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Does interferon treatment improve hepatic fibrosis in non virological responders with hepatitis C?
AJG – September, Suppl., 2002
283 DOES INTERFERON TREATMENT IMPROVE HEPATIC FIBROSIS IN NON VIROLOGICAL RESPONDERS WITH HEPATITIS C? Kaoru Kikuchi, M.D., Masatake Miyagi, M.D., Seiho Hayashi, M.D. and Yoshihide Keida, M.D.*. Gastroenterology, Okinawa Chubu Hospital, Gushikawa, Okinawa, Japan. Purpose: Histological improvement of hepatic fibrosis in patients with hepatitis C who obtained virological response to interferon treatment has been noted, but the histological effects of interferon treatment on non virological responders, whose HCV–RNA have been still positive after treatment, remains unclear. Methods: We retrospectively reviewed date on patients with hepatitis C who received a 6 –month interferon treatment at our hospital from 1992 to 1995. This study included non virological rsponders who underwent liver biopsies both before and after treatment and whose Type IV collagen 7s, a serum hepatic fibrosis marker, levels were measured before and several times after treatment. The paired liver biopsies were estimated using the criteria of Dosmet and colleagues (F0 to F4) for fibrosis staging and that of the French METAVIR Cooperative Study Group (A0 to A3) for activity grading, respectively. The results were analyzed using paired t test. Results: Forty patients received interferon treatment. Eleven patients were virological responders who became negative for serum HCV–RNA after interferon treatment and remaining 27 patients were non virological responders. Of these non responders, 21 patients were followed for more than 5 years (mean follow up period 102⫾13 months, range 64 to 116). Four patients were performed liver biopsies both before and after treatment in mean interval 108 months (range 101 to 116). There were no significant difference in fibrosis staging scores between before and after treatment (mean 2, 1.8, respectively) and no diference in activity grades (mean 2, 2, respectively). Type IV collagen 7s levels were measured in 21 patients. Mean type IV collagen 7s levels before treatment, short term after treatment (mean interval 43⫾8 months), and long term after treatment (mean interval 104⫾11 months) were 7.2⫾2.7 ng/ml, 5.5⫾2.0 ng/ml, and 6.1⫾1.9 ng/ml, respectively. Type IV collagen 7s levels short term after treatment were significantly decreased compared with those of before treatment (P⬍0.001), but there were no significant difference between before and long term after treatment. Conclusions: Interferon treatment may have short term inprovement of hepatic fibrosis in non virological responders with hepatitis C, but does not achieve long term improvement of hepatic fibrosis.
284 INCREASED LEVELS OF ALKALINE PHOSPHATASE, TRIGLYCERIDES AND CHOLESTEROL MAY DISTINGUISH THE PRESENCE OF LIVER COMPROMISE IN AMYLOIDOSIS Jesus K. Yamamoto–Furusho, M.D.* and Marco A. Olivera, M.D. Gastroenterology, Instituto Nacional de Ciencias Me´ dicas y Nutricion Salvador Zubiran, Mexico, D.F., Mexico and Gastroenterology, Instituto Nacional de Ciencias Me´ dicas y Nutricion Salvador Zubiran, Mexico, D.F., Mexico. Purpose: To describe the clinical and biochemical features in Mexican patients with liver amyloidosis and the morbidity after percutaneous liver biopsy. Methods: Fifty consecutive patients with diagnosis of amyloidosis were included between January 1987 and December 2000. All patients underwent standard evaluation including clinical history and laboratory assays. Twelve patients had histologically confirmed hepatic amyloidosis as the only manifestation of the disease. Percutaneous liver biopsy was carried out according to the standard institutional protocol.
Abstracts
S93
Results: Fifty patients had amyloidosis, mean age 51 years. Twelve patients (6 women) showed liver involvement. Six of them had liver compromise as the only manifestation. Fatigue (12/12), weight loss (12/12), hepatomegaly (10/12), edema (9/12), generalized pain (7/12) and splenomegaly (4/12) were the most common clinical features. No morbidity or complications after liver biopsy were present in these patients. Biochemical profiles in hepatic amyloidosis Biochemical variable
Liver involved
Liver not involved
p value
Hematocrit (%) Hemoglobin (g/dL) Leukocytes (mm3)3 Platelet (mm3) Total bilirubin (mg/dL) ALP⬘(IU/dL) AST (IU/mL) ALT (IU/dL) Albumin (g/dL) Triglycerides (mg/dL) Cholesterol (mg/dL)
39 ⫾ 7.7 12.8 ⫾ 2.5 37 ⫾ 3.7 230 ⫾ 152 .87 ⫾ .52 577 ⫾ 180 62 ⫾ 51 71 ⫾ 29 2.6 ⫾ .96 197 ⫾ 64 284 ⫾ 129
36 ⫾ 8.3 11.8 ⫾ 2.8 6.2 ⫾ 2.9 224 ⫾ 127 .78 ⫾ .54 81 ⫾ 54 35 ⫾ 26 35 ⫾ 15 3.1 ⫾ 1 126 ⫾ 66 213 ⫾ 93
0.36 0.27 0.31 0.90 0.61 0.001 0.021 0.063 0.138 0.007 0.046
Conclusions: In our series, liver involvement was present in 25% of patients with amyloidosis, similar to other reports. The elevations of ALP, triglycerides and cholesterol are variables that might suggest the presence of liver compromise in amyloidosis. Unlike other series, we had no complications related to the percutaneous liver biopsy.
285 RACIAL DIFFERENCES IN HEMOGLOBIN AND NEUTROPHIL LEVELS DURING INTERFERON AND RIBAVIRIN THERAPY FOR CHRONIC HEPATITIS C Syed Fehmi, M.B., B.S, Darlene Sifuentes, R.N., Hongbao Ma, M.D., Ph.D. and Daryl T.Y. Lau, M.D., M.P.H.*. Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX. Purpose: HCV therapy consists of interferon (IFN) and ribavirin (RBV). RBV can cause hemolytic anemia and IFN is associated with neutropenia. The purpose of this study is to examine the frequency of treatment–related anemia and neutropenia across the racial groups. Methods: Subjects included male inmates with compensated hepatitis C from the Texan prisons. Patients meeting inclusion criteria with Hgb ⱖ13g/l, absolute neutrophil count (ANC) ⱖ1500 received IFN–␣ 2a (3 mu tiw) and RBV (1000/ 1200mg qd) [Fisher]. Data from the first 166 consecutive patients were analyzed. Results: There were 87 whites (W), 34 African Americans (AA) and 45 Mexican American (MA) with similar ages (average 41 yrs). Baseline Hgb was significantly lower among AA (Fig. 1). Hgb fell rapidly during the initial 4 wks and reached the lowest level by wk 12 in all groups. Despite a lower baseline, AA had similar Hgb levels as W from wk 2 onward. MA had a more gradual decline in Hgb in the first 4 wks (p⬍0.02). Anemia with Hgb less than 10g/l was uncommon (3% W, 8% AA, 5% MA). There was no significant difference in pretreatment ANC in the three groups (Fig. 2). The rate of fall in ANC was greatest in the first 2 to 4 wks. AA experienced maximum decline by wk 12. MA had consistently higher ANC compared to W and AA from wk 4. ANC ⬍ 750 was rare (W⫽2, AA⫽1,MA⫽0). No patient developed significant infection. Conclusions: Significant anemia and neutropenia were infrequent in this male population. Interestingly, Mexican Americans had more gradual drop in Hgb and had higher neutrophil levels during therapy. They may be more likely to tolerate antiviral therapy without dose reduction compared to the other two races.
283 DOES INTERFERON TREATMENT IMPROVE HEPATIC FIBROSIS IN NON VIROLOGICAL RESPONDERS WITH HEPATITIS C? Kaoru Kikuchi, M.D., Masatake Miyagi, M.D., Seiho Hayashi, M.D. and Yoshihide Keida, M.D.*. Gastroenterology, Okinawa Chubu Hospital, Gushikawa, Okinawa, Japan. Purpose: Histological improvement of hepatic fibrosis in patients with hepatitis C who obtained virological response to interferon treatment has been noted, but the histological effects of interferon treatment on non virological responders, whose HCV–RNA have been still positive after treatment, remains unclear. Methods: We retrospectively reviewed date on patients with hepatitis C who received a 6 –month interferon treatment at our hospital from 1992 to 1995. This study included non virological rsponders who underwent liver biopsies both before and after treatment and whose Type IV collagen 7s, a serum hepatic fibrosis marker, levels were measured before and several times after treatment. The paired liver biopsies were estimated using the criteria of Dosmet and colleagues (F0 to F4) for fibrosis staging and that of the French METAVIR Cooperative Study Group (A0 to A3) for activity grading, respectively. The results were analyzed using paired t test. Results: Forty patients received interferon treatment. Eleven patients were virological responders who became negative for serum HCV–RNA after interferon treatment and remaining 27 patients were non virological responders. Of these non responders, 21 patients were followed for more than 5 years (mean follow up period 102⫾13 months, range 64 to 116). Four patients were performed liver biopsies both before and after treatment in mean interval 108 months (range 101 to 116). There were no significant difference in fibrosis staging scores between before and after treatment (mean 2, 1.8, respectively) and no diference in activity grades (mean 2, 2, respectively). Type IV collagen 7s levels were measured in 21 patients. Mean type IV collagen 7s levels before treatment, short term after treatment (mean interval 43⫾8 months), and long term after treatment (mean interval 104⫾11 months) were 7.2⫾2.7 ng/ml, 5.5⫾2.0 ng/ml, and 6.1⫾1.9 ng/ml, respectively. Type IV collagen 7s levels short term after treatment were significantly decreased compared with those of before treatment (P⬍0.001), but there were no significant difference between before and long term after treatment. Conclusions: Interferon treatment may have short term inprovement of hepatic fibrosis in non virological responders with hepatitis C, but does not achieve long term improvement of hepatic fibrosis.
284 INCREASED LEVELS OF ALKALINE PHOSPHATASE, TRIGLYCERIDES AND CHOLESTEROL MAY DISTINGUISH THE PRESENCE OF LIVER COMPROMISE IN AMYLOIDOSIS Jesus K. Yamamoto–Furusho, M.D.* and Marco A. Olivera, M.D. Gastroenterology, Instituto Nacional de Ciencias Me´ dicas y Nutricion Salvador Zubiran, Mexico, D.F., Mexico and Gastroenterology, Instituto Nacional de Ciencias Me´ dicas y Nutricion Salvador Zubiran, Mexico, D.F., Mexico. Purpose: To describe the clinical and biochemical features in Mexican patients with liver amyloidosis and the morbidity after percutaneous liver biopsy. Methods: Fifty consecutive patients with diagnosis of amyloidosis were included between January 1987 and December 2000. All patients underwent standard evaluation including clinical history and laboratory assays. Twelve patients had histologically confirmed hepatic amyloidosis as the only manifestation of the disease. Percutaneous liver biopsy was carried out according to the standard institutional protocol.
Abstracts
S93
Results: Fifty patients had amyloidosis, mean age 51 years. Twelve patients (6 women) showed liver involvement. Six of them had liver compromise as the only manifestation. Fatigue (12/12), weight loss (12/12), hepatomegaly (10/12), edema (9/12), generalized pain (7/12) and splenomegaly (4/12) were the most common clinical features. No morbidity or complications after liver biopsy were present in these patients. Biochemical profiles in hepatic amyloidosis Biochemical variable
Liver involved
Liver not involved
p value
Hematocrit (%) Hemoglobin (g/dL) Leukocytes (mm3)3 Platelet (mm3) Total bilirubin (mg/dL) ALP⬘(IU/dL) AST (IU/mL) ALT (IU/dL) Albumin (g/dL) Triglycerides (mg/dL) Cholesterol (mg/dL)
39 ⫾ 7.7 12.8 ⫾ 2.5 37 ⫾ 3.7 230 ⫾ 152 .87 ⫾ .52 577 ⫾ 180 62 ⫾ 51 71 ⫾ 29 2.6 ⫾ .96 197 ⫾ 64 284 ⫾ 129
36 ⫾ 8.3 11.8 ⫾ 2.8 6.2 ⫾ 2.9 224 ⫾ 127 .78 ⫾ .54 81 ⫾ 54 35 ⫾ 26 35 ⫾ 15 3.1 ⫾ 1 126 ⫾ 66 213 ⫾ 93
0.36 0.27 0.31 0.90 0.61 0.001 0.021 0.063 0.138 0.007 0.046
Conclusions: In our series, liver involvement was present in 25% of patients with amyloidosis, similar to other reports. The elevations of ALP, triglycerides and cholesterol are variables that might suggest the presence of liver compromise in amyloidosis. Unlike other series, we had no complications related to the percutaneous liver biopsy.
285 RACIAL DIFFERENCES IN HEMOGLOBIN AND NEUTROPHIL LEVELS DURING INTERFERON AND RIBAVIRIN THERAPY FOR CHRONIC HEPATITIS C Syed Fehmi, M.B., B.S, Darlene Sifuentes, R.N., Hongbao Ma, M.D., Ph.D. and Daryl T.Y. Lau, M.D., M.P.H.*. Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX. Purpose: HCV therapy consists of interferon (IFN) and ribavirin (RBV). RBV can cause hemolytic anemia and IFN is associated with neutropenia. The purpose of this study is to examine the frequency of treatment–related anemia and neutropenia across the racial groups. Methods: Subjects included male inmates with compensated hepatitis C from the Texan prisons. Patients meeting inclusion criteria with Hgb ⱖ13g/l, absolute neutrophil count (ANC) ⱖ1500 received IFN–␣ 2a (3 mu tiw) and RBV (1000/ 1200mg qd) [Fisher]. Data from the first 166 consecutive patients were analyzed. Results: There were 87 whites (W), 34 African Americans (AA) and 45 Mexican American (MA) with similar ages (average 41 yrs). Baseline Hgb was significantly lower among AA (Fig. 1). Hgb fell rapidly during the initial 4 wks and reached the lowest level by wk 12 in all groups. Despite a lower baseline, AA had similar Hgb levels as W from wk 2 onward. MA had a more gradual decline in Hgb in the first 4 wks (p⬍0.02). Anemia with Hgb less than 10g/l was uncommon (3% W, 8% AA, 5% MA). There was no significant difference in pretreatment ANC in the three groups (Fig. 2). The rate of fall in ANC was greatest in the first 2 to 4 wks. AA experienced maximum decline by wk 12. MA had consistently higher ANC compared to W and AA from wk 4. ANC ⬍ 750 was rare (W⫽2, AA⫽1,MA⫽0). No patient developed significant infection. Conclusions: Significant anemia and neutropenia were infrequent in this male population. Interestingly, Mexican Americans had more gradual drop in Hgb and had higher neutrophil levels during therapy. They may be more likely to tolerate antiviral therapy without dose reduction compared to the other two races.