Platelet count and plasma thrombopoietin level and liver function tests were measured in four groups of patients: twenty chronic patients with post-hepatitis C liver cirrhosis and thrombocytopenia (group I), ten chronic HCV-positive patients with liver cirrhosis without thrombocytopenia (group II), ten chronic HCV-positive patients without liver cirrhosis with thrombocytopenia (group III) and chronic ten HCV-positive patients without liver cirrhosis and without thrombocytopenia (group IV). Ten normal healthy individuals were included as a control group. Results: Plasma levels of albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), TPO and platelet counts in the four groups of patients were significantly different from their corresponding levels in the control group (P <0.001). There was a significant positive correlation between plasma TPO levels and platelet counts in group III patients (ρ (Spearman's [rho]) = 0.661, P= 0 .038). There was no significant correlation between TPO levels and platelet counts in the other three groups of patients. The logistic regression analysis in the three designated models, using dependent variables (chronic HCV infection, liver cirrhosis and thrombocytopenia) and an independent variable (TPO plasma level) revealed that liver cirrhotic patient and the thrombocytopenic patient have equally the best prediction model for the low plasma TPO. Conclusion: Decreased thrombopoietin production has a role in the pathogenesis of thrombocytopenia in liver cirrhosis.
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Introducción: el virus de la hepatitis C afecta a cerca de 170 millones de personas en el mundo. La organización mundial de la salud (OMS) estima una prevalencia mundial del 2%. La respuesta global al tratamiento en la era de la terapia dual para genotipo 1 es del orden de 40%. En Colombia hay datos limitados que confirmen un comportamiento similar y que describan las características clínicas de los pacientes con esta infección. Metodología: se revisaron retrospectivamente las historias clínicas de pacientes con diagnóstico de hepatitis C crónica que asistieron a consulta externa del servicio de Hepatología en la Clínica Universitaria Colombia y de la consulta externa del servicio de Hepatología de uno de los autores durante el periodo comprendido entre el 1 de enero del 2010 y el 30 de mayo de 2013, se describen las características clínicas, serológicas y de respuesta al tratamiento. Resultados: se evaluaron las historias clínicas de 163 pacientes, 62% mujeres y 38% hombres, con una edad promedio de 58,2 años. El principal factor de riesgo para la adquisición de la hepatitis C fue historia de transfusiones antes de 1992 en 62% de los pacientes. La decisión de iniciar tratamiento se tomó en 77 pacientes (47,2%) y en 86 (52,8%) no se inició por diferentes razones dentro de las cuales la edad avanzada y cirrosis avanzada suman más de 50%; otras razones para no iniciar el tratamiento fueron: enfermedad mínima (4,7%), enfermedad mínima más edad avanzada (10,5%), curación espontánea (14%), poca probabilidad de respuesta (3,3%) y otras (14%). De 62 pacientes de los que se contaba con información acerca de tratamientos previos o tratados recientemente 30,6% presentaron respuesta viral sostenida (RVS), 29,0% fueron clasificados como reincidentes o relapser, 8,1% como respondedores parciales, 19,4% no tuvieron respuesta y 12,9% suspendieron el tratamiento por intolerancia. Conclusiones: el antecedente más frecuente para la adquisición del VHC en el grupo de pacientes estudiado fue la historia de transfusiones antes de 1992 asociada con cirugía ginecológica. Cerca de la mitad de los pacientes se diagnostican tardíamente. Se muestra una mayor tendencia al tratamiento de la hepatitis con tasas de RVS similares a las encontradas en otras series. Este estudio abre puertas a la realización de otros que permitan definir de forma más amplia la prevalencia, factores de riesgo y variables de respuesta al tratamiento de esta entidad en nuestro país.
Introduction: Hepatitis C affects about 170 million people worldwide. The World Health Organization (WHO) has estimated global prevalence at 2%. Overall, about 40% of patients respond to dual therapy treatment for genotype. In Colombia data available for confirm a similar pattern and for describing the clinical characteristics of patients with this infection are scarce. Methods: Medical records of patients in the Hepatology outpatient service at the Clínica Universitaria Colombia who had been diagnosed with chronic hepatitis C by one of the authors between January 1, 2010 and May 30, 2013 were retrospectively reviewed for clinical characteristics, serological characteristics and treatment responses. Results: The medical records of 163 patients were evaluated: 62% were female, 38% were male, and their mean age was 58.2 years. The main risk factor for acquiring hepatitis C was a history of transfusions before 1992. This factor was present in 62% of the patients. The decision to start treatment was made for 77 patients (47.2%), but 86 patients (52.8%) did not start treatment. Reasons included advanced age and advanced cirrhosis which together accounted for more than 50% of these patients. Other reasons for not starting treatment were minimal disease (4.7%), minimal sign of disease plus advanced age (10.5%), spontaneous healing (14%), low probability of response (3.3%) and others (14%). Of the 62 patients for whom information about previous or recent treatments was available, 30.6% had sustained virological responses (SVR), 29.0% were classified as relapsers, 8.1% as partial responders, 19.4% had no response, and 12.9% discontinued treatment because of intolerance. Conclusions: The most frequent antecedent of HCV in the group of patients studied a history of transfusions associated with gynecological surgery before 1992. About half of the patients were diagnosed late. Hepatitis was more likely to have been treated in these patients than in patients in other studies, but the SVR rate was similar to those found in other series. This study opens doors to the realization of other studies to more broadly define the prevalence, risk factors and treatment response variables of this entity in our country.
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Humans , Male , Female , Middle Aged , Gastroenterology , Hepacivirus , Hepatitis C, Chronic , Risk Factors , TherapeuticsABSTRACT
Background Hypersplenism is traditionally treated by surgical splenectomy. Transcatheter ablation of splenic parenchyma is an alternative treatment modality. Methods We evaluated the efficacy and safety of partial splenic arterial embolization in 10 patients with chronic liver disease and hypersplenism with thrombocytopenia (platelet count <80,000/μL). Results At six months follow up, median (range) platelet counts (134.5 [71.5-164] × 103/μL) were significantly higher than those before treatment (33.5 [23-39] × 103/μL; p<0.05]). All patients developed post-embolization syndrome. Left-sided pleural effusion and increase in amount or new development of ascites occurred in six and five patients, respectively. Conclusions Our data suggest that partial splenic arterial embolization leads to an increase in platelet count in patients with thrombocytopenia due to chronic liver disease and hypersplenism. However, it is often associated with complications.
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Objective:To investigate the effects of lentinan combined with HCV NS3 DNA vaccine on the antigen specific immune response.Methods:BALB/c mice were ip with different dose of lentinan plus the same dose of NS3 plasmid(100 ?g/per mouse) in a prime and boost immunization strategy.10 days after the second injection,spleens were taken.The cell suspension was prepared and cultured with NS3 peptide as the stimulant.In addition,NS3 cocultured P815 cells were used as target cells.NS3 specific T cell proliferation and cytotoxicity T lymphocyte reaction(CTL)were analyzed by MTT methods,and the cytokines IL-4 and IFN-? in serum were detected by ELISA technique.Results:It was showed that the high and middle dose of lentinan plus NS3 plasmid specifically stimulated NS3 specific CTL reaction at the ratio of effector to target as 50∶1,compared with the single use of NS3 plasmid,P