ABSTRACT
Objective To investigate the correlation between serum ferritin (SF) level and antiviral effect of pegylated interferon-α-2a (Peg-IFNα-2a) in chronic hepatitis C (CHC) patients.Methods A total of 85 CHC patients who were admitted to The First People's Hospital of Zigong from November 2013 to July 2014 were enrolled and treated with subcutaneous injection of Peg-IFNc-2a 180 μμg once a week combined with oral ribavirin 10-15 mg · kg-1 · d-1.The course of treatment was 48 weeks and the patients were followed up for 24 weeks after the treatment ended.SF was measured at week 0,and HCV RNA was measured at weeks 0,4,12,24,48,and 72 to evaluate therapeutic outcome.According to the therapeutic outcome,the patients were divided into rapid virologic response (RVR) group,early virologic response (EVR) group,sustained virologic response (SVR) group,no response group (NR group),and recurrence group;according to the SF level,the patients were divided into high-SF group (≥400 ng/ml) and low-SF group (＜400 ng/ml).An analysis of variance was used for comparison of continuous data between groups,and SNK-q test was used for comparison between any two groups;the chi-square test was used for comparison of categorical data between groups,and Spearman rank correlation was used for correlation analysis.Results Of all patients,36 (42.35％) achieved RVR,70(82.35％) achieved EVR,68 (80.00％) achieved SVR,15 (17.65％) had no response,and 2 (2.35％) experienced recurrence.The NR group and recurrence group had a significant increase in SF level,and the NR group had a significantly higher SF level than RVR group (1489.15 ± 278.21 ng/ml vs 398.12 ±-252.45 ng/ml,q =10.826,P ＜0.01),EVR group (1489.15 ± 278.21 ng/ml vs 514.85-± 275.64 ng/ml,q =10.151,P ＜ 0.01),and SVR group (1489.15 ± 278.21 ng/ml vs 486.45 ± 251.60 ng/ml,q =10.614,P ＜0.01).SF level was negatively correlated with the therapeutic effect of PEG-IFN (rs =-0.688,P ＜0.001).Compared with the high-SF group,the low-SF group had a significantly higher proportion of patients who achieved RVR (85.29％ vs 13.73％,P ＜0.001),EVR (100％ vs 70.59％,P ＜ 0.001),or SVR (100％ vs 66.67％,P ＜ 0.001) and a significantly lower proportion of patients who had no response (0 vs 29.41％,P ＜ 0.001).Conclusion In CHC patients,SF level before treatment is correlated with the antiviral effect of PEG-IFN,suggesting that SF level can predict the antiviral effect of PEG-IFN in CHC patients.
ABSTRACT
Objective To investigate the correlation between serum ferritin (SF) level and antiviral effect of pegylated interferon-α-2a (Peg-IFNα-2a) in chronic hepatitis C (CHC) patients.Methods A total of 85 CHC patients who were admitted to The First People's Hospital of Zigong from November 2013 to July 2014 were enrolled and treated with subcutaneous injection of Peg-IFNc-2a 180 μμg once a week combined with oral ribavirin 10-15 mg · kg-1 · d-1.The course of treatment was 48 weeks and the patients were followed up for 24 weeks after the treatment ended.SF was measured at week 0,and HCV RNA was measured at weeks 0,4,12,24,48,and 72 to evaluate therapeutic outcome.According to the therapeutic outcome,the patients were divided into rapid virologic response (RVR) group,early virologic response (EVR) group,sustained virologic response (SVR) group,no response group (NR group),and recurrence group;according to the SF level,the patients were divided into high-SF group (≥400 ng/ml) and low-SF group (＜400 ng/ml).An analysis of variance was used for comparison of continuous data between groups,and SNK-q test was used for comparison between any two groups;the chi-square test was used for comparison of categorical data between groups,and Spearman rank correlation was used for correlation analysis.Results Of all patients,36 (42.35％) achieved RVR,70(82.35％) achieved EVR,68 (80.00％) achieved SVR,15 (17.65％) had no response,and 2 (2.35％) experienced recurrence.The NR group and recurrence group had a significant increase in SF level,and the NR group had a significantly higher SF level than RVR group (1489.15 ± 278.21 ng/ml vs 398.12 ±-252.45 ng/ml,q =10.826,P ＜0.01),EVR group (1489.15 ± 278.21 ng/ml vs 514.85-± 275.64 ng/ml,q =10.151,P ＜ 0.01),and SVR group (1489.15 ± 278.21 ng/ml vs 486.45 ± 251.60 ng/ml,q =10.614,P ＜0.01).SF level was negatively correlated with the therapeutic effect of PEG-IFN (rs =-0.688,P ＜0.001).Compared with the high-SF group,the low-SF group had a significantly higher proportion of patients who achieved RVR (85.29％ vs 13.73％,P ＜0.001),EVR (100％ vs 70.59％,P ＜ 0.001),or SVR (100％ vs 66.67％,P ＜ 0.001) and a significantly lower proportion of patients who had no response (0 vs 29.41％,P ＜ 0.001).Conclusion In CHC patients,SF level before treatment is correlated with the antiviral effect of PEG-IFN,suggesting that SF level can predict the antiviral effect of PEG-IFN in CHC patients.
ABSTRACT
Objective To explore the nutritional risk factors in patients with chronic hepatitis C (CHC), who have been accepted pegylated interferon (IFN) and ribavirin (RVB) therapy (PR). Methods A total of 175 CHC patients treated with PR were included in this study. Data of heights, body weights, and calculated body mass index (BMI) were recorded in patients. At the same time, patients were evaluated nutritional risk with Nutritional Risk Screen 2002 (NRS 2002), and divided into risk group (n=35) and non-risk group (n=140). Results There were significant differences in age, HCV genotype (1b type and not 1b), clinical type (CHC/cirrhosis), the length of treatment time and the tolerance degree for PR therapy between two groups (P<0.05). Logistic regression analysis showed that age (OR=16.068,β=2.777), IFN dosage (OR=3.096, β=1.130), RVB dosage (OR=3.382, β=1.219) and clinical type (OR=5.092, β=1.628) were nutritional risk factors. The HCV genotype (OR=0.384; β=-0.957) was protective factors for nutritional risk. Conclusion There is higher occurrence rate of nutritional risk for CHC patients accepted PR therapy. The dependant nutritional risk factors are advanced age, intolerance for PR therapy and cirrhosis associated CHC. HCV without genotypes 1b is not a nutritional risk factor.
ABSTRACT
ObjectiveTo investigate the efficacy of peginterferon alfa-2a (PEG-IFN α-2a) in the treatment of HBeAg-positive chronic hepatitis B (CHB) resistant to multiple nucleos(t)ide analogues (NAs). MethodsA total of 120 patients with HBeAg-positive CHB resistant to multiple nucleos(t)ide analogues who were hospitalized or treated in the outpatient department in our hospital from August 2009 to February 2014 were randomly divided into two groups, with 60 patients in each group. The patients in the treatment group stopped NAs and were given PEG-IFNα-2a for 48 weeks, and those in the control group received PEG-IFNα-2a for 48 weeks in addition to the original therapeutic regimen with NAs. The changes in the serological markers of hepatitis B and HBV DNA were observed at weeks 24 and 48 of treatment and at 24 weeks after drug discontinuation. The chi-square test was used for comparison of categorical data between groups, while comporison of continuous data was mode by t test. ResultsThe patients in both groups achieved a satisfactory outcome. The serum HBeAg clearance rate, HBeAg seroconversion rate, HBV DNA clearance rate, and HBsAg clearance rate showed no significant differences between the two groups at weeks 24 and 48 of treatment and at 24 weeks after treatment (all P＞0.05). The adverse events that occurred during PEG-IFNα-2a treatment were pyrexia, headache, inflammation at the injection site, diarrhea, neutropenia, anemia, and depression, and the disease is not serious. ConclusionPEG-IFNα-2a is safe and effective in the treatment of CHB resistant to multiple NAs, and the patients can convert to PEG-IFNα-2a directly as their antiviral therapy.
ABSTRACT
Behcet's disease (BD) involves multisystem vasculitis of unknown origin. Ocular manifestations of BD mostly include bilateral panuveitis and retinal vasculitis, which are very challenging to treat. Interferon alfa-2a (IFN) has been recently introduced for treating refractory Behcet uveitis, mainly in Germany and Turkey. Nonetheless, there is so far no consensus about the ideal treatment regimen of IFN for Behcet uveitis. We report our experience of IFN treatment in five Korean BD patients with refractory uveitis. All patients complained of oral ulcers; one patient had a positive pathergy test and 2 showed the presence of HLA-B51. Immunosuppressive agents used prior to IFN treatment included cyclosporine and methotrexate. The IFN treatment was commenced with a dose of 6-9 MIU/day for 7 days, adjusted according to individual ocular manifestations, tapered down to 3 MIU three times in a week, and then discontinued. All patients showed positive response to IFN treatment; 50% of them showed complete response without additional major ocular inflammation during the follow-up period. Other BD symptoms also improved after IFN treatment in most cases. After treatment, the relapse rate and the required dose of oral corticosteroid were decreased in most cases, showing a significant steroid-sparing effect. However, the visual acuity was not improved in most cases due to irreversible macular sequelae. Despite the small sample size of this study, we suggest that, in Korean patients, IFN is an effective treatment modality for BD uveitis as was observed in German and Turkish patients.
Subject(s)
Adult , Female , Humans , Male , Behcet Syndrome/complications , Chronic Disease , Cyclosporine/therapeutic use , Immunosuppressive Agents/administration & dosage , Interferon-alpha/therapeutic use , Recombinant Proteins/therapeutic use , Recurrence , Remission Induction , Treatment Outcome , Turkey , Uveitis/diagnosis , Visual AcuityABSTRACT
Objective To investigate the efficacy of sequential add-on of pegylated interferon α-2a (PEGIFN-α-2a) for 48 weeks in chronic hepatitis B (CHB) patients with low serum hepatitis B e antigen (HBeAg) titer after long term adefovir dipivoxil (ADV) monotherapy.Methods This was a randomized,open and prospective clinical trial.Patients who had been treated with ADV for 72 to 144 weeks,with undetectable serum hepatitis B virus (HBV) DNA level,low HBeAg titer (5 S/CO＜ HBeAg＜50 S/CO) and serum hepatitis B surface antigen (HBsAg) ＜5000 IU/mL were included.The patients were categorized into ADV monotherapy group and ADV plus PEGIFN-a-2a combination therapy group by random number table.Patients in ADV group continued ADV monotherapy and patients in combination therapy group added PEGIFN-α-2a to ADV for 48 weeks.After the treatment,efficacy of the two therapies were assessed by comparing the reduction of serum HBeAg reduction,HBeAg loss rate,HBeAg seroconversion rate,and reduction of intrahepatic HBV DNA and HBV covalently closed circular DNA (cccDNA).Pre-and post-treatment results were compared by paired samples t test.Comparison between groups was performed using indepedent samples t test.Comparison of rates between groups was performed using x2 test.Results The trial enrolled 55 CHB patients,and there were 27 patients in ADV monotherapy group,28 patients in combination therapy group.Baseline characteristics including age distribution,sex ratio,alanine aminotransferase (ALT),aspartate aminotransferase (AST),total bilirubin (TBil),serum HBeAg and HBsAg,hepatic HBV DNA and HBV cccDNA were all comparable (all P＞0.05).Twenty-five patients in ADV monotherapy group and 26 patients in combination therapy group completed 48 weeks treatment.HBeAg loss rates and seroconversion rates of combination therapy group were higher than those of ADV monotherapy group (x2 =5.38 and 4.69,respectively,both P＜0.05).HBeAg titers of both groups were significantly lower than those of baseline (t=8.43 and 8.50,respectively,both P＜0.05).The HBeAg titer of combination therapy group was lower than that of monotherapy group (t=5.60,P＜ 0.01).HBV DNA and HBV cccDNA in liver tissue of combination therapy group was (6.934±0.52) lg IU/mg and (5.63±0.54) lg IU/mg post-treatment,respectively,which were both lower than baseline (t＝7.12.6.67,respectively,both P＜0.01).HBV DNA in liver tissue of monotherapy group was (7.09＝0.43) lg IU/mg post-treatment,which was lower than baseline (t=2.67,P=0.02).After treatment,HBV cccDNA in liver tissue of combination therapy group was lower than that of monotherapy group (t =2.87,P=0.00).Conclusions Compared with ADV monotherapy,sequential add-on of PEGIFN-a-2a in combination with ADV can achieve higher serum HBeAg loss rate and seroconversion rate and facilitate the clearance of hepatic HBV DNA and HBV cccDNA in CHB patients with low HBeAg titer after long-term ADV monotherapy.
ABSTRACT
Objective To study the efficacy of peg-interferon plus ribavirin treatment for hepatitis C recurrence after liver transplantation.Methods The clinical data of 16 patients with hepatitis C recurrence after liver transplantation were collected from June 2002 to March 2012 in our hospital.Results There were 1620 patients receiving liver transplantation.66 of these patients received the treatment because of hepatitis C related diseases.16 of the 66 patients received peg-interferon plus ribavirin treatment after liver transplantation.The hepatitis C virus (HCV) RNA concentrations of all the 16 patients were detected.Twelve of the 16 patients were negative for HCV RNA,and the HCV RNA concentration was reduced by more than 2 log after treatment for 12 weeks in 2 cases.The early viral response (EVR) was 87.5％.The HCV RNA of all the 16 patients became negative after treatment for 24 weeks.Conclusion The EVR was high (87.5％) among patients who received peg-interferon plus ribavirin treatment after liver transplantation,and the combination therapy with interferon plus ribavirin was safe and effective for hepatitis C recurrence after liver transplantation.
ABSTRACT
OBJETIVO: Analisar e comparar os efeitos colaterais do tratamento da hepatite C com interferon peguilado e ribavirina no Centro de Referência de Imunobiológicos Especiais (CRIE) do Hospital Mário Covas (Santo André), de 23/02/2011 a 05/05/2011. MÉTODOS: Estudo do tipo transversal, por questionário, com amostra não probabilística composta por 340 pacientes que receberam pelo menos uma dose da medicação. RESULTADOS: Os efeitos colaterais apresentados foram cansaço (82,9%), artralgia e/ou mialgia (76,8%), emagrecimento (71,8%), cefaleia (67,6%), desânimo (65,9%), depressão e/ou irritabilidade (64,4%), prurido (60,6%), febre (59,1%), alopecia (51,5%), tosse seca (34,1%), náuseas (11,7%), inapetência (11,7%) e tontura (7,9%). Foram relatados até 19 sintomas durante o tratamento. Apenas quatro pacientes (1,2%) não apresentaram efeitos colaterais. Ao comparar os interferons, observamos que o uso do alfa-2b causou uma média de 8,01 sintomas por paciente, enquanto o do alfa-2a foi responsável por uma média de 7,50. Os pacientes em uso do interferon alfa-2b apresentaram mais febre, emagrecimento, cefaleia, artralgia e/ou mialgia, cansaço, desânimo, depressão e/ou irritabilidade e tosse seca do que os pacientes em uso do alfa-2a, que, por sua vez, tiveram mais alopecia e prurido. CONCLUSÃO: O estudo mostra uma grande morbidade relacionada ao tratamento, já que apenas 1,2% dos pacientes não apresentaram efeitos colaterais. Na amostra, o interferon peguilado alfa-2b foi responsável por maior prevalência de febre e emagrecimento quando comparado ao alfa-2a, sendo essa relação estatisticamente significante (p < 0,05).
OBJECTIVE: To review and compare side effects of hepatitis C treatment with pegylated interferon and ribavirin at the CRIE of the Hospital Mário Covas (Santo André), São Paulo, Brazil, from February 23 to May 5, 2011. METHODS: Cross-sectional study through questionnaire, with a non-probability sample comprised of 340 patients that had received at least one dose of the medication. RESULTS: Side effects presented were fatigue (82.9%), arthralgia and/or myalgia (76.8%), weight loss (71.8%), headache (67.6%), listlessness (65.9%), depression and/or irritability (64.4%), itching (60.6%), fever (59.1%), alopecia (51.5%), dry cough (34.1%), nausea (11.7%), inappetence (11.7%), and dizziness (7.9%). Up to 19 symptoms were reported during treatment. Only four patients (1.2%) did not present side effects. When comparing the types of interferon, it was observed that alpha-2b caused an average of 8.01 symptoms per patient, while alpha-2a was responsible for an average of 7.50 symptoms. Patients using interferon alpha-2b showed more fever, weight loss, headache, arthralgia and/or myalgia, fatigue, listlessness, depression and/or irritability, and dry cough than patients using alpha-2a, who had more alopecia and itching. CONCLUSION: The study shows a high morbidity related to the treatment, as only 1.2% of the patients showed no side effects. In the sample, the pegylated interferon alpha-2b was responsible for higher prevalence of fever and weight loss when compared to alpha-2a, and this was a statistically significant relation (p < 0.05).
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Antiviral Agents/adverse effects , Hepatitis C/drug therapy , Interferon-alpha/adverse effects , Polyethylene Glycols/adverse effects , Ribavirin/adverse effects , Cross-Sectional Studies , Drug Therapy, Combination , Hepatitis C/transmission , Morbidity , Recombinant Proteins/adverse effectsABSTRACT
The treatment of chronic hepatitis C has frequent side effects such as cytopenias and neuropsychiatric symptoms. However, pulmonary toxicity associated with interferon is rarely described. This paper describes the clinical case of a 67-year-old female patient with chronic hepatitis C who presented an acute onset of dry cough, dyspnoea, and fever 36 weeks after the use of pegylated interferon alfa-2a and ribavirin. The lung biopsy confirmed the diagnosis of a bronchiolitis obliterans organizing pneumonia (BOOP). Corticotherapy was initiated, with clinical and radiological improvement. This paper aims to advise physicians to this occasional, though severe, adverse event related to hepatitis C virus (HCV) treatment.
O tratamento da hepatite C crônica apresenta efeitos colaterais frequentes como citopenias e sintomas neuropsiquiátricos. Contudo, a toxicidade pulmonar associada ao interferon é raramente descrita. Relatamos o caso de uma paciente com 67 anos que apresentou início agudo de tosse, dispnéia e febre após 36 semanas de uso do interferon peguilado alfa-2a e ribavirina. A biópsia pulmonar confirmou o diagnóstico de bronquiolite obliterante com pneumonia em organização, com significativa melhora clínico-radiológica após instituída a corticoterapia. Este relato de caso visa alertar os médicos para a possibilidade desse ocasional, embora grave, evento adverso associado ao tratamento da hepatite C.
Subject(s)
Aged , Female , Humans , Antiviral Agents/adverse effects , Cryptogenic Organizing Pneumonia/chemically induced , Hepatitis C, Chronic/drug therapy , Interferon-alpha/adverse effects , Polyethylene Glycols/adverse effects , Cryptogenic Organizing Pneumonia/pathology , Lung/pathology , Recombinant Proteins/adverse effectsABSTRACT
Objective To evaluate the effects of pegylated interferon plus ribavirin on naive and retreated chronic hepatitis C (CHC) patients.Methods A total of 67 CHC patients were divided into naive group (n =35) and retreat group (n =32) based on their treatment history.And their virological responses [rapid virological response (RVR),early virological response (EVR),virological response to etravirine (ETR) and sustained virological response (SVR)] and risk factors were analyzed.Results ①RVR and EVR of naive group were 60％ (n =21) and 77％ (n =27),respectively,and the retreat group were 28％ (n =9),53％ (n =17).The differences between the two groups were significant (both P ＜ 0.05).On the contrary,CHC patients in both groups might achieve similar ETR and SVR rates (P ＞ 0.05) ; ② The relapse rate in the retreat group was higher than that in the naive group (22％ vs.10％).But the differences had no statistical significance (P ＞ 0.05) ; ③ CHC patients in the retreat group could achieve similar responses,including RVR,EVR,ETR and SVR (P ＞ 0.05) whether treated previously with standard interferon or pegylated interferon; ④ According to muhivariable logistic regression analysis,the retreated genotype 1 CHC patients has a lower SVR rate compared with naive genotype non-1 counterparts (OR =0.29 and 0.26,all P ＜ 0.05).Conclusions CHC patients in the naive group could achieve higher virological responses and a lower relapse rate compared to those in the retreat group.The previous treatment regimeu has no significant effect on virological responses of CHC patients retreated with Peg-IFN plus ribavirin.Genotype 1 and retreatment are both risk factors of achieving SVR.
ABSTRACT
Objective To study the safety and efficacy of low dose Peginterferon-alpha-2a (PEG-INF-α-2a) combined with Ribavirin treating chronic hepatitis C in renal transplant recipients.Methods A total of 13 cases of HCV hepatitis were randomly divided into treatment and control groups.Seven cases in treatment group were given PEG-INF-α-2a (90 μg/week) and ribavirin (600mg/day) for 16 to 48 weeks,and the rest 6 cases in control group were subjected to general liver protection and anti-inflammatory treatment. All patients were followed up for more than 2 years.Results There were 5 cases getting early response in treatment group for 16 weeks,including four cases of complete response and no non-effects response patients. In 4 cases voluntarily receiving treatment for 48 weeks,1 case had facial muscle myalgia and increased Cr level at 35th week,humoral graft rejection was confirmed pathologically,and the treatment was terminated; 1 case had recurrence of HCV RNA replication and PEG-INF-α-2a was withdrawn at 38th week.As results,5 patients in the treatment group obtained complete response after two years,including 2 cases whose HCV-IgG had got negative,HCV RNA replication was significantly lower than in the control group,and the average Cr higher than in control group (P＞ 0.05). There were adverse reactions during this treatment protocol: fever,muscle myalgia,agranulocytosis, anemia and humoral graft rejection.Conclusion The efficacy of low lose PEG-INF α-2a combined with ribavirin is definite in the treatment of chronic HCV hepatitis in kidney transplant recipients.The 16-week treatment duration is reasonable.It is remarkable that PEG-INF-α-2a may cause humoral graft rejection and Cr crawling.
ABSTRACT
This study aimed to evaluate the rate of sustained virological response (SVR) and the clinical and treatment characteristics of patients with chronic hepatitis C (CHC). A retrospective uncontrolled cohort study was conducted among patients who received treatment for CHC between 2005 and 2008 attended at the Center for the Application and Monitoring of Injectable Medications, in Florianopolis, SC, Brazil. The inclusion criteria were: patients over 18 years of age, with a confirmed diagnosis of chronic hepatitis C according to Brazilian guidelines, treated with PEG-IFN alfa-2a or 2b associated with RBV. A total of 188 patients were included in the study: 70% men, 59% genotype 1, 27% coinfected with HIV, 31% with cirrhosis. The SVR rate, calculated by probability theory, was determined as 26% (max=57.4% and min=12.8%) and the intention to treat was 12.8%. Associations between Sustained Virological Response (SVR) and the variables sex (p=0.017), age (p=0.003), genotype (p=0.648) and cirrhosis (p=0.275), were determined in the bivariate analysis and only sex and age were significantly associated with SVR. The SVR rate was considered low, which can be partially explained by patients' unfavorable pretreatment characteristics.
O objetivo do estudo foi avaliar a taxa de resposta viral sustentada (RVS) e as características clínicas e do tratamento dos pacientes portadores de hepatite C crônica. Realizou-se uma coorte retrospectiva não controlada com recorte temporal dos anos de 2005 a 2008, dos pacientes atendidos no Polo de Aplicação e Monitoramento de Medicamentos Injetáveis, em Florianópolis, SC. Os critérios de inclusão foram: pacientes maiores de 18 anos, com diagnóstico confirmado de hepatite C crônica de acordo com o protocolo brasileiro, tratados com PEG-IFN alfa-2a ou 2b associado a ribavirina. Total de 188 pacientes foi incluído no estudo, 70% homens, 59% genótipo 1, 27% co-infectados com o HIV e 31% apresentando cirrose. A taxa de RVS calculada através da teoria das probabilidades foi de 26% (max=57,4% and min=12,8%) e por intenção de tratamento de 12,8%. Verificou-se a associação da RVS com as variáveis: sexo (p=0,017), idade (p=0,003), genótipo (p=0,648) e presença de cirrose (p=0,275). Somente sexo e idade foram associados significativamente com a RVS. A taxa de RVS foi considerada baixa e, em parte, pode ser explicada pelas características desfavoráveis dos pacientes para a obtenção de RVS.
Subject(s)
Humans , Ribavirin/analysis , /analysis , Interferons/analysis , Hepatitis C, Chronic , Patients/classificationABSTRACT
Os autores apresentam o caso de um paciente de 45 anos, assintomático, portador de HCV genótipo 3a, com baixos títulos de HCV-RNA pré-tratamento e baixo grau de fibrose, submetido ao tratamento com interferon e ribavirina, e que obteve resposta virológica sustentada (RVS), com HCVRNA indetectável seis meses após o término do tratamento. A descrição deste caso justifica-se não pela raridade, mas para incentivar a classe médica a manter-se alerta no tocante a essa infecção, promovendo, assim, os benefícios esperados com o diagnóstico e tratamento precoce.
The authors present a case of 45-year-old man, asymptomatic, HCV genotype 3a carrier, with low pretreatment serum HCV-RNA levels and low grade fibrosis, who received interferon plus ribavirin therapy and achieved sustained virological response (SVR) presenting undetectable HCVRNA six months after this treatment. This report case is not justified because of its rarity, but we aim to alert about the importance of early diagnosis and treatment of hepatitis C.
Subject(s)
Humans , Male , Middle Aged , Hepatitis C , Medication Adherence , Ribavirin , Hepatitis C, ChronicABSTRACT
Objective To identify the predictive factors associated with hepatitis B surface antigen (HBsAg) loss in hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) patients treated with pegylated interferon (PEG-IFNα-2a).Methods Seventy-two HBeAg positive CHB patients were treated with PEG-IFNa-2a 180 μg weekly for 48 weeks. The serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and hepatitis B virus (HBV) DNA,HBeAg, and HBsAg were quantitatively detected every 3 months. The relationship between HBV DNA, HBeAg, and HBsAg levels at baseline, week 12, 24 of treatment and HBsAg loss was analyzed.The data were statistically assessed by Fisher's exact test,and receiver operating characteristic (ROC) curve. ResultsTotally 65 patients accomplished the therapy, and 7 (10.8％)patients achieved HBsAg loss. HBsAg loss at week 48 of treatment was associated with HBeAg level at week 12 of treatment (Fisher's exact test, P= 0. 023), HBeAg level at week 24 (Fisher's exact test, P=0. 004), and lower HBsAg levels (＜250 IU/mL) at week 12 and 24 of treatment (Fisher's exact test,P=0. 001 and 0.002, respectively). HBsAg loss was associated with HBV DNA negative ( ＜ 1000 copy/mL) at week 12 of treatment (Fisher's exact test, P = 0. 039), while not associated with HBV DNA negative at week 24 of treatment (Fisher's exact test, P=0. 130). ROC curve analysis revealed that the AUC was 0. 8584(P=0. 0021) of HBsAg level at week 12, 0. 9606(P=0. 001) of HBsAg level at week 24, and 0. 8350(P=0. 040) of HBeAg level at week 24. ConclusionLevels of HBsAg and HBeAg at week 24 of treatment might serve as effective factors to predict HBsAg loss in patients received PEG-IFN monotherapy.
ABSTRACT
CONTEXT: Accumulating data propose that active injecting drug users might not differ from the general population in terms of sustained virological response when adherent to therapy for chronic hepatitis C. However, current guidelines contain restrictive recommendations for therapy in this group of patients. OBJECTIVE: Therefore, we evaluated a cohort of chronic hepatitis C patients regarding the potent influence of active drug using on initial informed consent, compliance and sustained virological response to treatment. METHOD: For that purpose, 162 consecutive patients (of which 62 active injecting drug users), who had been evaluated during the last 6 years in our center for chronic hepatitis C and proposed to receive treatment with pegylated interferon alpha and ribavirin, were enrolled. Initial informed consent, compliance, and sustained virological response as well as data regarding age, gender, body mass index, genotype, viral load, coinfection with HBV/HDV/HIV, administered interferon alpha (2a or 2b), liver function tests, liver histology, urban residence, ethnicity, and concomitant use of alcohol were collected and analyzed in respect with injecting drug using. RESULTS: Injecting drug using was positively correlated with male gender (P<0.001), young age (P<0.001), native origin (P = 0.043), and concomitant use of alcohol (P<0.001). Comparable initial informed consent (P = 0.836), compliance (P = 0.879), and sustained virological response (P = 0.132) were observed between injecting drug users and non- injecting drug users. The results were confirmed using a multiple regression model. CONCLUSION: Our data further support that active injecting drug users do not constitute a distinct chronic hepatitis C patient group in terms of initial informed consent, compliance, or sustained virological response. Therefore, injecting drug using should not be a major determinant influencing the decision for treatment of chronic hepatitis C in eligible patients.
CONTEXTO: Dados acumulados demonstram que usuários ativos de drogas injetáveis podem não diferir da população em geral em termos de resposta virológica sustentada quando aderentes à terapia para a hepatite crônica C. No entanto, as atuais orientações publicadas contêm recomendações restritivas para a terapia nesse grupo de pacientes. OBJETIVO: Com este propósito, avaliou-se uma coorte de pacientes com hepatite crônica C após consentimento informado inicial, no que diz respeito à influência da droga ativa na adesão e na resposta virológica sustentada ao tratamento. MÉTODOS: Para o efeito, foram convidados 162 pacientes (dos quais 62 ativos usuários de drogas injetáveis), que foram avaliados durante os últimos 6 anos em um centro de referência para a hepatite crônica C e se propuseram a receber tratamento com interferon alfa peguilado e ribavirina. O consentimento inicial, a adesão ao tratamento e a resposta virológica sustentada, bem como dados sobre idade, sexo, índice de massa corporal, genótipo, carga viral, com coinfecção HBV/HDV/HIV, tipo de interferon alfa administrado (2a ou 2b), testes de função hepática, histologia hepática, residência urbana, etnia e uso concomitante de álcool foram coletados e analisados em relação com o uso de drogas injetáveis. RESULTADOS: O uso de drogas injetáveis teve correlação positiva com o sexo masculino (P<0,001), idade (P<0,001), de origem nativa (P = 0,043) e uso concomitante de álcool (P<0,001). Foram observados entre usuários de drogas injetáveis e usuários de drogas não-injetáveis dados comparáveis em relação ao consentimento informado inicial (P = 0,836), adesão (P = 0,879) e resposta virológica sustentada (P = 0,132). Os resultados foram confirmados através de um modelo de regressão múltipla. CONCLUSÃO: Os dados confirmam ainda que usuários ativos de drogas injetáveis não constituem um grupo distinto de paciente com hepatite crônica C em termos de consentimento inicial, adesão, ou a resposta virológica sustentada. Assim, o uso de drogas injetáveis não deve ser um dos principais determinantes que influenciam a decisão para o tratamento da hepatite C crônica em pacientes elegíveis.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Antiviral Agents/therapeutic use , Hepatitis C, Chronic/drug therapy , Hepatitis C, Chronic/virology , Interferon-alpha , Ribavirin/therapeutic use , Substance Abuse, Intravenous/virology , Cohort Studies , Drug Therapy, Combination , Genotype , Hepacivirus/genetics , Medication Adherence , Socioeconomic Factors , Viral LoadABSTRACT
Objective To observe the efficacy and safety of peginterferon α-2a and entecavir treatment in chronic hepatitis B(CHB)patients with alanine aminotransferase(ALT)＜2×upper limit of normal(ULN)and hepatic inflammatory activity(G)≥2.Methods 0ne hundred CHB patients with ALT＜2×ULN and G≥2 were enrolled in the open-label and control study. Fifty patients were treated with peginterferon α-2a including 34 hepatitis B e antigen(HBeAg)positive cases and the other 50 patients were treated with entecavir including 33 HBeAg positive cases.The patients were evaluated at week 48 of treatment. The data were analyzed using variance test,t test,Wileoxon test and X~2 test. Results Baseline levels of hepatitis B virus(HBV)DNA,ALT, HBeAg, hepatitis B surface antigen(HBsAg)and hepatic histology were comparable in peginterferon a-2a group and entecavir group. At week 48 of treatment, HBV DNA negative rates in the 2 groups were 66.0% and 72.0%,respectively(X~2=0.421,P=0.517);HBV DNA levels decreased(3.08±1.43)lg copy/mL and(3.79±1.36)lg copy/mL, respectively(t=2.544,P=0.013).Five(10%)patients in peginterferon α-2a group achieved HBsAg loss, while only 1(2.0%)in entecavir group(X~2=2.837,P=0.204);three(6%)patients in peginterferon α-2a group achieved HBsAg seroconversion, while no one in entecavir group(X~2=3.093,P=0.242).Fourteen(41.2%)HBeAg positive patients in peginterferon α-2a group achieved HBeAg loss and seroconversion,while 5(15.2%)HBeAg positive patients in entecavir group achieved HBeAg loss and 4 of them(12.1%)obtained HBeAg seroconversion (X~2=5.583,P=0.018;X~2=7.159,P=0.007).Paired liver biopsies before and after treatment were done in 15 patients in peginterferon α-2a group and 14 in entecavir group. Eleven patients in peginterferon α-2a group and 9 in entecavir group achieved necroinflammatory improvement(Knodell score decline ≥2)at week 48 of treatment(X~2=0.277,P=0.599).Concusions CHB patients with ALT＜2×ULN and G≥2 treated with peginterferon α-2a could achieve virological response,serological response and histologic improvement with good safety. HBeAg seroconversion rate in patients treated with pegintert'eron α-2a is much higher than that in patients treated with entecavir.
ABSTRACT
Objective To analyze CD127 expression on the memory CD8+ lymphocytes from hepatitis B e antigen (HBeAg) positive chronic hepatitis B (CHB) patients treated with peginterferon α-2a (Pegasys). Methods Thirty HBeAg positive CHB patients were treated with peginterferon α-2a 180 μg once a week for 48 weeks and followed up for 24 weeks. The memory CD8+ lymphocytes were characterized by expressing CD45RA and CD27 markers. CD127 expression on cell surface was measured by four-colour flow cytometry. The difference of mean values between groups was evaluated by Mann-Whitney test. Results The CD127 expression on CD8+ T lymphocytes was significantly lower in HBeAg positive CHB patients compared to healthy controls (Z=2.889, P＜0.05), which was negatively correlated with serum hepatitis B virus (HBV) DNA level and HBeAg titers. The CD127 expression increased along with the decrease of HBV DNA and HBeAg after 24-week, 48-week and 72-week treatment in patients showing good response to peginterferon α-2a, while CD127 expression didn't change markedly in non responders (Z24w = 1.954, Z48w = 2.789, Z72w = 2. 989; all P＜0. 05). Conclusion CD127 expression on memory CD8+ lymphocytes increases along with effective anti-HBV treatment in CHB patients, which can be used as a marker for evaluating the effectiveness of anti-viral treatment.
ABSTRACT
Objective To compare the efficacy of peginterferon (Peg-IFN) α-2a in HBeAg positive chronic hepatitis B (CHB) patients with mildly elevated alanine aminotransferase (ALT) level [ALT＜2× upper limit of normal (ULN)] and active hepatic inflammation(G≥2).Methods Fiftyfive HBeAg positive CHB patients with mildly elevated ALT (＜2×ULN) and active hepatic inflammation (G≥2) were enrolled in this randomized,open-label,controlled study.These patients were treated with either Peg-IFN α-2a 180 μg once weekly (n=27) or entecavir 0.5 mg once daily (n=28) for 48 weeks.The data were analyzed using chi-square test and t test.Results After 24 weeks of treatment,8 cases (29.6%) achieved HBeAg loss and 6 cases (22.2%) achieved HBeAg seroconversion in Peg-IFN α-2a group while none in entecavir group (χ2=9.71,P＜0.01;χ2=6.98,P＜0.0 1).Besides,two patients (7.4%) in Peg-IFN α-2a group achieved HBsAg loss.Compared with baseline level,the mean HBeAg titer at week 24 decreased (1 179.8±582.6) PEIU/mL in Peg-IFN α-2a group and (441.5±258.8) PEIU/mL in entecavir group (t=2.66,P=0.01),respectively.At week 24,the serum HBV DNA reduction in entecavir group was more dramatic than that in Peg-IFN α-2a group [(4.520±0.694) lg copy/mL vs.(3.520±1.442) lg copy/mL,t=2.45,P=0.029].In PegIFN α-2a group,the rate of HBeAg loss in patients with G=3 was higher than that in patients with G=2 (χ2=4.23,P=0.041).Conclusions Twenty-four-week treatment with Peg-IFN α-2a is more effective in term of HBeAg loss,HBeAg seroconversion and HBeAg titer reduction than entecavir,while entecavir is more effective in term of serum HBV DNA reduction.Patients with higher baseline hepatic inflammatory activity scores are more possible to achieve HBeAg loss when treated with Peg-IFN α-2a.
ABSTRACT
Objective To report the clinical and pathological features of the sensory neuropathy caused by a combined therapy of telbivudine and pegylated interferon α-2a in 2 patients with hepatitis B virus infection Methods Two male patients aged 48(case 1)and 20(case 2),who suffered from hepatitis B virus infection.were given telbivudine and pegylated interferon α-2a.After 4 months treatment,both patients developed numbness and pain in the lower limbs.The physical examination showed decreased pain sensation in distal extremities.Hypahidrosis appeared in distal extremities.The nails were pale changed in fingers and toes in cage 1.Case 2 presented mild weakness in the proximal muscle of lower limbs and the tendon reflex was decreased in both lower limbs.His 8erunl creatine kinase level was mild elevated.The electromyography examination and sural nerve biopsies were performed on both patients.Results Electromyography examination showed significant decrease of amplitude of sensory nerve action potentials and mild decrease of sensory nerve conduction velocities in both patients.The amplitude of motor nerve action potentials was also decreased in case 2.Light microscope examination revealed middle reduction of myelinated fibers,wallerian degeneration of myelinated fibers and small clusbers of regenerated fibers in sural nerve.Electro microscopy examination revealed the loss of unmyehnated nerve fibers.After the combined therapy was stopped and vitamin B,CoQ10 and L-camitine were administered,the patients recovered gradually.Conclusions Combined therapy of telbivudine and pegylated interferon α-2a may cause sensory neuropathy with electrophsiological and pathological abnormalities of axonal lesions.The sensory neuropathy induced by the combined therapy may be reversible.