|
|
HEPATOLOGY WATCHฎ |
Editorial Board:
Emmet B. Keeffe, MD (Chair); M. Eric Gershwin, MD; Ira S. Goldman, MD; John L. Gollan, MD, PhD; Kris V. Kowdley, MD; Paul Martin, MD;
Marion G. Peters, MD |
MARCH 2005
CHRONIC HEPATITIS C VIRUS (HCV)
INFECTION
Persistence of HCV after a sustained
virologic response (SVR). Whether antiviral treatment results in complete elimination of HCV is
unknown. Marek Radkowski and colleagues used sensitive reverse-transcriptase
polymerase chain reaction assays to detect HCV RNA in serum, peripheral blood
mononuclear cells, and liver tissue from 17 chronic HCV patients who had SVR
after interferon/ribavirin therapy.
Samples were collected at 3- to 6-month intervals from 40 to 109 months
after treatment. Only 2 of 17 patients
were negative for HCV RNA in all analyzed samples. HCV RNA was detected in macrophages (n=11),
lymphocytes (n=7), sera (n=4), and liver specimens (n=3). In addition, viral replicative forms were found
in lymphocytes of 2 patients and macrophages of 4 patients. These findings
demonstrate that HCV RNA may persist in mononuclear cells or liver for up to 9
years after SVR. Jordan Feld and T. Jake
Liang address these provocative findings in an accompanying editorial. The
clinical relevance of occult HCV infection remains unknown. Further studies are
needed to determine if patients with low level of virus are infectious or at
risk for reactivation of disease.
(Radkowski M, et al. Hepatology 2005;41:106114;
Feld JJ and Liang TJ. Hepatology
2005;41:2325)
Antiviral therapy for HCV with
cirrhosis is associated with reduced hepatocellular carcinoma (HCC) and
improved survival. Y. Shiratori and others from the Tokyo-Chiba Hepatitis Research Group
prospectively studied 345 patients with chronic hepatitis C and cirrhosis, who
had been enrolled in previous trials from 25 clinical centers, to determine the
incidence of HCC and long-term survival following antiviral therapy. Interferon therapy (6 to 9 million units 3
times weekly) had been administered to 271 patients for 26 to 88 weeks; 74
patients had declined to receive interferon treatment (untreated control
group). During 6.8 years of follow-up,
the cumulative incidence of HCC in the interferon-treated group was lower than
that in the untreated control group (P=0.03). Furthermore, the patients in the interferon
group had an improved chance of survival compared with that of the control
group (P=0.02). These findings
indicate that interferon therapy for patients with chronic hepatitis C and
cirrhosis is associated with a decreased risk for HCC and improved
survival. (Shiratori Y, et al. Ann Intern Med 2005;142:105114)
CHRONIC HEPATITIS B VIRUS (HBV)
INFECTION
Peginterferon (PEG-IFN) alfa-2b ฑ
lamivudine in HBeAg-positive patients. Harry Janssen and coworkers conducted a large study in which 307 patients
with HBeAg-positive chronic hepatitis B were randomized to receive PEG-IFN
alfa-2b (100 μg/week) plus lamivudine (100 mg/day) or PEG-IFN alfa-2b plus
placebo for 52 weeks, with 26 weeks of follow-up off treatment. At the end of treatment, serum HBeAg was
undetectable and serum HBV DNA was <200,000 copies/mL in greater percentages
of combination-treated than monotherapy-treated patients (44% vs 29%, P=0.01, and 74% vs 29%, P<0.0001, respectively). However, at the end of the follow-up period,
these differences were not sustained, and similar percentages of patients in
the combination and PEG-IFN alfa-2balone treatment groups had undetectable HBeAg
(36% vs 35%) and HBV DNA suppression (32% vs 27%). HBeAg loss varied by HBV
genotype: 47% for genotype A patients, 44% for genotype B patients, 28% for
genotype C patients, and 25% for genotype D patients (P=0.01). These findings demonstrated that PEG-IFN
alfa-2b is effective treatment for patients with HBeAg-positive chronic
hepatitis B and that the addition of lamivudine does not enhance efficacy as
compared with PEG-IFN alone. In addition, HBV genotype is a predictor of
response. (Janssen HL, et al. Lancet
2005;365:123129)
NONALCOHOLIC
STEATOHEPATITIS (NASH)
Vitamin
E and pioglitazone. Arun Sanyal and others conducted a pilot study to investigate if the
combination of an antioxidant and an insulin sensitizer is an effective treatment
for NASH. They randomized 10 nondiabetic, noncirrhotic patients with NASH to
receive vitamin E 400 IU/d plus pioglitazone 30 mg/d or vitamin E alone. Although vitamin E alone significantly
decreased steatosis, combination therapy produced greater improvement in
overall NASH histology. Moreover,
combination therapy resulted in a significant increase in metabolic clearance
of glucose and a decrease in fasting free fatty acid. Leon Adams and Paul Angulo discuss these
results in an editorial and suggest that the roles of insulin-sensitizing
agents and antioxidants may be clarified by data from 2 ongoing large
randomized trials recently initiated by the NASH Clinical Research Network. (Sanyal
AJ, et al. Clin Gastroenterol Hepatol
2004;2:11071115;
PREGNANCY-ASSOCIATED GALLBLADDER
DISEASE
Natural history study. Cynthia Ko and colleagues prospectively assessed the natural history of
gallstones and sludge during pregnancy and the postpartum period in 3,254
women. They found sludge or stones to
occur commonly in pregnancy and the postpartum period (7.9% by the 3rd
trimester and 10.2% by 46 weeks postpartum).
Prepregnancy obesity and serum leptin levels were risk factors for
pregnancy-associated gallbladder disease. (Ko CW, et al. Hepatology 2005;41:359365)
PRIMARY BILIARY CIRRHOSIS (PBC)
Cross-sectional study in
Hepatology Watch is produced through
educational grant from 
Hepatology Watch is a registered trademark of Market Development Group