December 13, 2010

Coffee Slows Progression of Hep C Liver Disease

December 13, 2010

People living with chronic hepatitis C virus (HCV) infection and advanced liver disease who drink three or more cups of coffee per day have a 53 percent lower risk of liver disease progression than non-coffee drinkers, according to a new study published in the November issue of Hepatology. According to the paper, authored by Neal Freedman, PhD, MPH, of the National Cancer Institute and his colleagues, patients with hepatitis C–related bridging fibrosis or cirrhosis who did not respond to standard treatment benefited from increased coffee intake.

This study included 766 participants enrolled in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis (HALT-C) trial who had hepatitis C–related bridging fibrosis or cirrhosis and failed to respond to standard treatment with pegylated interferon and ribavirin. Upon entering the study, HALT-C volunteers were asked to report their typical frequency of coffee intake and portion size over the past year. A similar question was asked for black and green tea intake.

Participants were seen every three months during the 3.8–year study period to assess clinical outcomes that included: ascites (abnormal accumulation of fluid in the abdomen), prognosis of chronic liver disease, death related to liver disease, hepatic encephalopathy (brain and nervous system damage), hepatocellular carcinoma (liver cancer), spontaneous bacterial peritonitis, variceal hemorrhage and/or increase in fibrosis. Liver biopsies were also taken at 1.5 and 3.5 years to determine the progression of liver disease.

Results showed that participants who drank three or more cups of coffee per day had a relative risk (RR) of 0.47 for reaching one of the clinical outcomes. An RR above 1.00 suggests an increase in the risk of disease progression, whereas an RR below 1.00 suggests a decrease in the risk of disease progression.

Researchers did not observe any association between tea intake and liver disease progression, though tea consumption was low in the study.

“Given the large number of people affected by HCV, it is important to identify modifiable risk factors associated with the progression of liver disease,” Freedman said. “Although we cannot rule out a possible role for other factors that go along with drinking coffee, results from our study suggest that patients with high coffee intake had a lower risk of disease progression.”

Results from this study should not be generalized to healthier populations, the authors cautioned.


Also See:
AASLD: Coffee is associated with virologic response in chronic Hepatitis C: Findings from the Hepatitis C Long - Term Treatment against Cirrhosis Trial (HALT - C)

WATCH: Jewish boy saves Christmas for kids impacted by HIV/AIDS in Fort Worth

Posted on 13 Dec 2010 at 4:16pm

This story must be the antithesis to First Baptist Church of Dallas’ “Grinch alert” website .

Carter Haber, a 12-year-old Jewish boy from Aledo, saved Christmas for more than 50 children whose families are clients of Samaritan House, which provides housing for low-income people with HIV/AIDS in Tarrant County.

Carter raised $5,000 for the gifts as a service project for his bar mitzvah after the Samaritan House lost a corporate sponsor, according to CBS 11:

And the fact a Jewish rite of passage provides Christmas to children? “I don’t think it matters,” Haber said. “A good deed is a good deed any day, any time, anywhere.”

Now Carter wants to continue raising money to help Samaritan House clients pay their rent. To contribute, e-mail


Development and Progression of Portal Hypertensive Gastropathy in Patients With Chronic Hepatitis C

Am J Gastroenterol. 2010 Dec 7. [Epub ahead of print]

Fontana RJ, Sanyal AJ, Ghany MG, Bonkovsky HL, Morgan TR, Litman HJ, Reid AE, Lee WM, Naishadham D.

Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.


OBJECTIVES: The objective of this study was to determine the incidence and risk factors associated with new-onset and worsening portal hypertensive gastropathy (PHG) in patients with chronic hepatitis C (CHC).

METHODS: A total of 831 CHC patients with bridging fibrosis or cirrhosis at the time of entry were prospectively monitored for clinical and histological liver disease progression while receiving either low-dose peginterferon α2a or no antiviral therapy in the HALT-C (Hepatitis C Antiviral Long-term Treatment against Cirrhosis) trial. Upper endoscopy with grading of PHG was performed at baseline and at year 4 of the study. The presence and severity of PHG were determined using the NIEC (New Italian Endoscopy Conference) criteria, and worsening PHG was defined as a score increase of ≥1 point.

RESULTS: During a median follow-up of 3.85 years, 50% of 514 subjects without PHG developed new-onset PHG, whereas 26% of 317 patients with baseline PHG had worsening PHG. Independent predictors of new-onset PHG included higher alkaline phosphatase and being diabetic, whereas predictors of worsening PHG were Caucasian race, lower albumin, as well as higher serum aspartate transaminase/alanine transaminase ratio and homeostatic model assessment levels. New-onset and worsening PHG were significantly associated with clinical and histological progression. They were also associated with new-onset and worsening gastroesophageal varices.

CONCLUSIONS: New-onset and worsening PHG develop at a rate of 12.9% per year and 6.7% per year, respectively, in non-responder CHC patients with advanced fibrosis. If confirmed in other studies, endoscopic surveillance for PHG may need to be tailored to individual patient risk factors.Am J Gastroenterol advance online publication, 7 December 2010; doi:10.1038/ajg.2010.456.

PMID: 21139575 [PubMed - as supplied by publisher


Hepatitis C virus treatment rates and outcomes in HIV/hepatitis C virus co-infected individuals at an urban HIV clinic

Eur J Gastroenterol Hepatol. 2011 Jan;23(1):45-50.

Murray MC, Barrios R, Zhang W, Hull M, Montessori V, Hogg RS, Montaner JS.

aDivision of Infectious Disease bDivision of AIDS, Department of Medicine, University of British Columbia cBritish Columbia Centre for Excellence in HIV/AIDS, Providence Health Care dFaculty of Health Sciences, Simon Fraser University, Vancouver, Canada.


OBJECTIVES: The factors associated with hepatitis C virus (HCV) treatment uptake and responses were assessed among HCV/HIV co-infected individuals referred for HCV therapy at an urban HIV clinic.

METHODS: Retrospective review of HIV/HCV patients enrolled in the HCV treatment program at the John Ruedy Immunodeficiency Clinic in Vancouver. The factors associated with treatment uptake were assessed using multivariate analysis.

RESULTS: A total of 134 HCV/HIV co-infected individuals were recalled for assessment for HCV therapy. Overall 64 (48%) initiated treatment, and of those treated 49 (76.6%) attained end treatment response, whereas 35 (57.8%) achieved sustained virological response (SVR). When evaluated by genotype, 53% (17/32) of those with genotype 1, and 65% (20/31) of those with genotype 2 or 3 infections attained SVR. In treated individuals, alanine aminotransferase dropped significantly after treatment (P<0.001). During treatment, CD4 counts dropped significantly (P<0.001) in all patients. The counts recovered to baseline in patients who achieved SVR, but remained lower in patients who failed the therapy (P=0.015). On multivariate analysis, history of injection drug use (odds ratio: 3.48; 95% confidence interval: 1.37-8.79; P=0.009) and low hemoglobin levels (odds ratio: 4.23; 95% confidence interval: 1.36-13.10; P=0.013) were associated with those who did not enter the treatment.

CONCLUSION: Only half of treatment-eligible co-infected patients referred for the therapy initiated treatment. Of those referred for the therapy, history of injection drug use was associated with lower rates of treatment uptake. Treated HIV/HCV co-infected individuals benefitted from both decreased alanine aminotransferase (independent of SVR), and rates of SVR similar to those described in HCV monoinfected patients.

PMID: 21139470 [PubMed - in process]


Incidence and risk factors for steatosis progression in adults coinfected with HIV and hepatitis C virus

Gastroenterology. 2010 Dec 3. [Epub ahead of print]

Woreta TA, Sutcliffe CG, Mehta SH, Brown TT, Higgins Y, Thomas DL, Torbenson MS, Moore RD, Sulkowski MS.

Johns Hopkins Hospital/University School of Medicine.


BACKGROUND AND AIMS: Hepatic steatosis is a common histological finding in patients that are co-infected with HIV and hepatitis C virus (HCV), although little is known about its natural history. We prospectively examined the natural history of steatosis in patients co-infected with HIV and HCV that attended an urban HIV clinic.

METHODS: The study cohort consisted of 222 co-infected patients (87% African American, 94% with HCV genotype 1 infection) who had at least 2 liver biopsies performed between 1993 and 2008. Biopsies were scored by a single pathologist; samples were classified as having trivial (< 5% of hepatocytes affected) or significant (>5%) levels of fat (steatosis). We characterized progression to significant levels of fat among patients whose first biopsy samples had no or trivial levels of fat, and regression among those with significant fat, using logistic regression.

RESULTS: Initial biopsies from most patients (88%) had no or trivial amounts of fat. Among second biopsy samples, 74% had no or trivial fat and 13% had significant amounts of fat. The strongest risk factors for steatosis progression were alcohol abuse and overweight/obesity; cumulative exposure to anti-retroviral therapy between biopsies and high counts of CD4+ T cells were associated with reduced progression of steatosis. Among the 28 patients whose initial biopsy had significant fat levels, most (75%) regressed.

CONCLUSIONS: Antiretroviral therapy and high counts of CD4+ T cells are associated with reduced progression of steatosis in patients co-infected with HIV and HCV. Efforts to diagnose and prevent steatosis should focus on persons with high body mass index and excessive alcohol intake.

Copyright © 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.

PMID: 21134375 [PubMed - as supplied by publisher]


Maintenance Peginterferon Therapy and Other Factors Associated with Hepatocellular Carcinoma in Patients with Advanced Hepatitis C

Gastroenterology. 2010 Nov 30. [Epub ahead of print]

Lok AS, Everhart JE, Wright EC, Di Bisceglie AM, Kim HY, Sterling RK, Everson GT, Lindsay KL, Lee WM, Bonkovsky HL, Dienstag JL, Ghany MG, Morishima C, Morgan TR; HALT-C Trial Group.

Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, MI.


BACKGROUND & AIMS: Interferon reportedly decreases the incidence of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C. The Hepatitis C anti-viral long-term treatment against cirrhosis (HALT-C) trial showed that 4 years of maintenance therapy with peginterferon does not reduce liver disease progression. We investigated whether peginterferon decreases the incidence of HCC in the HALT-C cohort over a longer post-treatment follow-up period.

METHODS: The study included 1,048 patients with chronic Hepatitis C (Ishak fibrosis scores ≥3) who did not have a sustained virological response (SVR) to therapy. They were randomly assigned to groups given a half-dose of peginterferon or no treatment (controls) for 3.5 years and followed for a median 6.1 (maximum 8.7) years.

RESULTS: Eighty-eight patients developed HCC (68 definite, 20 presumed): 37/515 that were given peginterferon (7.2%) and 51/533 controls (9.6%; P=0.24). There was a significantly lower incidence of HCC among patients given peginterferon therapy who had cirrhosis, but not fibrosis, based on analysis of baseline biopsy samples. After 7 years, the cumulative incidences of HCC in treated and control patients with cirrhosis were 7.8% and 24.2%, respectively (hazard ratio [HR]=0.45; 95% confidence interval [CI]: 0.24-0.83); in treated and control patients with fibrosis they were 8.3% and 6.8%, respectively (HR=1.44; 95% CI: 0.77-2.69). Treated patients with a ≥2-point decrease in the histologic activity index, based on a follow-up biopsy, had a lower incidence of HCC than those with unchanged or increased scores (2.9% vs. 9.4%; P=0.03).

CONCLUSIONS: Extended analysis of the HALT-C cohort showed that long-term peginterferon therapy does not reduce the incidence of HCC among patients with advanced hepatitis C who did not achieve SVRs. Patients with cirrhosis who received peginterferon treatment had a lower risk for HCC than controls.

Copyright © 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.

PMID: 21129375 [PubMed - as supplied by publisher]


Predictive value of tumor markers for hepatocarcinogenesis in patients with hepatitis C virus

J Gastroenterol. 2010 Dec 7. [Epub ahead of print]

Kumada T, Toyoda H, Kiriyama S, Tanikawa M, Hisanaga Y, Kanamori A, Tada T, Tanaka J, Yoshizawa H.

Department of Gastroenterology, Ogaki Municipal Hospital, 4-86, Minaminokawa-cho, Ogaki, Gifu, 503-8052, Japan,


BACKGROUND: Increases in tumor markers are sometimes seen in patients with chronic liver disease without hepatocellular carcinoma (HCC). The aim of this study was to determine the relationship between the levels of three tumor markers [alpha-fetoprotein (AFP), Lens culinaris agglutinin-reactive fraction of AFP (AFP-L3%), and des-γ-carboxy prothrombin (DCP)] and hepatic carcinogenesis to identify hepatitis C virus (HCV) carriers at high risk for cancer development.

METHODS: A total of 623 consecutive HCV carriers with follow-up periods of >3 years were included. The average integration values were calculated from biochemical tests, and tumor markers, including AFP, AFP-L3%, and DCP, and factors associated with the cumulative incidence of HCC were analyzed.

RESULTS: HCC developed in 120 (19.3%) of the 623 patients. Age >65 years [adjusted relative risk, 2.303 (95% confidence interval, 1.551-3.418), P < 0.001], low platelet count [3.086 (1.997-4.768), P < 0.001], high aspartate aminotransferase value [3.001 (1.373-6.562), P < 0.001], high AFP level [≥10, <20 ng/mL: 2.814 (1.686-4.697), P < 0.001; ≥20 ng/mL: 3.405 (2.087-5.557), P < 0.001] compared to <10 ng/mL, and high AFP-L3% level [≥5, <10%: 2.494 (1.291-4.816), P = 0.007; ≥10%: 3.555 (1.609-7.858), P < 0.001] compared to <5% were significantly associated with an increased incidence of HCC on multivariate analysis.

CONCLUSIONS: Increased AFP or AFP-L3% levels were significantly associated with an increased incidence of HCC. Among HCV carriers, patients with ≥10 ng/mL AFP or patients with ≥5% AFP-L3% are at very high risk for the development of HCC even if AFP is less than 20 ng/mL or AFP-L3% is less than 10%, which are the most commonly reported cutoff values.

PMID: 21132575 [PubMed - as supplied by publisher]


Pre-treatment prediction of response to pegylated-interferon plus ribavirin for chronic hepatitis C using genetic polymorphism in IL28B and viral factors

J Hepatol. 2010 Sep 19. [Epub ahead of print]

Kurosaki M, Tanaka Y, Nishida N, Sakamoto N, Enomoto N, Honda M, Sugiyama M, Matsuura K, Sugauchi F, Asahina Y, Nakagawa M, Watanabe M, Sakamoto M, Maekawa S, Sakai A, Kaneko S, Ito K, Masaki N, Tokunaga K, Izumi N, Mizokami M.

Division of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan.


BACKGROUND & AIMS: Pegylated interferon and ribavirin (PEG-IFN/RBV) therapy for chronic hepatitis C virus (HCV) genotype 1 infection is effective in 50% of patients. Recent studies revealed an association between the IL28B genotype and treatment response. We aimed to develop a model for the pre-treatment prediction of response using host and viral factors.

METHODS: Data were collected from 496 patients with HCV genotype 1 treated with PEG-IFN/RBV at five hospitals and universities in Japan. IL28B genotype and mutations in the core and IFN sensitivity determining region (ISDR) of HCV were analyzed to predict response to therapy. The decision model was generated by data mining analysis.

RESULTS: The IL28B polymorphism correlated with early virological response and predicted null virological response (NVR) (odds ratio=20.83, p<0.0001) and sustained virological response (SVR) (odds ratio=7.41, p<0.0001) independent of other covariates. Mutations in the ISDR predicted relapse and SVR independent of IL28B. The decision model revealed that patients with the minor IL28B allele and low platelet counts had the highest NVR (84%) and lowest SVR (7%), whereas those with the major IL28B allele and mutations in the ISDR or high platelet counts had the lowest NVR (0-17%) and highest SVR (61-90%). The model had high reproducibility and predicted SVR with 78% specificity and 70% sensitivity.

CONCLUSIONS: The IL28B polymorphism and mutations in the ISDR of HCV were significant pre-treatment predictors of response to PEG-IFN/RBV. The decision model, including these host and viral factors may support selection of optimum treatment strategy for individual patients.

Copyright © 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

PMID: 21129805 [PubMed - as supplied by publisher]


A comparison of the natural history and outcome of treatment for Asian and non-Asian hepatitis C-infected patients

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

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

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


Summary.  Ethnicity is an important host variable, but its impact on disease progression and response to therapy in Hepatitis C infection is unclear. Here we compare the natural history and outcome of therapy in White and Asian (Indian subcontinent) Hepatitis C infected patients. A total of 2123 White and 120 Asian HCV infected patients were identified within the Trent HCV study. Response to therapy was assessed in 224 White and 46 Asian patients with genotype 3 infection who received Pegylated Interferon and Ribavirin. Asian patients were more likely to be older, female, infected with genotype 3 and to consume no alcohol. At time of first biopsy, fibrosis stage was significantly higher in Asian patients than in Whites (3.0 ± 2.3 vs 1.8 ± 2.0, P < 0.001), as were necro-inflammation and steatosis scores. However, in those patients where duration of infection could be estimated, fibrosis progression was similar for both groups (0.25 ± 0.31 vs 0.16 ± 0.54 Ishak points/year, P = 0.068). 78.3% of Asian and 67.9% of White genotype 3 patients had a sustained virological response following Pegylated Interferon and Ribavirin. Cirrhosis and increased levels of GGT, but not ethnicity were associated with a reduction in the likelihood of a sustained virological response on multivariate analysis. Asian patients with Hepatitis C are more likely to be female, less likely to give a history of risk factors, present to medical services at an older age, and have more severe liver disease at diagnosis, but disease progression and response to treatment are similar to White patients.

© 2010 Blackwell Publishing Ltd.

PMID: 21138506 [PubMed - as supplied by publisher]


Integrated internist - addiction medicine - hepatology model for hepatitis C management for individuals on methadone maintenance

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

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

Division of General Internal Medicine and Hepatology, Department of Medicine, University of California San Diego, San Diego, CA Division of Gastroenterology and Hepatology, Center for the Study of Hepatitis C Division of Infectious Diseases, Department of Medicine Department of Public Health, Weill Cornell Medical College The Laboratory of the Biology of Addictive Diseases, Rockefeller University, New York, NY, USA.


Summary.  Despite a high prevalence of hepatitis C virus (HCV) among drug users, HCV evaluation and treatment acceptance are extremely low among these patients when referred from drug treatment facilities for HCV management. We sought to increase HCV treatment effectiveness among patients from a methadone maintenance treatment program (MMTP) by maintaining continuity of care. We developed, instituted and retrospectively assessed the effectiveness of an integrated, co-localized care model in which an internist-addiction medicine specialist from MMTP was embedded in the hepatitis clinic. Methadone maintenance treatment program patients were referred, evaluated by the internist and hepatologist in hepatitis clinic and provided HCV treatment with integration between both sites. Of 401 evaluated patients, anti-HCV antibody was detected in 257, 86% of whom were older than 40 years. Hepatitis C virus RNA levels were measured in 222 patients, 65 of whom were aviremic. Of 157 patients with detectable HCV RNA, 125 were eligible for referral to the hepatitis clinic, 76 (61%) of whom accepted and adhered with the referral. Men engaged in MMTP <36 months were significantly less likely to be seen in hepatitis clinic than men in MMTP more than 36 months (odds ratio = 7.7; 95% confidence interval 2.6-22.9) or women. We evaluated liver histology in 63 patients, and 83% had moderate to advanced liver disease. Twenty-four patients initiated treatment with 19 completing and 13 (54%) achieving sustained response. In conclusion, integrated care between the MMTP and the hepatitis clinic improves adherence with HCV evaluation and treatment compared to standard referral practices.

© 2010 Blackwell Publishing Ltd.

PMID: 21129131 [PubMed - as supplied by publisher]


Quantification of hepatitis C virus in patients treated with peginterferon-alfa 2a plus ribavirin treatment by COBAS TaqMan HCV test

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

Kanda T, Imazeki F, Yonemitsu Y, Mikami S, Takada N, Nishino T, Takashi M, Tsubota A, Kato K, Sugiura N, Tawada A, Wu S, Tanaka T, Nakamoto S, Mikata R, Tada M, Chiba T, Kurihara T, Arai M, Fujiwara K, Kanai F, Yokosuka O.

Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan Kikkoman Hospital, Noda, Japan Toho University Sakura Medical Center, Sakura, Japan Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan Saiseikai Narashino Hospital, Narashino, Japan Institute of Clinical Medicine and Research, Jikei University School of Medicine, Kashiwa, Japan Narita Red Cross Hospital, Narita, Japan National Hospital Organization Chiba Medical Center, Chiba, Japan.


Summary.  Extremely low levels of serum hepatitis C virus (HCV) RNA can be detected by COBAS TaqMan HCV test. To investigate whether the COBAS TaqMan HCV test is useful for measuring rapid virological response (RVR) and early virological response (EVR) to predict sustained virological response (SVR), we compared the virological response to PEG-IFN-alfa 2a plus RBV in 76 patients infected with HCV genotype 1 when undetectable HCV RNA by the COBAS TaqMan HCV test was used, with those when below 1.7 log IU/mL HCV RNA by COBAS TaqMan HCV test was used, which corresponded to the use of traditional methods. Among the 76 patients, 28 (36.8%) had SVR, 13 (17.1%) relapsed, 19 (25.0%) did not respond, and 16 (21.0%) discontinued the treatment due to side effects. The positive predictive values for SVR based on undetectable HCV RNA by COBAS TaqMan HCV test at 24 weeks after the end of treatment [10/10 (100%) at week 4, 21/23 (91.3%) at week 8 and 26/33 (78.7%) at week 12] were superior to those based on <1.7 log IU/mL HCV RNA [17/19 (89.4%) at week 4, 27/38 (71.0%) at week 8, and 27/43 (62.7%) at week 12]. The negative predictive values for SVR based on <1.7 log IU/mL HCV RNA by COBAS TaqMan HCV test [46/57 (80.7%) at week 4, 37/38 (97.3%) at week 8, and 32/33 (96.9%) at week 12] were superior to those based on undetectable HCV RNA [48/66 (72.7%) at week 4, 46/53 (86.7%) at week 8, and 41/43 (95.3%) at week 12]. The utilization of both undetectable RNA and <1.7 log IU/mL HCV RNA by COBAS TaqMan HCV test is useful and could predict SVR and non-SVR patients with greater accuracy.

© 2010 Blackwell Publishing Ltd.

PMID: 21129130 [PubMed - as supplied by publisher]


Impact of liver steatosis on the correlation between liver stiffness and fibrosis measured by transient elastography in patients coinfected with human immunodeficiency virus and hepatitis C virus

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

Sánchez-Conde M, Montes Ramírez ML, Bellón Cano JM, Caminoa A, Rodríguez FA, Garcia JG, Martín PM, Bernardino de la Serna I, Bernardo de Quirós JC, Arribas López JR, Ochaíta JC, Pascual Pareja JF, Alvarez E, Berenguer JB.

Infectious Diseases and HIV Unit, Hospital Universitario Gregorio Marañón, Madrid, Spain Department of Internal Medicine 2, Hospital Universitario La Paz, Madrid, Spain Biomedical Research Foundation, Hospital Universitario Gregorio Marañón, Madrid, Spain Department of Pathology, Hospital Universitario La Paz, Madrid, Spain Department of Pathology, Hospital Universitario Gregorio Marañón, Madrid, Spain.


Summary.  We assessed the effect of different hepatic conditions such as fibrosis, steatosis and necroinflammatory activity on liver stiffness as measured by transient elastography in HIV/HCV-coinfected patients. We studied all consecutive HIV/HCV-coinfected patients who underwent liver biopsy and elastography between January 2007 and December 2008. Liver fibrosis was staged following METAVIR Cooperative Study Group criteria. Steatosis was categorized according to the percentage of affected hepatocytes as low (≤10%), moderate (<25%) and severe (≥25%). A total of 110 patients were included. Fibrosis was distributed by stage as follows: F0, n = 13; F1, n = 47; F2, n = 29; F3, n = 18; and F4, n = 3. Liver biopsy revealed the presence of hepatic steatosis in 68 patients (low to moderate, n = 53; and severe n = 15). By univariate regression analysis, fibrosis, necroinflammatory activity, and the degree of steatosis were correlated with liver stiffness. However, in a multiple regression analysis, steatosis and fibrosis were the only independent variables significantly associated with liver stiffness. With a cut-off of 9.5 kPa to distinguish patients with F ≤ 2 from F ≥ 3, elastography led to a significantly higher number of misclassification errors (25%vs 5%; P = 0.014), most of which were false positives for F ≥ 3. Our study suggests that the correlation between liver stiffness and fibrosis as estimated by transient elastography may be affected by the presence of hepatic steatosis in HIV/HCV-coinfected patients.

© 2010 Blackwell Publishing Ltd.

PMID: 21129129 [PubMed - as supplied by publisher]


Effect of maintenance therapy with low-dose peginterferon for recurrent hepatitis C after living donor liver transplantation

J Viral Hepat. 2010 Dec 3. doi: 10.1111/j.1365-2893.2010.01398.x. [Epub ahead of print]

Ueda Y, Marusawa H, Kaido T, Ogura Y, Oike F, Mori A, Ogawa K, Yoshizawa A, Hatano E, Miyagawa-Hayashino A, Haga H, Egawa H, Takada Y, Uemoto S, Chiba T.

Department of Gastroenterology and Hepatology Department of Surgery Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan.


Summary.  Approximately 30% of patients who have recurrent hepatitis C after liver transplantation achieve sustained virological response (SVR) by taking a combination therapy of pegylated interferon and ribavirin. For the remaining non-SVR patients, an effective management treatment has not yet been established. In this study, efficacy of long-term peginterferon maintenance therapy for non-SVR patients was evaluated. Forty patients who had previously received the combination therapy for hepatitis C after living donor liver transplantation were classified into one of the following three groups: the SVR group (n = 11); the non-SVR-IFN group (n = 17), which received low-dose peginterferon maintenance therapy for non-SVR patients; and the non-SVR-Withdrawal group (n = 12), which discontinued the interferon treatment. We then compared histological changes among these three groups after 2 or more years follow-up. Activity grade of liver histology improved or remained stable in patients in the SVR and non-SVR-IFN groups, but deteriorated in half of the patients in the non-SVR-Withdrawal group. Fibrosis improved or remained stable in 10 of 11 SVR patients and in 13 of 17 non-SVR-IFN patients, but deteriorated in all non-SVR-Withdrawal patients. Mean changes in fibrosis stage between pretreatment and final liver biopsy were -0.18, +0.06 and +2.2 in the SVR, non-SVR-IFN and non-SVR-Withdrawal groups, respectively. Fibrosis stage deteriorated to F3 or F4 significantly more rapidly in the non-SVR-Withdrawal group than in the other two groups. In conclusion, continuing long-term maintenance therapy with peginterferon prevented histological progression of hepatitis C in patients who had undergone living donor liver transplantation.

© 2010 Blackwell Publishing Ltd.

PMID: 21129128 [PubMed - as supplied by publisher]