ABSTRACT
UNLABELLED: Wide range of different autoantibodies (e.g. rheumatoid factor, antinuclear antibodies, smooth muscle antibodies, anticardiolipin antibodies) can be detected in low titres in more than 70% of patients with chronic hepatitis. THE AIM OF THE STUDY: Prevalence of serological markers typical for rheumatic diseases in patients with chronic viral hepatitis was examined and the correlation between those markers and serum activity of liver enzymes was evaluated. MATERIAL AND METHODS: 80 patients (30 female and 50 male aged 43.5 +/- 10 years) with chronic viral hepatitis hospitalized in Department of Internal Diseases and Rheumatology of Medical Military Institute in Warsaw were included in the study. 16 of patients were infected with hepatitis virus B, 60 with hepatitis virus C, 4 suffered from both infections. Blood morphology, ESR, CRP aminotransferases activity, protein and bilirubin levels were measured in every patient. Serological examination included levels of antinuclear antibodies (ANA), smooth muscle antibodies (SMA), LKM-1, antineutrophil antibodies (ANCA), anticardiolipin antibodies (aCL), antimitochondrial antibodies (AMA), circulating immunological complexes (CIC), cryoglobulins and rheumatoid factor. RESULTS: At least one serological marker was found in 60 (75%) patients. Latex fixation reaction was positive in 42 (54%), rheumatoid factor was present in 25 (31%), aCL in 28 (34%), pANCA in 22 (27%) and CIC in 16 (20%). Antibodies ANA, AMA, LKM-1 and cryoglobulins were less frequently observed (6%, 5.5% and 7% respectively). The presence of autoantibodies was more frequent in patients with hepatitis C (77% vs. 62%). AMA, LKM-1 and cryoglobulins were detected only in that group of patients. There was no correlation between liver enzymes activity and presence of serological markers of rheumatic diseases. CONCLUSIONS: Serological markers considered to be typical for rheumatic disorders were detected in 75% patients (especially in patients with HCV). There is no correlation between aminotransferases activity and tested serological.
Subject(s)
Arthritis/diagnosis , Arthritis/epidemiology , Hepatitis, Viral, Human/epidemiology , Adult , Arthritis/blood , Autoantibodies/blood , Biomarkers/blood , Chronic Disease , Comorbidity , Female , Humans , Male , Serologic TestsABSTRACT
We investigated the safety, efficacy, and impact of ribavirin and peginterferon dose reduction on complete early virologic response and sustained virologic response (SVR) to triple therapy with telaprevir in treatment-experienced patients with advanced liver fibrosis.Treatment was initiated for 211 patients who failed treatment with peginterferon and ribavirin, with bridging fibrosis (F3, nâ=â68) or cirrhosis (F4, nâ=â143), including 103 (49%) null-responders (NR), 30 (14%) partial responders (PR), and 78 (37%) relapsers (REL). Impaired liver function (ILF) platelets <100,000/mm or albumin <35âg/L were present in 40 patients. The distribution of hepatitis C virus subtypes was: 1a, 1b, or 1, with undetermined subtype for 10 (5%), 187 (89%), and 14 (6%) patients, respectively. Treatment was started with peginterferon alpha-2a or alpha-2b, ribavirin, and telaprevir at standard doses.The overall SVR24 rate was 56% and was lower in cirrhotic patients (NR: 35%, PR: 40%, and REL: 63%, respectively) than in patients with bridging fibrosis (NR: 50%, PR: 75%, and REL: 75%, respectively). The lowest probability of SVR24 was in NRs with ILF (26%). The SVR24 rate significantly decreased in NRs receiving <60% vs >60% of the total ribavirin dose (23% vs 44%, respectively) or <80% vs >80% of the total ribavirin dose (33% vs 48%, respectively). A significant SVR24 decrease was noted subsequent to a total peginterferon dose reduction, both when comparing patients who received <60% vs >60% of the total dose (NR: 0% vs 44%; REL: 33% vs 68%) and patients who received <80% vs >80% of the total dose (NR: 17% vs 50%; REL: 46% vs 71%).Serious adverse events were observed in 31 patients (15%). Deaths occurred in 4 patients. All of the deceased subjects were cirrhotic members of the ILF (baseline serum albumin level <35âg/L and/or platelet count <100,000/mm) group.Ribavirin dose reduction did not affect efficacy in REL but did in NR. Peginterferon dose reduction decreased the SVR24 rate for all groups, particularly in prior NR. ILF increased the risk of fatal complications with a low probability to achieve SVR24. One solution might be to provide wide and early access to novel, efficient, and safe interferon-free combinations to treatment-experienced patients, particularly those with liver cirrhosis.