4 NEW HCV Abstracts

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J Viral Hepat. 2010 Dec 7. doi: 10.1111/j.1365-2893.2010.01406.x. [Epub ahead of

print]

A comparison of the natural history and outcome of treatment for Asian and

non-Asian hepatitis C-infected patients.

Lawson A; on behalf of the Trent Hepatitis C Study Group.

Department of Hepatology, Royal Derby Hospital, Derby, UK.

Abstract

Summary.  Ethnicity is an important host variable, but its impact on disease

progression and response to therapy in Hepatitis C infection is unclear. Here we

compare the natural history and outcome of therapy in White and Asian (Indian

subcontinent) Hepatitis C infected patients. A total of 2123 White and 120 Asian

HCV infected patients were identified within the Trent HCV study. Response to

therapy was assessed in 224 White and 46 Asian patients with genotype 3

infection who received Pegylated Interferon and Ribavirin. Asian patients were

more likely to be older, female, infected with genotype 3 and to consume no

alcohol. At time of first biopsy, fibrosis stage was significantly higher in

Asian patients than in Whites (3.0 ± 2.3 vs 1.8 ± 2.0, P < 0.001),

as were necro-inflammation and steatosis scores. However, in those patients

where duration of infection could be estimated, fibrosis progression was similar

for both groups (0.25 ± 0.31 vs 0.16 ± 0.54 Ishak points/year,

P = 0.068). 78.3% of Asian and 67.9% of White genotype 3 patients had a

sustained virological response following Pegylated Interferon and Ribavirin.

Cirrhosis and increased levels of GGT, but not ethnicity were associated with a

reduction in the likelihood of a sustained virological response on multivariate

analysis. Asian patients with Hepatitis C are more likely to be female, less

likely to give a history of risk factors, present to medical services at an

older age, and have more severe liver disease at diagnosis, but disease

progression and response to treatment are similar to White patients.

© 2010 Blackwell Publishing Ltd.

PMID: 21138506 [PubMed - as supplied by publisher]

Related citations

J Viral Hepat. 2010 Dec 3. doi: 10.1111/j.1365-2893.2010.01411.x. [Epub ahead of

print]

Integrated internist - addiction medicine - hepatology model for hepatitis C

management for individuals on methadone maintenance.

ez AD, Dimova R, Marks KM, Beeder AB, Zeremski M, Kreek MJ, Talal AH.

Division of General Internal Medicine and Hepatology, Department of Medicine,

University of California San Diego, San Diego, CA Division of Gastroenterology

and Hepatology, Center for the Study of Hepatitis C Division of Infectious

Diseases, Department of Medicine Department of Public Health, Weill Cornell

Medical College The Laboratory of the Biology of Addictive Diseases, Rockefeller

University, New York, NY, USA.

Abstract

Summary.  Despite a high prevalence of hepatitis C virus (HCV) among drug

users, HCV evaluation and treatment acceptance are extremely low among these

patients when referred from drug treatment facilities for HCV management. We

sought to increase HCV treatment effectiveness among patients from a methadone

maintenance treatment program (MMTP) by maintaining continuity of care. We

developed, instituted and retrospectively assessed the effectiveness of an

integrated, co-localized care model in which an internist-addiction medicine

specialist from MMTP was embedded in the hepatitis clinic. Methadone maintenance

treatment program patients were referred, evaluated by the internist and

hepatologist in hepatitis clinic and provided HCV treatment with integration

between both sites. Of 401 evaluated patients, anti-HCV antibody was detected in

257, 86% of whom were older than 40 years. Hepatitis C virus RNA levels were

measured in 222 patients, 65 of whom were aviremic. Of 157 patients with

detectable HCV RNA, 125 were eligible for referral to the hepatitis clinic, 76

(61%) of whom accepted and adhered with the referral. Men engaged in MMTP

<36 months were significantly less likely to be seen in hepatitis clinic than

men in MMTP more than 36 months (odds ratio = 7.7; 95% confidence interval

2.6-22.9) or women. We evaluated liver histology in 63 patients, and 83% had

moderate to advanced liver disease. Twenty-four patients initiated treatment

with 19 completing and 13 (54%) achieving sustained response. In conclusion,

integrated care between the MMTP and the hepatitis clinic improves adherence

with HCV evaluation and treatment compared to standard referral practices.

© 2010 Blackwell Publishing Ltd.

PMID: 21129131 [PubMed - as supplied by publisher]

Related citations

J Viral Hepat. 2010 Dec 3. doi: 10.1111/j.1365-2893.2010.01409.x. [Epub ahead of

print]

Quantification of hepatitis C virus in patients treated with peginterferon-alfa

2a plus ribavirin treatment by COBAS TaqMan HCV test.

Kanda T, Imazeki F, Yonemitsu Y, Mikami S, Takada N, Nishino T, Takashi M,

Tsubota A, Kato K, Sugiura N, Tawada A, Wu S, Tanaka T, Nakamoto S, Mikata R,

Tada M, Chiba T, Kurihara T, Arai M, Fujiwara K, Kanai F, Yokosuka O.

Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba

University, Chiba, Japan Kikkoman Hospital, Noda, Japan Toho University Sakura

Medical Center, Sakura, Japan Tokyo Women's Medical University Yachiyo Medical

Center, Yachiyo, Japan Saiseikai Narashino Hospital, Narashino, Japan Institute

of Clinical Medicine and Research, Jikei University School of Medicine, Kashiwa,

Japan Narita Red Cross Hospital, Narita, Japan National Hospital Organization

Chiba Medical Center, Chiba, Japan.

Abstract

Summary.  Extremely low levels of serum hepatitis C virus (HCV) RNA can be

detected by COBAS TaqMan HCV test. To investigate whether the COBAS TaqMan HCV

test is useful for measuring rapid virological response (RVR) and early

virological response (EVR) to predict sustained virological response (SVR), we

compared the virological response to PEG-IFN-alfa 2a plus RBV in 76 patients

infected with HCV genotype 1 when undetectable HCV RNA by the COBAS TaqMan HCV

test was used, with those when below 1.7 log IU/mL HCV RNA by COBAS TaqMan

HCV test was used, which corresponded to the use of traditional methods. Among

the 76 patients, 28 (36.8%) had SVR, 13 (17.1%) relapsed, 19 (25.0%) did not

respond, and 16 (21.0%) discontinued the treatment due to side effects. The

positive predictive values for SVR based on undetectable HCV RNA by COBAS TaqMan

HCV test at 24 weeks after the end of treatment [10/10 (100%) at week 4, 21/23

(91.3%) at week 8 and 26/33 (78.7%) at week 12] were superior to those based on

<1.7 log IU/mL HCV RNA [17/19 (89.4%) at week 4, 27/38 (71.0%) at week 8,

and 27/43 (62.7%) at week 12]. The negative predictive values for SVR based on

<1.7 log IU/mL HCV RNA by COBAS TaqMan HCV test [46/57 (80.7%) at week 4,

37/38 (97.3%) at week 8, and 32/33 (96.9%) at week 12] were superior to those

based on undetectable HCV RNA [48/66 (72.7%) at week 4, 46/53 (86.7%) at week 8,

and 41/43 (95.3%) at week 12]. The utilization of both undetectable RNA and

<1.7 log IU/mL HCV RNA by COBAS TaqMan HCV test is useful and could predict

SVR and non-SVR patients with greater accuracy.

© 2010 Blackwell Publishing Ltd.

PMID: 21129130 [PubMed - as supplied by publisher]

Related citations

J Viral Hepat. 2010 Dec 3. doi: 10.1111/j.1365-2893.2010.01407.x. [Epub ahead of

print]

Impact of liver steatosis on the correlation between liver stiffness and

fibrosis measured by transient elastography in patients coinfected with human

immunodeficiency virus and hepatitis C virus.

Sánchez-Conde M, Montes Ramírez ML, Bellón Cano JM, Caminoa A, Rodríguez FA,

JG, Martín PM, Bernardino de la Serna I, Bernardo de Quirós JC, Arribas

López JR, Ochaíta JC, Pascual Pareja JF, Alvarez E, Berenguer JB.

Infectious Diseases and HIV Unit, Hospital Universitario Gregorio Marañón,

Madrid, Spain Department of Internal Medicine 2, Hospital Universitario La Paz,

Madrid, Spain Biomedical Research Foundation, Hospital Universitario Gregorio

Marañón, Madrid, Spain Department of Pathology, Hospital Universitario La Paz,

Madrid, Spain Department of Pathology, Hospital Universitario Gregorio

Marañón, Madrid, Spain.

Abstract

Summary.  We assessed the effect of different hepatic conditions such as

fibrosis, steatosis and necroinflammatory activity on liver stiffness as

measured by transient elastography in HIV/HCV-coinfected patients. We studied

all consecutive HIV/HCV-coinfected patients who underwent liver biopsy and

elastography between January 2007 and December 2008. Liver fibrosis was staged

following METAVIR ative Study Group criteria. Steatosis was categorized

according to the percentage of affected hepatocytes as low (≤10%), moderate

(<25%) and severe (≥25%). A total of 110 patients were included. Fibrosis was

distributed by stage as follows: F0, n = 13; F1, n = 47; F2, n = 29;

F3, n = 18; and F4, n = 3. Liver biopsy revealed the presence of hepatic

steatosis in 68 patients (low to moderate, n = 53; and severe n = 15).

By univariate regression analysis, fibrosis, necroinflammatory activity, and the

degree of steatosis were correlated with liver stiffness. However, in a multiple

regression analysis, steatosis and fibrosis were the only independent variables

significantly associated with liver stiffness. With a cut-off of 9.5 kPa to

distinguish patients with F ≤ 2 from F ≥ 3, elastography led to a

significantly higher number of misclassification errors (25%vs 5%;

P = 0.014), most of which were false positives for F ≥ 3. Our study

suggests that the correlation between liver stiffness and fibrosis as estimated

by transient elastography may be affected by the presence of hepatic steatosis

in HIV/HCV-coinfected patients.

© 2010 Blackwell Publishing Ltd.

PMID: 21129129 [PubMed - as supplied by publisher]