Response to hepatitis B vaccination in a primary care setting: influence of HIV infection, CD4+ lymphocyte count and vaccination schedule

BackgroundA non-invasive method to assess liver fibrosis by measuring liver stiffness with transient elastography (TE) has been recently introduced. The role of TE among chronic hepatitis B (CHB) patients in starting antiviral therapy in the primary care setting is still controversial because of its high cost. The AST to platelet ratio index (APRI) could be a much cheaper alternative.ObjectivesThis study compares the diagnostic accuracy of TE and APRI in assessing liver fibrosis in CHB patients.Patients and MethodsA cross-sectional study in CHB patients intending to start antiviral treatment. Liver fibrosis was staged according to the METAVIR scoring system. Liver stiffness was measured by TE performed on the same day with liver biopsy, while APRI was calculated as follows: APRI=(AST/upper limit of normal)×100/platelet count (109/l). Cutoff levels of liver stiffness and APRI were calculated by using the receiver operating characteristic curve to detect significant liver fibrosis, defined as fibrosis stage F2 or more.Results117 patients were enrolled in the study; their mean age was 40.6±10.97 years. The median liver stiffness was 5.9 kPa (2.5–48 kPa) and the median APRI was 0.239 (0.09–2.73). The cutoff level of liver stiffness was 5.85 kPa for ≥F2 with an AUC of 0.614, 60.3% sensitivity, 63.6% specificity, 73.3% PPV, 49.1% NPV and a LR+ of 1.66. The APRI cutoff level was 0.235 for F≥2 with an AUC of 0.693, 64.4% sensitivity, 70.5% specificity, 78.3% PPV, 54.4% NPV and a LR+ of 2.18. Both methods gave comparable diagnostic accuracy.ConclusionAPRI is a useful marker to screen liver fibrosis in the primary care setting when TE is not available.

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The presence of HIV infection in a hospital-based primary care setting

Clinical Eye and Vision Care ◽

10.1016/s0953-4431(96)00200-7 ◽

1997 ◽

Vol 9 (1) ◽

pp. 3-12

Author(s):

Mark T. Dunbar ◽

John J. McSoley ◽

Michelle K. Caputo ◽

Hans M. Kell ◽

James R. Davis

Keyword(s):

Primary Care ◽

Hiv Infection ◽

Care Setting ◽

Primary Care Setting

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Diagnosis and management of chronic hepatitis B in the primary care setting

Postgraduate Medicine ◽

10.3810/pgm.2006.07.1745 ◽

2006 ◽

Vol 119 (2) ◽

pp. 28-36 ◽

Cited By ~ 2

Author(s):

Naoky Tsai

Keyword(s):

Primary Care ◽

Chronic Hepatitis ◽

Hepatitis B ◽

Chronic Hepatitis B ◽

Care Setting ◽

Primary Care Setting ◽

Diagnosis And Management

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Surrogate Markers for Assessing Treatment Response in HIV Disease

Annals of Pharmacotherapy ◽

10.1177/106002809302700412 ◽

1993 ◽

Vol 27 (4) ◽

pp. 450-455 ◽

Cited By ~ 5

Author(s):

Dennis F. Thompson ◽

Marsha A. Raebel ◽

R. Chris Rathbun

Keyword(s):

Clinical Trials ◽

Hiv Infection ◽

Treatment Response ◽

Lymphocyte Count ◽

Interleukin 2 ◽

Surrogate Markers ◽

Hiv Disease ◽

Cd4 Lymphocyte Count ◽

P24 Antigen ◽

Cd4 Lymphocyte

OBJECTIVE: To provide an awareness of the issues surrounding the selection and utility of surrogate markers to evaluate treatment response for new antiretroviral therapies for HIV infection. DATA SOURCES: A MEDLINE search of applicable articles published between 1987 to the present, including clinical trials, commentaries, and editorials, was performed. DATA SYNTHESIS: Surrogate markers are proximal indicators that are predictive of rare or distant outcomes and can be used in clinical trials to decrease sample size and study duration, Characteristics of potential surrogate endpoints include relevance to disease state, face validity, ability to be detected in the majority of patients, and correlation between treatment-induced changes and terminal endpoints. Potential surrogate markers for assessing treatment response in HIV infection can be categorized as either virologic (p24 antigen, plasma viremia, proviral DNA) or immunologic (CD4+ lymphocytes, neopterin, beta2-microglobulin, soluble interleukin-2 receptors, immunoglobulin A [IgA]). The CD4+ lymphocyte count and the p24 antigen have been evaluated in most of the clinical trials examining antiretroviral agents and have the greatest documentation supporting their use. Neopterin and beta2-microglobulin are nonspecific markers, but may improve the predictive value of the CD4+ count when used in combination. Other markers (i.e., soluble interleukin-2 receptors, IgA) remain relatively unstudied at this point. CONCLUSIONS: There is no current consensus regarding the selection of surrogate markers for HIV disease. On the basis of the present literature, the CD4+ lymphocyte count has the greatest endorsement; however, combination with several surrogate markers may prove to be useful in clinical trials. Studies are needed to verify the reliability of surrogate markers used alone and in combination to predict therapeutic response from antiretro viral therapy.

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