Guest guest Posted March 28, 2011 Report Share Posted March 28, 2011 Clin Infect Dis. 2011 Apr;52(7):889-900. Sustained virologic response to antiviral therapy for chronic hepatitis C virus infection: a cure and so much more. Pearlman BL, Traub N. Center for Hepatitis C, Atlanta Medical Center, Atlanta, Georgia. Abstract Sustained virologic response (SVR) is defined as aviremia 24 weeks after completion of antiviral therapy for chronic hepatitis C virus (HCV) infection. In analyses of SVR durability, the incidence of late relapse is extremely low (<1%). Histologic regression of both necroinflammation and fibrosis has been demonstrated in paired liver biopsy samples in SVR-achieving patients. More noteworthy is the sustained responder's favorable prognosis even with baseline cirrhosis; despite mostly retrospective analyses, relative to nonresponders or to those untreated, patients with SVR have significantly fewer liver-related complications, less hepatocellular carcinoma, and fewer liver-related deaths. Although HCV is associated with insulin resistance, successful eradication of HCV appears to reduce the risk of impaired fasting glucose and diabetes development. In summary, chronic HCV infection is curable with SVR attainment, and with cure comes improved liver histology and more favorable clinical outcomes, in comparison with patients who do not achieve the same therapeutic milestone. PMID: 21427396 [PubMed - in process]Free Article Related citations ------------------------------------------------------------- Gastroenterol Hepatol. 2011 Mar 22. [Epub ahead of print] [Treatment of hepatitis C virus in HIV-positive patients.] [Article in Spanish] Mallolas Masferrer J, MartÃnez-Rebollar M, Laguno Centeno M. Servicio de Infecciones, Hospital ClÃnic-IDIBAPS, Barcelona, España. Abstract Hepatitis C virus (HCV)-HIV coinfection currently occurs in more than 30% of HIV-positive patients in Spain. Nowadays, the treatment of choice for chronic hepatitis due to HCV infection in HIV-positive patients is pegylated interferon plus ribavirin. This combination achieves an overall cure rate of 50%, which is somewhat lower than those obtained in patients with HCV monoinfection. Adverse effects are frequent, leading to treatment withdrawal in 10-20% of patients. Importantly, there are three new features of hepatitis C in patients with HIV: (1) the recent development of epidemic outbreaks of acute hepatitis due to HCV infection in HIV-positive men caused by homosexual activity, (2) pharmacogenetic markers in the form of genetic polymorphisms near the IL28B gene related to response to HCV treatment as well as spontaneous eradication of HCV after acute infection, and (3) new antiviral molecules have allowed triple combination treatments to be designed and the preliminary results of clinical trials reporting high response rates are highly promising. Copyright © 2011 Elsevier España, S.L. All rights reserved. PMID: 21435743 [PubMed - as supplied by publisher] Related citations -------------------------------------------------------------- Gastroenterol Hepatol. 2011 Mar 18. [Epub ahead of print] [Genetics and hepatitis C treatment: towards a personalized treatment?] [Article in Spanish] Lens GarcÃa S, Coto-Llerena M, Pérez Del Pulgar Gallart S, Forns Bernhardt X. Servicio de HepatologÃa, Institut de Malalties Digestives i Metabòliques (IMDiM), Hospital ClÃnic, Barcelona, España. Institut dÌInvestigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd). Abstract Chronic HCV (hepatitis C virus) infection is an important cause of liver cirrhosis and hepatocellular carcinoma worldwide. HCV-related cirrhosis is the main indication for liver transplantation in our geographical area. Thus, treatment of this disease represents an important economical burden for the Health Care System. Current treatment of hepatitis C consists of pegylated interferon and ribavirin: only half of the patients achieve a sustained virological response after treatment. Factors related to the virus and the host influence response to treatment. Polymorphisms near the gene IL28B (encoding interferon-λ-3) have been recently identified as strong predictors of spontaneous HCV clearance in acute infection and of response to antiviral treatment in chronic hepatitis C. The aim of this article is to review the genetic studies that have emerged during the last months and its clinical implications, as well as to emphasize how Genetics is gaining importance in the management of liver diseases. Copyright © 2010 Elsevier España, S.L. All rights reserved. PMID: 21420759 [PubMed - as supplied by publisher] Related citations -------------------------------------------------------- Gastroenterology. 2011 Mar 16. [Epub ahead of print] Maintenance Therapy With Peginterferon Alfa-2b Does Not Prevent Hepatocellular Carcinoma in Cirrhotic Patients With Chronic Hepatitis C. Bruix J, Poynard T, Colombo M, Schiff E, Burak K, Heathcote EJ, Berg T, Poo JL, Mello CB, Guenther R, Niederau C, Terg R, Bedossa P, Boparai N, Griffel LH, Burroughs M, Brass CA, Albrecht JK; EPIC(3) Study Group. BCLC Group; Liver Unit, Hospital Clinic of Barcelona, University of Barcelona; IDIBAPS, Centro de Investigación Biomédica en Red de HepatologÃa y Enfermedades Digestivas, Barcelona, Spain. ---------------------------------------------------------- Abstract BACKGROUND & AIMS: Several studies have reported that low doses of interferon can delay the development of hepatocellular carcinoma (HCC) and progression of chronic hepatitis C. We investigated the incidence of clinical events among participants of the Evaluation of PegIntron in Control of Hepatitis C Cirrhosis (EPIC(3)) program. METHODS: Data was analyzed from an open-label randomized study of patients with chronic hepatitis C who had failed to respond to interferon alfa plus ribavirin. All patients had compensated cirrhosis with no evidence of HCC. Patients received peginterferon alfa-2b (0.5 μg/kg/week; n = 311) or no treatment (controls, n = 315) for a maximum period of 5 years, or until 98 patients had a clinical event (hepatic decompensation, HCC, death, or liver transplantation). The primary measure of efficacy was time until the first clinical event. RESULTS: There was no significant difference in time to first clinical event among patients who received peginterferon alfa-2b, compared with controls (hazard ratio , 1.452; 95% confidence interval [CI], 0.880-2.396). There was no decrease in the development of HCC with therapy. The time to disease progression (clinical events or new or enlarged varices) was significantly longer for patients who received peginterferon alfa-2b, compared with controls (HR, 1.564; 95% CI, 1.130-2.166). In a prospectively defined subanalysis of patients with baseline portal hypertension, peginterferon alfa-2b significantly increased the time to first clinical event, compared with controls ( P =.016). There were no new safety observations. CONCLUSIONS: Maintenance therapy with peginterferon alfa-2b is not warranted in all patients and does not prevent HCC. However, there is a potential clinical benefit of long-term suppressive therapy in patients with preexisting portal hypertension. Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved. PMID: 21419770 [PubMed - as supplied by publisher] Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.