Management of Hepatitis C in Children – A New Paradigm

Introduction: With the advent of direct-acting antivirals (DAAs), the past decade has seen a paradigm shift in the management of hepatitis C (HCV) infection in children. In this review, we summarize the various treatment options for pediatric HCV infection, highlighting the recent changes in the management. Methods: A literature search was performed using the PubMed database with the relevant keywords. Filters included were human, ages 0-18 years, and the English language. Results: Initial phase of HCV treatment using conventional or pegylated interferon and ribavirin combination regimens yielded poor outcomes in children, especially in genotypes 1 and 4, with an overall sustained virologic response of 58%. Also, treatment with interferon and ribavirin combination was associated with significant side effects in up to 52% of those treated. Presently, various combinations of direct-acting antivirals (DAAs) have been approved in children above three years of age with documented evidence of high efficacy (SVR12 of 92% to 100%) and excellent safety, and the current standard of care. Conclusion: With various DAA regimens now being approved for children above three years of age, the treatment of active HCV infection (HCV-RNA positive) in children has become simple. Besides the effectiveness of DAA therapy, public awareness about HCV transmission, better screening, and making the DAAs available at a subsidized price in the public sectors are necessary to eliminate HCV infection in India.

Status of clinical research in HCV-negative recipients undergoing kidney transplantation from HCV-positive renal allografts / 器官移植

Antiviral therapy for chronic hepatitis C virus (HCV) infection has entered the era of direct antiviral agent (DAA), and up to 95% of patients could be clinically cured. Under this circumstance, HCV infection has gradually changed from relative contraindication to surgical indication for kidney transplantation. However, at present, the number of kidney transplantation from HCV-infected donors or recipients has been rarely reported in China. The short-term follow-up data of HCV-negative recipients undergoing kidney transplantation from HCV-positive renal allografts in other countries have confirmed that DAA yields high cure rate and safety in the treatment of HCV infection, and recipients could obtain favorable short-term survival and allograft outcome. However, the long-term safety of HCV-infected kidney transplantation remains to be validated by clinical trials with large sample size and long-term follow-up. In this article, the virological clearance, allograft outcome and safety of DAA use in HCV-negative recipients undergoing kidney transplantation from HCV-positive renal allografts under the intervention of DAA were investigated, aiming to evaluate clinical safety and efficacy of this pattern of kidney transplantation and deepen the understanding of safe use of HCV-positive organs.

Assessment of efficacy and safety of daclatasvir, sofusbuvirand ribavirin regimen for 12 weeks as compared to daclatasvir and sofusbuvir combination regimen for 24 weeks in decompensated cirrhotic patients due to hepatitis C virus genotype 3 infection

Background: Assessment of efficacy and safety of daclatasvir+sofosbuvir+ribavirin (DCV+SOF+RBV) for 12 weeks as compare to daclatasvir and sofusbuvirfor 24 weeks in decompensated cirrhotic patients due to hepatitis C virus (HCV) genotype 3 infection. Methods: An observational, prospective, COHORTstudy over 1 year, in decompensated cirrhosis due to G3-HCV infected adult patients. Treatment was a combination of sofosbuvir 400 mg/day+daclatasvir 60 mg/day, with or without a weight-adjusted dosing of ribavirin for 12 or 24 weeks. The primary efficacyendpoint was sustained virologic response rates 12 weeks after therapy (SVR 12). The primary safety endpoint was treatment withdrawal rates secondary to severe adverse events. Results: The32 patients were screened and 2 were excluded, one patient due toassociated HBV+, one patient due to severe anemia. 30 patients were randomized. All 30 randomized patients were divided into two groups. Group 1 was given SOF+DCV+RBV for 12 weeks while group 2 patients were given SOF+DCV for 24 weeks. 81.8% of the participants in the group1 achieved SVR 12. The 90.9% of the participants in the group 2 achieved SVR12 (p=1). No other patient or treatment basal variables influenced the treatment effectiveness. No patient treatment withdrawal secondary to severe adverse events was observed. Conclusions: Both the regimen SOF+DCV with or without RBV are highly efficacious and safe. Addition of RBV can reduce the treatment duration to 12 weeks, and it will further improve compliance and more convenient for the patients.

Three regimens for re-treatment failure of Sofosbuvir-based therapy for chronic hepatitis-C genotype-4: a cohort study

ABSTRACT Despite the high sustained virologic response (SVR) rates of direct-acting antiviral (DAAs) therapy, a small number of patients does not eradicate the virus, and these patients represent a challenge. This study aims to compare the outcomes of three second-line regimens for DAAs-experienced patients with chronic hepatitis C (CHC). This prospective observational study was conducted at the Damanhur Viral Hepatitis Center from January 2017 to February 2020. We included patients with CHC who did not achieve SVR after the complete course of Sofosbuvir/Daclatasvir±Ribavirin (SOF/DAC±RBV). The primary endpoint was SVR-12 after re-treatment. This study included 360 patients (with a mean age of 51.53±11.38 years). Approximately 51.1% of the patients were males, and 65.5% had liver cirrhosis. All patients of group 1 (45 patients) received SOF/VEL/VOX over 12-weeks; SVR-12 was achieved in 44 patients (97.8%). Group 2 (28 patients) received SOF/DAC/RBV over 24-weeks; (one patient was lost during follow-ups and one patient discontinued treatment due to hepatic decompensation). SVR-12 was achieved in 25 patients (96.2%). Group 3 (287 patients) received SOF/Ombitasvir/Paritaprevir/Ritonavir/RBV) over 12-weeks. Eight patients were lost during follow-ups, and one patient discontinued treatment due to grade 4 adverse events. SVR-12 was achieved in 276 patients (99.3%). There was no difference between the groups regarding their age, gender distribution, baseline viral load or comorbidities. Adverse events (thrombocytopenia, anemia, hyperbilirubinaemia and prolonged INR) were significantly higher in group 3, while group 1 did not experience any. The three studied retreatment regimens can be used for DAAs treatment-experienced patients considering availability. The SOF/VEL/VOX combination had the least adverse events.

Lassa fever coinfection with COVID-19 among health care workers: report of two cases

Lassa fever (LF) coinfection with hepatitis B and HIV has been reported among hospitalized patients in Southwest Nigeria and HIV patients coinfected with COVID-19 have been described among hospitalized patients in North Central Nigeria, no study has reported cases of coinfection of Lassa disease and COVID-19 among health care workers (HCWs) worldwide. A case report of two HCWs who were infected with both LF virus and SARS-CoV-2 virus at same time and were successfully managed without any sequelae. Both cases presented with typical signs of LF with COVID-19 suspected, they were promptly diagnosezd with positive outcomes after treatment. While case 1 became negative for LF virus and SARS-CoV-2 after 6 and 30 days, respectively, case 2 became negative for both viruses after 14 and 32 days, respectively. The diagnosis of LF-COVID-19 coinfection in HCWs is a frightening dimension to the health risks faced by HCWs, therefore, HCWs now more than ever before want to know what comes next and how safe is the practice of medicine

Lassa fever coinfection with COVID-19 among health care workers: Report of two cases

Lassa fever (LF) coinfection with hepatitis B and HIV has been reported among hospitalized patients in Southwest Nigeria and HIV patients coinfected with COVID-19 have been described among hospitalized patients in North Central Nigeria, no study has reported cases of coinfection of Lassa disease and COVID-19 among health care workers (HCWs) worldwide. A case report of two HCWs who were infected with both LF virus and SARS-CoV-2 virus at same time and were successfully managed without any sequelae. Both cases presented with typical signs of LF with COVID-19 suspected, they were promptly diagnosed with positive outcomes after treatment. While case 1 became negative for LF virus and SARS-CoV-2 after 6 and 30 days, respectively, case 2 became negative for both viruses after 14 and 32 days, respectively. The diagnosis of LF-COVID-19 coinfection in HCWs is a frightening dimension to the health risks faced by HCWs, therefore, HCWs now more than ever before want to know what comes next and how safe is the practice of medicine.

Association of inosine triphosphate pyrophosphatase gene polymorphisms with ribavirin combined with direct-acting antiviral agent in treatment of hepatitis C patients with hemolytic anemia / 临床肝胆病杂志

Objective To investigate the influencing factors for ribavirin (RBV)-induced hemolytic anemia in the treatment of chronic hepatitis C, and to provide a reference for the early prediction of ribavirin-related hemolytic anemia in clinical practice. Methods A total of 49 patients with chronic hepatitis C who attended or were hospitalized in Hebei Petrochina Central Hospital from January 2018 to July 2019 and received antiviral therapy with direct-acting antiviral agent (DAA) and RBV were enrolled, with a major allele of C allele and a minor allele of A allele at the rs1127354 locus of the inosine triphosphate pyrophosphatase (ITPA) gene, and the patients with AA and AC genotypes were compared with those with CC genotype. During treatment, RBV was reduced to 600 mg when hemoglobin (Hb) level was < 100 g/L and was withdrawn when Hb level was < 85 g/L. Routine blood test, liver function, liver stiffness measurement, HCV RNA, HCV genotype, and ITPA genotype were measured before antiviral therapy, and the routine blood test was performed at weeks 2, 4, 8, and 12 of treatment. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. Results A total of 49 patients were enrolled in this study, among whom 22 had chronic hepatitis C and 27 had liver cirrhosis, with a sustained virologic response (SVR) rate of 95.9%. The dose of RBV was reduced in 3 patients (2 in the AA/AC group and 1 in the CC group) due to anemia, and RBV was withdrawn in 3 patients (1 in the AA/AC group and 2 in the CC group); all these 6 patients had liver cirrhosis and finally achieved SVR. During the anti-HCV therapy with DAA+RBV, there was relatively mild RBV-related hemolysis, and the maximum reduction in Hb from baseline was compared between the patients with AA/AC genotype at ITPA rs1127354 and those with CC genotype, which showed no significant difference between the two groups ( Z =-0.18, P =0.87). Conclusion During the treatment with RBV+DAA, RBV is withdrawn or reduced for liver cirrhosis patients due to anemia, and no obvious statistical relation is observed between ITPA genotype and the maximum reduction in Hb from baseline. Therefore, detection of ITPA genotype before the application of RBV does not improve safety during treatment, and it is not recommended to perform conventional detection of ITPA gene polymorphisms.

Association of inosine triphosphate pyrophosphatase gene polymorphisms with ribavirin combined with direct-acting antiviral agent in treatment of hepatitis C patients with hemolytic anemia / 临床肝胆病杂志

Objective To investigate the influencing factors for ribavirin (RBV)-induced hemolytic anemia in the treatment of chronic hepatitis C, and to provide a reference for the early prediction of ribavirin-related hemolytic anemia in clinical practice. Methods A total of 49 patients with chronic hepatitis C who attended or were hospitalized in Hebei Petrochina Central Hospital from January 2018 to July 2019 and received antiviral therapy with direct-acting antiviral agent (DAA) and RBV were enrolled, with a major allele of C allele and a minor allele of A allele at the rs1127354 locus of the inosine triphosphate pyrophosphatase (ITPA) gene, and the patients with AA and AC genotypes were compared with those with CC genotype. During treatment, RBV was reduced to 600 mg when hemoglobin (Hb) level was < 100 g/L and was withdrawn when Hb level was < 85 g/L. Routine blood test, liver function, liver stiffness measurement, HCV RNA, HCV genotype, and ITPA genotype were measured before antiviral therapy, and the routine blood test was performed at weeks 2, 4, 8, and 12 of treatment. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. Results A total of 49 patients were enrolled in this study, among whom 22 had chronic hepatitis C and 27 had liver cirrhosis, with a sustained virologic response (SVR) rate of 95.9%. The dose of RBV was reduced in 3 patients (2 in the AA/AC group and 1 in the CC group) due to anemia, and RBV was withdrawn in 3 patients (1 in the AA/AC group and 2 in the CC group); all these 6 patients had liver cirrhosis and finally achieved SVR. During the anti-HCV therapy with DAA+RBV, there was relatively mild RBV-related hemolysis, and the maximum reduction in Hb from baseline was compared between the patients with AA/AC genotype at ITPA rs1127354 and those with CC genotype, which showed no significant difference between the two groups ( Z =-0.18, P =0.87). Conclusion During the treatment with RBV+DAA, RBV is withdrawn or reduced for liver cirrhosis patients due to anemia, and no obvious statistical relation is observed between ITPA genotype and the maximum reduction in Hb from baseline. Therefore, detection of ITPA genotype before the application of RBV does not improve safety during treatment, and it is not recommended to perform conventional detection of ITPA gene polymorphisms.

Diagnostic and prognostic roles of miRNA and dielectric parameters in HCV Egyptian patients

Hepatic C virus (HCV) infection is a special case in Egypt due to its historical aspects, epidemiology, risk factors, andgenotype. Therefore, an urgent need arose to assess the HCV progression and efficacy of the used antiviral drugs. Thisstudy aimed to evaluate the role of different miRNAs types and blood dielectric measurements in the early diagnosisand prognosis of HCV in Egyptian patients. The study was carried out on a total of 80 blood samples. Twenty of theseblood samples were withdrawn from healthy volunteers and were served as the control group (G1). Sixty HCV patientsamples were divided according to the received treatment into four groups (15 for each). The second group (G2)included HCV patient samples, who did not receive any treatment. The third (G3), fourth (G4), and fifth (G5) groupsincluded the samples of HCV patients who were treated with Sovaldi (400mg) for 1, 2, and 3 months, respectively. G3,G4, and G5 were simultaneously administered Ribavirin (200 mg) and Daclatasvir (60mg) daily for 3 months. Theobtained results demonstrated the upregulation of miR-21, miR-155, and miR-205 and downregulation of miR-122and miR-133a in all HCV patients. HCV patients who did not receive any treatment showed a lower conductivity dueto the action of the virus; either the free charges on the surface of the red blood cells (RBCs) or membrane deformationor alterations were reduced. Noticeable improvement reached to nearly normal values in different miRNA expressionsand RBC dielectric relaxations was achieved by Sovaldi treatment.

A novel analytical liquid chromatography–tandem mass spectrometry method for the estimation of Ribavirin in bulk and pharmaceutical formulation

The aim of this study is to develop and validate a method that is simple, precise, sensitive, and rapid compared tousing the liquid chromatography–tandem mass spectrometry method for the quantitative determination of Ribavirin(antiviral drug) in its tablet formulation. The development and validation of the method were achieved using a column(Zorbax 50 mm × 4.6 mm × 5 µm) with mobile phase ammonium formate (pH: 7.50): acetonitrile in the ratio (30:70,v/v) with the flow rate of 0.5 ml/min. The retention time for Ribavirin was 1.1 minutes with the total run time of2.5 minutes. The linearity range for Ribavirin was from 2 to 100 ng/ml with a correlation coefficient of 0.9956. Thedetection and quantitation limits of Ribavirin are 0.7 and 2 ng/ml, respectively. The percentage recovery of Ribavirinranged from 94.00% to 98.33%. The percentage relative standard deviation for intraday and interday precision resultswas found to be 0.67%–2.11% and 1.92%–3.11%, respectively. The new method developed for Ribavirin drug wasfound to be rapid, sensitive, selective, and economical. The established method was the evaluation of Ribavirin in itsmarketed formulation (tablet). The values obtained from the analysis were found out to be within the acceptable limitsas per the International Council for Harmonisation (ICH) guidelines.

Therapeutic Drug Monitoring and Individualized Medication of Ribavirin / 中国药学杂志

Ribavirin is a widely used nucleoside antiviral drug. During the epidemic of coronavirus disease 2019 (COVID-19), ribavirin was recommended for empirical treatment in the Clinical Management of Human Infection with COVID-19 (trial guidance v6). However, due to the large inter-individual variations in dose-response relationship, and extremely long terminal half time, it is necessary to perform therapeutic drug monitoring and individualized dose adjustment for ribavirin in special populations. In this article, the pharmacokinetics and therapeutic drug monitoring of ribavirin in different populations are reviewed in order to provide reference for clinical rational use and individualized medication of ribavirin for treatment of COVID-19.

Preparation and preliminary evaluation of ribavirin liposome-powder inhaler / 药学实践杂志

Objective In order to solve the obvious adverse reactions of ribavirin, to develop ribavirin liposome inhalation powder and to evaluate its quality characteristics. Methods The ribavirin liposomes were prepared by the thin film dispersion method, and then lyophilized to prepare ribavirin liposome powder. The appearance, fluidity, bulk density, encapsulation efficiency, particle size of the complex solution, PDI, potential and hydrophilicity were examined. Results Ribavirin liposome powder has good morphology, particle size, potential, fluidity and hydrophilicity, which can meet the basic requirements of powder medicine for drug administration. Conclusion The technique of preparing ribavirin liposome powder aerosol preparation by this method is feasible, and it provides the basic technology for future in vivo and in vitro studies.

Hepatite C e as novas estratégias de tratamento: revisão deliteratura / Hepatitis C and the new treatment strategies: literature review

As hepatites virais são uma das maiores causas de transplantes hepáticos no mundo, com destaque para hepatite C (HCV), com mais de 240 milhões de pessoas infectadas. A história da HCV é marcada pela evolução silenciosa da doença, afetando negativamente o diagnóstico, sendo que os primeiros sintomas manifestam-se apenas na fase aguda e avançada da doença, comprometendo a eficácia do tratamento. Estudos apontam que cerca de 350 mil pessoas perdem a vida anualmente em decorrência da doença. O tratamento dos casos de HCV era feito pela combinação dos medicamentos interferon e ribavirina, no entanto, essa combinação tem como um grande problema a limitação de seu uso em alguns pacientes e, principalmente, seus intensos efeitos colaterais. Esse estudo se dedicou a apresentar os novos tratamentos, através de revisão de literatura, com coleta de dados em Pubmed, SciElo, entre outros bancos de dados, servindo como um informativo às pessoas doentes e seus familiares. A revisão apontou que uma avaliação da gravidade da doença hepática deve ser feita com a finalidade de fornecer subsídios ao processo de decisão sobre o regime de tratamento mais adequado. Essas novas terapias foram introduzidas e demonstraram melhores resultados, perfil de segurança e eficácia.

Viral hepatitis is one of the biggest causes of liver transplants in the world, with hepatitis C (HCV), with more than 240 million people infected all over the world. The history of HCV is marked by the silent evolution of the disease, negatively affecting the diagnosis, and the first symptoms manifest only in the acute and advanced stage of thedisease, compromising the effectiveness of the treatment. Studies indicate that about 350,000 people die each year from the disease.The treatment of HCV cases was made by the combination of interferon and ribavirin, however, this combination has a major problem limiting its use in some patients and especially its intense side effects. This study was dedicated to presenting the new treatments, through literature review, with data collection in Pubmed, SciELO, among other databases, serving as an informative to sick people and their families. The review pointed out that an assessment of the severity of liver disease should be done in order to provide input to the decision process o n the most appropriate treatment regimen. These new therapies were introduced and demonstrated better results, safety profile and efficacy

Economic evaluation of novel direct-acting antivirals in the treatment of chronic hepatitis c virus genotype 1b in china based on markov model / 中国药学杂志

OBJECTIVE: To evaluate the cost-effectiveness of combinations of different direct-acting antivirals(DAAs) for treatment-naive patients infected with chronic hepatitis C virus genotype 1b in China, which would provide pharmacoeconomic evidence for relevant health care decisions. METHODS: A Markov model was constructed based on the natural history of chronic hepatitis C to evaluate the quality-adjusted life years (QALYs) and direct medical costs for noncirrhotic patients and compensated cirrhotic patients from the payer perspective, and to further calculate incremental cost-effectiveness ratio (ICER) of different regimens. Lifetime horizon(100 years of age) and one year cycle length were adopted. A 5% discount rate was applied to both QALYs and costs. One-way sensitivity analysis and probabilistic sensitivity analysis were performed. RESULTS: Base-case analysis showed that six DAAs regimens not only gained QALYs but also reduced medical costs compared with no treatment and PR regimen. Among all the DAAs regimens, the combination of paritaprevir/ombitasvir/ritonavir+dasabuvir± ribavirin (POR+DAS±RBV) was the most cost-effective alternative for all the target population. The findings from the base-case analysis were confirmed by the sensitivity analyses. CONCLUSION: Among all the regimens, the combination of POR+DAS±RBV is the economically dominant regimen in the treatment of treatment-naive patients infected with chronic hepatitis C virus genotype 1b in China.

Antiviral therapy of adenovirus pneumonia / 中国小儿急救医学

Adenovirus pneumonia is a common type of pneumonia in immunocompetent and immunocompromised patients, and its prognosis is poor.Antiviral therapy includs ganciclovir, valganciclovir, cidofovir, brincidofovir, ribavirin and so on.Among them, cidofovir and brincidofovir have obvious antiviral activity against adenovirus in vitro and in vivo, but further RCT results are still needed.Therefore, antiviral therapy of adenovirus pneumonia still needs further study.

Observation on the effect of Jinqiao-Reduqing granule for hte children with herpetic angina fever / 国际中医中药杂志

Objective To evaluate the effect of Jinqiao-Reduqing granule in the treatment of children with herpes angina fever.Methods A total of 90 children with herpes angina were randomly divided into two groups,with 45 cases in each group.Both groups received the symptom-supported treatment.On this basis,the control group took ribavirin granules,while the observation group took Jinqiao-Reduqing granule.Both groups were treated for 4 days.The symptoms and signs were scored before and after treatment.The fever abatement time,herpes subsidence time,salivation disappearance time and appetite recovery time were observed and recorded.The serum levels of IL-2,IL-6,IL-10 and TNF-α were detected by ELISA,and peripheral blood levels of CD4+,CD8+,CD4+/CD8+ were detected by flow cytometry.Results After treatment,the scores of symptoms and signs in the observation group were significantly lower than those in the control group (3.02 ± 2.89 vs.6.88 ± 2.31;t=6.999,P＜0.01).The time of fever abatement (16.8 ± 3.2 h vs.29.9 ± 4.4 h,t=16.202),herpes subsidence (72.3 ± 5.4 h vs.96.7 ± 6.2 h,t=19.765),salivation disappearance (26.4 ± 2.0 h vs.46.3 ± 3.6 h,t=32.479) and appetite recovery (19.6 ± 4.2 h vs.39.7 ± 4.9 h,t=20.907) were significantly earlier than those in the control group (P＜0.01).After treatment,the serum levels of IL-2,IL-6,IL-10 and TNF-α in the observation group were lower than those in the control group (t were 4.974,4.410,6.447 and 4.767,respectively,all Ps＜0.01);CD4+ levels and CD4+/CD8+ were significantly higher than those in the control group (t were 4.033,6.860,all Ps＜ 0.01),and CD8+ levels was significantly lower than those in the control group (t=4.928,P＜0.01).Conclusions The Jinqiao-Reduqing granule can shorten the time of symptoms subsidence,reduce the level of inflammatory cytokines and improve the immunity of children with herpes angina fever.

A phase II, single-arm, open-label, multicenter clinical study to evaluate the efficacy and safety of sofosbuvir combined with ribavirin in patients with genotype 2 chronic hepatitis C virus infection / 中华肝脏病杂志

Objective@#To evaluate the efficacy and safety of sofosbuvir (Nanjing Zhengda Tianqing Pharmaceutical Co., Ltd.) combined with ribavirin in patients with genotype 2 chronic hepatitis C virus infection.@*Methods@#Treatment-naïve or treatment experienced genotype 2 chronic hepatitis C patients from sixteen research centers of China were screened. All subjects received once-daily dose of sofosbuvir (400 mg) combined with ribavirin (body weight < 75 kg, 1 000 mg/day, 400 mg in the morning and 600 mg in the evening; body weight > 75 kg, 1 200 mg/d, 600 mg in the morning and 600 mg in the evening) for 12 weeks. Patients were followed-up for a period of 12 weeks after discontinuation of treatment. Continuous variables were expressed as mean ± standard deviation. The proportion of subjects with virologic response at different follow-up time points and 95% confidence intervals were estimated by maximum likelihood ratio and Clopper-Pearson interval.@*Results@#132 cases with genotype 2 chronic hepatitis C virus infection from sixteen research centers of China were included, 12 cases of whom were associated with cirrhosis, and the remaining 120 cases were not associated with cirrhosis. One hundred and thirty-one cases completed the study, and one patient lost to follow-up at week 4 after the end of treatment. The sustained virological response rate was 96.2% (95% confidence interval: 92.37% - 99.16%) after 12 weeks of drug withdrawal. Virological relapse occurred in four cases. Of the 132 subjects enrolled in the study, 119 (90.2%) reported 617 adverse events during treatment, of which 359 (76.5%) were TEAE related to sofosbuvir and/or ribavirin. There were nine TEAEs of grade 3 and above, and six cases (4.5%) of them had six severe adverse events. Only one serious adverse event was associated with sofosbuvir and ribavirin (unstable angina pectoris). There were no adverse events leading to drug discontinuation or death.@*Conclusion@#Sofosbuvir combined with ribavirin has a high SVR rate in the treatment of genotype 2 chronic hepatitis C virus infection, and most of the adverse events occurred were mild with acceptable safety profile.

Clinical observation of Huangqi injection combined with ribavirin in children with viral myocarditis / 国际中医中药杂志

Objective To evaluate the efficacy of Huangqi injection combined with ribavirin in the treatment of viral myocarditis in children.Methods A total of 89 children with viral myocarditis were randomly divided into treatment group (45 cases) and control group (44 cases) by random number table method.The control group received ribavirin intravenously on the basis of routine treatment,and the treatment group was given Huangqi injection intravenously on the basis of the control group.Both groups were treated continuously for 14 days.The Serum creatine kinase (CK),creatine kinase MB (CK-MB),lactate dehydrogenase (LDH) and aspartate transaminase (AST) were detected by automatic biochemical analyzer.The Serum IL-6,IL-8 and TNF-α were detected by ELISA.The level of CD3+,CD4+,and the ratio of CD4+/CD8+ in peripheral blood was measured by flow cytometry,and the clinical efficacy was evaluated.Results After treatment,the level of serum CK (110.19 ± 12.17 U/L vs.143.81 ± 17.53 U/L,t=10.530),CK-MB (18.43 ± 4.40 U/L vs.30.28 ± 5.21 U/L,t=11.602),LDH (139.57 ± 10.36 U/L vs.162.18 ± 13.22 U/L,t=8.992),AST (24.14 ± 2.19 U/L vs.35.58 ± 3.34 U/L,t=19.150) in the treatment group were significantly lower than those in the control group (P＜0.01).The Serum level of IL-6,IL-8 and TNF-α in the treatment group were significantly lower than those of the control group (t=14.884,17.043 and 14.364,respectively,P＜0.01).The level of CD3+,CD4+,and the ratio of CD4+/CD8+ in peripheral blood of the treatment group was significantly higher than that of the control group (t=6.256,0.219 and 3.895,respectively,P＜0.01).Conclusions The Huangqi injection combined with ribavirin can significantly reduce the degree of myocardial injury and inflammation in children with viral myocarditis,and improve the immune function of children with viral myocarditis.

Sofosbuvir-based regimens combined with ribavirin for recipients with genotype 1 hepatitis C after liver transplantation: a Meta-analysis / 器官移植

Objective To evaluate whether sofosbuvir (SOF)-based direct-acting antiviral agents (DAAs) combined with ribavirin (RBV) (combined RBV) can yield benefits to the recipients infected with hepatitis C virus (HCV) genotype 1 (GT1) after liver transplantation through systematic evaluation and Meta-analysis. Methods Multiple databases at home and abroad were systematically searched, the literature screening was conducted according to relevant standards, the quality of literatures was evaluated and data extraction was performed. The literature was divided into two groups according to the recipients with HCV-GT1 hepatitis after liver transplantation who received the treatment combined RBV or SOF-based DAAs alone without RBV (not combined RBV). Meta-analysis of the data was carried out using Rev Man 5.3 and R3.4.3 software. The incidence of sustained virological response 12 weeks (SVR12) after therapy was evaluated. Results A total of 2 195 articles were retrieved, and 6 articles published in English were eventually included according to the inclusion criteria. The Meta-analysis results demonstrated that the incidence of SVR12 did not significantly differ between the combined RBV and not combined RBV groups (P=0.28). However, the incidence of anemia in the combined RBV group was significantly higher than that in the other group (P < 0.01). Both combined RBV and not combined RBV therapies were efficacious in treating HCV-GT1a and HCV-GT1b subtypes after liver transplantation with similar clinical efficacy (P=0.33). The incidence of SVR in HCV-GT1 recipients did not significantly differ after receiving 12- and 24-weeks therapy after liver transplantation (P=0.95). Conclusions When SOF-based DAAs regimen is adopted to treat HCV-GT1 in recipients after liver transplantation, combination with RBV not only fails to improve the virus clearance rate and bring clinical benefits, but also increases the risk of anemia in the recipients.

Clinical efficacy of Xiao'er Chiqiaoqingre granule in the treatment of acute upper respiratory tract infection / 中国基层医药

Objective To investigate the clinical efficacy and safety of Xiao'er Chiqiaoqingre granule in the treatment of acute upper respiratory tract infection.Methods From January 2017 to December 2017,a total of 116 children with upper respiratory tract infection in Taizhou Integrated Traditional Chinese and Western Medicine Hospital were selected and randomly divided into control group and observation group according to different treatment regimens,with 58 cases in each group.The control group was given ribavirin granules,ibuprofen suspension drops for treatment.The observation group was given Xiao'er Chiqiaoqingre granule on the basis of the control group.The two groups were treated for 5 days,then the clinical effect,the improvement of clinical symptoms,the time of cure,the level of serum cytokines and safety were compared between the two groups.Results After treatment,the cure rate of the observation group was 96.6％,which was significantly higher than 81.0％ of the control group (P ＜0.05).The antipyretic time,cough disappeared time,healing time in the observation group were (1.4 ± 0.5) d,(2.1 ± 0.4) d,(4.5 ± 1.4) d,respectively,which were significantly shorter than those in the control group[(2.6 ± 0.9) d,(3.4 ± 1.1) d,(5.8 ±1.9) d] (all P ＜ 0.05).The throat irritation subsided time of the observation group was (3.5 ± 1.1) d,which of the control group was (3.8 ± 1.3) d,the difference was not statistically significant (P ＞ 0.05).The serum levels of IL-6,IL -10 and TNF-in the observation group were (108.45 ± 25.61) μg/L,(34.88 ± 9.07) μg/L,(1.26 ± 0.86) mg/mL,respectively,which were significantly lower than those in the control group[(129.27 ± 28.31) μg/L,(43.27 ±10.09)μg/L,(2.11 ± 1.03)mg/mL] (all P ＜ 0.05).There were no other serious adverse reactions in the two groups.Conclusion Xiao'er Chiqiaoqingre granule in the treatment of acute upper respiratory tract infection can significantly improve clinical symptoms,improve clinical curative effect,and has good safety and certain clinical value.