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HEPATOLOGY WATCH® |
Editorial Board:
Emmet B. Keeffe, MD (Chair); John L. Gollan, MD, PhD; Kris V. Kowdley, MD; Paul Martin, MD;
Marion G. Peters, MD |
APRIL 2005
PRIMARY BILIARY CIRRHOSIS (PBC) AND PRIMARY
SCLEROSING CHOLANGITIS (PSC)
Endoscopic screening for esophageal
varices. Current AASLD guidelines suggest that patients with cirrhosis, including
patients with PBC or PSC, should undergo screening with endoscopy for
esophageal varices when the platelet count is <140,000/mm3. To determine if these guidelines are valid in
clinical practice, Bressler and colleagues retrospectively reviewed the data of
235 patients with chronic liver disease, including 86 patients with PBC or PSC,
who underwent screening endoscopy at a single center. Esophageal varices were detected in 30% of
the PBC/PSC group. Multiple logistic regression analysis identified platelet
count <200,000/mm3, serum albumin level <40 g/L, and serum
bilirubin level >20 μmol/L to be predictive for esophageal varices in
patients with PBC/PSC. The authors concluded that the AASLD guidelines were not
valid for the PBC/PSC patients they studied, but further research may determine
the appropriate threshold for screening. (Bressler B, et al. Gut. 2005;54:407–410)
Increased prevalence of PSC among
first-degree relatives. Annika Bergquist and coworkers sent questionnaires to first-degree
relatives of 145 PSC patients treated at the
Effect of ursodeoxycholic acid
(UDCA) therapy. Christophe Corpechot and colleagues used a Markov model to assess the
effect of UDCA treatment in 262 patients with PBC who had received UDCA 13–15
mg/kg daily for a mean of 8 years (range, 1–22 years). The survival rates of
UDCA-treated patients who did not undergo liver transplantation were 84% and
66% at 10 and 20 years, respectively, and were only slightly lower than those
of an age- and sex-matched control population.
These findings indicated that UDCA treatment started at an early PBC
stage was associated with a near-normalization of survival rates. (Corpechot C, et al. Gastroenterology. 2005;128:297–303)
NONALCOHOLIC FATTY LIVER DISEASE
(NAFLD)
Central obesity and
cirrhosis-related death or hospitalization.
George Ioannou and coworkers
reviewed data from 11,434 persons included in the first National Health and
Nutrition Examination Survey who did not have evidence of cirrhosis at study
entry or during the first 5 years of follow-up to determine the interaction
between body fat distribution and risk for cirrhosis-related death or
hospitalization. Participants were
categorized into central or peripheral fat distribution groups according to
their subscapular-to-triceps skinfold thickness ratio. At a mean follow-up of
12.9 years, cirrhosis had resulted in death or hospitalization in 88
partici-pants. The risk of cirrhosis-related death or hospitalization was increased
only among those cirrhosis patients who were overweight or obese and had a
central fat distribution. The excess
risk associated with central obesity in cirrhosis patients might be related to
insulin resistance and hepatic steatosis and warrants further study. (Ioannou GN, et al. Clin Gastroenterol Hepatol. 2005;3:67–74)
CHRONIC HEPATITIC C VIRUS (HCV)
INFECTION
Hepatic iron content and virologic
response. Stephen Rulyak and others performed a multicenter retrospective review of
clinical data from 112 patients with HCV infection who underwent liver biopsy
before and after interferon and ribavirin therapy to determine the effect of
pretreatment hepatic iron concentration on virologic response. In total, 60
(54%) patients achieved a sustained virologic response. No difference in pretreatment median hepatic
iron concentration was detected between responders and nonresponders. In addition, there was no significant change
in hepatic iron concentration after interferon and ribavirin treatment in
responders or nonresponders. These results show that pretreatment hepatic iron
concentration is not a predictor of virologic response to interferon and
ribavirin therapy. (Rulyak SJ, et al. Am J Gastroenterol. 2005;100:332–337)
Cost considerations for the treatment
of chronic HCV infection in prison inmates. Richard Sterling and others conducted a retrospective cohort analysis of
302 inmates within the Virginia Department of Corrections who underwent liver
biopsy for chronic HCV infection at the Virginia Commonwealth University Health
System to develop a prison-population cost model. The cost of treatment was
most influenced by the price of peginterferon and ribavirin. They found that
the cost of performing liver biopsy and treating patients with hepatic fibrosis
was approximately $400,000 less per 100 patients evaluated than the cost of
treating patients with an elevated serum ALT level. These data can be used to
develop an HCV treatment strategy that balances the health care rights of
inmates with the financial resources of the correctional system. (Sterling RK,
et al. Am J Gastroenterol. 2005;100:313–321)
Survival in HIV patients coinfected
with HCV. Hashem El-Serag and colleagues utilized national VA databases to
retrospectively review clinical data from 5,320 patients who had HCV/HIV
coinfection and 12,761 patients with HIV monoinfection hospitalized between
October 1991 and September 2000. The number of deaths per 100 patient-years was
7.33 in the coinfected group and 14.13 in the HIV monoinfected group during
22,054 and 40,655 person-years of follow-up, respectively (P<0.0001). The difference remained statistically significant for
patients treated during the HAART era. Although previous studies have
demonstrated increased mortality rates in HIV patients coinfected with HCV, the
findings of the current study showed that HIV/HCV coinfection was associated
with a lower mortality rate than HIV monoinfection. (El-Serag H, et al. Clin Gastroenterol Hepatol. 2005;3:175–183)
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