Recurrent hepatitis C virus (HCV) infection after liver transplantation results in subsequent accelerated fibrosis. However, the prognosis as it relates to the timing of direct-acting antiviral (DAA) treatment after liver transplantation has not been widely investigated.
Background: The precise evaluation of hepatic fi brosis is crucial in the management of Chronic Hepatitis C (CHC). Multiple noninvasive serological scores and devices have been used in the accurate prediction of fibrosis however; early changes in non-invasive
biomarkers of liver fibrosis following antiviral therapy are widely unknown. We aim to evaluate changes of liver stiffness and 6 noninvasive serological fibrosis scores, easy to calculate particularly in poor areas, following sofosbuvir- based treatment.
Methods: This is a cohort study that included 155 CHC Egyptian patients. Transient elastography values were recorded as well
as Aspartate Aminotransferase-To-Platelet Ratio Index (APRI), FIB-4, Lok score, fibrosis index, King Score and fibro Q score were calculated at baseline and 12 weeks post-treatment.
Management of chronic hepatitis c before and after liver transplantApollo Hospitals
Hepatitis C infection is the most common cause of cirrhosis worldwide. Management of chronic hepatitis C in peri-transplant period is challenging. Patients with compensated/Child's A cirrhosis due to hepatitis C virus (HCV) infection are treated like noncirrhotics, with peginterferon (PEG-IFN) and ribavirin, albeit with a higher incidence of complications. Treatment is not recommended for decompensated cirrhotics due to higher complication rate including the risk of death. After liver transplant, immunosuppression should be adjusted to prevent/delay recurrent HCV disease. Incidence and severity of recurrent HCV disease as well as patient and graft survival is similar between living donor and deceased donor liver transplants. It is currently recommended to treat established recurrent hepatitis C, that is raised alanine aminotransferase (ALT) with HAI >4 and/or F >1. Pre-emptive/prophylactic antiviral therapy is poorly tolerated and has low efficacy. Standard dose regimen (PEG-IFN 1.5 μg/Kg or 180 μg weekly + ribavirin 800–1200 mg/day) for 48 weeks irrespective of the genotype is the recommended treatment protocol. Therapy poses significant problems in the form of anemia, neutropenia, higher risk of rejection, and so on.
This document provides information on managing hepatitis C in primary care. It discusses gaps in the hepatitis C care continuum, with up to 90-95% of individuals living with hepatitis C being unaware of their infection. Screening for hepatitis C is important for improving detection and treatment. The natural history of hepatitis C infection is described, showing how timely treatment can arrest disease progression and prevent death. Groups at risk for hepatitis C infection are identified. Guidelines for pre-treatment assessment and approved direct-acting antiviral treatment regimens are presented, along with considerations for special patient groups such as those with HIV, hepatitis B, or kidney disease coinfection. Monitoring during and after treatment is also covered.
Treatment of hepatitis C in liver transplant patientApollo Hospitals
A significant proportion of patients with chronic hepatitis C virus (HCV) infection develop cirrhosis and complications of end-stage liver disease over two to three decades and require liver transplantation. However, reinfection is common and leads to further adverse events under immunosuppression. Pretransplant antiviral or pre-emptive therapy is limited to mildly decompensated patients due to poor tolerance. The main stay of management represents directed antiviral therapy after evidence of recurrence of HCV in the transplanted patient.
This study analyzed clinical outcomes of treated and untreated patients with hepatitis C virus (HCV) infection in two cohorts. It found that HCV patients who did not respond to interferon-alpha based treatment had a significantly increased risk of developing cirrhosis compared to untreated patients, even after adjusting for factors like fibrosis stage and psychosocial risks. Specifically, treatment nonresponders had a 2.35 times higher hazard of cirrhosis in the Veterans Affairs cohort and a 5.9 times higher hazard in the University Hospital cohort compared to untreated patients. However, the overall survival of nonresponders was not significantly different than untreated patients. This suggests that while interferon-alpha treatment failure may accelerate liver fibrosis, it does not necessarily impact overall
This study evaluated the safety and efficacy of sofosbuvir/velpatasvir (SOF/VEL) for 12 weeks in 59 hepatitis C virus (HCV)-infected patients with end-stage renal disease (ESRD) undergoing dialysis. The study found SOF/VEL to be safe and well tolerated, with 95% of patients achieving a sustained virologic response at 12 weeks post treatment. Plasma levels of HCV RNA declined rapidly in all patients, with 100% having undetectable viral loads by 4 weeks. This demonstrates SOF/VEL as an effective treatment option for HCV in patients with ESRD on dialysis.
This study evaluated the safety and efficacy of sofosbuvir/velpatasvir (SOF/VEL) for 12 weeks in 59 patients with hepatitis C virus (HCV) infection and end-stage renal disease (ESRD) undergoing dialysis. The overall sustained virologic response rate at 12 weeks post-treatment (SVR12) was 95%. Adverse events were mostly mild to moderate and consistent with ESRD. Plasma exposures of SOF and its metabolites were higher than in patients with normal renal function but were well tolerated. SOF/VEL for 12 weeks was safe and effective for HCV in patients with ESRD on dialysis.
Background: The precise evaluation of hepatic fi brosis is crucial in the management of Chronic Hepatitis C (CHC). Multiple noninvasive serological scores and devices have been used in the accurate prediction of fibrosis however; early changes in non-invasive
biomarkers of liver fibrosis following antiviral therapy are widely unknown. We aim to evaluate changes of liver stiffness and 6 noninvasive serological fibrosis scores, easy to calculate particularly in poor areas, following sofosbuvir- based treatment.
Methods: This is a cohort study that included 155 CHC Egyptian patients. Transient elastography values were recorded as well
as Aspartate Aminotransferase-To-Platelet Ratio Index (APRI), FIB-4, Lok score, fibrosis index, King Score and fibro Q score were calculated at baseline and 12 weeks post-treatment.
Management of chronic hepatitis c before and after liver transplantApollo Hospitals
Hepatitis C infection is the most common cause of cirrhosis worldwide. Management of chronic hepatitis C in peri-transplant period is challenging. Patients with compensated/Child's A cirrhosis due to hepatitis C virus (HCV) infection are treated like noncirrhotics, with peginterferon (PEG-IFN) and ribavirin, albeit with a higher incidence of complications. Treatment is not recommended for decompensated cirrhotics due to higher complication rate including the risk of death. After liver transplant, immunosuppression should be adjusted to prevent/delay recurrent HCV disease. Incidence and severity of recurrent HCV disease as well as patient and graft survival is similar between living donor and deceased donor liver transplants. It is currently recommended to treat established recurrent hepatitis C, that is raised alanine aminotransferase (ALT) with HAI >4 and/or F >1. Pre-emptive/prophylactic antiviral therapy is poorly tolerated and has low efficacy. Standard dose regimen (PEG-IFN 1.5 μg/Kg or 180 μg weekly + ribavirin 800–1200 mg/day) for 48 weeks irrespective of the genotype is the recommended treatment protocol. Therapy poses significant problems in the form of anemia, neutropenia, higher risk of rejection, and so on.
This document provides information on managing hepatitis C in primary care. It discusses gaps in the hepatitis C care continuum, with up to 90-95% of individuals living with hepatitis C being unaware of their infection. Screening for hepatitis C is important for improving detection and treatment. The natural history of hepatitis C infection is described, showing how timely treatment can arrest disease progression and prevent death. Groups at risk for hepatitis C infection are identified. Guidelines for pre-treatment assessment and approved direct-acting antiviral treatment regimens are presented, along with considerations for special patient groups such as those with HIV, hepatitis B, or kidney disease coinfection. Monitoring during and after treatment is also covered.
Treatment of hepatitis C in liver transplant patientApollo Hospitals
A significant proportion of patients with chronic hepatitis C virus (HCV) infection develop cirrhosis and complications of end-stage liver disease over two to three decades and require liver transplantation. However, reinfection is common and leads to further adverse events under immunosuppression. Pretransplant antiviral or pre-emptive therapy is limited to mildly decompensated patients due to poor tolerance. The main stay of management represents directed antiviral therapy after evidence of recurrence of HCV in the transplanted patient.
This study analyzed clinical outcomes of treated and untreated patients with hepatitis C virus (HCV) infection in two cohorts. It found that HCV patients who did not respond to interferon-alpha based treatment had a significantly increased risk of developing cirrhosis compared to untreated patients, even after adjusting for factors like fibrosis stage and psychosocial risks. Specifically, treatment nonresponders had a 2.35 times higher hazard of cirrhosis in the Veterans Affairs cohort and a 5.9 times higher hazard in the University Hospital cohort compared to untreated patients. However, the overall survival of nonresponders was not significantly different than untreated patients. This suggests that while interferon-alpha treatment failure may accelerate liver fibrosis, it does not necessarily impact overall
This study evaluated the safety and efficacy of sofosbuvir/velpatasvir (SOF/VEL) for 12 weeks in 59 hepatitis C virus (HCV)-infected patients with end-stage renal disease (ESRD) undergoing dialysis. The study found SOF/VEL to be safe and well tolerated, with 95% of patients achieving a sustained virologic response at 12 weeks post treatment. Plasma levels of HCV RNA declined rapidly in all patients, with 100% having undetectable viral loads by 4 weeks. This demonstrates SOF/VEL as an effective treatment option for HCV in patients with ESRD on dialysis.
This study evaluated the safety and efficacy of sofosbuvir/velpatasvir (SOF/VEL) for 12 weeks in 59 patients with hepatitis C virus (HCV) infection and end-stage renal disease (ESRD) undergoing dialysis. The overall sustained virologic response rate at 12 weeks post-treatment (SVR12) was 95%. Adverse events were mostly mild to moderate and consistent with ESRD. Plasma exposures of SOF and its metabolites were higher than in patients with normal renal function but were well tolerated. SOF/VEL for 12 weeks was safe and effective for HCV in patients with ESRD on dialysis.
This study evaluated the safety and efficacy of pegylated interferon alpha-2a (PEG-IFN) monotherapy in 78 hepatitis C virus (HCV) positive hemodialysis patients. An early viral response was seen in 61.5% of patients at 12 weeks. However, only 19.2% had undetectable HCV RNA levels at end of treatment. A sustained viral response was achieved in 14.1% of the initial population. Adherence was poor, with 32% unable to complete the 48-week treatment due to adverse effects. Adverse events were common, occurring in 83% of patients. The incidence of serious adverse events was high at 0.19 per patient-year. The study
HCV MANAGEMENT IN PATIENT WITH KIDNEY DISEASE..reuploadedPratap Tiwari
HCV infection is associated with an increased risk of chronic kidney disease and renal impairment. Treatment of HCV in patients with renal disease prior to direct-acting antivirals was not very effective due to significant side effects of interferon-based regimens. The introduction of direct-acting antivirals such as sofosbuvir provided more effective and tolerable treatment options, though patients with severe renal impairment still experienced worse side effects and lower response rates. Effective treatment of HCV in patients with renal disease is important given their risk of faster liver disease progression and greater liver-related morbidity and mortality compared to those with normal renal function.
Peritoneal dialysis (PD) is associated with better preservation of residual kidney function compared to hemodialysis (HD). PD also has advantages such as lower infection risks and improved quality of life through increased employment rates and lifestyle flexibility compared to HD. However, PD remains underutilized in many countries despite its benefits. Factors contributing to underutilization include modality preferences of nephrologists, lack of patient education, and system-related barriers. Integrated care approaches emphasizing early referral and shared modality decision-making between patients and nephrologists are optimal for end-stage renal disease treatment.
This document discusses HIV and its effects on the kidney. It begins by outlining how HIV medications and the virus itself can impact renal function. It then discusses how monitoring renal function in HIV patients requires looking beyond creatinine and eGFR, as proximal tubule damage is common. Studies mentioned show increasing rates of chronic kidney disease in HIV populations and risk factors like tenofovir use and older age. Biopsy results from local patients demonstrate frequent tenofovir toxicity and the value of the urine APR test. Ongoing research aims to better estimate glomerular filtration rate and understand discrepancies with estimated values.
Cathy Logan, MD, of the UC San Diego AntiViral Research Center, presents "Solid Organ Transplantation and HIV" at AIDS Clinical Rounds on August 29, 2014
This document discusses treatment of hepatitis C in patients with chronic kidney disease. It begins by establishing the association between HCV infection and CKD, noting that HCV can cause renal impairment and progression of kidney disease through various mechanisms. It then reviews outcomes in this population such as increased prevalence of CKD, faster progression to ESRD, higher mortality rates, and poorer outcomes after renal transplant compared to those without HCV infection. The document next evaluates earlier treatment options with interferon-based regimens, which had low efficacy and significant side effects. It then discusses approval and study of newer direct-acting antiviral regimens, finding improved efficacy and safety particularly with sofosbuvir and glecaprevir/pibrentasvir
This document summarizes updates to the 2009 American Association for the Study of Liver Diseases (AASLD) Practice Guidelines for the management of chronic hepatitis B. Key changes include:
1) Tenofovir is now recommended as a first-line oral antiviral treatment based on its superior efficacy compared to adefovir in clinical trials. Adefovir is now recommended as a second-line treatment.
2) Entecavir is no longer recommended for patients co-infected with HBV and HIV due to data on its anti-HIV activity.
3) Screening recommendations were expanded to include persons born in intermediate endemic areas and those receiving cancer chemotherapy or long-term immunosuppression based on
Pegintron and decompensated cirrhosis due to hcv final with glutathioneShendy Sherif
This study assessed the effect of combination therapy with pegylated interferon alfa-2b and ribavirin in 29 Egyptian patients with advanced cirrhosis due to HCV genotype 4. One patient died during treatment and 4 withdrew due to side effects. Of the remaining 24 patients, 16 showed an initial virological response and continued treatment. 12 patients (41.4% of the original group) achieved a sustained virological response. Liver biopsies found reduced glutathione levels and histological activity were significantly reduced in patients with a sustained response. The study concluded that patients with advanced cirrhosis but without contraindications can be treated similarly to earlier cases, with nearly similar responses and tolerability.
Hepatitis C is caused by the hepatitis C virus (HCV), which is a single-stranded RNA virus from the Flaviviridae family. It is transmitted through blood and bodily fluids. HCV replicates within liver cells and evades the immune system, leading to persistent infection in some cases. Symptoms are often mild or absent. Diagnosis involves testing for HCV antibodies or RNA. Treatment involves direct-acting antiviral drugs, which have high cure rates. Special populations like those with HIV/HCV coinfection, kidney disease, or other liver diseases may require modified treatment approaches.
The document discusses the relationship between hepatitis C virus (HCV) infection and diabetes mellitus (DM). It notes that the liver plays an important role in glucose metabolism, which helps explain the association between cirrhosis and impaired glucose regulation. There is increasing evidence that HCV infection is linked to DM by mechanisms like pancreatic beta cell damage. DM can accelerate liver disease progression in HCV patients. Traditional antiviral therapy has been shown to improve DM outcomes and reduce risks of complications like heart attack and stroke. However, the impact of new direct-acting antiviral treatments on DM needs further research. Overall control of DM is important for good response to HCV treatment and reducing related complications.
Современное лечение ВИЧ: лечение ВИЧ у пациентов с вирусными гепатитами.Conte...hivlifeinfo
Современное лечение ВИЧ: лечение ВИЧ у пациентов с вирусными гепатитами.Contemporary Management of HIV. Managing HIV in Viral Hepatitis Coinfection.2016
In this downloadable slideset, David L. Wyles, MD, and Program Director Eric S. Daar, MD, review key data and optimal approaches for ART management in patients with HIV and viral hepatitis coinfection.
Format: Microsoft PowerPoint (.ppt)
File size: 1.85 MB
This document provides an overview of a study that introduced reflex AST testing in primary care in Wales to increase detection of advanced liver disease. The following key points were discussed:
- Over 17,000 individuals with elevated ALT levels had AST testing performed, and 12% had an AST:ALT ratio over 1, which is indicative of potential advanced liver disease.
- Around 750 of these individuals were referred from primary care for further assessment, with 348 undergoing Fibroscan examination. This identified 192 new cases of advanced fibrosis, an 81% increase in coded cirrhosis diagnoses.
- The study demonstrated that reflex AST testing in primary care significantly increased rates of cirrhosis detection compared to relying only on elevated ALT levels.
C5 Case Study Session of Three Long-Term Survivors with HIV Disease JayaweeraDSHS
This case study describes a 35-year-old man who presented with end-stage AIDS and liver disease requiring possible liver transplantation. He had HIV for over 10 years, as well as hepatitis B and C. His CD4 count was 69 and viral load was over 100,000. He had severe ascites, high bilirubin, low albumin, and elevated INR. After starting antiretroviral therapy, his viral load decreased and CD4 increased, allowing him to undergo liver transplantation. He had an uneventful recovery and suppression of both HIV and HBV.
3TC-DTG Dual Therapy and Its Implications in Hepatic Steatosis in People Livi...semualkaira
Hepatic disease is one of the major comorbidities
in people living with HIV. We intended to define the incidence of
NAFLD and to identify any factors which may be associated with
such a condition.
Crimson Publishers: Interferon-Free Therapy for Hepatits C in Brazil and Sust...CrimsonGastroenterology
Introduction: Hepatitis C has been treated with interferon and ribavirin for over a decade with described global sustained virological response rates of 33% to 56%. Direct acting antiviral drugs available since 2013 in USA and 2015 in Brazil are changing this reality.
Purpose: Analyze the real-life efficacy and safety of interferon-free therapy.
Methods: Repot six cases of different treatments guided by north-american and european guildelines.
Results: Every reported patient achieved sustained virological response. The only adverse event was anemia in one patient.
Conclusion: Direct-acting antiviral drugs will dramatically change the population which can be treated and increase sustained virological response rates.
Acute Necrotizing Pancreatitis-Current Concepts and Latest Treatment Strategi...semualkaira
Acute Necrotizing Pancreatitis is a difficult clinical condition with a high death rate. Because of the severe inflammatory reaction, it is a difficult condition to treat. Treatment for this illness now includes less invasive options such percutaneous drainage and endoscopic drainage in addition to less invasive endoscopic and video-assisted or laparoscopic debridement. The timing and technique of treatment have also changed. This research reviews the literature on various interventions for acute necrotizing pancreatitis with the goal of shedding light on the step-up approach to acute necrotizing pancreatitis care.
Acute Necrotizing Pancreatitis-Current Concepts and Latest Treatment Strategi...semualkaira
Acute Necrotizing Pancreatitis is a difficult clinical condition with a high death rate. Because of the severe inflammatory reaction, it is a difficult condition to treat. Treatment for this illness now includes less invasive options such percutaneous drainage and endoscopic drainage in addition to less invasive endoscopic and video-assisted or laparoscopic debridement. The timing and technique of treatment have also changed. This research reviews the literature on various interventions for acute necrotizing pancreatitis with the goal of shedding light on the step-up approach to acute necrotizing pancreatitis care.
Acute Necrotizing Pancreatitis-Current Concepts and Latest Treatment Strategi...semualkaira
Acute Necrotizing Pancreatitis is a difficult clinical condition with
a high death rate. Because of the severe inflammatory reaction,
it is a difficult condition to treat. Treatment for this illness now
includes less invasive options such percutaneous drainage and
endoscopic drainage in addition to less invasive endoscopic and
video-assisted or laparoscopic debridement. The timing and technique of treatment have also changed. This research reviews the
literature on various interventions for acute necrotizing pancreatitis with the goal of shedding light on the “step-up approach” to
acute necrotizing pancreatitis care.
Deadenylase Expression in Small Cell Lung Cancer Related To Clinical Characte...daranisaha
Lung cancer is the second common malignancy and the most aggressive cancer worldwide with late diagnosis and poor prognosis. The search for biomarkers that promote early diagnosis and improve therapeutic strategies focuses to the understanding of the mechanisms underlying cancer development and progression. The deregulation of gene expression is one of the cancer hallmarks reflected to the stability...
A 43-Year-Old Male with PCM1-JAK2 Gene Fusion Experienced T-Lymphoblastic Lym...daranisaha
Myeloid/lymphoid neoplasms associated with eosinophilia and PCM1-JAK2 is a provisional entity in WHO 2016. Prior case reports have shown quite a few clinical presentations in different patients with this chromosome translocation,characterized by eosinophilia in combination with myelodysplastic/ myeloproliferative neoplasms, acute myeloid leukemia(AML) and rarely,
More Related Content
Similar to Inferior Outcomes after Late use of Direct-Acting Antiviral Agents in Patients with Recurrent Hepatitis C Infection after Liver Transplantation
This study evaluated the safety and efficacy of pegylated interferon alpha-2a (PEG-IFN) monotherapy in 78 hepatitis C virus (HCV) positive hemodialysis patients. An early viral response was seen in 61.5% of patients at 12 weeks. However, only 19.2% had undetectable HCV RNA levels at end of treatment. A sustained viral response was achieved in 14.1% of the initial population. Adherence was poor, with 32% unable to complete the 48-week treatment due to adverse effects. Adverse events were common, occurring in 83% of patients. The incidence of serious adverse events was high at 0.19 per patient-year. The study
HCV MANAGEMENT IN PATIENT WITH KIDNEY DISEASE..reuploadedPratap Tiwari
HCV infection is associated with an increased risk of chronic kidney disease and renal impairment. Treatment of HCV in patients with renal disease prior to direct-acting antivirals was not very effective due to significant side effects of interferon-based regimens. The introduction of direct-acting antivirals such as sofosbuvir provided more effective and tolerable treatment options, though patients with severe renal impairment still experienced worse side effects and lower response rates. Effective treatment of HCV in patients with renal disease is important given their risk of faster liver disease progression and greater liver-related morbidity and mortality compared to those with normal renal function.
Peritoneal dialysis (PD) is associated with better preservation of residual kidney function compared to hemodialysis (HD). PD also has advantages such as lower infection risks and improved quality of life through increased employment rates and lifestyle flexibility compared to HD. However, PD remains underutilized in many countries despite its benefits. Factors contributing to underutilization include modality preferences of nephrologists, lack of patient education, and system-related barriers. Integrated care approaches emphasizing early referral and shared modality decision-making between patients and nephrologists are optimal for end-stage renal disease treatment.
This document discusses HIV and its effects on the kidney. It begins by outlining how HIV medications and the virus itself can impact renal function. It then discusses how monitoring renal function in HIV patients requires looking beyond creatinine and eGFR, as proximal tubule damage is common. Studies mentioned show increasing rates of chronic kidney disease in HIV populations and risk factors like tenofovir use and older age. Biopsy results from local patients demonstrate frequent tenofovir toxicity and the value of the urine APR test. Ongoing research aims to better estimate glomerular filtration rate and understand discrepancies with estimated values.
Cathy Logan, MD, of the UC San Diego AntiViral Research Center, presents "Solid Organ Transplantation and HIV" at AIDS Clinical Rounds on August 29, 2014
This document discusses treatment of hepatitis C in patients with chronic kidney disease. It begins by establishing the association between HCV infection and CKD, noting that HCV can cause renal impairment and progression of kidney disease through various mechanisms. It then reviews outcomes in this population such as increased prevalence of CKD, faster progression to ESRD, higher mortality rates, and poorer outcomes after renal transplant compared to those without HCV infection. The document next evaluates earlier treatment options with interferon-based regimens, which had low efficacy and significant side effects. It then discusses approval and study of newer direct-acting antiviral regimens, finding improved efficacy and safety particularly with sofosbuvir and glecaprevir/pibrentasvir
This document summarizes updates to the 2009 American Association for the Study of Liver Diseases (AASLD) Practice Guidelines for the management of chronic hepatitis B. Key changes include:
1) Tenofovir is now recommended as a first-line oral antiviral treatment based on its superior efficacy compared to adefovir in clinical trials. Adefovir is now recommended as a second-line treatment.
2) Entecavir is no longer recommended for patients co-infected with HBV and HIV due to data on its anti-HIV activity.
3) Screening recommendations were expanded to include persons born in intermediate endemic areas and those receiving cancer chemotherapy or long-term immunosuppression based on
Pegintron and decompensated cirrhosis due to hcv final with glutathioneShendy Sherif
This study assessed the effect of combination therapy with pegylated interferon alfa-2b and ribavirin in 29 Egyptian patients with advanced cirrhosis due to HCV genotype 4. One patient died during treatment and 4 withdrew due to side effects. Of the remaining 24 patients, 16 showed an initial virological response and continued treatment. 12 patients (41.4% of the original group) achieved a sustained virological response. Liver biopsies found reduced glutathione levels and histological activity were significantly reduced in patients with a sustained response. The study concluded that patients with advanced cirrhosis but without contraindications can be treated similarly to earlier cases, with nearly similar responses and tolerability.
Hepatitis C is caused by the hepatitis C virus (HCV), which is a single-stranded RNA virus from the Flaviviridae family. It is transmitted through blood and bodily fluids. HCV replicates within liver cells and evades the immune system, leading to persistent infection in some cases. Symptoms are often mild or absent. Diagnosis involves testing for HCV antibodies or RNA. Treatment involves direct-acting antiviral drugs, which have high cure rates. Special populations like those with HIV/HCV coinfection, kidney disease, or other liver diseases may require modified treatment approaches.
The document discusses the relationship between hepatitis C virus (HCV) infection and diabetes mellitus (DM). It notes that the liver plays an important role in glucose metabolism, which helps explain the association between cirrhosis and impaired glucose regulation. There is increasing evidence that HCV infection is linked to DM by mechanisms like pancreatic beta cell damage. DM can accelerate liver disease progression in HCV patients. Traditional antiviral therapy has been shown to improve DM outcomes and reduce risks of complications like heart attack and stroke. However, the impact of new direct-acting antiviral treatments on DM needs further research. Overall control of DM is important for good response to HCV treatment and reducing related complications.
Современное лечение ВИЧ: лечение ВИЧ у пациентов с вирусными гепатитами.Conte...hivlifeinfo
Современное лечение ВИЧ: лечение ВИЧ у пациентов с вирусными гепатитами.Contemporary Management of HIV. Managing HIV in Viral Hepatitis Coinfection.2016
In this downloadable slideset, David L. Wyles, MD, and Program Director Eric S. Daar, MD, review key data and optimal approaches for ART management in patients with HIV and viral hepatitis coinfection.
Format: Microsoft PowerPoint (.ppt)
File size: 1.85 MB
This document provides an overview of a study that introduced reflex AST testing in primary care in Wales to increase detection of advanced liver disease. The following key points were discussed:
- Over 17,000 individuals with elevated ALT levels had AST testing performed, and 12% had an AST:ALT ratio over 1, which is indicative of potential advanced liver disease.
- Around 750 of these individuals were referred from primary care for further assessment, with 348 undergoing Fibroscan examination. This identified 192 new cases of advanced fibrosis, an 81% increase in coded cirrhosis diagnoses.
- The study demonstrated that reflex AST testing in primary care significantly increased rates of cirrhosis detection compared to relying only on elevated ALT levels.
C5 Case Study Session of Three Long-Term Survivors with HIV Disease JayaweeraDSHS
This case study describes a 35-year-old man who presented with end-stage AIDS and liver disease requiring possible liver transplantation. He had HIV for over 10 years, as well as hepatitis B and C. His CD4 count was 69 and viral load was over 100,000. He had severe ascites, high bilirubin, low albumin, and elevated INR. After starting antiretroviral therapy, his viral load decreased and CD4 increased, allowing him to undergo liver transplantation. He had an uneventful recovery and suppression of both HIV and HBV.
3TC-DTG Dual Therapy and Its Implications in Hepatic Steatosis in People Livi...semualkaira
Hepatic disease is one of the major comorbidities
in people living with HIV. We intended to define the incidence of
NAFLD and to identify any factors which may be associated with
such a condition.
Crimson Publishers: Interferon-Free Therapy for Hepatits C in Brazil and Sust...CrimsonGastroenterology
Introduction: Hepatitis C has been treated with interferon and ribavirin for over a decade with described global sustained virological response rates of 33% to 56%. Direct acting antiviral drugs available since 2013 in USA and 2015 in Brazil are changing this reality.
Purpose: Analyze the real-life efficacy and safety of interferon-free therapy.
Methods: Repot six cases of different treatments guided by north-american and european guildelines.
Results: Every reported patient achieved sustained virological response. The only adverse event was anemia in one patient.
Conclusion: Direct-acting antiviral drugs will dramatically change the population which can be treated and increase sustained virological response rates.
Acute Necrotizing Pancreatitis-Current Concepts and Latest Treatment Strategi...semualkaira
Acute Necrotizing Pancreatitis is a difficult clinical condition with a high death rate. Because of the severe inflammatory reaction, it is a difficult condition to treat. Treatment for this illness now includes less invasive options such percutaneous drainage and endoscopic drainage in addition to less invasive endoscopic and video-assisted or laparoscopic debridement. The timing and technique of treatment have also changed. This research reviews the literature on various interventions for acute necrotizing pancreatitis with the goal of shedding light on the step-up approach to acute necrotizing pancreatitis care.
Acute Necrotizing Pancreatitis-Current Concepts and Latest Treatment Strategi...semualkaira
Acute Necrotizing Pancreatitis is a difficult clinical condition with a high death rate. Because of the severe inflammatory reaction, it is a difficult condition to treat. Treatment for this illness now includes less invasive options such percutaneous drainage and endoscopic drainage in addition to less invasive endoscopic and video-assisted or laparoscopic debridement. The timing and technique of treatment have also changed. This research reviews the literature on various interventions for acute necrotizing pancreatitis with the goal of shedding light on the step-up approach to acute necrotizing pancreatitis care.
Acute Necrotizing Pancreatitis-Current Concepts and Latest Treatment Strategi...semualkaira
Acute Necrotizing Pancreatitis is a difficult clinical condition with
a high death rate. Because of the severe inflammatory reaction,
it is a difficult condition to treat. Treatment for this illness now
includes less invasive options such percutaneous drainage and
endoscopic drainage in addition to less invasive endoscopic and
video-assisted or laparoscopic debridement. The timing and technique of treatment have also changed. This research reviews the
literature on various interventions for acute necrotizing pancreatitis with the goal of shedding light on the “step-up approach” to
acute necrotizing pancreatitis care.
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2. clinicsofoncology.com 2
Volume 6 Issue 10 -2022 Research Article
2. Introduction
Chronic hepatitis C infection is a leading cause of end-stage liver
disease worldwide, and along with hepatocellular carcinoma and
hepatic failure, is one of the primary causes of liver transplanta-
tion. Moreover, the diverse category of direct-acting antivirals
(DAAs), which have become increasingly universal for all popula-
tions, are recommended before the disease becomes serious [1-2].
In addition, with advances in genotyping methodologies, the gen-
otypes of HCV patients can be differentiated precisely and rapidly
[3]. which is essential in the decision-making process to determine
the appropriate treatment and therapeutic duration. According to
the published guideline on the management of hepatitis C, differ-
ent intervals of post-liver transplantation sustained virological re-
sponse (SVR) monitoring are recommended for specific groups
and for those who are treated with different agents [4-5]. How-
ever, recurrence after transplantation is universal even in those
with undetectable HCV RNA in the early post-surgical stage [6-9].
The timing of DAA use for recurrent HCV infection after liver
transplantation has been a widely discussed topic in recent years
[10-14]. For patients with recurrence, several studies have sug-
gested that DAA still exerts powerful effects in terms of SVR and
its safety profile [11,13,15-17]. Guidelines for almost all patient
populations have also been published [6,18]. For patients on the
waiting list for transplantation, DAA agents can reduce the need
for transplantation by removing the virus, but the long-term prog-
nosis of this approach has not been confirmed [10,12] and some
studies have suggested that the use of interferon-free agents before
surgery will help dramatically reduce the recurrence rate after sur-
gery [4,7,11,15]. With the exception of the safety and effectiveness
of treatment before liver transplantation, similar results were also
confirmed in several studies including the period of peri-operation
and post-operation recurrence [16,19]. Although some research
has indicated that DAAs will increase the incidence of HCC for
some groups [20-22]. Research conducted in Brazil has refuted
this and found no recurrence of HCC or decompensated cirrhosis
after 20 months of follow-up after DAA treatment [13]. Moreover,
an international multicenter study did not find that DAA therapy
was a risk factor for mortality or HCC recurrence [23]. The timing
of DAA treatment after liver transplantation remains a controver-
sial issue, and no related studies have evaluated the prognosis until
now. Although DAAs are beneficial for most patients, there is no
effective, rapid, and non-invasive way for the clinicians to assess
the prognosis of liver fibrosis and other related prognosis for pa-
tients who use DAA.
We therefore report our experience that the interval between liver
transplantation and DAA agent treatment is correlated with liver
fibrosis in patients with recurrent hepatitis C infection.
3. Materials and Methods
This was a retrospective observational study of liver transplant re-
cipients with recurrent HCV infection that was performed at a sin-
gle medical center in Taiwan from September 2002 to September
2019. Due to its effectiveness, non-invasive nature,24 and its abili-
ty to stratify HCC risk in patients with HCV who achieve SVR,25-
26 this study adopted the Fibrosis-4 (FIB-4) score to predict the
severity of hepatic fibrosis.
The formula used for FIB-4 is: age (years) AST/[platelet count
(109/L) ALT1/2]. HCV RNA and genotypes were detected by the
Abbott RealTime Genotype II assay, HCV RNA viral load was
detected by the Roche cobas AmpliPrep/cobas TaqMan HCV Test,
and HBV viral load was detected by the Abbott RealTime HBV
Test.
4. Patients and Regimen
The main inclusion criteria were as follows: (1) patients at least
18 years of age who underwent a deceased-donor orthotopic liv-
er transplantation or living donor transplantation due to compli-
cations of chronic hepatitis C infection (end-stage liver cirrhosis
or hepatocellular carcinoma) (2) patients with positive HCV viral
load who started DAA treatment from January 22, 2015 to Sep-
tember 04, 2019 (3) patients with no contraindications for DAA
and no drug-drug interactions during treatment. The main exclu-
sion criteria were as follows: (1) presence of decompensated liver
disease (Child Pugh B or C) when DAA treatment was initiated (2)
evidence of HCC when DAA treatment was started (3) coinfection
with human immunodeficiency virus. (4) Use of DAA treatment
before liver transplantation. (5) donor positive for HCV. From
2002 to 2019, 130 patients underwent liver transplantation due to
liver decompensation or HCC secondary to chronic HCV infection.
We detected both HCV immunoglobulin G and HCV viral load
every 3 months during the first year after liver transplantation, and
then monitored liver function and performed abdominal sonogra-
phy every 3 months to determine whether the recurrence of HCV
should be further evaluated. Among those patients, 16 were lost to
follow-up after surgery and 49 died due to surgical complications,
graft rejection, hepatic decompensation due to HCV recurrence or
other etiology, or some extrahepatic comorbidity. HCV viral load
was not detected in 33 patients, 2 had HCV recurrence without
completion of DAA treatment due to impaired renal function or
drug-drug interaction, 7 received DAA therapy before transplanta-
tion and were HCV-negative after surgery, and 23 received DAA
after transplantation. Of these 23, 2 patients, who were consid-
ered outliers, were excluded because the interval was too long (97
months and 198 months for each patient).
The regimen comprised Ledipasvir/Sofosbuvir with or without
Ribavirin, Daclatasvir/Asunaprevir/Ribavirin, Glecaprevir/Pi-
brentasvir, Velpatasvir/Sofosbuvir, or Sofosbuvir with or without
Ribavirin. The antiviral regimen and treatment duration were de-
cided by the treating physician based on published guidelines6,18
and treatment availability. Patients returned to the outpatient de-
partment every 4 weeks for 12 total weeks during treatment for
drug refills, laboratory analyses, and evaluation of clinical side
3. clinicsofoncology.com 3
Volume 6 Issue 10 -2022 Research Article
effects and then returned every 12 weeks after treatment for lab-
oratory analyses, sonography (performed every 12 weeks), and
computed tomography (CT) (performed every 24 weeks).
5. Statistical Analyses
The baseline continuous variables of the patients are presented as
the mean and standard deviation. Variables in different time points
were compared using the generalized estimating equation. The
correlation between the period after liver transplantation and the
FIB-4 score was determined using Spearman’s correlation coef-
ficient.
Serum HCV RNA is expressed as the logarithmic transformation
of the original values.
6. Ethical Considerations
This study was approved by the NDMC Ethics Committee (ap-
proval number is B202005128). In this study, we followed the Hel-
sinki and Istanbul guidelines and no executed prisoners were used
as donors.
7. Results
7.1. Baseline Patient Data
Twenty-one patients were enrolled in the present study (Tables 1,
2, 3. Table 3 in interval order). The mean age of the patients was
58.95 years, and 57.14 % (n=10) of the patients were male. The
HCV RNA viral load was 6.76 log IU/mL before DAA treatment.
The patients were infected with the 1a,1b, 2, 3, and 4 HCV geno-
types. The reasons for liver transplantation were HCC (n=6), he-
patic decompensation (n=8), and both HCC and decompensation
(n=7). Seventeen patients underwent living donor liver transplan-
tation, while the other 4 underwent deceased-donor liver trans-
plantation. Two patients received interferon therapy before liver
transplantation, but none received this therapy after surgery. Liv-
er cirrhosis or HCC was not detected in any patient before DAA
treatment. The major comorbidities were diabetes (n=9), hyperten-
sion(n=4), chronic renal disease (n=2), and coronary artery disease
(n=2). The mean FIB-4 score before DAA treatment was 4.08. The
mean interval between liver transplantation and DAA treatment
was 19.14 months. HCV RNA was undetectable at treatment week
12 in all patients. HCV RNA was detectable (6,039,768 IU/mL) in
only one patient 12 weeks after treatment, but in this case, the HCV
RNA was undetectable 24 weeks after treatment. One patient treat-
ed with Ledipasvir/Sofosbuvir with Ribavirin experienced severe
anemia, which subsided after Ribavirin was discontinued. Among
the 4 patients who were HBV carriers before liver transplantation,
no HBV DNA viral load was detected before DAA treatment; they
also maintained the use of oral entecavir at a dose of 0.5 mg to
prevent HBV flare-ups after liver transplantation. Then, 24 weeks
after therapy cessation, sonography and CT showed no HCC or
cirrhosis in any of the patients.
Table 1. The basic characteristics of the patients before operation and before the DAA usage.
Variable (n) (%) (mean) (SD)
Gender
Female 9 42.86%
Male 12 57.14%
Age when operation (years) 21 56.38 7.24
Age when DAA (years) 21 58.95 7.86
The period of time of DAA after LT (months) 21 19.14 18.97
Table 2. Treatment response and FIB-4 score.
Variable β SE P value
95% C.I.
Lower Upper
Visit
12 weeks vs. Pre-DAA -0.490 0.995 0.622 -2.439 1.459
12 weeks after DAA vs. Pre-DAA -1.268 0.594 0.033 -2.432 -0.103
24 weeks after DAA vs. Pre-DAA -1.820 0.804 0.023 -3.395 -0.246
Dependent variable: FIB-4
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Volume 6 Issue 10 -2022 Research Article
Table 3. The correlation between the interval and FIB-4 score.
FIB-4 score
The period of time of DAA after the liver transplantation(months)
Spearman's correlation coefficient p value
pre-DAA 0.222 0.334
12 weeks 0.311 0.170
12 weeks after DAA 0.300 0.187
24 weeks after DAA 0.442 0.045
7.2. Treatment Response and FIB-4 Score
Figure 1 illustrates that in this study, the FIB-4 scores 24 weeks
after DAA treatment were lower than the pre-treatment baseline
scores except for the score in patient number 10 (Figure 1). Ac-
cording to the overall analysis using the generalized estimating
equation, the mean FIB-4 of SVR12 was lower than that before
DAA treatment (β=−1.268), and this difference was statistically
significant (P=0.033). The mean FIB-4 score of SVR24 was lower
than the pre-DAA score (β=−1.820), and this difference was statis-
tically significant (P=0.023) (Figure 2) .
7.3. The Correlation between the Interval and FIB-4 Score
The Spearman’s correlation coefficient was 0.222 for pre-DAA,
0.311 at 12 weeks after DAA treatment, 0.300 at 12 weeks af-
ter treatment, and 0.442 at 24 weeks after treatment. A positive
correlation was observed in all phases. The P-value for 24 weeks
post-DAA treatment was 0.045, which was statistically signifi-
cant (Figure 3,). Longer intervals were correlated with high FIB-4
scores, and the correlation coefficient became higher with longer
observation times.
Figure 1: Illustrates that in this study, the FIB-4 scores 24 weeks after DAA treatment were lower than the pre-treatment baseline scores except for the
score in patient number 10.
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Volume 6 Issue 10 -2022 Research Article
Figure 2: The mean FIB-4 score of SVR24 was lower than the pre-DAA score (β=−1.820), and this difference was statistically significant (P=0.023).
Figure 3: The P-value for 24 weeks post-DAA treatment was 0.045, which was statistically significant.
8. Discussion
As far as we know, this is the first report to evaluate the correlation
between the time to DAA treatment after liver transplantation and
hepatic fibrosis using the FIB-4 scoring system in a single medical
center patient sample. The positive correlation provided us with
information about how inferior outcomes, as measured by the fi-
brosis score, are associated with longer intervals, and led to a new
method that can predict the prognosis of patients undergoing treat-
ment. One of the possible reasons for this positive correlation may
be the prolonged interval between HCV infection and HCV RNA
detection even under regular monitoring with prompt DAA treat-
ment.Another reason may be the post-transplantation immunosup-
pression that occurs in cases in which the virus is not eradicated
in recipients before liver transplantation [8,14,27]. However, the
decrease in FIB-4 score may be due to transaminase normalization
or the increase in the number of platelets, which cannot fully re-
flect a change in fibrosis. With significantly improved FIB-4 score
in almost all patients, patients who take the drug earlier after liv-
er transplantation will have relatively better FIB-4 score results.
Moreover, we believe that in the long-term prognosis for the liver
graft after liver transplantation, the possibility of progression to
fibrosis will also be relatively low for patients who take the drug
earlier.
8.1. Current DAA use for Liver Transplantation with Recur-
rence in Taiwan
Prior to the introduction and approval of interferon-free agents,
liver transplantation in HCV-positive patients was associated with
poor outcomes and an increased mortality rate compared with liver
transplantation for other indications [22,28]. The inferior graft and
survival rates are largely due to accelerated graft fibrosis as a result
of recurrent HCV infection. If left untreated, the condition will
progress to cirrhosis in approximately 30% of patients at 5 years
post-liver transplantation [9,14,29-31]. In Taiwan, it is mandatory
for all citizens to have National Health Insurance (NHI), which has
a coverage rate of approximately 99%. DAA treatment has been
reimbursed by the NHI since 2017 and has been available for pa-
tients with HCV viremia regardless of their liver fibrosis status
and early virologic response since 2019 [4,32-33]. The adminis-
6. clinicsofoncology.com 6
Volume 6 Issue 10 -2022 Research Article
tration of DAA before surgery not only eradicates the hepatitis C
virus with a high SVR rate, but it also reduces the recurrence rate
after surgery [6,11,15]. However, this treatment cannot resolve the
problems of HCC and cirrhosis or serve as a substitute for the crit-
ical role of transplantation in those patients. After DAA use, some
liver transplantation candidates with a lower MELD score (MELD
<16) showed a remarkable clinical improvement and could be re-
moved from the waiting list, but some with a higher MELD score
may lose priority on the waiting list and experience the “MELD
purgatory” effect [6,34-35].
8.2. The Variable Timing of Recurrence after Liver Transplan-
tation
The other new perspective put forward by this study was the great
variability in the timing of recurrence. In our study, HCV RNA
could not be detected after surgery but was detected after an in-
terval of post-operative follow-up that ranged from 1 month to
71 months. The latest strategies were supposed to prevent HCV
recurrence,8-9,14 but it is impossible to predict precisely when re-
currence occurred after surgery. Initiation of DAA treatment very
early after surgery when HCV RNA is not detected seems to be
an attractive treatment approach, but there are no large datasets to
demonstrate its effectiveness and safety. Potential damage to liver
and kidney functions after surgery and increased drug interactions
with immunosuppressants have prevented the mainstream use of
DAAs.6
8.3. Our Perspective on HCV Monitoring after Liver Trans-
plantation
An early study reported that the HCV viral load only reflects the
amount of virus present in the liver but that the viral load was not
correlated with aminotransferase levels or the histological diagno-
sis,36 and recurrence could not be evaluated by liver function test.
No definite guidelines exist for the interval of HCV monitoring,
and thus, the interval can only be evaluated by clinicians. Since
the interval between liver transplantation and DAA treatment has
become a new way to predict prognosis in our study and due to
the unexpected timing of HCV RNA detection, regular HCV viral
load monitoring was needed for all patients. Our experience sug-
gested that due to the high possibility of recurrence within 2 years
(76.1%), the HCV viral load should be monitored immediately af-
ter surgery and then at 12-week intervals for at least 2 years, even
when liver function tests are within the normal range. More than
10% of recipients (16/130) were observed without regular fol-
low-up at 1 medical center even under the system of Taiwan’s NHI
with over 99% coverage for all Taiwanese nationals.32-33 For the
reasons mentioned above, we supposed that many liver recipients
in regions where HCV is prevalent do not undergo regular fol-
low-up after liver transplantation under different medical systems,
and some may have even abandoned treatment after intolerance to
interferon therapy or other agents during the early period.
9. Limitations
Limitations of this study include its observational nature and small
sample size. HCV carriers who undergo liver transplantation, ex-
perience HCV recurrence, and who are treated with DAA have
comprised relatively small groups in the past. In the future, more
cross-participation among medical centers and even cross-border
cooperation are needed to include more samples and a higher ref-
erence value. Moreover, although transient elastography or liver
biopsy will provide more information, the characteristics and ad-
vantages of this test that it is non-invasive and the results can be
quickly determined.
10. Conclusion and Practical Application
DAA use before transplantation is the best time for most recipi-
ents according to the latest published guideline. For the patients
who were not administered DAA before liver transplantation, the
appropriate timing of DAA use for HCV infection after liver trans-
plantation is soon after the HCV viral load is detected due to the
higher possibility of developing liver cirrhosis with the period of
time after liver transplantation. This is especially true in patients
who were negative for HCV in the early disease phase and who
were then lost to regular follow-up and those who had received
interferon, which failed due to intolerance. The potential popula-
tion of patients with HCV recurrence might be underestimated,
and the overall prognosis of patients with hepatic fibrosis who are
prepared to use DAAmight be correlated with the interval between
liver transplantation and the initiation of DAA treatment.
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