PAIgG and PAIgM levels in secondary dengue virus infections lead to thrombocytopenia in patients from KP, Pakistan

Objective: To understand the impact of platelet associated immunoglobulin G (PAIgG)/platelet associated immunoglobulin M (PAIgM) on severity of dengue virus infection leading to thrombocytopenia. Methods: In this study we examined a total of 52 patients who were having secondary infection of dengue in acute phase by using competitive ELISA. Results: A decrease in the platelet count was observed at the acute phase of infection while all along the recovery stage the count of platelet was significantly increased. A significant decrease was observed in PAIgG and PAIgM in these subjects. Inverse correlation was found between platelets count and PAIgG/PAIgM among the subjects studied. In the platelets elution from ten subjects, anti-dengue virus immunoglobulin G and immunoglobulin M were observed. PAIgG and PAIgM with inclined levels were higher in dengue hemorrhagic fever than the classical dengue fever. In the development of dengue hemorrhagic fever PAIgM inclined level was independently associated with high specificity, showing a possible indication of dengue hemorrhagic fever. Conclusions: This study suggests that in secondary dengue virus infection, the PAIgG and PAIgM levels, and the activity of anti-dengue virus play key roles, both in the development and severity of the disease.

Weight loss in HCV patients can be used as a surrogate marker for evaluation of interferon [IFN-alpha] treatment efficacy - a prospective pilot study

The aim of the study was to investigate whether weight loss followed the same pattern in HCV patients ['responders' and 'non-responders] after interferon [IFN-alpha] treatment. A total of 20 male HCV positive patients [mean age 33.1 +/- 9.9] in Peshawar, Pakistan participated in this study. They were initially tested as HCV positive, and were given IFN/Ribavarin treatment for 6 months. Changes in body weight [BW], lean body mass [LBM] and body fat [BF] were monitored on monthly basis. End to treatment response [ETR] was established by a final undetectable HCV RNA in serum at the end of therapy and the patients were categorized as either 'responders' or 'non-responders'. The results show a total of 12 out of 20 patients as 'responders' [60%]. All patients lost weight and the mean weight loss in 'responders' and 'non-responders' was 6.2 [ +/- 1.5] and 5.8 [ +/- 1.4] Kg, respectively. There was a significant difference in the mean change in BW, LBM, and BF between 'responders' and 'non-responders' during the last 3 month period only. This suggests that difference in drug response in HCV starts from month 4 and onwards [i.e. during the last 3 months]. In conclusion, weight trends during treatment should be monitored as weight loss may be used as a surrogate marker for ERT to the current standard of care.

effects and underlying mechanism of interferon therapy on body weight and body composition

Body weight changes in HCV patients on interferon therapy are well documented. However, the underlying mechanism involved in these changes is poorly understood and rarely reported. The main objectives of this review are to 1] discuss changes in body weight and other compartments of body composition, particularly, body fat, and 2] to discuss the underlying mechanism for these changes. The literature review suggests weight loss [12-29%] as a function of interferon therapy is common, affecting up to 90% of HCV patients. Whilst, loss in weight means proportionate loss in other body compartments [lean body mass and body fat, in particular] data on changes in segmented body composition are fragmentary. The possible mechanisms underlying weight loss or changes in other body composition have been reported and these include suppressed appetite due to induction of TNF by IFN, a decrease in serum leptin level, and importantly mitochondrial damage induced by the therapy. It is, therefore, suggested that close monitoring of chronic HCV patients receiving PEG-IFN and/or ribavirin for side effects of these drugs, particularly those related to weight loss, is vitally important from clinical point of view