[Outcome of treatment with peg-interferon and ribavirin in HIV-HCV co-infected patients: "real life" single center experience].

BACKGROUND AND AIM: Recently, with the emergence of highly effective antiretroviral treatment (ART), chronic liver disease has become the leading cause of morbidity and mortality in co-infected HIV-HCV (Human immunodeficiency virus-Hepatitis C virus) patients. The overall SVR rate in this population remains unsatisfactory. The aim of this study was to evaluate the response to therapy in HIV-HCV co-infected patients in a single center. PATIENTS AND METHODS: Consecutive HIV-HCV co-infected patients were evaluated in the liver clinic between 2003 -2010. Liver needle biopsy was conducted in 100% of the patients. The patients were treated by a multidisciplinary team consisting of immunologists, hepatologists, social workers and nurses and a close follow-up was conducted. The 48 weeks duration of peg-interferon and ribavirin combination was used for all genotypes according to recent guidelines. Weight-adjusted ribavirin doses were applied. Treatment was initiated after stabilization of HIV parameters and successful weaning from drug and alcohol addiction. RESULTS: A total of 86 out of 143 HIV- HCV co-infected patients, were evaluated; 39 completed treatment. Of those 31 (77%) achieved SVR. Out of 22 genotype 1 patients, 18 (82%) achieved SVR. Six patients had spontaneous viral clearance and 8 are still receiving treatment. In 17 non-one genotype patients, the SVR rate was 76.4% (13 of 17 patients); 6 patients were defined as relapsers and non-responders. Overall adherence to the treatment was high. CONCLUSION: Measures, such as the use of a multidisciplinary approach, high adherence of physicians to the guidelines, weight-based ribavirin dose, and selecting patients who are ready to start therapy, can significantly improve the SVR rate in this difficult-to-treat patient population.

Prophylactic analgesia before percutaneous liver biopsy: a clinical comparative study.

INTRODUCTION: Liver biopsy remains the gold standard for the diagnosis and staging of liver diseases. Despite being painful, analgesia before liver biopsy is usually avoided due to the notion that pain is minor and due to the concern of masking possible abdominal symptoms. Postbiopsy pain levels were previously mapped for the purpose of analgesia planning. AIM: To compare pain and anxiety levels between two prophylactic treatment regimens, a combination of sublingual tramadol Hcl with oral lorazepam and oral diazepam only. PATIENTS AND METHODS: One hundred and thirteen consecutive patients were selected to receive either prophylactic analgesia with sublingual tramadol Hcl (50 mg) flashtabs and oral lorazepam [(1 mg) analgesia group (AG), n=56] or oral diazepam (5 mg) alone [nonAG (NAG), n=57]. Pain and anxiety levels were assessed using Visual Analogue Scale (1-10) and State Anxiety Inventory, respectively, 30 min before, and 30 min and 6 h after the biopsy. RESULTS: The groups were comparable with respect to baseline characteristics. Thirty minutes after the procedure, pain levels were significantly lower in the AG (mean Visual Analogue Scale ± standard error of the mean, 1.8 ± 0. 3; median=1) compared with the NAG (3.1 ± 0.3, median=3; P<0.005). Patients in the NAG (13.8%), reported high pain intensities (>7) compared with the patients in the AG (3.6%; P=0.09). Six hours after the procedure, pain intensity remained significantly lower in the AG compared with the NAG (0.8 ± 0.1 vs. 1.5 ± 0.2; P<0.005). Anxiety levels were comparable. CONCLUSION: Prophylactic combination of short-acting tramadol and lorazepam is effective, safe, and can be used routinely before liver biopsy.