scholarly journals Predictors of Antiviral Therapy in a Post-Transfusion Cohort of Hepatitis C Patients

2006 ◽  
Vol 20 (2) ◽  
pp. 107-111 ◽  
Author(s):  
Maciej Witkos ◽  
Qi-Long Yi ◽  
Jenny Heathcote ◽  
Moira K Kapral ◽  
Murray D Krahn
Keyword(s):  
Hepatitis C ◽  
Antiviral Therapy ◽  
Disease Severity ◽  
Patient Preferences ◽  
Clinical Decision Making ◽  
Antiviral Treatment ◽  
Pegylated Interferon ◽  
Hiv Status ◽  
Medical Provider ◽  
Narrative Comments

INTRODUCTION: In the past, antiviral therapy has been given to 15% to 30% of patients infected with hepatitis C virus (HCV). The efficacy of therapy has recently improved with the addition of ribavirin and pegylated interferon. The aim of the present study was to identify the clinical, socioeconomic and health-system predictors of antiviral treatment for HCV.METHODS: A retrospective analysis of compensation claims data of patients who acquired HCV through blood transfusions between 1986 and 1990 was performed. The patients consisted of 2456 Canadian HCV-positive individuals. The authors reviewed narrative comments from physicians, and constructed univariate and multivariate logistic regression models, using receipt of antiviral therapy with interferon or interferon/ribavirin as the primary outcome.RESULTS: Of the 2456 patients, approximately 30% appeared to be eligible, but only 16% received treatment. Univariate analyses suggested that the disease severity, age, HIV status and province of residence were associated with the likelihood of receiving treatment (P<0.01). The final, multivariable model indicated that in patients with HCV: intermediate disease severity (eg, fibrosis, P<0.0001); middle age (P<0.0001); HIV-negative status (P<0.0001); and province of residence (Quebec, P<0.0001; and Saskatchewan, P<0.0001) were independent predictors of treatment. Narrative comments of physicians emphasized the importance of age, HIV status and patient preferences in clinical decision-making.DISCUSSION: Given the efficacy and cost-effectiveness of current antiviral therapy, treatment rates of HCV patients may be suboptimal. Further work is required to understand barriers to treatment related to geography, organization of medical care, age, medical provider and patient preferences.

scholarly journals Hepatitis C Virus Clearance after Discontinuation of Pegylated Interferon Alpha-2a Monotherapy in a Child

2012 ◽  
Vol 2012 ◽  
pp. 1-4
Author(s):  
Takeshi Endo ◽  
Koichi Ito ◽  
Tokio Sugiura ◽  
Kenji Goto
Keyword(s):  
Hepatitis C Virus ◽  
Viral Load ◽  
Hepatitis C ◽  
Antiviral Therapy ◽  
Interferon Alpha ◽  
Antiviral Treatment ◽  
Pegylated Interferon ◽  
Hcv Rna ◽  
Pegylated Interferon Alpha ◽  
Present Patient

The present patient was a 4-year-old boy. His hepatitis C virus genotype was 2a, and his viral load was high (1400,000 U/mL). The pretreatment liver biopsy revealed no fibrosis or malignancy and mild chronic hepatitis; his Knodell's histological activity (HAI) score was 4. Single nucleotide polymorphism of IL28B (rs8099917) was major type. The patient began antiviral treatment with pegylated interferon alpha 2a (90 μg/week). At week 9, serum HCV RNA became undetectable, with a sensitivity of 50 copies/mL. Antiviral treatment was discontinued at week 11 because the ALT level increased to 610 U/L. After discontinuation of therapy, the patient’s serum HCV RNA status became positive again. The serum viral load increased to 100,000 U/mL. During this period, he had been observed without medication. Sixteen months after stopping treatment, serum HCV became undetectable. Over a 4-year period, HCV RNA became negative and his anti-HCV antibody titer gradually decreased. In conclusion, though antiviral therapy resulted in failure or incomplete therapy, a reduced viral load resulted in viral clearance in the present patient. Interleukin 28B genotype might have association with the clearance of hepatitis C virus after discontinuation of antiviral therapy.

A Laparoscopic Splenectomy Allows the Induction of Antiviral Therapy for Patients with Cirrhosis Associated with Hepatitis C Virus

2011 ◽  
Vol 77 (2) ◽  
pp. 174-179
Author(s):  
Yoshinobu Shigekawa ◽  
Kazuhisa Uchiyama ◽  
Katsunari Takifuji ◽  
Masaki Ueno ◽  
Takashi Hama ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Antiviral Therapy ◽  
Laparoscopic Splenectomy ◽  
Antiviral Treatment ◽  
Pegylated Interferon ◽  
Virologic Response ◽  
Median Hospital Stay ◽  
Postoperative Death ◽  
Median Hospital

It is difficult to treat patients with cirrhosis-associated hepatitis C with pegylated interferon (PEG-IFN) and ribavirin because of thrombocytopenia-related hypersplenism. Both safety and clinical efficacy were retrospectively analyzed for patients who underwent a laparoscopic splenectomy (LS) from January 2003 to December 2007. A total of 35 patients with cirrhosis associated with hepatitis C virus had LS for thrombocytopenia before PEG-IFN and ribavirin therapy, and all patients had thrombocytopenia, which was a contraindication for antiviral therapy. The hepatopathy was Child A in 24 patients, Child B in 10 patients, and Child C in one patient. All 35 patients increased platelet count from 48,000 ± 15,000 to 155,000 ± 55,000/μl ( P < 0.0001) after LS. The median hospital stay and blood loss were 13.0 days (range, 8 to 57 days) and 342.0 mL (range, 5 to 2350 mL). There was no postoperative death. Twenty-nine (83%) patients had PEG-IFN and ribavirin therapy after LS; 18 had complete therapy and 11 had partial therapy. Of these, nine had a sustained virologic response. A laparoscopic splenectomy for patients with cirrhosis associated with hepatitis C virus can be performed safely and allows induction of antiviral treatment.

scholarly journals Plasma chemokine levels correlate with the outcome of antiviral therapy in patients with hepatitis C

Blood ◽  
2005 ◽  
Vol 106 (4) ◽  
pp. 1175-1182 ◽  
Author(s):  
David Butera ◽  
Svetlana Marukian ◽  
Amy E. Iwamaye ◽  
Edgardo Hembrador ◽  
Thomas J. Chambers ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Antiviral Therapy ◽  
B Lymphocytes ◽  
Baseline Level ◽  
Antiviral Treatment ◽  
Plasma Concentrations ◽  
Pegylated Interferon ◽  
Hcv Infection ◽  
Immune Clearance ◽  
Cxcr3 Expression

Abstract Chronic infection with the hepatitis C virus (HCV) is associated with failures of T-cell–mediated immune clearance and with abnormal B-cell growth and activation. We examined the levels of chemokines that bind to CXC chemokine receptor 3 (CXCR3) to determine whether such chemokines might play a role in the failure of the immune system to clear HCV infection. Elevations in CXC ligand 9 (CXCL9), CXCL10, and CXCL11 were observed in all patients with HCV. CXCR3 expression was increased significantly on peripheral blood B lymphocytes, but not T lymphocytes, from individuals with HCV infection. Chemokine levels were measured in samples collected before, during, and after antiviral therapy from a group of 29 patients infected with HCV genotypes 1a (24 patients) and 1b (5 patients). Levels of CXCL10 and CXCL9 decreased following successful antiviral therapy; CXCL11 did not decline significantly during or in the first 6 months after therapy. The baseline level of CXCL10 (measured before the start of antiviral treatment) was greatest in patients with HCV who subsequently became nonresponders to therapy. These results suggest that plasma concentrations of immunoreactive CXCL10 may be a predictor of responsiveness or nonresponsiveness to antiviral therapy with pegylated interferon (IFN) with or without ribavirin. This observation has implications for understanding the pathogenesis of HCV infection.

scholarly journals Neopterin as a Marker of Response to Antiviral Therapy in Hepatitis C Virus Patients

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Gregory F. Oxenkrug ◽  
Pura J. Requintina ◽  
Dennis L. Mikolich ◽  
Robin Ruthazer ◽  
Kathleen Viveiros ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Antiviral Therapy ◽  
Antiviral Treatment ◽  
Cost Effective ◽  
Well Being ◽  
Pegylated Interferon ◽  
Interferon Stimulated Genes ◽  
Viral Therapy ◽  
Rate Limiting

Predicting the efficacy of antiviral treatment of hepatitis C virus (HCV) is of importance for both patient well-being and health care expense. The expression of interferon-stimulated genes (IFN-SGs) in the liver was suggested as a marker of response to anti-viral therapy. IFN-SGs encode the guanosine triphosphate cyclohydrolase 1 (GTPCH), a rate-limiting enzyme of pteridines biosynthesis. Neopterin, a stable byproduct of GTPCH-catalyzed reaction, is used as a marker of interferon-induced GTPCH activation. We hypothesized that assessment of neopterin concentrations might predict the response to antiviral therapy. Neopterin concentrations were evaluated in 260 HCV patients treated by pegylated interferon combined with ribavirin. Mean and median pretreatment neopterin concentrations were lower in patients with sustained virological response than in nonresponders. The rate of response was twofold higher among patients with pretreatment neopterin levels <16 nmol/L than in patients with neopterin levels ≥16 nmol/L, even after controlling for HCV genotype status. Our study suggests that the pretreatment level of neopterin might be used in routine clinical practice as rapid and cost-effective marker to predict the response to antiviral therapy in HCV patients.

Effects of Smoking on Pegylated Interferon alpha 2a and First Generation Protease Inhibitor-based Antiviral Therapy in Naïve Patients Infected with Hepatitis C Virus Genotype 1

2016 ◽  
Vol 25 (1) ◽  
pp. 15-24 ◽  
Author(s):  
Tim Zimmermann ◽  
Dietrich Hueppe ◽  
Stefan Mauss ◽  
Peter Buggisch ◽  
Heike Pfeiffer-Vornkahl ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Antiviral Therapy ◽  
Interferon Alpha ◽  
Virological Response ◽  
Sustained Viral Response ◽  
Pegylated Interferon ◽  
Genotype 1 ◽  
Pegylated Interferon Alpha ◽  
Viral Response

Background & Aims: Smoking has multiple effects on factors influencing hepatitis C and antiviral therapy, including lipid metabolism, fibrosis, platelet count and adherence aspects. The aim of this analysis was to determine the impact of smoking on hepatitis C virus antiviral therapy. Methods: Data of two cohorts of an observational multicenter study including therapy-naïve patients infected with genotype 1 hepatitis C virus (HCV) treated with dual antiviral therapy (n=7,796) with pegylated interferon alpha 2a in combination with ribavirin, or triple antiviral therapy (n=1,122) containing telaprevir or boceprevir, were analysed. Results: In the univariate matched pair analysis of dual antiviral therapy patients (n=584), smoking was significantly associated with lower sustained viral response rates (p=0.026, OR 0.69 CI: 0.50 – 0.96). The effect of smoking on sustained viral response remained significant (p=0.028, OR 0.67 CI: 0.47 – 0.96) in the multivariate analysis when adjusting for all other baseline parameters with a significant association in the univariate analysis, i.e. diabetes, fibrosis, body mass index, transaminases and baseline viral load. Under protease inhibitors the influence of smoking on virological response did not arise. Conclusions: Smoking has a negative impact on antiviral therapy in naïve patients infected with HCV genotype 1 independently of age, gender, history of drug use or alcoholic liver disease. The effects of smoking might be overcome by the new antiviral agents.Abbreviations: APRI: AST to platelet ratio index; DAA: direct antiviral agent; DT: dual antiviral therapy; EoTR: end of treatment response; RVR: rapid virological response; EVR: early virological response; HCV: hepatitis C virus; IFN: interferon alpha; MPA: Matched Pair Analysis; NS: non-smokers; PEG-IFN: pegylated interferon alpha 2a; PI: protease inhibitor; RBV: ribavirin; SAE: serious adverse event; SOC: standard of care; S: smokers; SVR: sustained viral response.    

scholarly journals Pleuro-Pulmonary Nocardiosis as Opportunistic Infection in a Patient with Chronic Hepatitis C under Combination Treatment with Pegylated Interferon, Ribavirin, and Boceprevir

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Csilla Putz-Bankuti ◽  
Harald H. Kessler ◽  
Thomas Valentin ◽  
Eva Leitner ◽  
Emina Talakic ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Pulmonary Infection ◽  
Antiviral Treatment ◽  
Pegylated Interferon ◽  
Hepatitis C Virus Infection ◽  
Chronic Hepatitis C Virus ◽  
Aerobic Actinomycetes

Nocardiosis is an infrequent but serious pulmonary infection caused by Gram-positive aerobic actinomycetes. In this paper, we report on a 48-year-old patient with pleuropulmonary nocardiosis and cirrhosis due to chronic hepatitis C virus infection treated with triple antiviral treatment complicated by prolonged neutropenia.

Changes in Serum Level of Autotaxin with Direct-Acting Antiviral Therapy in Patients with Chronic Hepatitis C

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Khaled Mohamed Hussein Abdelwahab ◽  
Shereen Abou Bakr Saleh ◽  
Ghada Abdelrahman Ahmed ◽  
Asmaa Mady Gomaa Mady
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Serum Level ◽  
Antiviral Therapy ◽  
Chronic Hepatitis C ◽  
Antiviral Treatment ◽  
Post Treatment ◽  
Direct Acting Antiviral ◽  
Direct Acting

Abstract Background Hepatitis C virus virus is global health burden and major health hazard in Egypt, since the virus is the etiological factor of chronic hepatitis. Hepatitis C virus (HCV) accounts for approximately 15%-20% cases of acute hepatitis. After acute infection, around 50% to 80% of HCV patients will develop chronic infection. Approximately, HCV infects 170 million individuals worldwide). Chronic hepatitis C (CHC) patients are at high risk to develop lifethreatening complications, including cirrhosis in 20% of cases and hepatocellular carcinoma. Objectives The aim of this study was to validate Changes in serum level of autotaxin in patients with chronic hepatitis C before and after antiviral treatment. Patients and methods This study was designed as a prospective observational cohort study to evaluate Changes in serum levels of autotaxin with direct-acting antiviral therapy in patients with chronic hepatitis C before (baseline) and after (sustained virologic response week 12) treatment. This prospective study was conducted on 48 chronic HCV infected patients eligible for antiviral treatment with direct acting antivirals, agreeable to regular follow up, recruited from Hepatology and virology outpatient clinic at DMNI (Damanhour Medical National Institute) during the period from September 2018 till Mars 2019. Results This study showed that Autotaxin level significantly decreased from baseline to 12 weeks post-treatment. ATX therefore represents a novel non-invasive biomarker for liver fibrosis and a prognostic indicator of disease activity. Conclusion Serum Autotaxin was found to be higher in chronic hepatitis c and ATX levels became significantly decreased from baseline to 12 weeks post-treatment with direct acting antiviral drugs in patients achieving a SVR.

A Review on the Use of Eltrombopag in Patients with Advanced Liver Disease

2009 ◽  
Vol 1 ◽  
pp. CMT.S2267
Author(s):  
Edoardo G. Giannini ◽  
Alfredo Greco ◽  
Vincenzo Savarino
Keyword(s):  
Chronic Hepatitis ◽  
Liver Disease ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Antiviral Treatment ◽  
Pegylated Interferon ◽  
Severe Thrombocytopenia ◽  
Current Standard ◽  
Advanced Liver Disease ◽  
Orally Bioavailable

Thrombocytopenia is the most common hematological abnormality in patients with chronic, advanced liver disease. In these patients, the presence of severe thrombocytopenia is an obstacle to the performance of invasive diagnostic and therapeutic procedures, and the current standard treatment for these patients is platelet transfusions, a remedy whose characteristics are far from being ideal. Furthermore, thrombocytopenia in patients with chronic hepatitis C virus infection may render the patients ineligible to antiviral treatment or may limit its efficacy because of premature discontinuation. Although the cause of thrombocytopenia in patients with chronic liver disease is likely multi-factorial, decreased thrombopoietin production by the liver undoubtedly plays a significant role. In this regard, eltrombopag, a non-peptide, orally bioavailable thrombopoietin receptor agonist has been shown to safely increase platelet count in a dose-dependent fashion in both healthy subjects and thrombocytopenic patients with chronic hepatitis C. Furthermore, in this latter group of patients, it has been shown to be superior to placebo in counteracting the myelosuppressive effect of short-term pegylated interferon treatment.

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