scholarly journals Comparative analysis of the interleukin-28b gene alleles in patients with hepatitis C monoinfection and combined HIV/hepatitis C infection

2013 ◽  
Vol 94 (3) ◽  
pp. 316-320
Author(s):  
V K Fazylov ◽  
E R Manapova ◽  
S V Tkacheva ◽  
F M Yakupova ◽  
A T Beshimov
Keyword(s):  
Viral Load ◽  
Comparative Analysis ◽  
Hepatitis C ◽  
Absolute Number ◽  
Hcv Infection ◽  
Hcv Rna ◽  
Hepatitis C Infection ◽  
Genotype 3 ◽  
Median Percentage ◽  
Baseline Activity

Aim. To identify the frequency and to perform the comparative analysis of IL-28B genotypes distribution in patients with hepatitis C (HCV) mono-infection and combined HIV/HCV infection. Methods. 101 patients (65% - males, average age 33.85±0.62 years) were included in the study. The first group (n=58) - patients with HCV mono-infection, second (n=43) - patients with combined HIV/HCV infection. Single nucleotides polymorphism at rs8099917 and rs12979860 locuses of IL-28B gene was performed using the «AmpliSens Genoscreen-IL28V-FL» reagent kit in the viral hepatitis laboratory of the molecular diagnostics department, CSRIE, Moscow. The baseline activity of HCV infection was determined by RNA-HCV viral load 400 000 copies/mL and alanine aminotransferase level (ALT). In the first group high RNA-HCV viral load (400 000 copies/mL) was observed in 30 (51.7%) patients, mean ALT level was 72.79±9.85 U/L; in the second group high HCV-RNA viral load was detected in 35 (81.4%) patients, mean ALT level was 85.46±7.73 U/L. In the group with combined infection 26 (60.5%) of patients received antiretroviral therapy (ART); in 14 (53.8%) of them there was no detectable viral load. The median absolute number of CD4+ lymphocytes was 0.400±0.04 cells/μL, median percentage - 25.41%±2.41. In 17 (39.5%) treatment-naïve patients the viral load was low (10 000 copies/mL), in 11 (64.8%) of these patients mean CD4+ count was 0.470±0.04 cells/μL (25.33%±2.15); the term of HIV antibodies detection was 6.89±0.53 years. The sensitivity of the PCR method for the qualitative detection of HCV-RNA was 111.1 copies/mL, quantitative - 275 copies/mL, for HIV-RNA - 150 copies/mL. Results. In patients with HCV mono-infection the rate of unfavorable IL-28B CT and TT rs12979860 genotypes and ТG and GG rs8099917 genotypes was 45 (77.6%) и 26 (44.8%) correspondingly, favorable СС rs12979860 and ТТ rs8099917 genotypes were registered in 13 (22.4%) and 32 (55.1%) patients correspondingly. In patients with HIV/HCV infection (n=43) unfavorable IL-28B CT and TT rs12979860 genotypes and ТG and GG rs8099917 genotypes were detected in 20 (46.5%) и 13 (30.2%) of cases, and favorable СС rs12979860 and ТТ rs8099917 genotypes - in 23 (53.5%) and 30 (69.8%) of cases correspondingly. Conclusion. Results show that favorable CC rs12979860 and TT rs8099917 genotypes of the IL-28B and their combination are found quite frequently in patients with mixed HCV/HIV infection, particularly in patients with HCV genotype 3, these patients also had more significant inflammatory reaction and high HCV RNA viral load compared to HCV mono-infected patients.

scholarly journals Prevalence of Hepatitis C Infection and its Genotypes in Suspected Hemodialysis Patients, Southwest of Iran

2021 ◽  
Vol 14 (11) ◽  
Author(s):  
Marzieh Jamalidoust ◽  
Maryam Eskandari ◽  
Mazyar Ziyaeyan
Keyword(s):  
Viral Load ◽  
Hepatitis C ◽  
Management Practices ◽  
Hemodialysis Patients ◽  
Hcv Infection ◽  
Research Center ◽  
Enzyme Linked Immunosorbent Assay ◽  
Hcv Rna ◽  
Hepatitis C Infection ◽  
Genotype 3

Background: Hemodialysis patients are more prone to Hepatitis C Virus (HCV) infection due to the need for long-term hemodialysis and blood transfusions. Objectives: The present study aimed to determine the HCV infection burden, viral load, and genotype pattern in hemodialysis patients referred to a research center from 2011 to 2018. Methods: Among 131 hemodialysis patients with suspected HCV infection, referred to Prof. Alborzi Clinical Microbiology Research Center, Shiraz, Iran, from 2011 to 2018, the HCV rate was assessed with the enzyme-linked immunosorbent assay and the HCV RNA load and genotypes by one-step TaqMan real-time PCR. Results: The prevalence of HCV-Ab positivity was 29% among hemodialysis patients, of whom 21 (57%) were HCV RNA-positive. In the rest of the hemodialysis patients who were HCV-Ab-negative, the HCV RNA was detected in five (12%) patients. Genotype 3 (Gt-3) was the most prevalent one detected in 50% of the patients whose genotypes were determined. Also, the HCV viral load in HCV-seropositive patients was generally higher than that in HCV-seronegative ones. Conclusions: This study showed that high HCV infection and different genotype patterns among hemodialysis patients compared to the general population are the main predictors of HCV infection, which indicates healthcare facility transmission because of inappropriate infection management practices.

Hepatitis C infection among survivors of childhood cancer

Blood ◽  
2000 ◽  
Vol 95 (10) ◽  
pp. 3065-3070 ◽  
Author(s):  
Donald K. Strickland ◽  
Caroline A. Riely ◽  
Christian C. Patrick ◽  
Dana Jones-Wallace ◽  
James M. Boyett ◽  
...  
Keyword(s):  
Liver Disease ◽  
Hepatitis C ◽  
Liver Function ◽  
Childhood Cancer ◽  
Normal Liver ◽  
Hcv Infection ◽  
Hcv Rna ◽  
Hepatitis C Infection ◽  
Primary Malignancy ◽  
Survivors Of Childhood Cancer

Abstract Preliminary reports have suggested that survivors of childhood cancer and aplastic anemia who are infected with the hepatitis C virus (HCV) have a low risk for progression to significant liver disease. Among our surviving patients who were transfused between 1961 and March 1992, 77 (6.6% of surviving patients tested thus far) have evidence of HCV infection, whereas 4 surviving patients who were transfused after March 1992 are HCV-infected. One patient chronically infected with HCV died of liver failure, and 2 patients died of hepatocellular carcinoma. To characterize the risk for these and other complications, 65 patients are enrolled in a longitudinal study of HCV infection, of whom 58 (89.2%) had circulating HCV RNA at the time of protocol enrollment, with genotypes 1A and 1B most commonly isolated. Most enrolled patients have few or no symptoms, carry out normal activities, and have normal liver function. To date, 35 patients have undergone liver biopsy for abnormal liver function since the diagnosis of primary malignancy; central pathology review shows 28 (80%) have chronic active hepatitis, 25 (71%) have fibrosis, and 3 (9%) have cirrhosis. These preliminary data suggest that though most survivors of childhood cancer who are infected with HCV are clinically well, some are at risk for clinically significant liver disease. Identification of other HCV-infected patients and prospective monitoring of this cohort are ongoing to determine the risk for, and to identify factors associated with the progression of, liver disease.

scholarly journals Interferon treatment for chronic hepatitis C infection in hemophiliacs-- influence of virus load, genotype, and liver pathology on response

Blood ◽  
1996 ◽  
Vol 87 (5) ◽  
pp. 1704-1709 ◽  
Author(s):  
JP Hanley ◽  
LM Jarvis ◽  
J Andrew ◽  
R Dennis ◽  
PC Hayes ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Early Stage ◽  
Hcv Infection ◽  
Hcv Rna ◽  
Interferon Treatment ◽  
Hepatitis C Infection ◽  
Virus Load ◽  
Chronic Hcv

In this study, we assessed the effectiveness of interferon treatment in 31 hemophiliacs with chronic hepatitis C virus (HCV) infection. Interferon alfa-2a (3 MU three times weekly) was administered for 6 months. Response was assessed by both serial alanine transaminase (ALT) and HCV RNA levels measured by a sensitive semiquantitative polymerase chain reaction (PCR) method. HCV genotype was determined by restriction fragment length polymorphism (RFLP), and evidence of changing genotypes during interferon therapy was sought. Severity of liver disease was assessed by both noninvasive and invasive methods, including laparoscopic liver inspection and biopsy. Sustained normalization of ALT levels occurred in eight patients (28%), and seven (24%) became nonviremic as assessed by PCR (<80 HCV/mL). Responders universally cleared HCV RNA within 2 months of starting interferon. Genotype 3a was associated with a favorable response to interferon. No evidence was found for a change in circulating genotype in patients who failed to respond to interferon or who relapsed. This study confirms that response rates to interferon are low in hemophiliacs as compared with other groups with chronic HCV infection. We have also demonstrated that virus load measurement over the first 8 to 12 weeks of treatment is an extremely useful method to identify responders at an early stage.

scholarly journals COMBINED NS5A & NS5B NUCLEOTIDE INHIBITOR THERAPY FOR PATIENTS WITH CHRONIC HEPATITIS C WITH STAGE 5 CHRONIC KIDNEY DISEASE ON HEMODIALYSIS

2020 ◽  
Vol 57 (1) ◽  
pp. 39-44 ◽  
Author(s):  
Prasanta DEBNATH ◽  
Sanjay CHANDNANI ◽  
Pravin RATHI ◽  
Sujit NAIR ◽  
Vinay PAWAR ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Post Treatment ◽  
Hcv Infection ◽  
Maintenance Hemodialysis ◽  
Hcv Rna ◽  
Genotype 3 ◽  
Open Label ◽  
Genotype 2

ABSTRACT BACKGROUND: Hepatitis C virus (HCV) infection is the most common hepatotropic viral infection affecting the patients on maintenance hemodialysis. Treatment of chronic HCV infection in stage 4 and 5 CKD includes a combination of elbasvir/grazoprevir and glecaprevir/pibrentasvir, which are not available in many countries. OBJECTIVE: Hence, we have conducted this study to look for the safety and efficacy of sofosbuvir combination therapy in this difficult to treat population. METHODS: We conducted a single-center, prospective, open-label study in which Stage 5 CKD patients on maintenance hemodialysis with HCV infection. Total of 18 patients was included. sofosbuvir with daclatasvir or ledipasvir was used according to genotype for 12 weeks. HCV RNA, genotype, transient elastography (TE) was considered for every patient. HCV RNA was quantified at 4th week, 12th week and 12 weeks post-treatment to look for sustained virologic response (SVR 12). RESULTS: Infection due to genotype 1 was seen in 12 (66.7%) patients followed by genotype 3 in 4 (22.3%) with each patient of genotype 2 and 5. The median value of HCV RNA was 2,35,000 IU/mL. On TE, all had liver stiffness of <9.4 KPa. All patients had HCV RNA of <15 IU/mL at 4th and 12th week of treatment and 12 weeks post-treatment. No significant change in hemoglobin, eGFR and liver stiffness was observed. CONCLUSION: Full dose sofosbuvir i.e. 400 mg, in combination with NS5A inhibitors daclatasvir or ledipasvir is found to be safe and effective in patients with end stage renal disease, who are on maintenance hemodialysis.

scholarly journals Clinical, Biochemical and Virological Profile of Patients with Chronic Hepatitis C Virus Infection - A Study from University Hospital in Nepal

2015 ◽  
Vol 4 (1) ◽  
pp. 32-35
Author(s):  
Dipesh Gurubacharya ◽  
Mohan Khadka ◽  
Khadga B Shreshta ◽  
Prem Khadga ◽  
Sashi Sharma
Keyword(s):  
Hepatitis C Virus ◽  
Viral Load ◽  
Hepatitis C ◽  
Drug Use ◽  
Injection Drug Use ◽  
Hcv Infection ◽  
Genotype 3 ◽  
Hcv Genotypes ◽  
Chronic Hcv Infection ◽  
Chronic Hcv

Introduction: Hepatitis C virus (HCV) infection is a major public health challenge. It is a major cause for cirrhosis and hepatocellular carcinoma worldwide. Both the genotype and viral load of HCV determine the choice of therapy as well as outcome of therapy. The aim of this study was to evaluate clinical, biochemical and virological profile and association of HCV genotypes with viral load and liver biochemical profile.Material and Methods: This was descriptive observational study of chronic HCV infected patients who attended at the outpatient clinic of Department of Gastroenterology of TUTH, IOM from April 2013 to November 2014. During this study period 38 patients with chronic HCV infection were analyzed. Clinical profile, possible risk factors for transmission of HCV infection and liver biochemical profile were recorded. Virological profile included HCV viral load and HCV genotypes.Results: Out of 38 patients 34(89.5%) were male and 4(10.5%) were female. Injection drug use (IDU) was the most common mode for acquisition of HCV infection (55.3%). Genotype 3 was found in 21(55.26%) patients and genotype 1 was found in 17(44.74%) patients. There was no significant association between HCV genotypes and serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) level. And also there was no significant association between HCV viral load and different HCV genotypes.Conclusions: In our study HCV genotype 3 was the most prevalent genotype in patients with chronic HCV infection. Injection drug use was identified as most common identifiable risk factor for transmission of HCV infection. There was no significant association between different HCV genotypes and serum ALT, AST level and HCV viral load. Journal of Nobel College of Medicine Vol.4(1) 2015: 32-35

scholarly journals Hepatitis C Core Antigen Testing to Diagnose Active Hepatitis C Infection Among Haemodialysis Patients

2020 ◽  
Author(s):  
XZ Wong ◽  
CC Gan ◽  
R M ◽  
R Y ◽  
S G ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Predictive Value ◽  
Hcv Infection ◽  
Core Antigen ◽  
Hcv Rna ◽  
Hepatitis C Infection ◽  
Hcv Treatment ◽  
Serological Screening ◽  
Cross Sectional ◽  
Spearman Test

Abstract BACKGROUNDHepatitis C virus (HCV) infects more than 71 million people worldwide and chronic HCV infection increases the risk of liver cirrhosis and failure. Haemodialysis (HD) is one of the renal replacement therapies with risk of HCV transmission. Anti-HCV antibodies are the serological screening test for HCV infection that does not detect active phase of infection. Majority HCV infected HD patients in Malaysia do not have further HCV RNA performed due to high cost and thus HCV treatment is less frequently offered. HCV Core Antigen (HCV Ag) can potentially be used to diagnose active HCV infection in HD population in comparison to HCV RNA, at lower cost. METHODS We conducted a cross-sectional study to assess the correlation between HCV Ag and HCV RNA and to identify the prevalence of active HCV infection among HCV seropositive HD patients from dialysis centres across West Malaysia from July 2019 to May 2020. Pre-dialysis blood was taken and tested for both HCV Ag and HCV RNA tests. HCV Ag was tested with Abbott ARCHITECT HCV Ag test.RESULTS We recruited 112 seropositive HD patients from 17 centres with mean age of 54.04±11.62 years, HD vintage of 14.1±9.7 years, and male constitute 59.8% (67) of the study population. HCV Ag correlates well with HCV RNA (Spearman test coefficient 0.833, p<0.001). The sensitivity was 90.7%, specificity 100%, positive predictive value (PPV) 100%, negative predictive value (NPV) 76.5%, and accuracy 92.9%. For HCV RNA level >3000 IU/mL, HCV Ag had a higher sensitivity of 95.1% and greater correlation (Spearman test coefficient 0.897, p<0.001). The prevalence of active HCV infection was 76.8% among HCV seropositive HD patients. CONCLUSIONS Although HCV Ag is less sensitive, it shows an excellent correlation with HCV RNA and has 100% PPV. HCV Ag can be considered as an alternative diagnostic tool for chronic active HCV infection among HD cohort, who can then be considered for HCV treatment. For seropositive HD patient with negative HCV Ag, we recommend to follow-up with HCV RNA test.

scholarly journals Clinical and epidemiological characteristics and gene variant structure of HCV-infection in the area of the Krasnodar Territory

2013 ◽  
Vol 18 (6) ◽  
pp. 8-16
Author(s):  
M. G. Avdeeva ◽  
V. N. Gorodin ◽  
A. A. Konchakova ◽  
V. A. Dubinina ◽  
N. V. Kotova ◽  
...  
Keyword(s):  
Viral Load ◽  
Hepatitis C ◽  
Clinical Manifestations ◽  
Hcv Infection ◽  
Genotype 3 ◽  
Virus Genotype ◽  
Hcv Genotypes ◽  
Genotype 1B ◽  
Genotype 2 ◽  
Epidemiological Characteristics

The purpose of research - based on analysis of the clinical-epidemiologic data, the level of viral load and the prevalence of HCV genotypes to determine current consistencies and epidemiological trends of the development of HCV-infection in the area of the Krasnodar Territory. Patients and methods. Population incidence of hepatitis C in the Krasnodar Territory was studied for the period from 2004 to 2011. Clinical manifestations of the disease we evaluated on the base of a retrospective analysis of 1913 hospital records of patients with chronic hepatitis C. There were investigated the results of 19,338 qualitative PCR studies of RNA-HCV, 2041 studies for genotyping and 363 results of quantitative evaluation of RNA-HCV Results. In the Krasnodar Territory there is revealed circulation of 1a, 1b, 2, 3a HCV genotypes. In a population of genotypes 1b (48 %) and 3a (38 %) prevail. In recent years there has been visible trend to displacement of genotype 1b by the increase the incidence of genotype 3 a in a set of areas. Social Portrait of the patient with hepatitis C: a man aged 28 to 48, a city resident, a salary earner or unemployed. There were established gender peculiarities: males are more often infected with hepatitis C genotype 3a, females - genotype 1b. In most cases (65%) viremia is characterized by moderate viral load. In the studied population there is revealed the relationship between the activity of the process and infection with certain genotype. Moderate grade of hepatitis activity is significantly more frequently recorded in the disease caused by 1c and 3 a virus subtypes. Minimal activity of hepatitis is not typical for the process caused by genotype 2 and in genotype 3 a occurs much less frequently than in cases caused by genotype 1b. Conclusion. Epidemiological analysis of the incidence of hepatitis C should take into account trends in the spread of various genotypes of the virus. Hepatitis C virus genotype should be taken into account as in the forecast of the disease and in determination of the indications for antiviral therapy. The main socio-age group actively involved in the epidemic process and need for causal treatment, are young persons of working age.

EFFICACY OF SOFOSBUVIR AND DACLATASVIR IN COMPENSATED CHRONIC HEPATITIS C INFECTION: A SINGLE CENTER, OPEN-LABEL AND PROOF OF CONCEPT STUDY

2021 ◽  
pp. 27-30
Author(s):  
Manisha Thakur ◽  
Anurag Chauhan ◽  
Prashant Jambunathan ◽  
Shikha Awasthi ◽  
Thilagavathi K ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Sustained Virological Response ◽  
Chronic Hepatitis C ◽  
Virological Response ◽  
Sustained Viral Response ◽  
Hcv Rna ◽  
Hepatitis C Infection ◽  
Genotype 3 ◽  
Treatment Naïve

AIMS AND OBJECTIVES: The advent of directly acting agents for the treatment of Hepatitis C infection has forever transformed our understanding and management of viral infections. With over 95 % patients achieving a sustained viral response at 12 weeks with some of these newly inducted agents, the prospect of eradicating the Hepatitis C virus seems like an achievable target, which makes this one of the most important discoveries in modern medicine. We studied the combination of Sofosbuvir and Daclatasvir in patients with chronic hepatitis C infection (Genotype 3) to assess the rates of sustained virological response at 12 weeks. We studied 67 treatment naive METHODS: patients with compensated chronic hepatitis C infection (genotype 3). They were all started on Tab Sofosbuvir 400 mg daily and Tab Daclatasvir 60 mg once daily for 12 weeks and followed up for a total of 24 weeks, which includes a treatment duration and observation period of 12 weeks each. The patients were monitored with HCV RNA levels at one, three and six months, with as many evaluations of liver function and routine hemogram. Our results show that 70.5% (p<0.05) achieved a rapid vi RESULTS: rological response, 88.5% (p<0.05) achieved an end of treatment response and, similarly, an impressive 88.05% (p<0.05) showed a sustained virological response at the end of 12 weeks. One patient who developed a psoriasiform rash discontinued the medication and was excluded from the analysis, as duration of treatment had not been completed. No major dose related adverse events were reported. Sofosbuvir and Daclatasvir is an acceptable, well tolerated regimen for treatment naive, CONCLUSIONS: compensated patients with genotype 3 infection. Based on our observations and data, we recommend this as the rst line DAA for patient with compensated genotype 3 infection until medications with higher SVR 12 are available in the Indian market.

Hepatitis C infection among survivors of childhood cancer

Blood ◽  
2000 ◽  
Vol 95 (10) ◽  
pp. 3065-3070
Author(s):  
Donald K. Strickland ◽  
Caroline A. Riely ◽  
Christian C. Patrick ◽  
Dana Jones-Wallace ◽  
James M. Boyett ◽  
...  
Keyword(s):  
Liver Disease ◽  
Hepatitis C ◽  
Liver Function ◽  
Childhood Cancer ◽  
Normal Liver ◽  
Hcv Infection ◽  
Hcv Rna ◽  
Hepatitis C Infection ◽  
Primary Malignancy ◽  
Survivors Of Childhood Cancer

Preliminary reports have suggested that survivors of childhood cancer and aplastic anemia who are infected with the hepatitis C virus (HCV) have a low risk for progression to significant liver disease. Among our surviving patients who were transfused between 1961 and March 1992, 77 (6.6% of surviving patients tested thus far) have evidence of HCV infection, whereas 4 surviving patients who were transfused after March 1992 are HCV-infected. One patient chronically infected with HCV died of liver failure, and 2 patients died of hepatocellular carcinoma. To characterize the risk for these and other complications, 65 patients are enrolled in a longitudinal study of HCV infection, of whom 58 (89.2%) had circulating HCV RNA at the time of protocol enrollment, with genotypes 1A and 1B most commonly isolated. Most enrolled patients have few or no symptoms, carry out normal activities, and have normal liver function. To date, 35 patients have undergone liver biopsy for abnormal liver function since the diagnosis of primary malignancy; central pathology review shows 28 (80%) have chronic active hepatitis, 25 (71%) have fibrosis, and 3 (9%) have cirrhosis. These preliminary data suggest that though most survivors of childhood cancer who are infected with HCV are clinically well, some are at risk for clinically significant liver disease. Identification of other HCV-infected patients and prospective monitoring of this cohort are ongoing to determine the risk for, and to identify factors associated with the progression of, liver disease.

scholarly journals Interferon treatment for chronic hepatitis C infection in hemophiliacs-- influence of virus load, genotype, and liver pathology on response

Blood ◽  
1996 ◽  
Vol 87 (5) ◽  
pp. 1704-1709 ◽  
Author(s):  
JP Hanley ◽  
LM Jarvis ◽  
J Andrew ◽  
R Dennis ◽  
PC Hayes ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Early Stage ◽  
Hcv Infection ◽  
Hcv Rna ◽  
Interferon Treatment ◽  
Hepatitis C Infection ◽  
Virus Load ◽  
Chronic Hcv

Abstract In this study, we assessed the effectiveness of interferon treatment in 31 hemophiliacs with chronic hepatitis C virus (HCV) infection. Interferon alfa-2a (3 MU three times weekly) was administered for 6 months. Response was assessed by both serial alanine transaminase (ALT) and HCV RNA levels measured by a sensitive semiquantitative polymerase chain reaction (PCR) method. HCV genotype was determined by restriction fragment length polymorphism (RFLP), and evidence of changing genotypes during interferon therapy was sought. Severity of liver disease was assessed by both noninvasive and invasive methods, including laparoscopic liver inspection and biopsy. Sustained normalization of ALT levels occurred in eight patients (28%), and seven (24%) became nonviremic as assessed by PCR (<80 HCV/mL). Responders universally cleared HCV RNA within 2 months of starting interferon. Genotype 3a was associated with a favorable response to interferon. No evidence was found for a change in circulating genotype in patients who failed to respond to interferon or who relapsed. This study confirms that response rates to interferon are low in hemophiliacs as compared with other groups with chronic HCV infection. We have also demonstrated that virus load measurement over the first 8 to 12 weeks of treatment is an extremely useful method to identify responders at an early stage.

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