Experiences on antiviral treatment for chronic viral B and C hepatitis patients in Hungary. 1998–2004

2007 ◽  
Vol 148 (18) ◽  
pp. 819-826 ◽  
Author(s):  
Alajos Pár ◽  
István Tornai ◽  
Ferenc Szalay
Keyword(s):  
Hepatitis C ◽  
Antiviral Treatment ◽  
Interferon Α ◽  
Standard Interferon

Az utolsó évtizedben számos multicentrikus, randomizált vizsgálat bizonyította az előrehaladást a krónikus vírushepatitisek kezelésében. Ugyanakkor csak korlátozott számú és ellentmondásos adatokat közöltek az antivirális terápia reális értékéről a mindennapos rutin klinikai gyakorlatában. Cél: Retrospektív felmérést végeztünk a terápia hatékonyságának megállapítására krónikus B- és C-hepatitisben, egy 7 éves periódus alatt kezelt országos populációban. Emellett bemutatjuk még egy hazai prospektív vizsgálat néhány adatát is. Módszerek: 220 krónikus B-hepatitises beteget kezeltünk, közülük 112 standard interferon-, 23 pegilált interferon-, 85 lamivudin-terápiában részesült, akikben a HbeAg-szerokonverzió és/vagy HBV-DNS-negatívvá válás arányát vizsgáltuk. A retrospektív elemzésben szereplő 2442 krónikus C-hepatitises közül 333 standard interferon-monoterápiát, 1122 standard interferon + ribavirin kombinációt és 987 pegilált interferon + ribavirin-kezelést kapott. A prospektív vizsgálatban 69 HCV1-beteg pegilált interferon α-2a + ribavirin terápiában részesült 6–12 hónapon át. A tartós virológiai válasz mellett vizsgáltuk a kedvező kimenetel prediktorait és a mellékhatások előfordulását. Eredmények: Krónikus B-hepatitisben a standard interferon 31%-os, a pegilált interferon 30%-os, a lamivudin 31–33%-os tartós vírusnegativitáshoz vezetett. Krónikus C-hepatitisben a tartós virológiai válasz aránya az interferon-monoterápiával észlelt 13%-ról a pegilált interferon + ribavirin mellett 31%-ra nőtt, a prospektív vizsgálatban ez 48% volt. A jó prognózis prediktora a rapid (4 hetes) és a korai (12 hetes) virológiai válasz, a női nem, az életkor, BMI és az adherencia volt. A betegek 9%-ában fordult elő mellékhatás, leggyakrabban cytopenia, haemolysis és depresszió. Következtetés: A krónikus B-hepatitisszel ellentétben, a hepatitis C-vírusinfekció kezelésének effektivitása hazánkban is fokozatosan javult. A mindennapi gyakorlat országos adatai azonban elmaradnak a prospektív vizsgálat sikerességétől. A jövőben hatékonyabb terápiás stratégiák szükségesek, beleértve az individualizált dozírozást és az új antivirális szerek alkalmazását.

The effect of antiviral therapy on t(14;18) translocation and immunoglobulin gene rearrangement in patients with chronic hepatitis C virus infection

Blood ◽  
2001 ◽  
Vol 97 (6) ◽  
pp. 1555-1559 ◽  
Author(s):  
Eli Zuckerman ◽  
Tsila Zuckerman ◽  
Dvora Sahar ◽  
Sara Streichman ◽  
Dina Attias ◽  
...  
Keyword(s):  
Hepatitis C ◽  
B Cell ◽  
Cell Lymphoma ◽  
Antiviral Treatment ◽  
B Cell Lymphoma ◽  
Interferon Α ◽  
Clonal Proliferation ◽  
Chronic Hcv Infection ◽  
Igh Rearrangement ◽  
Chronic Hcv

The mechanism of lymphomagenesis of hepatitis C virus (HCV)–related B-cell lymphoma is unknown. Recently, it has been suggested that HCV may induce B-cell clonal proliferation and t(14;18) translocation in patients chronically infected with the virus. Thus, this study investigated the effect of antiviral treatment on immunoglobulin heavy-chain gene (IgH) rearrangement and t(14;18) translocation in HCV infected patients. Twenty-nine patients with chronic HCV infection were studied in whom IgH rearrangement and/or t(14;18) translocation were previously detected. The IgH rearrangement (FR3/JH) and t(14;18) translocation (MBR bcl2-JH) were detected in peripheral blood mononuclear cells by polymerase chain reaction. Fifteen of 29 patients (8 with IgH rearrangement, 6 with t(14;18) translocation, and 1 with both) were treated with either interferon-α or by combination therapy with interferon and ribavirin for 6 to 12 months. IgH rearrangement became negative in 7 of 9 treated patients compared with only 1 of 8 of nontreated patients (P < .02). The t(14;18) translocation became negative in 6 of 7 treated patients compared with 1 of 6 nontreated patients (P = .03). Disappearance of IgH rearrangement or t(14;18) translocation was strongly associated with virologic response to treatment. Two t(14;18)+patients developed B-cell lymphoma during follow-up. Antiviral treatment appears to be effective in eliminating the clonal proliferation of B cells in patients with chronic HCV infection and may prevent the subsequent development of lymphoma. The mechanism can be related to a direct effect of interferon-α on the proliferating clone or to an indirect effect by eradicating the antigenic stimulus.

Chronic hepatitis C, depression and gender: a state of art

2015 ◽  
Vol 8 (4) ◽  
pp. 193-210 ◽  
Author(s):  
Rocio Martin-Santos ◽  
Elfi Egmond ◽  
Myriam Cavero ◽  
Zoe Mariño ◽  
Susana Subira ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Multidisciplinary Approach ◽  
Antiviral Treatment ◽  
Antidepressant Drugs ◽  
Interferon Α ◽  
Content Type ◽  
Route Of Transmission ◽  
And Gender

Purpose – The purpose of this paper is to provide a comprehensive overview of the current knowledge regarding chronic hepatitis C (CHC) infection, antiviral therapy, depression, and gender. Design/methodology/approach – CHC and its treatment options were reviewed examining their relationship with depression and gender. Findings – CHC is a high prevalent chronic infection worldwide, being similar in men and women. However, the infection shows many gender differences in terms of innate response, genetic variability (i.e. IL-28B), route of transmission (i.e. intravenous drug use), disease progression (i.e. fibrosis), lifetime period (i.e. pregnancy), and risk factors (i.e. HIV). Both the hepatitis C infection and antiviral treatment (especially when using the pro-inflammatory cytokine interferon α), are highly associated with depression, where female gender constitutes a risk factor. It seems that the new direct-acting antiviral combinations produce fewer neuropsychiatric side effects. In fact, the presence of depression at baseline is no longer a limitation for the initiation of antiviral treatment. Antidepressant drugs have been recommended as current depression and prophylactic treatment in risk subgroups. However, caution should be exercised due to the risk of drug-drug interactions with some antiviral drugs. Women should be counselled prenatal, during and after pregnancy, taking into account the clinical situation, and the available evidence of the risks and benefits of antiviral and antidepressant treatments. Multidisciplinary approach shows cost-efficacy results. Originality/value – The paper clarifies the complex management of CHC therapy and the importance of individualizing treatment. The results also underline the need for an integrated multidisciplinary approach.

Genetic polymorphisms as the predictors of response to antiviral treatment in chronic hepatitis C virus infection

2011 ◽  
Vol 152 (22) ◽  
pp. 876-881
Author(s):  
Alajos Pár
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Genetic Polymorphisms ◽  
Chronic Hepatitis C ◽  
Genome Wide Association Study ◽  
Antiviral Treatment ◽  
Hcv Infection ◽  
Snp Analysis ◽  
Chronic Hcv

The review discusses the genetic polymorphisms involved in the pathogenesis of hepatitis C virus (HCV) infection, that may determine the outcome of disease. In this field earlier both certain major histocompatibility complex (MHC) alleles and some cytokine gene variants have also been studied. Recently, the genome-wide association study (GWAS) and targeted single nucleotide polymorphism (SNP) analysis have revealed that a variant in the promoter region of interleukin-28B (IL-28B) gene is strongly linked to viral clearance and it may be the strongest pretreatment predictor of treatment response in chronic hepatitis C. Last year it was shown that two genetic variants leading to inosine triphosphatase deficiency protect against haemolytic anemia in patients receiving ribavirin during antiviral treatment for chronic HCV infection. Orv. Hetil., 2011, 152, 876–881.

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