Does end-stage kidney failure influence hepatitis C progression in hemodialysis patients?

BACKGROUND/AIMS: The influence of end-stage kidney failure on the progression of liver disease in patients infected with hepatitis C virus and treated with hemodialysis is still controversial. METHODOLOGY: Liver histology of 154 hepatitis C virus infected non-uremic patients was compared with liver histology of 13 hepatitis C virus infected uremic patients treated with hemodialysis. RESULTS: In either group of altogether 167 patients, no normal liver histology was found. Each patient had at least a low-grade lobular and/or portal inflammation. However, statistically significant differences were observed between hepatitis C virus infected uremic and non-uremic patients in the extent of intralobular changes, portal inflammation, and degree of fibrosis. CONCLUSIONS: Non-uremic hepatitis C virus infected patients appear to have more active and progressive liver disease than hepatitis C virus infected patients on hemodialysis. Regular follow-up of uremic patients, associated with earlier detection of hepatitis C virus infection, so as suggested uremia-associated impaired immunoreactivity and increased levels of hepatocyte growth factor described recently, might be implicated in a more favorable course of hepatitis C virus infection in uremic patients. In addition, due to the absence of normal liver histology in either group of hepatitis C virus infected patients, we propose liver biopsy to be mandatory in all these patients, provided that no contraindications exist clinically.

Efficacy of chronic hepatitis C therapy with interferon alpha (IFN-alpha) in Slovenia.

BACKGROUND/AIMS: Eighty Slovene patients with chronic hepatitis C were included in a prospective study conducted in the period 1997-1998 with the purpose to establish the efficacy of interferon alpha therapy. The average age of the patients was 39 years. In more than half of the patients (52%) the mode and time of onset of the infection were unknown. Two thirds of the patients were males. The plasma viral load exceeded 2 x 10(6) copies/mL in only three patients and in more than half of the cases (54%) HCV genotype 1b was present. METHODOLOGY: The 18-month treatment with 3 MU interferon alpha three times a week was concluded in 53 patients and, after doubling the initial dose of interferon alpha from 3 MU to 6 MU, in 5 patients. In 11 patients, the treatment was discontinued prematurely, after six months, due to therapeutic failure (despite doubling the initial dose of interferon alpha Eleven patients withdrew from the treatment: six of them due to side effects and five due to personal reasons. RESULTS: Complete response to therapy with disappearance of HCV from the blood was observed in 34 patients (49%), while in 24 the response to therapy was partial, i.e., the biochemical tests showed normalization of values but viremia persisted. There was a significant relation between the therapeutic response and those patients with the genotype 3 (p = 0.01). After three months of follow-up, complete therapeutic response was still observed in 19 patients (28%), most of them with genotype 3. Despite persistent viremia there was no progression of liver inflammation in eight partial responders, as evidenced by liver rebiopsy. Thus, it was confirmed that treatment is justified in these patients. CONCLUSIONS: During the continuation of the follow-up period we shall record further course of the disease and make an attempt in a subsequent study to improve the efficacy of the treatment by introducing a combination of interferon alpha and ribavirin into therapy.

Comparative evaluation of three commercial assays for quantitative measurement of hepatitis B virus DNA in serum samples.

BACKGROUND/AIMS: Quantitative determination of HBV DNA in serum samples is indispensable for predicting disease progression and for monitoring the antiviral treatment in patients with chronic HBV infection. METHODOLOGY: Three commercial assays for quantification of HBV DNA: Digene Hybrid-Capture HBV DNA Assay, Bayer Quantiplex HBV DNA Assay and Roche Amplicor HBV Monitor Test were comparatively evaluated under the routine conditions of diagnostic virology laboratory, using 61 serum samples obtained from 55 Slovenian patients with chronic hepatitis B. RESULTS: HBV DNA was detected by Amplicor, Quantiplex and Hybrid-Capture in 38 (62.3%), 34 (55.7%) and 27 (44.3%) samples, respectively. The sensitivity of Amplicor and Quantiplex assays did not differ significantly (p = 0.13), while both Amplicor and Quantiplex assays were found to be significantly more sensitive than Hybrid-Capture (p = 0.003 and p = 0.02, respectively). For a given sample, the highest correlation was observed between HBV DNA loads determined by Quantiplex and Hybrid-Capture assays (r = 0.85, p < 0.0001). CONCLUSIONS: Amplicor HBV Monitor Test seems to be the most sensitive assay for the detection of HBV DNA in serum samples and can be clinically used for monitoring patients with chronic HBV infection.