Guest guest Posted February 28, 2011 Report Share Posted February 28, 2011 Arch Virol. 2011 Feb 22. [Epub ahead of print] Post-transfusion-transmitted hepatitis C virus infection: a study on thalassemia and hemodialysis patients in southeastern Iran. Hassanshahi G, Arababadi MK, Assar S, Hakimi H, Karimabad MN, Abedinzadeh M, Rafatpanah H, Derakhshan R. Molecular Medicine Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran, ghassanshahi@.... Abstract Thalassemia and hemodialysis patients are at risk of blood-transmitted infections due to their long-term need for blood transfusion. Nowadays, control of viral infections, including HCV infections, is one of the main tasks of blood transfusion services worldwide. Therefore, the aim of this research was to investigate the prevalence of HCV infection in thalassemia and hemodialysis patients in Kerman, in southeastern Iran. In this cross-sectional experimental study, 384 (203 hemodialysis and 181 thalassemia) patients were examined for HCV infection. Demographic data were also collected by questionnaire, and HCV infection was screened by enzyme-linked immunosorbent assay (ELISA) and confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR). Data were analyzed by chi-square and t-test. Our results showed that 81 (44.7%) thalassemia and 64 (31.5%) hemodialysis patients were infected with HCV. There was a significant relationship between HCV positivity and the frequency of blood transfusion and the duration of dialysis in thalassemia and hemodialysis patients, respectively. Based on our results, the prevalence of HCV infection in thalassemia and hemodialysis patients in the southeastern part of Iran is higher than the other parts. Therefore, it is suggested that clinical and health authorities in southeastern Iran should pay more attention to preventing the transmission of HCV through blood and blood components. PMID: 21340738 [PubMed - as supplied by publisher] Related citations --------------------------------------------------------------------------------\ ---- Dig Dis Sci. 2011 Feb 19. [Epub ahead of print] Direct-Acting Antiviral Therapy for Hepatitis C: Attitudes Regarding Future Use. Gaglio PJ, Moss N, McGaw C, Reinus J. Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA, pgaglio@.... Abstract INTRODUCTION: Response to current therapy of hepatitis C virus (HCV) is suboptimal. Direct-acting antiviral therapies (DAA) are expected to improve treatment outcomes. Additional treatments for HCV will invariably make therapeutic choices and patient management more complex. We hypothesize that current perceptions regarding the complexity of DAA therapy will influence attitudes towards future use by practitioners who are currently treating HCV. METHODS: An Internet-based survey was sent to 10,082 AASLD and AGA members to determine if they treat HCV infection, their knowledge of DAA therapies, attitudes towards current and future HCV treatments, and if they participated in clinical trials using DAA agents. RESULTS: Out of a total of 1,757 individuals responding to the survey, 75% treat HCV; 79% were MDs, 67% were Gastroenterologists, and 24% were Hepatologists. Of the respondents, 77% indicated they were " very aware " or " aware " of DAA therapies, 20% participated in clinical trials, and 3% had minimal knowledge of DAA agents. Comparing treatment " today " versus in the future when DAAs were available, 85 vs. 81% would treat (p = 0.0054), 6 vs. 10% would refer to an " HCV expert " (p = 0.016), and 1% would refer to an ID specialist. Of respondents with " minimal knowledge " of DAA, 52% stated that they would use them in the future. CONCLUSIONS: Although the majority of respondents appear ready to utilize DAA agents in the future, referrals to " hepatitis C experts " will increase. More than half of respondents with " minimal knowledge " of DAA therapies also appear to be willing to utilize these compounds, raising concerns regarding their inappropriate use. Broad education of healthcare providers to prevent inappropriate use of these agents will be critical. PMID: 21336604 [PubMed - as supplied by publisher] Related citations ------------------------------------------------------------- Gastroenterology. 2011 Feb 15. [Epub ahead of print] Iron Levels in Hepatocytes and Portal Tract Cells Predict Progression and Outcome of Patients with Advanced Chronic Hepatitis C. Lambrecht RW, Sterling RK, Naishadham D, Stoddard AM, T, Morishima C, TR, Bonkovsky HL; HALT-C Trial Group. Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA. Abstract BACKGROUND & AIMS: Iron might influence severity and progression of non-hemochromatotic liver diseases. We assessed the relationships between iron, variants in HFE, and progression and outcomes using data from the HALT-C Trial. We determined whether therapy with pegylated interferon (PegIFN) affects iron variables. METHODS: Participants were randomly assigned to groups given long-term therapy with PegIFN (n=400) or no therapy (n=413) for 3.5 y and followed for up to 8.7 y (median 6.0 y). Associations between patient characteristics and iron variables, at baseline and over time, were made using Kaplan-Meier analyses, regression models, and repeated measures analysis of covariance. Iron was detected by Prussian blue staining. RESULTS: Patients with poor outcomes (increase in Child-Turcotte-Pugh score to ≥ 7, development of ascites, encephalopathy, variceal bleeding, spontaneous bacterial peritonitis, hepatocellular carcinoma, death) had significantly higher baseline scores for stainable iron in hepatocytes and cells in portal tracts than those without outcomes. Staining for iron in portal triads correlated with lobular and total Ishak inflammatory and fibrosis scores ( P <0.0001). High baseline levels of iron in triads increased the risk for poor outcome (hazard ratio=1.35, P =0.02). Iron staining decreased in hepatocytes but increased in portal stromal cells over time ( P <0.0001). Serum levels of iron and total iron binding capacity decreased significantly over time ( P <0.0001), as did serum ferritin ( P =0.0003). Long-term therapy with PegIFN did not affect levels of iron staining. Common variants in HFE did not correlate with outcomes, including development of hepatocellular carcinoma. CONCLUSIONS: Degree of stainable iron in hepatocytes and portal tract cells predicts progression and clinical and histological outcomes of patients with advanced chronic hepatitis C. Long-term therapy with low-dose PegIFN did not improve outcomes or iron variables. Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved. PMID: 21335007 [PubMed - as supplied by publisher] Related citations ______________________________________________________________ 9. J Hepatol. 2011 Feb 18. [Epub ahead of print] Controlled HIV Viral Replication, Not Liver Disease Severity Associated with Low Bone Mineral Density in HIV/HCV Co-Infection. El-Maouche D, Mehta SH, Sutcliffe C, Higgins Y, son MS, RD, DL, Sulkowski MS, Brown TT. s Hopkins School of Medicine Baltimore, MD; s Hopkins Bloomberg School of Public Health, Baltimore, MD. Abstract OBJECTIVE: To evaluate the prevalence and risk factors for low bone mineral density (BMD) in persons co-infected with HIV and Hepatitis C. METHODS: HIV/HCV co-infected study participants (n=179) were recruited into a prospective cohort and underwent dual-energy X-ray absorptiometry (DXA) within 1 year of a liver biopsy. Fibrosis staging was evaluated according to the METAVIR system. Osteoporosis was defined as a T-score < -2.5. Z-scores at the total hip, femoral neck, and lumbar spine were used as the primary outcome variables to assess the association between degree of liver disease, HIV-related variables, and BMD. RESULTS: The population was 65% male, 85% Black with mean age 50.3 years. The prevalence of osteoporosis at either at the total hip, femoral neck, or lumbar spine was 28%, with 5% having osteoporosis of the total hip, 6% at the femoral neck, 25% at the spine. The mean Z-scores (standard deviation) were -0.42 (1.01) at the total hip, -0.16 (1.05) at the femoral neck, and -0.82 (1.55) at the lumbar spine. In multivariable models, controlled HIV replication (HIV RNA < 400 copies/mL vs ⩾400 copies/mL) was associated with lower Z-scores (mean ± standard error) at the total hip (-0.44±0.17, p=0.01), femoral neck (-0.59±0.18, p=0.001), and the spine (-0.98±0.27, p=0.0005). There was no association between degree of liver fibrosis and Z-score. CONCLUSION: Osteoporosis was very common in this population of predominately African-American HIV/HCV co-infected patients, particularly at the spine. Lower BMD was associated with controlled HIV replication, but not liver disease severity. Copyright © 2011. Published by Elsevier B.V. PMID: 21338640 [PubMed - as supplied by publisher] Related citations ------------------------------------------------------------------ J Hepatol. 2011 Feb 17. [Epub ahead of print] Low 25-OH vitamin D serum levels correlate with severe fibrosis in HIV-HCV co-infected patients with chronic hepatitis. Terrier B, Carrat F, Geri G, Pol S, Piroth L, Halfon P, Poynard T, Souberbielle JC, Cacoub P. Department of Internal Medicine, Groupe Hospitalier Pitié-Salpêtrière; CNRS UMR 7211, Groupe Hospitalier Pitié-Salpêtrière. Abstract BACKGROUND: Recent findings in hepatitis C virus (HCV)-monoinfected patients have shown a correlation between low serum levels of 25-OH vitamin D3 [25(OH)D3] and severe liver fibrosis and low sustained virologic response to therapy. Data are lacking in HIV-HCV coinfected patients. METHODS: 189 HIV-HCV coinfected patients who received ⩾ 80% of interferon (IFN) plus ribavirin therapy were analyzed for baseline serum 25(OH)D3 levels. Correlations between serum 25(OH)D3 levels, chronic hepatitis C features, HCV virologic response to antiviral therapy and HIV infection characteristics were analyzed. RESULTS: Mean serum 25(OH)D3 level was 18.5±9.8 ng/mL, including 162 (85%) patients with level ⩾ 30 ng/mL. Serum 25(OH)D3 levels were significantly correlated with the histological Metavir fibrosis score (r= -0.16; P=0.027). Patients with severe fibrosis (Metavir F3/F4) had lower serum 25(OH)D3 levels compared to F2 and F1 patients (16.2±10.0 vs. 18.9±8.5 and 20.9±11.1 ng/mL, respectively; P=0.06). In multivariate analysis, low serum 25(OH)D levels were independently associated with severe liver fibrosis (P=0.04) and cold season (P=0.0002). Serum levels of 25(OH)D3 were also significantly correlated with liver fibrosis as assessed by Fibrotest® (r= -0.22; P=0.008) and serum α2-macroglobulin levels (r= -0.23; P=0.006). In contrast, no correlation was found between 25(OH)D3 levels and HCV sustained virologic response to IFN-based therapy [OR 0.98 (0.95-1.01); P=0.22]. No association was found between 25(OH)D3 levels and markers of HIV-related immunodeficiency. CONCLUSION: In HIV-HCV coinfected patients, low serum 25(OH)D3 levels correlate with severe liver fibrosis. In contrast, serum 25(OH)D3 levels are not linked to HCV virologic response to therapy or the severity of immunodeficiency. Copyright © 2011. Published by Elsevier B.V. PMID: 21334402 [PubMed - as supplied by publisher] Related citations _________________________________________________________________ J Infect Dis. 2011 Mar;203(6):847-53. Loss of Virus-specific T-Cell Responses in HCV Exposed Uninfected Injection Drug Users With Drug Rehabilitation. Thurairajah PH, Hegazy D, Demaine A, Kaminski ER, Cramp ME. Hepatology Research Group, Peninsula College of Medicine and Dentistry, Universities of Plymouth & Exeter, Plymouth. Abstract Introduction. Hepatitis C virus (HCV)-specific T lymphocyte responses have been demonstrated in peripheral blood from injection drug users (IDUs) persistently HCV antibody and RNA negative despite high-risk behavior. We have termed these apparently HCV resistant cases " Exposed Uninfecteds " (EUs), and have studied the evolution of T-cell responses to determine if they are protective in nature. Methods. Twenty-one EU cases were studied using a questionnaire to ascertain injecting behavior details. Peripheral blood mononuclear cells were isolated from whole blood and an interferon-gamma (IFN-γ) enzyme-linked immunosorbent spot (ELISPOT) assay used to detect T-cell responses to a panel of HCV proteins. EU cases were subdivided by injecting drug patterns into (1) cases in rehabilitation who stopped injecting, (2) prisoners (infrequent/noninjectors), and (3) cases who continued to inject. Results. EUs continuing to inject had significantly stronger (P < .01) and more frequent (P < ..05) HCV-specific IFN-γ ELISPOT responses than controls or noninjecting EUs. EUs in rehabilitation lost their T-cell responses during follow-up, while those continuing to inject maintained them. Conclusions. HCV-specific T-cell responses in EU cases wane within months of cessation of injection drug use. Maintenance of these T-cell responses appears to be dependent on continuing HCV exposure through injection drug use. PMID: 21343150 [PubMed - in process]Free Article Related citations Quote Link to comment Share on other sites More sharing options...
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