HEPATOLOGY WATCH®
Timely
Information for Practicing Physicians
august 2000
Hepatocellular
Carcinoma (HCC)
Positron emission tomography
(PET). M. Akram Khan and colleagues conducted a
retrospective review of patients with HCC treated at St. Louis University
Hospital and had both PET scans and computerized tomography (CT) scans done
between 1995 and 1998 for the diagnosis and staging of HCC. Twenty patients were identified, and PET
scores of tumor activity were compared with CT scan results. PET scans were positive in 11 patients
(55%), while CT scans were positive in 18 patients (90%). However, CT scan results were unremarkable
in 3 patients who had metastatic lesions by PET scans. Pathological review demonstrated that
well-differentiated tumors had lower PET scores than moderately or poorly
differentiated tumors. These results
showed that PET scans were less sensitive than CT scans in detecting HCC,
although metastatic lesions in 3 patients were discovered on PET scan that had
not been seen on CT scan. Further
studies and cost analyses are needed to define the role of PET scans as an
adjunct to CT scan evaluation of patients with HCC. (Khan MA, et al. J Hepatol
2000;32:792-797)
Hepatitis
C Virus (HCV)
Early testing for HCV viremia
during interferon therapy. Francisco Jose Castro and coworkers studied
184 patients with chronic HCV infection who received interferon-based therapy
to identify predictors of treatment outcome.
Sixty-two patients were treated with interferon alone for 12 months, and
122 patients were still HCV RNA positive at 2 months were given an additional
12-month course of interferon and ribavirin therapy. Multivariate analysis showed that the strongest predictors of a
sustained virological response during therapy were loss of detectable HCV
viremia at 1 month (in the interferon group) and at 5 months (in the
combination group). These data indicate
that early testing for serum HCV RNA is the most useful predictor of response
during interferon-based therapy of patients with chronic HCV infection. (Castro FJ, et al. J Hepatol 2000;32:843-849)
HIV
Infection
Effect of hepatitis G virus (HGV)
infection. HGV is a newly discovered flavivirus that is
distantly related to HCV. HGV RNA is
present in 1% to 2% of healthy volunteer blood donors; however, HGV does not
appear to cause clinically apparent hepatitis.
Anthony Yeo et al. conducted a prospective cohort study consisting of
131 patients with hemophilia who became HIV-positive between 1978 and 1985 to
investigate the effect of HGV infection on AIDS-free survival. The mean follow-up was 11.2 years, and
testing for HGV RNA and anti-E2 antibodies detected 60 HGV-positive patients
(46%). HGV-positive patients were found
to have higher CD4+ lymphocyte counts (p=.004), lower HIV viral loads (p=.002),
and a superior 12-year AIDS-free survival rate (68% vs. 40%; p=.03) compared to
HGV-negative patients. This study
showed that HGV infection decreased the risk for the development of AIDS in
HIV-infected hemophilia patients. The mechanism
and the significance of this interesting and novel finding are unknown. (Yeo AFT, et al. Ann Intern Med 2000;132:959-963)
Hemochromatosis
Population screening. The current
standard screening test for hemochromatosis is the measurement of transferrin
saturation (TS). Paul Adams and
colleagues performed unbound iron-binding capacity (UIBC) and TS testing as
well as genetic analyses for the C282Y mutation in 5,211 voluntary blood donors
to identify the optimal population screening strategy for hemochromatosis. Patients heterozygous for C282Y or with a TS
>45% also were tested for the H63D mutation. Sixteen C282Y homozygotes, 69 compound heterozygotes, and 371
simple heterozygotes were found in this population. Mean values for UIBC and TS in homozygotes were significantly
different from those for heterozygotes or normals. The correlation coefficient in the 5, 211 blood donors between
UIBC and TS was –0.71 (p<.0001). A
receiver operating characteristic curve analysis was done to estimate the
probability of correct diagnostic classification, and this measure of test
accuracy was 0.93 for UIBC and 0.83 for TS.
It was determined that threshold of TS ³46% and of UIBC £28 umol/L would detect 75% and 81% of C282Y homozygotes,
respectively. Thus UIBC is an accurate
and cost-efficient means to select subjects for genotyping. These results are consistent with those of a
recent Australian study (Hickman PE, et
al. Gut 2000;46:405-409), which found
UIBC to be an appropriate and economical screening test for
hemochromatosis. (Adams PC, et al. Hepatology 2000;31:1160-1164)
Hepatorenal Syndrome (HRS)
New treatments. The most
serious complication of cirrhosis and ascites is HRS. Its prognosis is poor with standard medical therapy, and liver
transplantation is the treatment of choice.
Steffen Mitzner et al. conducted a prospective, controlled trial of 13
patients with high-risk type I HRS who had not improved with volume expansion
and dopamine therapy and for whom OLT was not available. These patients were randomized to receive
hemodiafiltration (HDF) and medical therapy (n=5) or HDF, medical therapy, and
molecular adsorbent recirculating system (MARS) treatment (n=8). The MARS system selectively removes from
plasma albumin-bound substances that accumulate in liver failure by an
albumin-enriched dialysate fluid.
Mortality was 100% in the HDF group by day 7 of therapy compared to
62.5% by day 7 and 75% by day 30 in the MARS group (p<.01). In a second study, Juan Uriz and coworkers
treated 9 consecutive HRS patients with terlipressin (glypressin), a
vasoconstrictor agent, and intravenous albumin. Serum creatinine levels were normalized in 7 patients, mean
arterial blood pressure improved, and no signs of distal ischemia
developed. These studies indicate that
there may now be new effective treatments available for patients with HRS, and
a recent editorial by Vicente Arroyo recommends that these new treatments
should be assessed in multicenter trials.
(Mitzner SR, et al. Liver Transpl 2000;6:277-286, Uriz J, et
al. J
Hepatol 2000;33:43-48, and Arroyo V. Liver
Transpl 2000;6:287-289)
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