Aim
Previous studies have suggested that patients with chronic hepatitis
C
with a low pretreatment hepatitis
C
virus (
HCV
) level have a high sustained virological response (
SVR
) rate, and that ...there would be a subpopulation of patients in which
HCV
can be eradicated with pegylated interferon (
PEG IFN
) alone without a decrease in
SVR
. However, the efficacy of
PEG IFN
monotherapy in patients with low
HCV RNA
levels is unclear. Several studies have reported that interferon sensitivity‐determining region (
ISDR
) and the single‐nucleotide polymorphism (
SNP
) of interleukin‐28
B
(
IL‐28B
) contribute to
IFN
response, but these relationships are controversial. The aim of this study was to determine whether the
SNP
of
IL‐28B
(rs8099917) and amino acid substitutions in the
ISDR
among patients with low
HCV
levels affect the response to
PEG IFN
monotherapy.
Methods
One hundred and four patients with low‐level
HCV
infection were studied. Low
HCV
level was defined as 100
KIU
/m
L
or less.
Results
SVR
was achieved in 94 patients (92.2%).
HCV
levels (≤50
KIU
/m
L
) and
ISDR
(≥2 mutations) were associated with
SVR
on univariate analysis. The rates of
SVR
in the patients with
IL‐28B
genotypes
TT
,
TG
and
GG
were 94.5%, 77.8% and 100%, respectively. The
G
allele tended to be associated with poor response to
IFN
therapy (
P
= 0.0623). On multivariate analysis, the
ISDR
was the factor predictive of
SVR
(
P
= 0.004).
Conclusion
The
ISDR
is significantly associated with a good response to
PEG IFN
monotherapy in patients with low
HCV
levels.
In view of the findings and concomitant disease, it is also necessary to perform other imaging modalities as needed, such as CT (computed tomography) or MRI (magnetic resonance imaging), to confirm ...the diagnosis. B-mode Findings Major type Subtype Shape Border/contour Tumor margin Intra-tumor Posterior echo Additional findings Hepatocellular carcinoma Nodular type (≤2 cm) Round, roundish Moderately well-defined, smooth Hypoechoic peripheral zone (infrequent) Various echo levels (mosaic pattern is sometimes observed) Unchanged–sometimes enhanced Bright loop Nodular type (>2 cm) Round, roundish Well-defined, smooth Thin hypoechoic peripheral zone (halo) Mosaic pattern, nodule in nodule. Tumor size is an indirect finding in the characterization that is closely related to the internal structure. ...the typical findings, extracted from different size categories, are stated in the nodular type of HCC. Doppler findings (Table 2; Fig. 7) In Doppler
Background: It remains unclear how we can shorten the treatment duration of antiviral combination therapy with peginterferon and ribavirin for patients with chronic hepatitis C virus (HCV) genotype 2 ...infection who achieved a rapid virological response (RVR).
Aim: We compared the efficacy of antiviral combination therapy with peginterferon and ribavirin for 8 vs. 24 weeks for the treatment of patients with HCV genotype 2 infection and with RVR.
Methods: Sixty‐one patients were enrolled. Serum HCV RNA was not detected at 4 weeks after the start of treatment in 32 patients with an RVR. These 32 patients were randomly assigned to 8‐week (n=15) or 24‐week (n=17) treatment regimens. Patients in the 8‐week group who relapsed underwent a 24‐week retreatment.
Results: No significant difference in patient characteristics was observed between the 8‐ and the 24‐week treatment groups. A sustained virological response (SVR) was seen in five of 15 patients (33.3%) in the 8‐week treatment group and 14 of 17 (82.4%) in the 24‐week treatment group; the rate was significantly higher in the 24‐week treatment group (P=0.0140). Nine of 10 relapsed patients in the 8‐week treatment group underwent a 24‐week retreatment, and seven achieved an SVR.
Conclusion: An 8‐week regimen of combination antiviral therapy with peginterferon and ribavirin yielded an increase in the relapse rate, indicating the limitation of a reduction of treatment below 12 weeks in patients with genotype 2, after RVR.
Although the efficacy and safety of pegylated-interferon (PEG-IFN) alpha-2a and PEG-IFN alpha-2b have been comparatively studied, there are few study results available in which the two PEG-IFN ...products were strictly compared. To compare the effects of two PEG-IFN products on blood cell profile.
The time-course change in blood cell counts was compared between chronic hepatitis C patients with genotype 1b receiving PEG-IFN alpha-2a/ribavirin and PEG-IFN alpha-2b/ribavirin combination therapy. The comparison was made after matching patients from the two groups based on ribavirin apparent clearance (CL/F), a surrogate marker of the steady state blood ribavirin level, in order to eliminate the effect of ribavirin. Fifteen pairs of matched patients were selected.
The time-course change in hemoglobin did not differ significantly between the two groups. However, significantly greater reductions in both neutrophil and platelet counts were observed with PEG-IFN alpha-2a compared to PEG-IFN alpha-2b. A slightly longer period was required with PEG-IFN alpha-2a than with PEG-IFN alpha-2b for a reduction in neutrophil or platelet count large enough to necessitate dose reduction.
Two types of PEG-IFN products affected the blood cell profile in different manners. Long-term monitoring of laboratory test values is necessary with PEG-IFN alpha-2a.
We investigated the prevalence of antibody against hepatitis E virus (HEV) in Japanese patients with hemophilia.
IgG antibody against HEV was measured in serum of 80 Japanese patients with hemophilia ...by enzyme-linked immunosorbent assay. The prevalence of HEV antibody was compared with the reported prevalence of HEV antibody in Japanese patients undergoing hemodialysis and in Japanese healthy blood donors. Characteristics of patients and coinfection with other transfusion-transmissible viruses were compared in patients with and without HEV antibody.
Anti-HEV IgG antibody was detected in 13 of 80 patients (16.3%). The prevalence was far higher than that reported in Japanese blood donors (3.7%) and was higher than that in Japanese patients undergoing hemodialysis (9.4%). The patients with HEV antibody were significantly older than those without. HEV antibody was not detected in patients <20 years of age and in patients who had received only virus-inactivated coagulation factors. No association was observed between positivity for anti-HEV antibody and severity of hemophilia or coinfection with other parenterally transmissible viruses.
Our results suggest that the parenteral transmission of HEV may have occurred in Japanese patients with hemophilia via non-virus-inactivated coagulation factors.
The course and outcome in patients infected with hepatitis C virus (HCV) genotype 1b with partial early virologic response during combination therapy with peginterferon and ribavirin, in whom serum ...HCV RNA is detectable but has decreased by more than 2 log₁₀ 12 weeks after the start of the therapy, has not been elucidated sufficiently. The outcome in this group of patients was investigated. Serum HCV RNA levels was measured every 4 weeks in 149 patients with HCV genotype 1b infection who underwent combination therapy for 48 weeks. In patients with partial early virologic response, the time point when serum HCV RNA became undetectable as well as the final virologic response to treatment was determined. Sixty‐three patients (42.3%) had partial early virologic response. The time when serum HCV RNA became undetectable ranged from 16 to 48 weeks after the start of therapy. Serum HCV RNA remained detectable in 17 patients. The rates of sustained virologic response decreased with the delay of the time when serum HCV RNA became undetectable; sustained virologic responder was not found in patients in whom HCV RNA was still detectable at 24 weeks after the start of treatment. The degree of decrease in serum HCV RNA levels at 12 weeks corresponded to the rate of sustained virologic response in partial early virologic responders. The outcome of partial early virologic responders varied greatly, and close monitoring of serum HCV RNA is required for predicting the outcome of treatment in these patients. J. Med. Virol. 83:101-107, 2011.
We investigated the usefulness of contrast harmonic imaging in the characterization of focal nodular hyperplasia (FNH). Gray scale sonography, Doppler sonography and contrast harmonic imaging with ...ultrasound contrast agent Levovist® were performed on five patients with clinically diagnosed five FNHs. All nodules were evaluated vascular phase (early vascular phase and late vascular phase) and post vascular phase after injection of contrast agent. Four nodules showed hypoechoic lesions and one nodule isoechoic lesion on gray scale sonography, and three nodules showed centrifugal pulstile signal on Doppler sonography. On contrast harmonic imaging, all nodules showed central arterial supply with centrifugal filling pattern in early vascular phase and enhanced an equal amount the liver in post vascular phase. Contrast harmonic imaging seemed to be a promising characteristic modality for the diagnosis of FNH.
Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein (AFP-L3%) is a recently described marker of hepatocellular carcinoma (HCC), and its usefulness has been demonstrated in many studies. ...We evaluated the usefulness of serial measurement of AFP-L3% as a marker of prognosis and recurrence after treatment of small HCC.
AFP-L3% was measured before and after initial treatment in 60 patients with small HCC (maximum diameter < or = 2 cm). AFP-L3% was taken as the ratio of AFP-L3 to total AFP and multiplied by 100%, and levels > or = 10% were considered positive. Outcomes and recurrence were compared between patients AFP-L3%-negative after initial treatment (Group A, n = 43) and patients who were AFP-L3%-positive after initial treatment (Group B, n = 17).
Before treatment, AFP-L3% was positive in 14 (23.3%) of the 60 patients. The cumulative survival rate of Group A was significantly longer (p = 0.0091) than that of Group B. The recurrence rate was significantly higher in Group B (p = 0.0104) than in Group A. When recurrence was limited to intrahepatic metastasis, the recurrence rate was significantly higher in Group B (p = 0.0064). However, the recurrence rate of multicentric occurrence did not differ significantly between Groups A and B.
Measurement of AFP-L3% after treatment may be useful for understanding prognosis and recurrence of HCC.
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