Update on the treatment of hepatitis C genotypes 2-6.

PURPOSE OF REVIEW: The hepatitis C virus remains a global health issue, and the established standard of care has consisted of pegylated interferon alpha in conjunction with ribavirin. However, this regimen is associated with significant side-effects and poor sustained virological responses. The aim of this review is to assess the effects of the direct-acting antivirals upon hepatitis C genotypes 2-6 from publications from the past 18 months. RECENT FINDINGS: The impact of direct-acting antivirals has already substantially improved treatments for genotypes 2-6, with the size of improvement much less marked for genotype 3. Although still responsive to these agents, genotype 3 has inherent resistance to treatments possibly owing to its effects on host metabolic pathways. These treatments have moved sustained virological responses to the threshold of 90%, with reduced side-effects and shortened courses of treatment and some options for interferon-free therapy. These newer medications are transforming clinical guidelines at a rapid rate, but this will have to be balanced with the impact it places on global health budgets. SUMMARY: Although direct-acting antivirals are transforming the treatment of all hepatitis C genotypes, ongoing studies will optimize treatment duration and provide interferon-free alternatives.

Microbiological effects of consuming a synbiotic containing Bifidobacterium bifidum, Bifidobacterium lactis, and oligofructose in elderly persons, determined by real-time polymerase chain reaction and counting of viable bacteria.

BACKGROUND: Because of changes in gut physiology, immune system reactivity, and diet, elderly people are more susceptible to gastrointestinal infections than are younger adults. The gut microflora, which provides a natural defense against invading microorganisms, changes in elderly people with the development of potentially damaging bacterial populations, which may lead to alterations in bacterial metabolism and higher levels of infection. METHODS: A randomized, double-blind, controlled feeding trial was done with 18 healthy elderly volunteers (age, >62 years) using a synbiotic comprising Bifidobacterium bifidum BB-02 and Bifidobacterium lactis BL-01 (probiotics) together with an inulin-based prebiotic (Synergy 1; Orafti). Real-time PCR was employed to quantitate total bifidobacteria, B. bifidum, and B. lactis in fecal DNA before, during, and after synbiotic consumption. Counting all viable anaerobes, bifidobacteria, and lactobacilli and identification of bacterial isolates to species level was also done. RESULTS: Throughout feeding, both bifidobacteria species were detected in fecal samples obtained from all subjects receiving the synbiotic, with significant increases in the number of copies of the 16S rRNA genes of B. bifidum, B. lactis, and total bifidobacteria, compared with the control week and the placebo group. At least 1 of these species remained detectable in fecal samples 3 weeks after feeding in individuals that had no fecal B. bifidum and/or B. lactis in the control week, indicating that the probiotics persisted in the volunteers. Counting of viable organisms showed significantly higher total numbers of fecal bifidobacteria, total numbers of lactobacilli, and numbers of B. bifidum during synbiotic feeding. CONCLUSION: Synbiotic consumption increased the size and diversity of protective fecal bifidobacterial populations, which are often very much reduced in older people.

Modulation of a heterologous immune response by the products of Ascaris suum.

Helminth infections are among the most potent stimulators of Th2-type immune responses and have been widely demonstrated to modify responsiveness to both nonparasite antigens and other infectious agents in a nonspecific manner in infected animals. We investigated the immunomodulatory properties of pseudocoelomic body fluid from adult Ascaris suum gastrointestinal helminths (ABF) and its defined allergen (ABA-1) by examining their effects on the immune response to a heterologous antigen, ovalbumin. Our results indicate that ABF has potent immunomodulatory activity and that the effects observed are consistent with skewing towards a Th2-type response rather than induction of anergy. Our findings show that the immunomodulatory activities of ABF are associated with components other than the major constituent and putative allergen, ABA-1. Furthermore, the allergic responses to ABA-1 are not a result of an intrinsic allergenicity of the protein but are more a reflection of the wider induction of a Th2 response by the infection. Importantly, the induction of interleukin-10 by ABF also suggests that T regulatory cells may play a role in immunomodulation of immune responses by parasitic helminths.