Chun-Hao Chen1,2, Jee-Fu Huang1,3,4, Chung-Feng Huang1,5,6, Ming-Lun Yeh6, Jeng-Fu Yang6,7, Ming-Yen Hsieh3,5,6, Nai-Jen Hou4, Zu-Yau Lin3,6, Shinn-Cherng Chen3,6, Ming-Yuh Hsieh3,6, Liang-Yen Wang3,6, Wan-Long Chuang3,6, Chia-Yen Dai3,6, Ming-Lung Yu8,9,10. 1. Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. 2. Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan. 3. Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. 4. Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan. 5. Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan. 6. Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Rd, Kaohsiung, 807, Taiwan. 7. Department of Preventive Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. 8. Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. fish6069@gmail.com. 9. Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan. fish6069@gmail.com. 10. Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Rd, Kaohsiung, 807, Taiwan. fish6069@gmail.com.
Abstract
BACKGROUND AND AIMS: A discrepancy in virological and biochemical responses may occur throughout interferon-based therapy for hepatitis C virus (HCV). We aimed to explore the risk, associated factors, potential mechanisms, and impact on the treatment outcome of the discrepancy. SUBJECTS AND METHODS: Consecutive 496, chronic HCV-infected patients receiving interferon/ribavirin or peginterferon/ribavirin for 24 weeks with a 24-week follow-up period were enrolled. Of 433 patients with pretreatment liver biopsy, 46 received serial liver biopsies at the end of treatment and end of follow-up to explore the corresponding change in liver histopathology. A virological/biochemical discrepancy was defined as persistently elevated alanine aminotransferase levels throughout the treatment period, despite the seronegativity for HCV RNA at least at the end of treatment. The sustained virological response (SVR) was defined as seronegativity for HCV RNA 6 months after the end of treatment. RESULTS: Virological/biochemical discrepancy was observed in 28.7 % (137/478) patients. The SVR rate was comparable between patients with (75.2 %, 103/137) and without discrepancy (81.2 %, 277/341, p = 0.14). For patients with discrepancy and SVR, 78 (75.7 %) had a subsequent normalization of alanine aminotransferase. Hepatic steatosis, advanced fibrosis, obesity, older age, peginterferon preparation, and low viral load were independently predictive of a virological/biochemical discrepancy. Serial liver histology showed that significant transient aggravation of hepatic steatosis during interferon-based therapy was observed among patients with a virological/biochemical discrepancy (difference 0.64 ± 0.93, p = 0.022), but not among those without it (difference 0.09 ± 0.69, p = 0.447). CONCLUSIONS: A virological/biochemical discrepancy no longer exists after treatment cessation in most patients, and had little impact on the HCV treatment outcome. Treatment-related hepatic steatosis might play an important role in the pathogenesis of the discrepancy.
BACKGROUND AND AIMS: A discrepancy in virological and biochemical responses may occur throughout interferon-based therapy for hepatitis C virus (HCV). We aimed to explore the risk, associated factors, potential mechanisms, and impact on the treatment outcome of the discrepancy. SUBJECTS AND METHODS: Consecutive 496, chronic HCV-infectedpatients receiving interferon/ribavirin or peginterferon/ribavirin for 24 weeks with a 24-week follow-up period were enrolled. Of 433 patients with pretreatment liver biopsy, 46 received serial liver biopsies at the end of treatment and end of follow-up to explore the corresponding change in liver histopathology. A virological/biochemical discrepancy was defined as persistently elevated alanine aminotransferase levels throughout the treatment period, despite the seronegativity for HCV RNA at least at the end of treatment. The sustained virological response (SVR) was defined as seronegativity for HCV RNA 6 months after the end of treatment. RESULTS: Virological/biochemical discrepancy was observed in 28.7 % (137/478) patients. The SVR rate was comparable between patients with (75.2 %, 103/137) and without discrepancy (81.2 %, 277/341, p = 0.14). For patients with discrepancy and SVR, 78 (75.7 %) had a subsequent normalization of alanine aminotransferase. Hepatic steatosis, advanced fibrosis, obesity, older age, peginterferon preparation, and low viral load were independently predictive of a virological/biochemical discrepancy. Serial liver histology showed that significant transient aggravation of hepatic steatosis during interferon-based therapy was observed among patients with a virological/biochemical discrepancy (difference 0.64 ± 0.93, p = 0.022), but not among those without it (difference 0.09 ± 0.69, p = 0.447). CONCLUSIONS: A virological/biochemical discrepancy no longer exists after treatment cessation in most patients, and had little impact on the HCV treatment outcome. Treatment-related hepatic steatosis might play an important role in the pathogenesis of the discrepancy.
Authors: M C Hsieh; M L Yu; W L Chuang; S J Shin; C Y Dai; S C Chen; Z Y Lin; M Y Hsieh; J F Liu; L Y Wang; W Y Chang Journal: Eur J Endocrinol Date: 2000-05 Impact factor: 6.664
Authors: Daniele Prati; Mitchell L Shiffman; Moisés Diago; Edward Gane; K Rajender Reddy; Paul Pockros; Patrizia Farci; Christopher B O'Brien; Pilar Lardelli; Steven Blotner; Stefan Zeuzem Journal: J Hepatol Date: 2006-01-25 Impact factor: 25.083
Authors: J R Larrubia; S Benito-Martínez; J Miquel-Plaza; E Sanz-de-Villalobos; F González-Mateos; T Parra Journal: Rev Esp Enferm Dig Date: 2009-05 Impact factor: 2.086