- Email: [email protected]
The effect of intradermal HBV vaccine in patients with chronic liver disease (CLD)
Category 6: Viral hepatitis: clinical aspects 8.48% in the 14-19 year-old groups to 40.70% in the 40--49 year-olds. The figures for Thrace were 18.1% (955 persons), varying from 4.68% in the 14-19-year-old group up to 35.4% in the 50-59 year-olds. Anti-HCV prevalence in Bulagaria was 1.28% (138 positive) varying from 0.87% to 1.86% in different age groups, while in Greece was 0.19% (10 positive) varying from 0.1% to 0.53%. Conclusions: The HBsAg prevalence in North Greece (2.48%) was found to be lower than in Bulgaria (3.86%), but the difference in the prevalence of antibodies to hepatitis C virus (HCV) between Bulgaria (1.28%) and Greece (0.19%) was more remarkable.
~ - 8 - t ANTI-CARDIOLIPIN ANTIBODIES (anti-CL) IN PATIENTS WITH HEPATITIS C VIRUS (HCV) INFECTION ARE INDEPENDENT OF beta2-GLYCOPROTEIN I (b2GPI) CO-FACTOR OR FEATURES OF ANTIPHOSPHOLIPID SYNDROME (APS) Kalliopi Zachou 1, Christos Liaskos 1, Demitrios Christodoulou 3, Mara Kardasi 4, Georgia Papadamou 2, Nikolaos Gatselis 1, Fotios Gerovasilis 4, Epameinondas Tsianos 3, Georgios Dalekos 1.2.
1Research Laboratory of Internal Medicine, 2Academic Liver Unit, Larisa Medical School University of Thessaly, Larisa; 3Department of Internal Medicine, Division of Gastroenterology, School of Medicine, University of loannina, loannina; 4Division of Gastroenterology, General Hospital of Volos, Volos, Greece Increased incidence of anti-CL has been reported in HCV patients. However, the clinical importance of these findings is still controversial. We conducted a study in order to assess the significance of these autoantibodies in 174 consecutive HCV patients. We investigated for the presence of IgG anti-CL using a quantitative ELISA set up in our laboratory and whether anti-CL were b2-GPI dependent ('thrombogenic'). Associations between anti-CL and clinical, laboratory and demographic features of the patients were also done. IgG anti-b2GPI was determined using commercial ELISA (anti-b2GPI IgG, INOVA). HCV genotype was available in 84 patients. As disease controls 50 patients with hepatitis B were tested for anti-CL and anti-b2GPI. 260 healthy donors were also investigated. There was no significant difference neither between the HCV and HBV patients tested positive for anti-CL (37/174 (21.3%) vs 7/50 (14%), respectively) nor between patients with anti-b2GPI seropositivity (4/174 (2.3%) vs 1/50 (2%) respectively). However, anti-CL were detected in only 2.2% of healthy (p < 0.01 compared to patients). The mean titres of anti-CL in HCV/anti-CL positive patients did not differ compared with those found in HBV/anti-CL positive patients. Anti-CL detection was not associated with HCV genotype or platelets among HCV patients. Moreover, anti-CL were not associated with sex, age, source and duration of infection, past medical history, alcohol consumption, biochemical parameters, disease stage, liver histology and presence of clinical features of APS in both HCV and HBV patients. However, anti-CL positivity was associated with higher mean globulin levels in HCV patients, and with lower platelets in HBV patients. Conclusions: A significant proportion of HCV and HBV patients tested anti-CL positive. The clinical importance of these findings appears to be weak, since the majority of anti-CL positive cases failed to be associated with the 'thrombogenic' anti-b2GPI or the development of thrombotic events.
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"TOTAL HCV CORE ANTIGEN ASSAY": A NEW MARKER OF VIREMIA AND IT'S APPLICATION IN DIAGNOSIS
Alessandro Zanetti I , Francoise Lunel-Fabiani2, Christian Trepo 3, Patrick Marcellin 4. 1Alessandro Zanetti, DirectorInst. ViroL Univ. Milan,
Milan, Italy; 2Francoise Lunel-FabianL Chief of Service Bact. and Virology, Central university Hospital Angers; 3Christian Trepo, Director Inserm, Lyon; 4patrickMarcellin, Directorlnserm, HospitalBeaujon, Clichy, France Aim: To evaluate the Ortho Total HCV Core Antigen Assay as a new marker of viremia and replication, in the presence or absence of anti-HCV antibodies. Methods: A multi-site study of over 1500 HCV patients, diagnosed by risk factor and RNA determination, and 567 non-HCV associated hepatitis patients, was carried out. HCV core antigen quantification and viral RNA load were measured at treatment baseline and during the course of IFN/Ribavirin therapy (Ortho Total HCV Core Antigen Assay ELISA and Amplicor ver. 2.0). Results: The assay can be completed in 3 hrs. There was a 90.5% concordance between RNA copy and antigen (cut-off 1.5 pg/ml) at baseline of treatment, and a 100% agreement above 1,000-13,000 IU/ml. Sensitivity dilutions of genotypes 1-5 samples showed a 92-94% correspondence with PCR values. The core antigen assay was linear to greater than 10 E(6) RNA copies/ml. Standard calibrator linearity was studied in 26 consecutive runs (r(2) = 0.992), and reproducibility of controls was within 10-12% CV. Performance of the assay on serum vs. plasma was excellent (r(2) = 0.990). Conclusions: The Ortho Total HCV Core Antigen Assay provides a new indicator of HCV infection that is compatible with NAT, allows monitoring of HCV virus replication status, and may offer unique information on the disease state.
~ 0 ~ T H E EFFECT OF INTRADERMAL HBV VACCINE IN PATIENTS WITH CHRONIC LIVER DISEASE (CLD) Eli Zuckerman 1, Riad Hnifes I , Edmund Sabo 3, Ada Tamir 4, Itshak Srugu 2, Daniel Yeshurun t . 1Liver Unit, Department oflnternal
Medicine A, Bnai Zion Medical Center, Haifa; 2Division of Clinical Microbiology, Bnai Zion Medical Center, Haifa; 3Department of Pathology, CarmelMedical Center, Haifa; 4Department of Epidemiology, Technion Faculty of Medicine, Israel Patients with non-HBV-related CLD who acquire de novo HBV infection are at high risk to develop fulminant hepatic failure and therefore should be vaccinated with HBV vaccine. However, patients with CLD have decreased immune response and only 15-55% achieve protective titer of HBsAb's (>10 IU/L). Recently, we and others have shown that intradermel (i.d.) HBV vaccine may achieve protective HBsAb titer in healthy individuals who failed to respond to the conventional intramuscular (i.m.) vaccination. In the present study we evaluated the response to i.d. HBV vaccine in patients with CLD. 180 patients with non-HBV-related CLD were studied. 90 patients (45 cirrhotics and 45 non-cirrhotics) received a series of 3 i.d. injections of recombinant hepatitis B vaccine (5 micrograms of Engerix-B, SmithKline Beecham) at 0, 1, and 2 months. The other 90 patients (45 cirrhotics and 45 non-cirrhotics) received 3 i.m. injections of 20 micrograms at 0, 1, and 6 months. HBsAb titer was measured in each patient one month after the completion of vaccination. The two groups were comparable in respect to age and etiology of CLD. A protective titer of HBsAb was achieved in 69% by i.d. vaccination compared to only 43% by i.m. vaccination (p < 0.01). The presence of cirrhosis and an older age (>40 years) were associated with a decreased response rate in both groups, intradermal HBV vaccination is more effective than intramuscular vaccination and thus can be used in patients with CLD, with or without cirrhosis.
~ - 8 - t ANTI-CARDIOLIPIN ANTIBODIES (anti-CL) IN PATIENTS WITH HEPATITIS C VIRUS (HCV) INFECTION ARE INDEPENDENT OF beta2-GLYCOPROTEIN I (b2GPI) CO-FACTOR OR FEATURES OF ANTIPHOSPHOLIPID SYNDROME (APS) Kalliopi Zachou 1, Christos Liaskos 1, Demitrios Christodoulou 3, Mara Kardasi 4, Georgia Papadamou 2, Nikolaos Gatselis 1, Fotios Gerovasilis 4, Epameinondas Tsianos 3, Georgios Dalekos 1.2.
1Research Laboratory of Internal Medicine, 2Academic Liver Unit, Larisa Medical School University of Thessaly, Larisa; 3Department of Internal Medicine, Division of Gastroenterology, School of Medicine, University of loannina, loannina; 4Division of Gastroenterology, General Hospital of Volos, Volos, Greece Increased incidence of anti-CL has been reported in HCV patients. However, the clinical importance of these findings is still controversial. We conducted a study in order to assess the significance of these autoantibodies in 174 consecutive HCV patients. We investigated for the presence of IgG anti-CL using a quantitative ELISA set up in our laboratory and whether anti-CL were b2-GPI dependent ('thrombogenic'). Associations between anti-CL and clinical, laboratory and demographic features of the patients were also done. IgG anti-b2GPI was determined using commercial ELISA (anti-b2GPI IgG, INOVA). HCV genotype was available in 84 patients. As disease controls 50 patients with hepatitis B were tested for anti-CL and anti-b2GPI. 260 healthy donors were also investigated. There was no significant difference neither between the HCV and HBV patients tested positive for anti-CL (37/174 (21.3%) vs 7/50 (14%), respectively) nor between patients with anti-b2GPI seropositivity (4/174 (2.3%) vs 1/50 (2%) respectively). However, anti-CL were detected in only 2.2% of healthy (p < 0.01 compared to patients). The mean titres of anti-CL in HCV/anti-CL positive patients did not differ compared with those found in HBV/anti-CL positive patients. Anti-CL detection was not associated with HCV genotype or platelets among HCV patients. Moreover, anti-CL were not associated with sex, age, source and duration of infection, past medical history, alcohol consumption, biochemical parameters, disease stage, liver histology and presence of clinical features of APS in both HCV and HBV patients. However, anti-CL positivity was associated with higher mean globulin levels in HCV patients, and with lower platelets in HBV patients. Conclusions: A significant proportion of HCV and HBV patients tested anti-CL positive. The clinical importance of these findings appears to be weak, since the majority of anti-CL positive cases failed to be associated with the 'thrombogenic' anti-b2GPI or the development of thrombotic events.
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139
"TOTAL HCV CORE ANTIGEN ASSAY": A NEW MARKER OF VIREMIA AND IT'S APPLICATION IN DIAGNOSIS
Alessandro Zanetti I , Francoise Lunel-Fabiani2, Christian Trepo 3, Patrick Marcellin 4. 1Alessandro Zanetti, DirectorInst. ViroL Univ. Milan,
Milan, Italy; 2Francoise Lunel-FabianL Chief of Service Bact. and Virology, Central university Hospital Angers; 3Christian Trepo, Director Inserm, Lyon; 4patrickMarcellin, Directorlnserm, HospitalBeaujon, Clichy, France Aim: To evaluate the Ortho Total HCV Core Antigen Assay as a new marker of viremia and replication, in the presence or absence of anti-HCV antibodies. Methods: A multi-site study of over 1500 HCV patients, diagnosed by risk factor and RNA determination, and 567 non-HCV associated hepatitis patients, was carried out. HCV core antigen quantification and viral RNA load were measured at treatment baseline and during the course of IFN/Ribavirin therapy (Ortho Total HCV Core Antigen Assay ELISA and Amplicor ver. 2.0). Results: The assay can be completed in 3 hrs. There was a 90.5% concordance between RNA copy and antigen (cut-off 1.5 pg/ml) at baseline of treatment, and a 100% agreement above 1,000-13,000 IU/ml. Sensitivity dilutions of genotypes 1-5 samples showed a 92-94% correspondence with PCR values. The core antigen assay was linear to greater than 10 E(6) RNA copies/ml. Standard calibrator linearity was studied in 26 consecutive runs (r(2) = 0.992), and reproducibility of controls was within 10-12% CV. Performance of the assay on serum vs. plasma was excellent (r(2) = 0.990). Conclusions: The Ortho Total HCV Core Antigen Assay provides a new indicator of HCV infection that is compatible with NAT, allows monitoring of HCV virus replication status, and may offer unique information on the disease state.
~ 0 ~ T H E EFFECT OF INTRADERMAL HBV VACCINE IN PATIENTS WITH CHRONIC LIVER DISEASE (CLD) Eli Zuckerman 1, Riad Hnifes I , Edmund Sabo 3, Ada Tamir 4, Itshak Srugu 2, Daniel Yeshurun t . 1Liver Unit, Department oflnternal
Medicine A, Bnai Zion Medical Center, Haifa; 2Division of Clinical Microbiology, Bnai Zion Medical Center, Haifa; 3Department of Pathology, CarmelMedical Center, Haifa; 4Department of Epidemiology, Technion Faculty of Medicine, Israel Patients with non-HBV-related CLD who acquire de novo HBV infection are at high risk to develop fulminant hepatic failure and therefore should be vaccinated with HBV vaccine. However, patients with CLD have decreased immune response and only 15-55% achieve protective titer of HBsAb's (>10 IU/L). Recently, we and others have shown that intradermel (i.d.) HBV vaccine may achieve protective HBsAb titer in healthy individuals who failed to respond to the conventional intramuscular (i.m.) vaccination. In the present study we evaluated the response to i.d. HBV vaccine in patients with CLD. 180 patients with non-HBV-related CLD were studied. 90 patients (45 cirrhotics and 45 non-cirrhotics) received a series of 3 i.d. injections of recombinant hepatitis B vaccine (5 micrograms of Engerix-B, SmithKline Beecham) at 0, 1, and 2 months. The other 90 patients (45 cirrhotics and 45 non-cirrhotics) received 3 i.m. injections of 20 micrograms at 0, 1, and 6 months. HBsAb titer was measured in each patient one month after the completion of vaccination. The two groups were comparable in respect to age and etiology of CLD. A protective titer of HBsAb was achieved in 69% by i.d. vaccination compared to only 43% by i.m. vaccination (p < 0.01). The presence of cirrhosis and an older age (>40 years) were associated with a decreased response rate in both groups, intradermal HBV vaccination is more effective than intramuscular vaccination and thus can be used in patients with CLD, with or without cirrhosis.