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Influence of dietary factors in the development of alcoholic hepatitis
328
TREATMENT OF HETEROSEXUALAND HOMOSEXUALPATIENTS WITH HBeAG POSITIVE CHRONIC HEPATITIS B WITH LOW DOSE INTERFERONALPHA (IFN-A). B. MOiler, U.Hopf, G. Sieber*, K. Rosenkranz, S. Poeschke and W. Siegert Department of Internal Medicine, Klinikum Charlottenburg and Klinikum S t e g l i t z * , Freie Universit~t B e r l in , FRG
Prognostic c r i t e r i a fo r response to a n t i v i r a l therapy with IFN-A are not yet a v a i l a b l e in patients with chronic h e p a t i t i s B. Dosage, schedule and a p p l i c a t i o n mode of IFN-A are s t i l l experimental. In the f o l l o w i n g c o n t r o l l e d study 19 patients with chronic h e p a t i t i s B and v i r a l r e p l i c a t i o n (12 heterosexuals and 7 homosexuals)rwere treated with recombinant IFN-A [Berofor Alpha 21F-RC IxxA) f o r 3 to 6 months ( 5x10~IU s.c., twice weekly). Untreated age- and sex-matched patients with chronic h e p a t i t i s B and HBV r e p l i c a t i o n served as controls. Diagnoses were confirmed in a l l cases by h i s t o l o g i c a l and serological examinations. HBV r e p l i c a t i o n was estimated in serum by s e r i a l measurements of HBeAg, HBcAg, HBV DNA and DNA polymerase a c t i v i t y over at least 12 months. Results: In the group of heterosexual patients two became p e r s i s t a n t l y HBeAg negative, three p ~ e n t s remained borderline HBeAg p o s i t i v e with reduced v i r a l r e p l i c a t i o n and one p a t ie n t reconverted to HBeAg in the f o l l o w up a f t e r t r a n s i e n t reduction of v i r a l r e p l i c a t i o n . No treated pat ient eliminated HBsAg. In the group of 7 homosexual patients with high HBV r e p l i c a t i o n before treatment one showed s i g n i f i c a n t reduction in HBV r e p l i c a t i o n markers during and a f t e r IFN-A treatment wlthout complete HBeAg seroconversion.ln the untreated control group no seroconversion occurred during the study period. Conc|usion: I t seems t h a t heterosexual patients with low HBV r e p l i c a t i o n have most b e n e f i t from IFN-A treatment as shown by v i r a l r e p l i c a t i o n markers. Homosexual patients with or without detectable immune defect usually e x h i b i t no response to IFN-A treatment. In our study only heterosexual patients with |ow HBV r e p l i c a t i o n before treatment seroconverted to HBeAg negative c a r r i e r state without any signs of v i r a l r e p l i c a t i o n .
329
INFLUENCE OF DIETARY FACTORS IN THE DEVELOPMENTOF ALCOHOLIC HEPATITIS. S~__Montull, LL. Caballerla, A. Par~s L J . Camps, J. Caballerla, R. Deulofeu and J.Rod~s. Alcohol and Liver Units. Hospital C l l n i c i P r o v i n c i a l . University o f ~ a . Barcelona. Spain. The c o n t r i b u t i o n of n u t r i t i o n in the development of n o n - c i r r h o t i c a l c o h o l i c l i v e r disease has been investigated in 51 chronlc alcohollcs (35 males, 16 females) who had drank m o r e than 80 g of ethanol d a i l y f o r at least 5 years. In a l l patients d i e t a r y and alcohol intake h i s t o r i e s over the preceding two months were assessed before diagnosis. Patients were divided into three groups according to h i s t o l o g i c a l an c l i n i c a l findings. 26 patients had normal l i v e r or minimal changes (N), 9 patients had f a t t y l i v e r with or without f i b r o s i s (FL), and 16 patients showed changes of a l c o h o l i c h e p a t i t i s (AH). There were no s i g n i f i c a n t differences in ethanol intake and duration of alcoholism among the three groups, although patients with f a t t y l i v e r had consumed more ethanol d a i l y in comparison with alcoholics without l i v e r disease. Patients with a l c o h o l i c h e p a t i t i s had consumed fewer non-alcohollc calories, p a r t i c u l a r l y protein and carbohydrate c a l o r i e s than alcoholics with normal or f a t t y l l v e r ( t a b l e ) . (Results are expressed as mean + SEM.) d a i l y c a l o r i c intake (kcal/kg) alcohol non-alcohol proteins carbohydrates lipids
N n = 26 20.2 17.5 4.0 9.3 4.2
+ ¥ ~ + ¥
1.7 1.8 0.4 0.9 0.5
p< .04 ns ns ns ns
FL n = 9 33.3 16.8 3.8 9.7 3.3
+ ¥ ~ + ¥
9.3 3.3 0.8 1.9 0.6
p, ns ns ns ns ns
AH n = 16 21.9 11.5 2.5 6.2 2.8
+ ¥ ¥ + ¥
2.4 2.0 0.5 1.0 0.5
p(vs N)L ns .04 .03 .04 ns
These results suggest that protein and carbohydrate-calorie m a l n u t r i t i o n may play role in the development of a l c o h o l i c h e p a t i t i s .
$170
a
TREATMENT OF HETEROSEXUALAND HOMOSEXUALPATIENTS WITH HBeAG POSITIVE CHRONIC HEPATITIS B WITH LOW DOSE INTERFERONALPHA (IFN-A). B. MOiler, U.Hopf, G. Sieber*, K. Rosenkranz, S. Poeschke and W. Siegert Department of Internal Medicine, Klinikum Charlottenburg and Klinikum S t e g l i t z * , Freie Universit~t B e r l in , FRG
Prognostic c r i t e r i a fo r response to a n t i v i r a l therapy with IFN-A are not yet a v a i l a b l e in patients with chronic h e p a t i t i s B. Dosage, schedule and a p p l i c a t i o n mode of IFN-A are s t i l l experimental. In the f o l l o w i n g c o n t r o l l e d study 19 patients with chronic h e p a t i t i s B and v i r a l r e p l i c a t i o n (12 heterosexuals and 7 homosexuals)rwere treated with recombinant IFN-A [Berofor Alpha 21F-RC IxxA) f o r 3 to 6 months ( 5x10~IU s.c., twice weekly). Untreated age- and sex-matched patients with chronic h e p a t i t i s B and HBV r e p l i c a t i o n served as controls. Diagnoses were confirmed in a l l cases by h i s t o l o g i c a l and serological examinations. HBV r e p l i c a t i o n was estimated in serum by s e r i a l measurements of HBeAg, HBcAg, HBV DNA and DNA polymerase a c t i v i t y over at least 12 months. Results: In the group of heterosexual patients two became p e r s i s t a n t l y HBeAg negative, three p ~ e n t s remained borderline HBeAg p o s i t i v e with reduced v i r a l r e p l i c a t i o n and one p a t ie n t reconverted to HBeAg in the f o l l o w up a f t e r t r a n s i e n t reduction of v i r a l r e p l i c a t i o n . No treated pat ient eliminated HBsAg. In the group of 7 homosexual patients with high HBV r e p l i c a t i o n before treatment one showed s i g n i f i c a n t reduction in HBV r e p l i c a t i o n markers during and a f t e r IFN-A treatment wlthout complete HBeAg seroconversion.ln the untreated control group no seroconversion occurred during the study period. Conc|usion: I t seems t h a t heterosexual patients with low HBV r e p l i c a t i o n have most b e n e f i t from IFN-A treatment as shown by v i r a l r e p l i c a t i o n markers. Homosexual patients with or without detectable immune defect usually e x h i b i t no response to IFN-A treatment. In our study only heterosexual patients with |ow HBV r e p l i c a t i o n before treatment seroconverted to HBeAg negative c a r r i e r state without any signs of v i r a l r e p l i c a t i o n .
329
INFLUENCE OF DIETARY FACTORS IN THE DEVELOPMENTOF ALCOHOLIC HEPATITIS. S~__Montull, LL. Caballerla, A. Par~s L J . Camps, J. Caballerla, R. Deulofeu and J.Rod~s. Alcohol and Liver Units. Hospital C l l n i c i P r o v i n c i a l . University o f ~ a . Barcelona. Spain. The c o n t r i b u t i o n of n u t r i t i o n in the development of n o n - c i r r h o t i c a l c o h o l i c l i v e r disease has been investigated in 51 chronlc alcohollcs (35 males, 16 females) who had drank m o r e than 80 g of ethanol d a i l y f o r at least 5 years. In a l l patients d i e t a r y and alcohol intake h i s t o r i e s over the preceding two months were assessed before diagnosis. Patients were divided into three groups according to h i s t o l o g i c a l an c l i n i c a l findings. 26 patients had normal l i v e r or minimal changes (N), 9 patients had f a t t y l i v e r with or without f i b r o s i s (FL), and 16 patients showed changes of a l c o h o l i c h e p a t i t i s (AH). There were no s i g n i f i c a n t differences in ethanol intake and duration of alcoholism among the three groups, although patients with f a t t y l i v e r had consumed more ethanol d a i l y in comparison with alcoholics without l i v e r disease. Patients with a l c o h o l i c h e p a t i t i s had consumed fewer non-alcohollc calories, p a r t i c u l a r l y protein and carbohydrate c a l o r i e s than alcoholics with normal or f a t t y l l v e r ( t a b l e ) . (Results are expressed as mean + SEM.) d a i l y c a l o r i c intake (kcal/kg) alcohol non-alcohol proteins carbohydrates lipids
N n = 26 20.2 17.5 4.0 9.3 4.2
+ ¥ ~ + ¥
1.7 1.8 0.4 0.9 0.5
p< .04 ns ns ns ns
FL n = 9 33.3 16.8 3.8 9.7 3.3
+ ¥ ~ + ¥
9.3 3.3 0.8 1.9 0.6
p, ns ns ns ns ns
AH n = 16 21.9 11.5 2.5 6.2 2.8
+ ¥ ¥ + ¥
2.4 2.0 0.5 1.0 0.5
p(vs N)L ns .04 .03 .04 ns
These results suggest that protein and carbohydrate-calorie m a l n u t r i t i o n may play role in the development of a l c o h o l i c h e p a t i t i s .
$170
a