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Charlotte E Costentin,
Jean-Baptiste Trabut, Vincent Mallet,
Stéphane Darbeda,
Véronique Thépot,
Bertrand Nalpas,
Béatrice Badin de Montjoye,
Béatrice Lavielle,
Anaïs Vallet-Pichard,
Philippe Sogni,
Stanislas Pol
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ABSTRACT: AimOptimal management of hepatitis C virus (HCV) infection is controversial in heavy drinkers. We compared the management of HCV infection of heavy drinkers with that of patients without a history of alcohol abuse.Methods
In a retrospective case-control study, 69 HCV-infected heavy drinkers [daily alcohol consumption at referral above 60 g/day, hereafter 'alcohol group'] were compared with matched HCV-infected patients with low alcohol consumption (<40 g/day, 'control group').ResultsPatients of the 'alcohol group' were younger (42 vs. 45 years, P = 0.05), more often male (69.6 vs. 56.5%, P = 0.11) and had been infected by intravenous drug use (85.5 vs. 45.0%, P < 0.0001). The percentage of patients with a recommendation for treatment according to the French 2002 consensus (bridging fibrosis or genotype 2 or 3) was 52 of 69 (75.4%) in both groups, while the proportion of patients treated was higher in the control group (71.0 vs. 44.9%, P = 0.002). In the 'alcohol group', patients had better access to treatment if they were employed or consumed 170 g/day or less at first referral. Sustained virological response (SVR) was obtained in 10 of 31 patients (32.3%) of the 'alcohol group' vs. 8 of 31 patients (25.8%) of the control group matched for genotype and type of treatment (P = 0.58).Conclusion
Heavy drinkers are less often considered for antiviral therapy compared with patients without a history of alcohol abuse. However, once treatment is actually initiated, SVR rates are comparable with those achieved in non-drinkers despite the continuation of alcohol consumption during therapy in some patients.
Alcohol and Alcoholism 03/2013; · 2.95 Impact Factor
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ABSTRACT: Nonalcoholic fatty liver disease (NAFLD) is a clinicopathologic syndrome that includes a range of disorders associated with fatty liver from steatosis to cirrhosis and hepatocellular carcinoma, defined by the presence of liver fat accumulation exceeding 5% of hepatocytes in the absence of other causes of liver disease such as alcohol consumption, viral hepatitis, or any other specific etiology. Half the patients with human immunodeficiency virus (HIV) who undergo additional testing for unexplained liver test abnormalities may suffer from NAFLD, which is the hepatic manifestation of the metabolic syndrome. In HIV-infected patients, NAFLD can result from the HIV itself, highly active antiretroviral therapy (HAART), and/or lipodystrophy. Evaluation of the liver impact of NAFLD remains mainly based on liver biopsy, but numerous noninvasive procedures are under evaluation. In HIV/hepatitis C virus (HCV-) coinfected patients, steatosis seems more frequent and severe by comparison with HCV-monoinfected patients, and is associated with significant liver fibrosis, which may contribute to the more rapid progression of liver disease. First-line treatment of NAFLD is mainly based on the adequate management of the metabolic syndrome, including lifestyle changes. Specific therapeutic approaches are under investigation.
Seminars in Liver Disease 05/2012; 32(2):158-66. · 7.05 Impact Factor
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Sylvie Lagaye,
Hong Shen,
Bertrand Saunier,
Michelina Nascimbeni,
Jesintha Gaston,
Pierre Bourdoncle,
Laurent Hannoun,
Pierre-Philippe Massault,
Anaïs Vallet-Pichard, Vincent Mallet,
Stanislas Pol
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ABSTRACT: The development of human cultured hepatitis C virus (HCV) replication-permissive hepatocarcinoma cell lines has provided important new virological tools to study the mechanisms of HCV infection; however, this experimental model remains distantly related to physiological and pathological conditions. Here, we report the development of a new ex vivo model using human adult liver slices culture, demonstrating, for the first time, the ability of primary isolates to undergo de novo viral replication with the production of high-titer infectious virus as well as Japanese fulminant hepatitis type 1, H77/C3, and Con1/C3. This experimental model was employed to demonstrate HCV neutralization or HCV inhibition, in a dose-dependent manner, either by cluster of differentiation 81 or envelope protein 2-specific antibodies or convalescent serum from a recovered HCV patient or by antiviral drugs. CONCLUSION: This new ex vivo model represents a powerful tool for studying the viral life cycle and dynamics of virus spread in native tissue and also allows one to evaluate the efficacy of new antiviral drugs.
Hepatology 03/2012; 56(3):861-72. · 11.66 Impact Factor
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Olivier Mir,
Romain Coriat,
Pascaline Boudou-Rouquette,
Stanislas Ropert,
Jean-Philippe Durand,
Anatole Cessot, Vincent Mallet,
Philippe Sogni,
Stanislas Chaussade,
Stanislas Pol,
François Goldwasser
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ABSTRACT: Some patients with advanced hepatocellular carcinoma (HCC) progressing under sorafenib remain eligible for further systemic therapy. Little is known on the feasibility of systemic treatment beyond sorafenib in this setting. Consecutive HCC patients pre-treated with sorafenib received gemcitabine 1,000 mg/m² and oxaliplatin 100 mg/m² every 14 days. Exclusion criteria included Child C cirrhosis, PS ≥ 3, creatinine clearance <20 ml/min, albumin <25 g/L and bilirubin > 54 μmol/L. Pre-treatment body composition was evaluated by CT scan to detect muscle wasting (sarcopenia). The primary evaluation criterion was safety. Secondary evaluation criteria were response rate, and progression-free (PFS) and overall survival (OS). Eighteen patients (median age: 64 years, range 25-77) received a total of 90 cycles (median per patient: 4, range 1-16). Eight patients (44.4 %) had a PS of 2, 5 (27.8 %) had Child-Pugh B cirrhosis and 13 (72.2 %) had a CLIP score >3. The most frequent toxicities were thrombocytopenia (grade 2-4: n = 7, 38.9 %) and peripheral neuropathy (grade 2-3: n = 7, 38.9 %). The overall response rate was 18.8 % (95 % CI: 0-37.9), and another 18.8 % of patients had stable disease. The median PFS and OS were 3.2 (95 % CI: 2.3-3.9) and 4.7 (95 % CI: 3.8-8.1) months, respectively. Overall survival was significantly longer in patients without sarcopenia [10.0 months (95 % CI: 7.0-13.8) vs. 3.0 months (95 % CI: 2.5-3.9), p < 0.001] and in patients with an ECOG PS < 2 [8.1 months (95 % CI: 7.0-13.8) vs. 3.8 months (95 % CI: 2.5-3.9), p = 0.017]. In our experience, gemcitabine-oxaliplatin was feasible and had detectable clinical activity in HCC patients pre-treated with sorafenib. Further studies are needed to confirm these findings.
Medical Oncology 03/2012; 29(4):2793-9. · 2.14 Impact Factor
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ABSTRACT: Hepatitis B virus (HBV) infection is more frequent in kidney recipients than in the general population with a higher rate of liver-related morbidity and mortality. We evaluated the benefit associated with HBV viral suppression by nucleos(t)ide analogues treatment in HBV-infected kidney recipients.
This retrospective study included 42 HBsAg-positive kidney recipients, 33 males, 9 females, median age 54 years, followed up during a mean of 15.4±11.8 years after kidney transplantation. Mean treatment duration by single or combined nucleos(t)ide analogues was 6.8±4.3 years. Fibrosis, before treatment, according to Metavir score was: F4 for 6 patients, F3 for 10, F2 for 6, and F0-F1 for 20 patients. The primary end point, the patient survival, was defined as patient death or liver transplantation, the secondary end point was graft survival.
HBV DNA at the last evaluation was undetectable (<12 IU/ml) in 92.8% of patients. During the follow-up, 8 patients died (17.7%), death being related to hepatocellular carcinoma in 4 (9.5%), including 1 patient with baseline mild fibrosis, and to extrahepatic causes in 4. This mortality rate is strikingly lower than that previously reported in HBV-infected kidney recipients before oral antiviral therapies. Graft survival seems to be improved when compared to the former series.
Suppression of HBV replication associated with nucleo(s)tide analogues treatment improves the survival of HBV-infected kidney recipients. Viral suppression does not exclude regular follow-up given the risk of occurrence of hepatocellular carcinoma even in non-cirrhotic patients.
Journal of Hepatology 03/2012; 57(1):55-60. · 9.26 Impact Factor
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Jean-Baptiste Trabut,
Véronique Thépot,
Bertrand Nalpas,
Béatrice Lavielle,
Simona Cosconea,
Marion Corouge,
Anaïs Vallet-Pichard,
Hélène Fontaine, Vincent Mallet,
Philippe Sogni,
Stanislas Pol
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ABSTRACT: Measurement of liver stiffness (LS) using real-time elastography appears as a promising tool to evaluate the severity of chronic liver diseases. Previous studies in patients with alcoholic liver disease have suggested that fibrosis was the only histological parameter to influence LS. To challenge this hypothesis, we have prospectively tested the short-term impact of alcohol withdrawal on LS value.
Patients hospitalized for alcohol withdrawal in our Liver and Addiction Unit between 2007 and 2010 had an LS determination at entry (D0) and 7 days after alcohol withdrawal (D7). LS value was given as the median of 10 measurements performed with a FibroScan(®) device. For a given patient, variation of LS was considered as significant when the comparison of the 10 measurements at D0 and at D7 yielded a p-value under 0.05 (Wilcoxon test).
One hundred and thirty-seven patients were included in the study (median alcohol consumption: 150 g/d; hepatitis C: n = 21 [15.6%]). Considering all patients, median LS value decreased from 7.2 to 6.1 kPa between D0 and D7 (p = 0.00001, paired Wilcoxon test). LS decreased significantly in 62 patients (45.3%), and there was a reduction in the estimated stage of fibrosis in 32 (23.3%). LS increased significantly in 16 patients (11.7%). Subgroup analyses revealed that the decrease in LS was still significant in patients with or without hepatitis C infection, and aspartate transaminase level below or above 100 UI/l.
LS decreases significantly in nearly half of heavy drinkers after only 7 days of abstinence. This result strongly suggests that nonfibrotic lesions (such as the presence of alcoholic hepatitis) may influence LS. From a practical point of view, it also shows that variation of alcohol consumption must be taken into account for the interpretation of LS value.
Alcoholism Clinical and Experimental Research 03/2012; 36(8):1407-11. · 3.34 Impact Factor
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Hepatology 01/2012; 55(6):2042-3. · 11.66 Impact Factor
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ABSTRACT: Although adherence is of major importance in long-term treatments, few studies have been published regarding the use of anti-HBV analogues in clinical practice. The aim of this study was to evaluate adherence to anti-HBV analogues and associated virological suppression.
A cross-sectional study was performed between 1 January 2009 and 15 July 2009 in Cochin Hospital, Paris, France. It included all patients being treated with anti-HBV analogues for at least three months, who were without coinfection (HIV, HCV or HDV) and who had not received organ transplants. At the time of enrolment, HBV viral load, analogue regimen and self-reported adherence were collected prospectively. Patients were classified as non-adherent, or moderately or totally adherent using a score based on analysis of self-reports. Other data were obtained retrospectively.
Among the 190 patients meeting the inclusion criteria, 33% were initially hepatitis B e antigen-positive and 50% had extensive fibrosis or cirrhosis. Pretreatment viral load was 6.0 log IU/ml (median). The median duration of treatment was 52 months. At enrolment, 61%, 32% and 7% of patients were classified as totally adherent, moderately adherent and non-adherent, respectively. Complete virological suppression (HBV DNA<12 IU/ml) was observed in 83% of patients at enrolment. In the multivariate analysis, lack of virological suppression was associated with an increased pretreatment viral load, with no change in analogue regimen and is classified as non-adherent.
Adherence seems to be an independent factor associated with virological suppression during anti-HBV analogue treatment. Therapeutic education and a systematic evaluation of adherence using self-reports should be promoted to assure long-term anti-HBV analogue efficacy in clinical practice.
Antiviral therapy 11/2011; 17(2):395-400. · 3.16 Impact Factor
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Eric Bavu,
Jean-Luc Gennisson,
Mathieu Couade,
Jeremy Bercoff, Vincent Mallet,
Mathias Fink,
Anne Badel,
Anaïs Vallet-Pichard,
Bertrand Nalpas,
Mickaël Tanter,
Stanislas Pol
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ABSTRACT: Supersonic shear imaging (SSI) has recently been demonstrated to be a repeatable and reproducible transient bidimensional elastography technique. We report a prospective clinical evaluation of the performances of SSI for liver fibrosis evaluation in 113 patients with hepatitis C virus (HCV) and a comparison with FibroScan (FS). Liver elasticity values using SSI and FS ranged from 4.50 kPa to 33.96 kPa and from 2.60 kPa to 46.50 kPa, respectively. Analysis of variance (ANOVA) shows a good agreement between fibrosis staging and elasticity assessment using SSI and FS (p < 10(-5)). The areas under receiver operating characteristic (ROC) curves for elasticity values assessed from SSI were 0.948, 0.962 and 0.968 for patients with predicted fibrosis levels F ≥ 2, F ≥ 3 and F = 4, respectively. These values are compared with FS area under the receiver operating characteristic curve (AUROC) of 0.846, 0.857 and 0.940, respectively. This comparison between ROC curves is particularly significant for mild and intermediate fibrosis levels. SSI appears to be a fast, simple and reliable method for noninvasive liver fibrosis evaluation.
Ultrasound in medicine & biology 09/2011; 37(9):1361-73. · 2.02 Impact Factor
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ABSTRACT: To validate magnetic resonance (MR) imaging cine phase-contrast blood flow mapping in vitro and in patients with chronic liver disease, with or without portal hypertension, and to assess the accuracy of azygos, splanchnic, and systemic blood flow measured with MR imaging in the detection of high-risk esophageal varices and compare these measurements with endoscopic evaluation, the reference standard.
The local ethics committee approved this study. Patients gave written informed consent. Two phantoms were used to validate the MR imaging phase-contrast flow sequence. Patients with liver cirrhosis (n = 59), chronic liver disease without cirrhosis (n = 12), and nodular regenerative hyperplasia (NRH) (n = 11), and healthy control subjects with no liver disease (n = 25) were included. The patients underwent upper digestive system endoscopy. Mean abdominal aorta, portal venous, and azygos blood flow was measured on MR images, which were reviewed by two blinded observers to determine the presence and grade of esophageal varices. The reproducibility and intra- and interobserver variability of the blood flow measurements were assessed with intraclass correlation coefficients (ICCs). The performance of the MR blood flow measurements in staging high-risk varices was determined with receiver operating characteristic curve analysis. The correlation between MR visual analysis and endoscopic grading was assessed by using κ statistics.
MR flow rate measurements had excellent correlations with actual flow values in vitro (ICC > 0.990 for phantoms 1 and 2). Mean aortic flow was significantly higher in patients with cirrhosis than in control subjects (P < .001). Mean azygos flow was significantly higher in patients with cirrhosis than in patients with chronic liver disease without cirrhosis (P = .005) and control subjects (P < .001). Low intra- and interobserver variability (ICC > 0.990 for each blood flow type) and high reproducibility (ICC > 0.850 for each blood flow type) were demonstrated. The optimal cutoff mean azygos flow value was 2.3 mL/sec for varices with grades of 2 or higher.
MR imaging azygos flow measurement appears to be a promising technique for detecting high-risk esophageal varices in patients with portal hypertension.
Radiology 07/2011; 261(1):144-55. · 5.73 Impact Factor
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Hepatology 04/2011; 53(4):1410-1. · 11.66 Impact Factor
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Annals of internal medicine 04/2011; 154(7):507-8. · 16.73 Impact Factor
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ABSTRACT: Maternal-infant transmission of hepatitis B virus (HBV) during birth carries a high risk of chronic HBV infection in infants. Appropriate neonatal prophylaxis is effective in preventing perinatal transmission of HBV. The purpose of this study was to evaluate the protective efficacy of anti-HBV sero-vaccination in newborns of HBsAg positive mothers from Mayotte, French island in the Mozambican canal.
One-hundred newborns of HBsAg positive mothers were identified retrospectively on the basis of hospital medical record and hepatitis B immune globulin (HBIG) prescriptions review from 1994 to 2007. To determine the rate of protective efficacy of neonatal prophylaxis defined by anti HBs antibodies >10 IU/mL with negative HBsAg, anti HBc and HBV DNA testing, HBV serological markers were performed in vaccinated children.
Eighty-three of 100 newborns (83%) were given a complete sero-vaccination. Maternal HBe Ag status at delivery (available in 93%) was positive in 56 (60%) of cases and HBV viral load (available in 57%) was <5 logIU/mL, between 5 and 7 logsIU/mL and >7 logsIU/mL in 23 (40.4%), 12 (21%) and 22 (38.6%), respectively. HBV markers in all children at a median age of 5 years [IQR 2-8] showed that 76% were protected with anti HBs >10 IU/mL, despite incomplete sero-vaccination in 12 infants; 6% of infants had anti-HBs and anti-HBc positivity with undetectable HBV DNA, 1% had isolated anti HBc while 14% were seronegative. Only 3% had evidence of immunoprophylaxis failure: 1 infant was HBsAg carrier and 2 had detectable HBV DNA without HBsAg (occult HBV infection). The only factor associated with sustained protective efficacy was on time serological control performed within one year of life, whereas maternal age, HBeAg status and HBV viral load on delivery were not.
The anti-HBV sero-vaccination of newborns of HBsAg-positive mothers is fairly done in Mayotte and allows a high protection of mother-to-child transmission in a mean endemic area with fair safety. Screening of sero-vaccination failures has to be reinforced in order either to revaccinate or to treat infected children.
Vaccine 02/2011; 29(16):2846-9. · 3.77 Impact Factor
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ABSTRACT: The evaluation of liver fibrosis in chronic viral hepatitis is of paramount importance since secondary complications, including hepatocellular carcinoma, occur in patients with extensive fibrosis and cirrhosis. Clinical examination and some simple biological and morphological tests represent the first step to appraise liver fibrosis in viral hepatitis. Biochemical (Fibrotest, Hepascore, Fibrometre) or morphological (Fibroscan) methods have emerged over the past ten years to avoid--in more than half of patients--the systematic use of the liver biopsy to appraise liver fibrosis in chronic hepatitis C virus infection. The liver biopsy remains however essential in many situations--especially for demonstrating regression of cirrhosis after viral inactivation. Regression of cirrhosis is now a recognized concept, thanks to the next generation of antiviral treatments. Today, the inactivation of viral hepatitis is an achievable primary goal and regression of cirrhosis becomes a reasonable secondary goal.
La Revue du praticien 01/2011; 61(1):39-43.
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ABSTRACT: The combination of antiretroviral (ARV) therapies introduced at the end of the 1990s profoundly changed the natural history of human immunodeficiency virus (HIV) infection. Liver diseases are one of the three primary causes of 'non-AIDS-related' death in people living with HIV for three reasons: the high prevalence of hepatotropic viral co-infections, the hepatotoxicity of ARV drugs and new emerging liver diseases, including nodular regenerative hyperplasia and hepatitis E virus infection. The impact of HIV infection on the natural history of hepatitis C virus (HCV) or hepatitis B virus (HBV)/HIV co-infection has markedly changed in the past few decades with the progress made in ARV treatment and the improved definition of therapeutic strategies for HCV or HBV. Initially, HIV had a negative impact on hepatotropic infections. Today, HIV does not appear to significantly modify the natural history of HCV and HBV infection. This is associated with fair immune restoration, viral suppression associated with analogues having dual activity against HBV and HIV and with the increasing efficacy of antiviral treatments against HCV. A significant decline is expected in the morbidity and mortality associated with chronic liver infection in co-infected patients. Nevertheless, today, there are three major issues: (i) improving preventive measures including vaccination and risk reduction; (ii) screening patients infected with HBV or HCV and evaluating the impact of chronic infection on the liver and finally; (iii) early screening of hepatocellular carcinoma whose occurrence is higher and that evolves more rapidly in co-infected than in mono-infected patients.
Liver international: official journal of the International Association for the Study of the Liver 01/2011; 31 Suppl 1:135-9. · 3.82 Impact Factor
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Armanda Casrouge,
Jérémie Decalf,
Mina Ahloulay,
Cyril Lababidi,
Hala Mansour,
Anaïs Vallet-Pichard, Vincent Mallet,
Estelle Mottez,
James Mapes,
Arnaud Fontanet,
Stanislas Pol,
Matthew L Albert
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ABSTRACT: Chronic infection with hepatitis C virus (HCV) is a major public health problem, with nearly 170 million infected individuals worldwide. Current treatment for chronic infection is a combination of pegylated IFN-α2 and ribavirin (RBV); however, this treatment is effective in fewer than 50% of patients infected with HCV genotype 1 or 4. Recent studies identified the chemokine CXCL10 (also known as IP-10) as an important negative prognostic biomarker. Given that CXCL10 mediates chemoattraction of activated lymphocytes, it is counterintuitive that this chemokine correlates with therapeutic nonresponsiveness. Herein, we offer new insight into this paradox and provide evidence that CXCL10 in the plasma of patients chronically infected with HCV exists in an antagonist form, due to in situ amino-terminal truncation of the protein. We further demonstrated that dipeptidyl peptidase IV (DPP4; also known as CD26), possibly in combination with other proteases, mediates the generation of the antagonist form(s) of CXCL10. These data offer what we believe to be the first evidence for CXCL10 antagonism in human disease and identify a possible factor contributing to the inability of patients to clear HCV.
The Journal of clinical investigation 01/2011; 121(1):308-17. · 15.39 Impact Factor
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ABSTRACT: Transplantation is the best treatment for end-stage organ failure. Hepatitis virus infections, mainly hepatitis B virus (HBV) and hepatitis C virus (HCV) infections still constitute a major problem because they are common in allograft recipients and are a significant cause of morbidity and mortality after transplantation. Recently, hepatitis E virus infection has been added as an emergent cause of chronic hepatitis in organ transplantation. The prevalence of HBV and HCV infections has markedly decreased in patients who are candidates for transplantation since the introduction of screening, hygiene and prevention measures, including systematic screening of blood and organ donations, use of erythropoietin, compliance with universal hygiene rules, segregation of HBV-infected patients from non-infected patients and systematic vaccination against HBV. A liver biopsy is preferable to non-invasive biochemical and/or morphological tests of fibrosis to evaluate liver fibrosis before and even after transplantation. Treatment with entecavir or tenofovir is indicated in HBV-infected dialyzed patients who have moderate or severe disease (≥A2 or F2 on the Metavir scale) in preparation for renal transplantation. Due to the risks of severe reactivation, fibrosing cholestatic hepatitis or histological deterioration after transplantation, systematic use of nucleoside or nucleotide analogues shortly before or at the time of transplantation is recommended (tenofovir or entecavir are preferable to lamivudine) in all patients, whatever the baseline histological evaluation. In HCV-infected dialyzed patients who are not candidates for renal transplantation, the indication for antiviral therapy is limited to significant fibrosis (fibrosis ≥2 on the Metavir scale). Treatment must be proposed to all candidates for renal transplantation, whatever their baseline histopathology, and interferon-α should be used as monotherapy. After transplantation, interferon-α is contraindicated but may be used in patients for whom the benefits of antiviral treatment clearly outweigh the risks, especially that of allograft rejection. All cirrhotic patients, notably after solid organ transplantation, should be screened for hepatocellular carcinoma. Sustained suppression of necro-inflammation may result in regression of cirrhosis, which in turn may lead to decreased disease-related morbidity and improved survival. Finally, due to the high mortality after renal transplantation, active (namely without sustained viral suppression) cirrhosis should be considered a contraindication to kidney transplantation, but an indication to combined liver-kidney transplantation; on the contrary, inactive (namely with sustained viral suppression) compensated cirrhosis may permit renal transplantation alone. Organ transplantations other than kidney (cardiac or pulmonary transplantations) involve the same diagnosis and therapeutic issues.
Journal of Hepatology 01/2011; 55(2):474-82. · 9.26 Impact Factor
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ABSTRACT: There is currently no accepted treatment of chronic hepatitis E virus (HEV) infection.
To report 2 patients in whom ribavirin therapy seemed to alter the natural history of chronic HEV infection.
Case reports.
Hepatology unit of a tertiary care center in France.
A kidney and pancreas transplant recipient and a patient with idiopathic CD4(+) T lymphocytopenia, both with biopsy-proven chronic HEV infection.
Patients received oral ribavirin, 12 mg/kg of body weight daily for 12 weeks.
Liver function tests, detection of HEV RNA (viremia and stool shedding) by reverse transcriptase polymerase chain reaction, and anti-HEV IgM and IgG antibodies.
Both patients had normalized liver function test results after 2 weeks of treatment and cleared HEV after 4 weeks of treatment. Hepatitis E virus RNA remained undetectable in the serum and stools throughout follow-up (3 months and 2 months for the first and second patient, respectively). Side effects were considered mild. Limitation: Given the relatively short follow-up, the achievement of HEV eradication could not be claimed.
Ribavirin is a potentially effective treatment of HEV infection and should be evaluated in patients with chronic HEV infection.
None.
Annals of internal medicine 07/2010; 153(2):85-9. · 16.73 Impact Factor
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ABSTRACT: Approximately 2% of the world population is infected by the hepatitis C virus (HCV). The incidence of new HCV infections is decreasing today, with new contaminations limited to specific risk groups: intravenous drug users and homosexual men. On the other hand, morbidity and mortality due to infections that occurred in the late 1970s and early 1980s are rising quite substantially. Approximately 20% of patients infected by HCV develop cirrhosis in about 20 years and every year 5% of them develop hepatocellular carcinoma (HCC). Current epidemiologic models suggest that the incidence of HCC and of the mortality associated with chronic HCV infection will continue to increase through 2015, a finding consisting with the perception of liver specialists today.
La Presse Médicale 04/2010; 39(4):446-51. · 0.67 Impact Factor
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ABSTRACT: Oxaliplatin-based chemotherapy induces sinusoidal obstruction syndrome (SOS) lesions in the nontumorous liver parenchyma, which may increase the risk of liver resection for colorectal liver metastases. The objective of this study was to evaluate the accuracy of aspartate aminotransferase to platelet ratio index (APRI) and FIB-4 scoring systems to predict chemotherapy-associated liver injury and to correlate the severity of sinusoidal injury with postoperative outcome.
Between 1998 and 2007, 78 patients were operated for colorectal liver metastases after preoperative oxaliplatin-based chemotherapy. Grading of steatosis and SOS in the nontumorous liver parenchyma was obtained in these patients. Univariate analysis of 18 preoperative factors to predict SOS occurrence was performed as well as multivariate analysis. Relevance of preoperative platelet count level, transaminase levels, and fibrosis scoring systems were evaluated to predict high grade lesions of SOS using a receiving operative curve analysis. Ninety-day mortality and morbidity were studied according to SOS severity in 51 patients who underwent major liver resection.
Overall, pathologic examination showed high-grade lesions of SOS (SOS 2/3) in 46 (59%) patients. Univariate analysis showed that a low preoperative platelet count, elevated preoperative aspartate aminotransferase, short interval between chemotherapy and surgery were significant factors associated with high-grade lesions of SOS. Multivariate analysis showed that only the APRI score was an independent predictive factor for severe SOS. Receiving operative curve analysis revealed that the cut-off value predicting high-grade lesions of SOS with the best accuracy was an APRI score of 0.36 (area under the curve, 0.85; sensitivity, 87%; specificity, 69%). After major liver resection (n = 51), SOS 2/3 (n = 38) was associated with postoperative hepatic dysfunction (26/38 in SOS 2/3 vs. 3/13 in SOS 0/1; P = 0.004) and ascites (P = 0.03).
A low preoperative platelet count and high APRI score seem to be the most reliable indicators to predict SOS severity.
Annals of surgery 02/2010; 251(3):454-60. · 7.90 Impact Factor
