Pegylated interferon alfa 2a and small dose ribavirin in the treatment of HCV genotype 4 in end-stage renal disease

As hepatitis C virus [HCV] infection is a major health problem in patients with end-stage renal disease [ESRD]. Explore the response rate and adverse effects of pegylated interferon and ribavirin in treating HCV genotype 4 in patients withend stage renal disease [ESRD] waiting renal transplantation. This study included 24 patients with ESRD and active HCV infection as detected by clinical, sonographic, biochemical, serological, virological and histological examination with liver biopsy. All patients were under hemodialysis with HCV antibodies positive > 6 months. Viral genotyping and both qualitative and quantitative PCR were carried out before starting therapy. Treatment was continued for 48 weeks using pegasys 135 micro g weekly and ribavirin 200 mg daily. The biochemical and virological responses were evaluated regularly during and after treatment. The sustained virological response [SVR] being evaluated 24 weeks later. The side effects were monitored throughout the treatment period. Rapid virological response [RVR] after week 4 was achieved in 11/24 [46%] patients. The sustained virological response [SVR] was achieved in 16/24 [66.7%] patients. No break through or relapses were detected during and after treatment respectively. Correlation was found between the viral load before treatment and that at week 4 with p < 0.001and at 12 weekand between the reduction of hemoglobin and the reduction of viral load at week 12 with p < 0.045. Genotype 4 HCV patients with ESRD can be considered for therapy pre-operatively to overcome all the morbidities associated with persistence of HCV after renal transplantation provided that the general condition, the hematological parameters and all other factors of treatment allowed such therapy

Plasma and hepatic tissue endothelin-1 levels in cirrhotic patients with and without bleeding varices

Bleeding from varices is the most lethal event in cirrhotic patients. Bleeding esophageal varices contributed to 51.6% of causes of upper gastrointestinal hemorrhage among Egyptians. The potent vasoconstrictive peptide, endothelin [ET] has been suggested to contribute to the pathogenesis of portal hypertension. So, the present study was designed to determine levels of both circulating ET-1 and hepatic tissue ET-1 in cirrhotic patients with and without bleeding varices. Patients suffering from liver cirrhosis, portal hypertension and upper gastrointestinal bleeding due to esophageal and/or gastric varices were included in the study. Patients who had liver cirrhosis but had never bled before were studied as a comparative group. All patients were classifed according to modified Child's classification. Esophago-gastro-dudenoscopy was done to all patients. Liver biopsy was done whenever possible. Material was divided for both histopathological examinations [using hematoxin and eosin stain] and detection of hepatic tissue ET-1. ELIZA determined plasma and tissue ET-1. Seventy-five subjects were included in this study [fifty bleeders from varices and 15 non-bleeders]. Age of patients ranged between 28 and 67 years with a mean of 45.1 +/- 8.5 years. Fifty-two were males and thirteen were females. Ten healthy controls with a mean age of 41.6 +/- 13.8 years had also been studied. They were 8 males and 2 females. There was a statistically significant increase in the level of plasma ET-1 in bleeder group [12.90 +/- 5.51] when compared to the non-bleeder group [7.50 +/- 2.52] [p< 0.05]. In the same time, there was a statistically significant increase in the level of hepatic tissue ET-1 in bleeder group [77.6 +/-14.03] when compared to the non-bleeder group [52 +/-10.56] [p< 0.05]. Plasma endothelin-1 level showed significant correlation with parameters of hepatic function. In conclusion, results demonstrated that plasma and hepatic tissue ET-1 might play an important role in the genesis of bleeding varices seen in advanced liver cirrhosis and portal hypertension