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Infection with hepatitis C virus subtype-3a is commonly associated with liver steatosis
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I c°e/°21
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INFECTION W I T H HEPATITIS C VIRUS SUBTYPE-3a IS COMMONLY ASSOCIATED W I T H LIVER STEATOSIS H. Hofer ], H.C. Bankl 2, E Wrba 2, P. Steindl-Munda l, L. Kazemi-Shirazi l, Ch. Mueller l, P. Ferenci t IDept. of Internal Medicine IV, Univ. of Vienna, Austria. 2Dept. of Clinical Pathology, Univ. of Vienna, Austria.
Background: Hepatic steatosis in chronic hepatitis C may be due to a direct cytopathic effect caused by the virus. Aim: The aim of this study was to investigate the influence of I-ICVsubtypes on development of liver steatosis. Patients and Methods: A liver biopsy was obtained in 101 patients (m=71, f=-30; mean age: 39+10.4) prior to randomization into a prospective trial ofinterferon/ribavirin combination therapy. Portal and periportal inflammation and fibrosis were graded/staged according to Ludwig. The degree of steatosis was measured in percent of liver cells containing fat. Body mass index (BMI), triglycerides and cholesterol levels were determined at baseline and during therapy. Results: Steatosis was more common in patients infected with HCV-subtype-3a (43.25*+ 29 (mean+SD, % of hepatoeytes)) than in patients with subtypes la or lb (11.8.-L13.5; p<0.05), while no difference in portal and periportal inflammation, or fibrosis was detected. The degree of steatosis did not correlate with body mass index (subtype 3: 23.5+3; subtype I: 24.3±3.5), serum triglycerides or cholesterol levels. Conclusion: Steatosis can be observed in a large proportion of patients infected with HCV-genotype 3. Fat storage in hepatocytes appears to be a direct consequence of viral replication and cannot be explained by obesity or altered lipid metabolism.
[
C06/023 I
COMPARISON OF TWO NEEDLES, THE SURECUT (18G) VERSUS THE "BIOPTY GUN" (BARD 18G) IN PERCUTANEOUS LIVER BIOPSY Z. Sparchez, S. Albu, E. Fayyad, D. Dumitra, A. Ban, O. Pascu 3rd Medical Clinic, University of Medicine Cluj, Romania. The main goal of pereutaueous liver biopsy in diffuse liver diseases is to obtain an adequate sample and to minimize the risk of complications and the discomfort of the patient. Aim: to compare the safety and efficacy in obtaining liver tissue of two needles, a Surecut needle (18G) versus an automatic biopsy device (Biopty Gun) with an 18G Bard needle. Methods: 145 patients underwent a percutaneans liver biopsy using one of these two needles determined by a randomized procedure. Sixty-seven patients were biopsied using the Surecut needle while 78 patients were biopsied with the Biopty Gun. There was no difference between groups regarding the platelet count, protrombin time and underlying liver disease. All biopsies were performed by the same gastroenterologist using ultrasound to assess the puncture site. The following parameters were recorded: number of passes to sample a good specimen, length of specimen, number of portal areas per specimen, pain at the moment of puncture, postbiopsy pain requiting analgesics and the complications. Results:
Biopty Gun Surecut
Passes (mean)
>lpass
1.26
18
12.74-3.3
8.1 4-4.3
70,5
1.56
34
12.5 4- 3.6
7.2 4- 3. I
41.8
(%)
Length of Numberof Negligible! the specimen ' portal areas Pain (%) (mm)
p
I C06/022 I
I C06/024 I
INTERFERON PLUS RIBAVIRIN DERMATOLOGICAL SIDE EFFECTS: ADDING SOLUTIONS, ADDING PROBLEMS G. Macedo, N. Fernandes. A. Correia. T. Ribeiro Gastroenterology Unit, H.S. Jo~o, Porto, Portugal.
SERUM BILE ACIDS IN CHRONIC HEPATITIS C PATIENTS RESPONDERS AND NON-RESPONDERS TO ANTIVIRAL THERAPY F. Jorouera I. J.A. Merayo 2, S. Sanchez-Campos 3, M.J. Monte 2, J.L. Olcoz l, J. Gonzfilez-Gallego 3, J.J.G. Marin 2 IHospital of Le6n, Spain. 2University of Salamanca, Spain. 3University of Le6n, Spain. Serum bile acid (BA) pool size and composition are sensitive markers of alterations in hepatic function. Aim: To investigate the existence of differences in serum BA in chronic hepatitis C, which could be used as a predictor of response to therapy. Methodology: 60 chronic hepatitis C patients treated with interferon aipha-2~ (IFN) (40) or IFN+ribavirin (20) for 12 months; control group (C, n=26) healthy volunteers. Serum BA concentrations (SBA) were determined by two coupled enzymatic reactions (3ct-hydroxysteroid dehydrogenase+ diaphorase). Proportion of molecular species was analyzed by gas chromatography/mass spectrometry. Results: 33 patients were considered as non-responders (non-R) at the end of treatment. SBA before treatment was signifieautly (p<0.05) higher in non-R (7.61~-0.95 gM) than in C (4.90-~-0.62 pM). None of C, but 27% of non-R presented values >10 pM (cutoff value for normal SBA range). These values were not significantly lower in non-R 3 months after starting the treatment (SBA: 7.30~1.13 pM, 23% >10 pM). The most significant difference in the composition of molecular species was a marked increase in the proportion of lithocholic acid (LCA); non-R: 4.1% vs. C: 0.5%. None of C but 37.5% of non-R showed LCA concentrations higher than 0.5 pM. SBA in responder patients (R) did not significantly differ from C (before treatment: 4.77¢-0.56 pM, 7.4% > 10 laM; 3 months after starting the treatment: 4.76¢-0.40 pM, 0% >10 pM). 48% of R patients maintained sustained response 6 months after finishing the treatment (SR), while relapse was detected in 52% of patients classified as R at the end of the therapy (Rr). No significant difference in SBA was found between both groups at the beginning of the therapy (Rs: 4.93¢-0.70 ttM, Rr: 4.60-£--0.91 pM). Proportion of LCA was lower in R (2.01i-0.45%, p<0.05) than in non-lL Moreover, LCA concentrations >0.5 pM was found in none of R. Conclusion: Baseline of SBA and, probably more accurately, LCA concentrations may be useful parameters ha predicting response to antivirai therapy in patients with chronic hepatitis C, but not to determine whether this will be transient or maintained.
Virtually all patients treated with interferon alfa (IFN) develop adverse effects, most of which are transient and subside spontaneously. In almost 10 years of its use as antiviral therapy, we have recognized many acute, subacute and chronic features, but some recent findings underline the importance of physicians increased awareness (and patient information) concerning the recognition of byzarre side effects in IFN therapy. The association with dbavidn steadily increased the virological and biochemical response rate, but some new problems may rise in this new treatment scenario. In a series of 55 patients treated with IFN + ribavidn (8001200 mg/day) -with a previous 6 month course of an uneventeful Interferon alone treatment - w e observed a series of dermatological side effects, clearly associated with the association of the 2 agents: transient urticaria in 4 patients, skin rash with prudtus in 3 patients, exacerbation of lichen planus in 1 patient, acute leucocytoclastic vasculitis in 2 patients and eczematous rash in 2 patients. In these last 4 patients we had to withdraw the combination treatment.
Conclusions: After an interferon alone treatment, the introduction of dbavidn may induce dermatological side effects in a relatively high proportion of patients (21%) and the need for treatment withdrawal (7%).
182
I c°e/°21
I
INFECTION W I T H HEPATITIS C VIRUS SUBTYPE-3a IS COMMONLY ASSOCIATED W I T H LIVER STEATOSIS H. Hofer ], H.C. Bankl 2, E Wrba 2, P. Steindl-Munda l, L. Kazemi-Shirazi l, Ch. Mueller l, P. Ferenci t IDept. of Internal Medicine IV, Univ. of Vienna, Austria. 2Dept. of Clinical Pathology, Univ. of Vienna, Austria.
Background: Hepatic steatosis in chronic hepatitis C may be due to a direct cytopathic effect caused by the virus. Aim: The aim of this study was to investigate the influence of I-ICVsubtypes on development of liver steatosis. Patients and Methods: A liver biopsy was obtained in 101 patients (m=71, f=-30; mean age: 39+10.4) prior to randomization into a prospective trial ofinterferon/ribavirin combination therapy. Portal and periportal inflammation and fibrosis were graded/staged according to Ludwig. The degree of steatosis was measured in percent of liver cells containing fat. Body mass index (BMI), triglycerides and cholesterol levels were determined at baseline and during therapy. Results: Steatosis was more common in patients infected with HCV-subtype-3a (43.25*+ 29 (mean+SD, % of hepatoeytes)) than in patients with subtypes la or lb (11.8.-L13.5; p<0.05), while no difference in portal and periportal inflammation, or fibrosis was detected. The degree of steatosis did not correlate with body mass index (subtype 3: 23.5+3; subtype I: 24.3±3.5), serum triglycerides or cholesterol levels. Conclusion: Steatosis can be observed in a large proportion of patients infected with HCV-genotype 3. Fat storage in hepatocytes appears to be a direct consequence of viral replication and cannot be explained by obesity or altered lipid metabolism.
[
C06/023 I
COMPARISON OF TWO NEEDLES, THE SURECUT (18G) VERSUS THE "BIOPTY GUN" (BARD 18G) IN PERCUTANEOUS LIVER BIOPSY Z. Sparchez, S. Albu, E. Fayyad, D. Dumitra, A. Ban, O. Pascu 3rd Medical Clinic, University of Medicine Cluj, Romania. The main goal of pereutaueous liver biopsy in diffuse liver diseases is to obtain an adequate sample and to minimize the risk of complications and the discomfort of the patient. Aim: to compare the safety and efficacy in obtaining liver tissue of two needles, a Surecut needle (18G) versus an automatic biopsy device (Biopty Gun) with an 18G Bard needle. Methods: 145 patients underwent a percutaneans liver biopsy using one of these two needles determined by a randomized procedure. Sixty-seven patients were biopsied using the Surecut needle while 78 patients were biopsied with the Biopty Gun. There was no difference between groups regarding the platelet count, protrombin time and underlying liver disease. All biopsies were performed by the same gastroenterologist using ultrasound to assess the puncture site. The following parameters were recorded: number of passes to sample a good specimen, length of specimen, number of portal areas per specimen, pain at the moment of puncture, postbiopsy pain requiting analgesics and the complications. Results:
Biopty Gun Surecut
Passes (mean)
>lpass
1.26
18
12.74-3.3
8.1 4-4.3
70,5
1.56
34
12.5 4- 3.6
7.2 4- 3. I
41.8
(%)
Length of Numberof Negligible! the specimen ' portal areas Pain (%) (mm)
p
I C06/022 I
I C06/024 I
INTERFERON PLUS RIBAVIRIN DERMATOLOGICAL SIDE EFFECTS: ADDING SOLUTIONS, ADDING PROBLEMS G. Macedo, N. Fernandes. A. Correia. T. Ribeiro Gastroenterology Unit, H.S. Jo~o, Porto, Portugal.
SERUM BILE ACIDS IN CHRONIC HEPATITIS C PATIENTS RESPONDERS AND NON-RESPONDERS TO ANTIVIRAL THERAPY F. Jorouera I. J.A. Merayo 2, S. Sanchez-Campos 3, M.J. Monte 2, J.L. Olcoz l, J. Gonzfilez-Gallego 3, J.J.G. Marin 2 IHospital of Le6n, Spain. 2University of Salamanca, Spain. 3University of Le6n, Spain. Serum bile acid (BA) pool size and composition are sensitive markers of alterations in hepatic function. Aim: To investigate the existence of differences in serum BA in chronic hepatitis C, which could be used as a predictor of response to therapy. Methodology: 60 chronic hepatitis C patients treated with interferon aipha-2~ (IFN) (40) or IFN+ribavirin (20) for 12 months; control group (C, n=26) healthy volunteers. Serum BA concentrations (SBA) were determined by two coupled enzymatic reactions (3ct-hydroxysteroid dehydrogenase+ diaphorase). Proportion of molecular species was analyzed by gas chromatography/mass spectrometry. Results: 33 patients were considered as non-responders (non-R) at the end of treatment. SBA before treatment was signifieautly (p<0.05) higher in non-R (7.61~-0.95 gM) than in C (4.90-~-0.62 pM). None of C, but 27% of non-R presented values >10 pM (cutoff value for normal SBA range). These values were not significantly lower in non-R 3 months after starting the treatment (SBA: 7.30~1.13 pM, 23% >10 pM). The most significant difference in the composition of molecular species was a marked increase in the proportion of lithocholic acid (LCA); non-R: 4.1% vs. C: 0.5%. None of C but 37.5% of non-R showed LCA concentrations higher than 0.5 pM. SBA in responder patients (R) did not significantly differ from C (before treatment: 4.77¢-0.56 pM, 7.4% > 10 laM; 3 months after starting the treatment: 4.76¢-0.40 pM, 0% >10 pM). 48% of R patients maintained sustained response 6 months after finishing the treatment (SR), while relapse was detected in 52% of patients classified as R at the end of the therapy (Rr). No significant difference in SBA was found between both groups at the beginning of the therapy (Rs: 4.93¢-0.70 ttM, Rr: 4.60-£--0.91 pM). Proportion of LCA was lower in R (2.01i-0.45%, p<0.05) than in non-lL Moreover, LCA concentrations >0.5 pM was found in none of R. Conclusion: Baseline of SBA and, probably more accurately, LCA concentrations may be useful parameters ha predicting response to antivirai therapy in patients with chronic hepatitis C, but not to determine whether this will be transient or maintained.
Virtually all patients treated with interferon alfa (IFN) develop adverse effects, most of which are transient and subside spontaneously. In almost 10 years of its use as antiviral therapy, we have recognized many acute, subacute and chronic features, but some recent findings underline the importance of physicians increased awareness (and patient information) concerning the recognition of byzarre side effects in IFN therapy. The association with dbavidn steadily increased the virological and biochemical response rate, but some new problems may rise in this new treatment scenario. In a series of 55 patients treated with IFN + ribavidn (8001200 mg/day) -with a previous 6 month course of an uneventeful Interferon alone treatment - w e observed a series of dermatological side effects, clearly associated with the association of the 2 agents: transient urticaria in 4 patients, skin rash with prudtus in 3 patients, exacerbation of lichen planus in 1 patient, acute leucocytoclastic vasculitis in 2 patients and eczematous rash in 2 patients. In these last 4 patients we had to withdraw the combination treatment.
Conclusions: After an interferon alone treatment, the introduction of dbavidn may induce dermatological side effects in a relatively high proportion of patients (21%) and the need for treatment withdrawal (7%).
182