MedWorm: Antiviral Therapy

Cytomegalovirus in inflammatory bowel disease: Pathogen or innocent bystander?

Inflammatory Bowel Diseases — Tue, 16 Mar 2010 00:00:00 +0100

This article reviews the immunobiology of CMV disease, the evidence for CMV's role in disease severity, and discusses the outcomes with antiviral therapy. (Inflamm Bowel Dis 2010) (Source: Inflammatory Bowel Diseases)

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End Points of Therapy in Chronic Hepatitis B

Medscape Today Headlines — Mon, 08 Mar 2010 11:09:10 +0100

What clinical, histological, biochemical and virological end points of antiviral therapy in chronic hepatitis B are most relevant? Expert Review of Gastroenterology and Hepatology (Source: Medscape Today Headlines)

Viral meningoencephalitis: a review of diagnostic methods and guidelines for management

European Journal of Neurology — Wed, 03 Mar 2010 00:00:00 +0100

Background: Viral encephalitis is a medical emergency. The prognosis depends mainly on the pathogen and host immunologic state. Correct immediate diagnosis and introduction of symptomatic and specific therapy has a dramatic influence upon survival and reduces the extent of permanent brain injury.Methods: We searched the literature from 1966 to 2009. Recommendations were reached by consensus. Where there was lack of evidence but consensus was clear, we have stated our opinion as good practice points.Recommendations: Diagnosis should be based on medical history and examination followed by CSF analysis for protein and glucose levels, cellular analysis, and identification of the pathogen by polymerase chain reaction amplification (recommendation level A) and serology (level B). Neuroimaging, p...

Performance of a Rapid Influenza Test in Children During the H1N1 2009 Influenza A Outbreak

PEDIATRICS — Mon, 01 Mar 2010 16:02:29 +0100

CONCLUSIONS: The RIDT had relatively poor sensitivity but excellent specificity in this consecutive series of respiratory specimens obtained from pediatric patients. Although a positive RIDT result was highly accurate in predicting infection with influenza type A H1N1 2009 in children, a negative RIDT result did not preclude a child having H1N1. Therefore, for children at high risk with influenza-like illnesses during high-prevalence periods of influenza, empiric initiation of antiviral therapy should be considered for patients with a negative RIDT result. (Source: PEDIATRICS)

Severe H1N1-Associated Acute Respiratory Distress Syndrome: A Case Series

The American Journal of Medicine — Mon, 01 Mar 2010 00:00:00 +0100

Conclusions: Clinicians should be vigilant for the potential of H1N1 infection to progress to severe acute respiratory distress syndrome in a variety of patient demographics, including younger patients without baseline cardiopulmonary disease. A high degree of suspicion is critical, especially with the relative insensitivity of rapid testing, and should prompt empiric antiviral therapy. (Source: The American Journal of Medicine)

Utilization and Antiviral Therapy in Patients with Chronic Hepatitis C: Analysis of Ambulatory Care Visits in the US

Digestive Diseases and Sciences — Fri, 26 Feb 2010 06:46:26 +0100

Conclusions Less than 10% of the ambulatory visits for hepatitis C were associated with a prescription for antiviral therapy, independent of demographic and insurance status. Purposes of the clinic visits were different in the CHC group compared to the general population. The reason for the low treatment rate is not clear but deserves further investigation. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10620-010-1147-zAuthors Ramsey Cheung, Stanford University Division of Gastroenterology and Hepatology Stanford CA USAAjitha Mannalithara, Stanford University Division of Gastroenterology and Hepatology Stanford CA USAGurkirpal Singh, Stanford University Division of Gastroenterology and Hepatology Stanford CA USA Journal Digestive Diseases a...

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The month of July: an early experience with pandemic influenza A (H1N1) in adults with cystic fibrosis

BMC Pulmonary Medicine - Latest articles — Thu, 25 Feb 2010 00:00:00 +0100

Conclusions: This observational study demonstrates that most adults with CF with H1N1 infection had mild clinical courses and recovered rapidly. (Source: BMC Pulmonary Medicine - Latest articles)

Role of Sleep Disturbance in Chronic Hepatitis C Infection

Current Hepatitis Reports — Sat, 20 Feb 2010 06:57:49 +0100

We present an overview of studies indicating sleep problems in patients with CHC, with about 60% to 65% of individuals reporting such complaints. Evidence suggests that impairments in sleep quality exist independent of antiviral therapy with interferon-α and prior to advanced stages of liver disease. Further investigation of sleep disturbance in CHC patients with a mild stage of liver disease may provide important information on disease course as well as allow additional opportunities for patient support. Content Type Journal ArticleDOI 10.1007/s11901-010-0030-xAuthors Meghan D. Carlson, University of California San Diego, 210 Dickinson Street, CTF-A Room 109 San Diego CA 92103-8423 USARobin C. Hilsabeck, University of California San Diego, 210 Dickinson Street, CTF-A Room 109 ...

Low vitamin D serum level is related to severe fibrosis and low responsiveness to interferon-based therapy in genotype 1 chronic hepatitis C

Hepatology — Wed, 17 Feb 2010 00:00:00 +0100

Conclusion: G1 CHC patients had low 25(OH)D serum levels, possibly because of reduced CYP27A1 expression. Low vitamin D is linked to severe fibrosis and low SVR on interferon (IFN)-based therapy. (HEPATOLOGY 2010.) (Source: Hepatology)

Inhibition of Newcastle Disease virus replication by RNA interference targeting the matrix protein gene in Chicken embryo fibroblasts.

Journal of Virological Methods — Wed, 17 Feb 2010 00:00:00 +0100

In this study, the application of RNA interference (RNAi) for inhibiting the replication of NDV in cell culture by targeting the viral matrix protein gene (M) is described. Two M-specific shRNA-expressing plasmid constructs, named pS(M641) and pS(M827,) were evaluated for antiviral activity against the NDV strain NA-1 by cytopathic effects (CPE), virus titration and real-time RT-PCR. After 36hours of infection, both pS(M641) and pS(M827) reduced virus titers by 79.4- and 31.6-fold, respectively, and they down-regulated mRNA expression levels of the matrix protein gene M by 94.6% and 84.8%, respectively, in chicken embryo fibroblast (CEF) cells, while only pS(M641) significantly decreased CPE, compared to the control group. These results indicated that the M gene 641 and 827 sites represent...

Depression and protective factors of mental health in people with hepatitis C: A questionnaire survey

International Journal of Nursing Studies — Tue, 16 Feb 2010 14:53:30 +0100

This study investigated depression in HCV-infected people. Sense of coherence and social support were surveyed as protective factors of mental health.Methods: In a cross-sectional study-design, 81 HCV-infected people with mild liver disease, who were not receiving antiviral therapy, were surveyed by validated measures. Anxiety (HADS), depression (BDI), psychopathological symptoms (SCL-90-R), social support (F-SozU) and resilience (SOC) were assessed.Results: Higher levels of depression than normal controls (p=.001) and a wide range of psychological symptoms were associated with HCV infection. Women, single participants, and persons with a shorter interval after first diagnosis exhibited significantly higher scores of depression. Gender and sense of coherence predicted depression scores in ...

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Recurrent vaginal shedding of herpes simplex type 2 virus in the mouse and effects of antiviral therapy.

Antiviral Research — Mon, 15 Feb 2010 00:00:00 +0100

Authors: Farley N, Bernstein DI, Bravo FJ, Earwood J, Sawtell N, Cardin RD A mouse model of recurrent herpes simplex type 2 (HSV-2) would improve our understanding of the immunobiology of recurrent disease and provide a useful model for evaluating antiviral treatments. We developed a model to evaluate recurrent vaginal HSV-2 shedding using high dose Acyclovir (ACV) therapy begun at 3 days post infection (dpi). Treatment with 150mg/kg of ACV for 10 days increased survival to 80% following vaginal challenge with HSV-2 strain 186 and to 100% after challenge with strain MS. We then evaluated recurrent vaginal HSV-2 shedding in surviving mice. Although infectious virus was not detected in vaginal samples after 21 dpi, viral DNA was detectable by PCR in 80% of mice (47/59) on at least one da...

Fatal herpetic encephalitis during brain radiotherapy in a cerebral metastasized breast cancer patient

Journal of Neuro-Oncology — Thu, 11 Feb 2010 11:49:30 +0100

We present the case of a 55-year-old female who developed HSE type 1 during brain irradiation and antioedematous dexamethasone treatment for leptomeningeal metastasized breast tumor with epileptic seizures. During the radiotherapy (RT), after a total of 32 Gray administrated in 16 fractions, our patient developed cognitive impairment and partial epileptic status without fever. Two days later the patient’s clinical conditions had deteriorated and high fever manifested. A diagnosis of HSE type 1 was made by a positive cerebrospinal fluid polymerase chain reaction. Antiviral therapy with high doses of acyclovir was practiced for four weeks but the comatose state persisted. The patient died 59 days after the last RT fraction. The temporal relationship of RT to the occurrence ...

New paradigms for treating hepatitis B in HIV/hepatitis B virus co-infected patients

Journal of Antimicrobial Chemotherapy — Tue, 09 Feb 2010 16:11:22 +0100

Until the advent of tenofovir, many HIV/hepatitis B virus (HBV) co-infected patients had been treated with lamivudine as the only agent active against HBV. Selection of lamivudine-resistant HBV strains occurred in many of these patients, complicating clinical prognosis and rescue therapy. These individuals might also transmit HBV-resistant strains. Moreover, a subset of these lamivudine-resistant HBV isolates may behave as vaccine escape mutants, complicating diagnostic accuracy (e.g. producing ‘occult’ hepatitis B) and reducing the efficacy of preventive measures (causing infection in vaccinated persons). Nowadays, periodic monitoring of HBV viral load in co-infected patients should be mandatory. It may allow the early recognition of HBV viraemic individuals who may benefit fr...

Respiratory syncytial virus infection outbreak among pediatric patients with oncologic diseases and/or BMT

Pediatric Pulmonology — Tue, 09 Feb 2010 00:00:00 +0100

Respiratory syncytial virus (RSV) has been reported to cause severe morbidity and mortality among cancer patients receiving chemotherapy with or without autologous/allogeneic hematopoetic stem cell transplantation (HSCT). There have been few reports describing the outcome of RSV infection specifically among pediatric oncology patients.Two RSV infection outbreaks developed between February-April 2006 and January-March 2009 in hospitalized pediatric patients for various hemato-oncological diseases ± HSCT. A survey of respiratory viruses was done using direct immunofluorescent antibody assay from nasopharyngeal washing aspirate.In two RSV infection outbreaks (2006 and 2009), RSV antigen was detected in 6/30 patients. Five of six patients with RSV antigen were all treated with 0.2-0.4 g/kg in...

Upper gastrointestinal endoscopic findings in the era of highly active antiretroviral therapy

HIV Medicine — Mon, 08 Feb 2010 00:00:00 +0100

The current literature suggests that there has been a decrease in opportunistic diseases among HIV-infected patients since the widespread introduction of highly active antiretroviral therapy (HAART) in 1995. The aim of the study was to investigate the impact of HAART and CD4 lymphocyte count on diseases of the upper gastrointestinal (UGI) tract, digestive symptoms, and endoscopic and histological observations. A review of 706 HIV-infected patients who underwent GI endoscopy was undertaken. The cohort was divided into three groups: group 1 (G1), pre-HAART, consisting of 239 patients who underwent endoscopy between January 1991 and December 1994; group 2 (G2), early HAART, consisting of 238 patients who underwent endoscopy between January 1999 and December 2002; and group 3 (G3), recent HAAR...

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Treatment of hepatitis B virus-associated glomerulonephritis: A meta-analysis.

World Journal of Gastroenterology : WJG — Sun, 07 Feb 2010 00:26:14 +0100

CONCLUSION: Antiviral but not corticosteroid treatment can decrease proteinuria and promote HBeAg clearance in HBV-GN patients. PMID: 20135728 [PubMed - in process] (Source: World Journal of Gastroenterology : WJG)

Natural History and Treatment of Hepatitis C in Liver Transplant Recipients

Current Hepatitis Reports — Fri, 05 Feb 2010 18:19:35 +0100

Abstract Hepatitis C is not cured with liver transplantation. Patients with hepatitis C virus (HCV) infection have reduced graft and patient survivals compared with non-HCV patients following liver transplantation. Both HCV recurrence and fibrosis are accelerated under the influence of transplantation and immunosuppression. Antiviral therapy has been shown to reduce fibrosis progression and graft loss. The goal of therapy is sustained virologic response and reduction of damage. However, the optimal timing and treatment regimen for patients with HCV following transplant is unclear. Following transplant, sustained virologic response rates are reduced and patient tolerance is limited. Improved treatment strategies are needed to reduce patient side effects and increase efficac...

Phlebotomy improves histology in chronic hepatitis C males with mild iron overload.

World Journal of Gastroenterology : WJG — Fri, 05 Feb 2010 04:10:38 +0100

CONCLUSION: Male CHC Caucasian non-responders to antiviral therapy with low-grade iron overload can benefit from mild iron depletion by long-term phlebotomy. PMID: 20128028 [PubMed - in process] (Source: World Journal of Gastroenterology : WJG)

Chimerix hires former GlaxoSmithKline executive Painter as chief medical officer

bizjournals.com Health Care:Biotechnology headlines — Thu, 04 Feb 2010 16:53:17 +0100

Antiviral therapy maker Chimerix has named pharmaceutical industry veteran Dr. Gwendolyn P. Painter as the company’s chief medical officer. (Source: bizjournals.com Health Care:Biotechnology headlines)

[Pregnancy and pandemic influenza A(H1N1) 2009. Current concepts for anaesthesia and critical care medicine.]

Annales Francaises d'Anesthesie et de Reanimation — Thu, 04 Feb 2010 00:00:00 +0100

Authors: Dubar G, Launay O, Batteux F, Tsatsaris V, Goffinet F, Mignon A Pregnant women are particularly vulnerable to the pandemic influenza A(H1N1) 2009. Indeed, they are at high risk of developing a severe or fatal form of the disease. The physiological changes and the "immune deviation" from cellular to humoral immunity occurring during pregnancy are hypotheses to explain this vulnerability. Severe forms, mainly viral pneumonias, require an urgent prescription of an effective antiviral therapy. Preventive measures, mainly vaccination, are essential to avoid the appearance of these severe forms. PMID: 20138461 [PubMed - as supplied by publisher] (Source: Annales Francaises d'Anesthesie et de Reanimation)

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Impact of international consensus guidelines on antiviral therapy of chronic hepatitis C patients in Switzerland.

Swiss Medical Weekly — Wed, 03 Feb 2010 00:00:00 +0100

CONCLUSIONS: Consistent with latest international consensus guidelines, patients enrolled in the Swiss Hepatitis C Cohort with a history of substance abuse were not withheld antiviral treatment. A multidisciplinary approach is warranted to provide antiviral treatment to patients suffering from depression. PMID: 20131123 [PubMed - as supplied by publisher] (Source: Swiss Medical Weekly)

Hepatitis C and Autoimmune Hepatitis: What Gets Treated First?

Current Hepatitis Reports — Tue, 02 Feb 2010 07:01:00 +0100

Abstract The coexistence of chronic hepatitis C (CHC) and autoimmune hepatitis (AIH) creates a clinical dilemma. Histologic features may suggest the predominance of one versus the other. Nevertheless, histologic differences are not absolute. Immunosuppressive therapy may be used as frontline treatment for patients with predominant histologic features of AIH. In the absence of clinical and biochemical improvement, interferon should not be withheld and a trial of antiviral therapy should be considered. Interferon can be frontline therapy for patients with the overlap syndrome, if histologic features of CHC predominate, a low titer of autoantibodies is present, and coexistent autoimmune diseases are absent. No matter what treatment is offered, close monitoring during the cour...

Viral infections associated with haemophagocytic syndrome

Reviews in Medical Virology — Tue, 02 Feb 2010 00:00:00 +0100

Haemophagocytic syndrome (HPS) or haemophagocytic lymphohistiocytosis (HLH) is a rare disease caused by a dysfunction of cytotoxic T cells and NK cells. This T cell/NK cell dysregulation causes an aberrant cytokine release, resulting in proliferation/activation of histiocytes with subsequent haemophagocytosis. Histiocytic infiltration of the reticuloendothelial system results in hepatomegaly, splenomegaly, lymphadenopathy and pancytopenia ultimately leading to multiple organ dysfunctions. Common clinical features include high fevers despite broad spectrum antimicrobials, maculopapular rash, neurological symptoms, coagulopathy and abnormal liver function tests. Haemophagocytic syndrome can be either primary, i.e. due to an underlying genetic defect or secondary, associated with malignancies...

Antiviral therapy for chronic hepatitis C: current status and perspectives.

Yakugaku Zasshi : Journal of the Pharmaceutical Society of Japan — Mon, 01 Feb 2010 00:00:00 +0100

Authors: Takehara T Antiviral therapy for chronic hepatitis C has advanced dramatically since the discovery of the hepatitis C virus and the introduction of interferon in early 1990s. An initial treatment regimen, 24 weeks of interferon monotherapy, achieved sustained virologic response, which is formally defined at 24 weeks after completion of the treatment, only for 5% of patients with genotype 1 high-viral load belonging to a difficult-to-treat group. Current standard therapy is a combination of pegylated interferon and ribavirin. Forty eight weeks of the combination therapy achieves successful viral eradication for 40-50% of genotype 1 patients while 24 weeks of that do so for 80% of genotype 2 patients. Early viral kinetics after the initiation of therapy is a useful predictor of ...

Telaprevir Useful as Adjunctive Agent in Refractory HCV

Internal Medicine News — Mon, 01 Feb 2010 00:00:00 +0100

BOSTON — The addition of the protease inhibitor telaprevir to antiviral therapy with pegylated interferon and ribavirin produced sustained virologic response in more than half of hepatitis C patients in a randomized trial who had previously failed the standard interferon/ribavirin protocol, Dr. John G. McHutchison reported at the annual meeting of the American Association for the Study of Liver Diseases. (Source: Internal Medicine News)

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Antiviral activity of Musa acuminata Colla, Musaceae

Revista Brasileira de Farmacognosia — Sat, 30 Jan 2010 14:05:23 +0100

This study evaluates the antiviral activity of extracts and fractions of Musa acuminata Colla collected in two regions of Rio de Janeiro State (Petrópolis and Santo Antônio de Pádua). The inflorescences of M. acuminata showed excellent activity for the two virus evaluated: simple human herpesvirus type 1 and simple human herpesvirus type 2, both resistant to Acyclovir. The results indicate that the tested extracts of M. acuminata can be potential target for use in antiviral therapy. (Source: Revista Brasileira de Farmacognosia)

Transient reappearance of serum hepatitis C virus RNA observed by real-time PCR during antiviral therapy with peginterferon and ribavirin in patients with HCV genotype 1b

Journal of Clinical Virology — Fri, 29 Jan 2010 00:00:00 +0100

Conclusions: Attention should be paid to this phenomenon in the antiviral treatment for patients with HCV infection. The transient reappearance of HCV RNA in the serum indicates a high likelihood of relapse, and is likely to be missed without frequent measurements by a sensitive detection method. (Source: Journal of Clinical Virology)

Causes and Predictive Factors of Mortality in a Cohort of Patients with Hepatitis C Virus-related Cryoglobulinemic Vasculitis Treated with Antiviral Therapy.

J Rheumatol — Thu, 28 Jan 2010 00:00:00 +0100

CONCLUSION: While renal involvement is still associated with poorer prognosis, infectious processes are now the most common cause of death in HCV cryoglobulinemia vasculitis. Immunosuppressive treatment is associated with an increased risk of death, independently from disease severity. Response to antiviral treatment is associated with significantly reduced mortality risk. PMID: 20110523 [PubMed - as supplied by publisher] (Source: J Rheumatol)

Hepatitis C Assays: The Pitfalls of Polymerase Chain Reaction and Genotyping

Current Hepatitis Reports — Wed, 27 Jan 2010 20:01:34 +0100

Abstract Hepatitis C virus (HCV) continues to represent a worldwide threat to the lives of millions of people chronically infected with the virus. Accurately identifying the virus in terms of genetic characteristics, as well as quantifying its replicative equilibrium both during steady state and in the presence of antiviral therapy, is critically important for providing optimal care and prognoses. Genotype testing continues to evolve; however, it is important to recognize its limitations, particularly as we enter the world of direct-acting antivirals, in which the precise subtyping of HCV may play an even more important role in guiding therapy. Polymerase chain reaction (PCR) has revolutionized the management of chronic viral illnesses, and the advent of real-time PCR has ...

Antiviral treatment for chronic hepatitis C in patients with human immunodeficiency virus

NeLM - Drug Class Focused Reviews — Tue, 26 Jan 2010 00:00:00 +0100

Source: Cochrane Library Area: Evidence > Drug Class Focused Reviews Background Antiviral treatment for chronic hepatitis C may be less effective if patients are co-infected with human immunodeficiency virus (HIV). Objectives To assess the benefits and harms of antiviral treatment for chronic hepatitis C in patients with HIV. Search strategy Trials were identified through manual and electronic searches in The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded. The last search was May 2009. Selection criteria Randomised trials comparing at least 12 weeks of any anti-HCV treatment versus another treatment regimen o...

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Antiviral treatment for chronic hepatitis C in patients with human immunodeficiency virus

Gastroenterology and Liver Diseases Specialist Library - Liver — Mon, 25 Jan 2010 16:51:20 +0100

Background Antiviral treatment for chronic hepatitis C may be less effective if patients are co-infected with human immunodeficiency virus (HIV). Objectives To assess the benefits and harms of antiviral treatment for chronic hepatitis C in patients with HIV. Search strategy Trials were identified through manual and electronic searches in The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded. The last search was May 2009. Selection criteria Randomised trials comparing at least 12 weeks of any anti-HCV treatment versus another treatment regimen or no treatment. Included patients had chronic hepatitis C and stable HIV irrespective of previous antiv...

Recurrent CMV retinitis in a non-HIV patient with drug-resistant CMV

Graefe's Archive for Clinical and Experimental Ophthalmology — Fri, 22 Jan 2010 10:08:58 +0100

Conclusion This case demonstrates that recurrent CMVR occurs in HIV-negative patients at CD4 cell counts thought to be protective in HIV patients, and suggests that an ineffective local immune response to retinal infection combined with CMV drug resistance may have been important factors leading to recurrent disease in this patient. Treatment producing high local concentrations of GCV may be effective therapy for CMV retinitis due to GCV-resistant virus. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00417-009-1283-3Authors Quan V. Hoang, University of Illinois at Chicago Department of Ophthalmology and Visual Sciences 1855 W. Taylor Street (M/C 648) Chicago IL 60612 USADavid M. Simon, Rush University Medical Center Section of Infectious Diseases Chicag...

Association between plasma levels of eotaxin (CCL-11) and treatment response to interferon-{alpha} and ribavirin in HIV/HCV co-infected patients

Journal of Antimicrobial Chemotherapy — Thu, 21 Jan 2010 08:07:07 +0100

Conclusions Our preliminary data suggest that plasma eotaxin levels prior to HCV antiviral therapy may be useful in predicting virological response to HCV treatment with IFN- + ribavirin in HIV/HCV co-infected patients. Further experimental research is necessary to corroborate this hypothesis. (Source: Journal of Antimicrobial Chemotherapy)

Influenza A/H1N1 2009 pneumonia in kidney transplant recipients: characteristics and outcomes following high-dose oseltamivir exposure

Transplant Infectious Disease — Thu, 21 Jan 2010 00:00:00 +0100

We report 2 cases of severe pneumonia due to the novel pandemic influenza A/H1N1 2009 in kidney transplant recipients. Our patients initially experienced influenza-like illness that rapidly progressed to severe pneumonia within 48 h. The patients became hypoxic and required non-invasive ventilation. The novel influenza A/H1N1 2009 was identified from their nasal swabs. These cases were treated successfully with a relatively high dose of oseltamivir, adjusted for their renal function. Clinical improvement was documented only after a week of antiviral therapy. Despite early antiviral treatment, we showed that morbidity following novel pandemic influenza A/H1N1 2009 infection is high among kidney transplant recipients. (Source: Transplant Infectious Disease)

Correlates of severe disease in patients with 2009 pandemic influenza (H1N1) virus infection.

cmaj — Thu, 21 Jan 2010 00:00:00 +0100

The objective of this study was to identify factors correlated with severity of disease in confirmed cases of pandemic H1N1 influenza. METHODS:This cumulative case-control study included all laboratory-confirmed cases of pandemic H1N1 influenza among residents of the province of Manitoba, Canada, for whom the final location of treatment was known. Severe cases were defined by admission to a provincial intensive care unit (ICU). Factors associated with severe disease necessitating admission to the ICU were determined by comparing ICU cases with two control groups: patients who were admitted to hospital but not to an ICU and those who remained in the community. RESULTS: As of Sept. 5, 2009, there had been 795 confirmed cases of pandemic H1N1 influenza in Manitoba for which the final treatmen...

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Progression of initially mild hepatic fibrosis in patients with chronic hepatitis C infection

Journal of Viral Hepatitis — Mon, 18 Jan 2010 00:00:00 +0100

Summary. A significant number of patients with chronic hepatitis C infection have minimal fibrosis at presentation. Although the short-term outlook for such patients is good, there are limited data available on long-term progression. We assessed the risk of fibrosis progression in 282 patients with chronic hepatitis C with Ishak stage 0 or 1 fibrosis on initial liver biopsy. Progression of fibrosis stage occurred in 118 patients (42%) over a median interval of 52.5 months. Thirteen (5%) progressed to severe (Ishak stage 4 or more) fibrosis. Progression was significantly associated with both age at initial biopsy [odds ratio (OR) for progression of 1.31 per 10 year increase in age] and median alanine transaminase (ALT) levels during follow-up (OR of 1.06 per 10 IU/L increase). There was no ...

Administration of neuraminidase inhibitors for the treatment of Japanese patients infected with the novel influenza A (H1N1)

Journal of Infection and Chemotherapy — Wed, 13 Jan 2010 17:53:58 +0100

Abstract The Centers for Disease Control and Prevention in the United States recommend the use of neuraminidase inhibitors for treating the novel influenza A (H1N1) in patients requiring desirable antiviral agents. However, the efficacy and side effects of neuraminidase inhibitors in Japanese patients infected with the novel influenza A (H1N1) are not well known. It is worth reporting on the results of the administration of neuraminidase inhibitors in Japanese patients infected with the novel influenza A (H1N1), as it is believed the number of Japanese patients will increase in the future. We treated seven Japanese patients (five adults and two juveniles) infected with the novel influenza A (H1N1) with oseltamivir and zanamivir, and good clinical courses were obtained. Our...

Effect of antiviral therapy on circulating cytokeratin-18 fragments in patients with chronic hepatitis C

Journal of Viral Hepatitis — Wed, 13 Jan 2010 00:00:00 +0100

Summary. Hepatocellular apoptosis plays a major role in the pathogenesis of chronic hepatitis C. It can be measured noninvasively by determining the circulating levels of cytokeratin-18 fragments. We hypothesized that the effect of antiviral therapy on this parameter will be different in patients with a sustained virological response, relapse (REL) and nonresponse (NR). We quantified cytokeratin-18 fragments in plasma of patients participating in the Swiss Hepatitis C cohort, who received antiviral therapy without stopping because of sides effects. A total of 315 patients were included, 183 with a sustained response, 64 with NR and 68 who relapsed. Mean levels ±SD of circulating cytokeratin-18 fragments before therapy were 174 ± 172 U/L for responsders, 188 ± 145 for nonresponders and 2...

The cell biology of Hepatitis C Virus (HCV) lipid addiction: molecular mechanisms and its potential importance in the clinic.

The International Journal of Biochemistry and Cell Biology — Sat, 09 Jan 2010 00:00:00 +0100

Authors: Eric P, Philippe R, Jean-Christophe P Hepatitis C virus (HCV) is a major cause of chronic hepatitis associated with liver steatosis, commonly evolving to cirrhosis or hepatocellular carcinoma. The World Health Organisation (WHO) estimates that there are around 170 million chronic HCV carriers worldwide. The virus has a highly variable sequence, allowing definition of 7 genotypes with different geographical distributions. Both clinical outcome and response to antiviral therapy are strongly influenced by HCV genotype. Importantly, several recent papers have suggested that the lipid profile of infected patients is strongly indicative of the various clinical outcomes of HCV infection. Furthermore, viral molecular and cellular studies have shown a tight link between cellular lipid ...

Patients hospitalized with 2009 pandemic influenza A (H1N1) - New York City, May 2009.

MMWR Morb Mortal Wkl... — Fri, 08 Jan 2010 00:00:00 +0100

This report summarizes the findings of this analysis. Approximately 60% of admitted patients were aged <;18 years. The most commonly documented underlying condition was asthma, observed among 50% of patients aged <18 years and 46% of adult patients. Multiple underlying conditions were observed in 17% of patients (12% of children, 24% of adults). Patients treated with oseltamivir within 2 days of symptom onset had shorter median hospitalizations than those who did not (2 days versus 3 days [p = 0.03]). The findings of this assessment were used to inform immediate outbreak response measures in New York City. During such outbreaks, public education campaigns should encourage patients at high risk of severe illness to seek treatment promptly after symptom onset and should emphasize the i...

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Occult hepatitis C virus infection: what does it mean?

Liver International — Thu, 07 Jan 2010 00:00:00 +0100

Occult hepatitis C virus infection (OCI) is a recently identified entity of which the existence became evident when nucleic acid amplification assays of enhanced sensitivity were introduced for the detection of hepatitis C virus (HCV) genome and its replication. This form of HCV infection has been found to persist in the presence of antibodies against HCV and normal levels of liver enzymes for years after spontaneous or antiviral therapy-induced resolution of hepatitis C and, therefore, can be termed as secondary OCI. HCV RNA in OCI circulate at fluctuating levels normally not exceeding 200 genome copies per millilitre of serum or plasma, while low levels of virus genome and its replicative intermediate RNA-negative strand are detectable in the liver and, importantly, immune cells, which p...

Is response to antiviral treatment influenced by hepatitis B virus genotype?

Journal of Hepatology — Wed, 06 Jan 2010 00:00:00 +0100

Recently released clinical practice guidelines and consensus conference statements point to the importance of hepatitis B virus (HBV) genotyping in therapeutic algorithms for the treatment of chronic hepatitis B. This information usually comes from post hoc analyses of clinical trials which were not designed to study associations with the HBV genotype. We have performed a literature search through to April 2009 and have selected randomized clinical trials of currently approved anti-HBV drugs providing information on HBV genotypes and (i) baseline characteristics of study subjects, (ii) any response to antiviral therapy, (iii) interaction between HBV genotypes and the type of therapy. There were several intrinsic features and weaknesses in the majority of clinical trials conducted so far wh...

Hepatitis C virus: Molecular biology & current therapeutic options.

Indian J Med Res — Fri, 01 Jan 2010 00:00:00 +0100

Hepatitis C virus: Molecular biology & current therapeutic options. Indian J Med Res. 2010 Jan;131:17-34 Authors: Sharma SD Hepatitis C virus (HCV) is a small (~55 to 65 nm), spherical, enveloped, hepatotropic RNA virus that causes acute and chronic hepatitis in humans. Persistent virus infection with HCV often leads to cirrhosis and hepatocellular carcinoma (HCC). At present there is neither a selective antiviral therapy nor a preventive vaccine. The only available treatment option is a long-acting pegylated-interferon-alpha, given in combination with nucleoside analog ribavirin, which is not very effective. Molecular studies of HCV began with the successful cloning of its genome in 1989. For many years, research to develop therapeutics was stalled by the inability to grow...

Antiviral Therapy Completion and Response Rates Among Hepatitis C Patients With and Without Schizophrenia

Schizophrenia Bulletin — Wed, 30 Dec 2009 19:43:41 +0100

Conclusion: Our retrospective chart review suggests that patients with SCHZ complete and respond to antiviral therapy for HCV at rates comparable with those without SCHZ. Based on these data, SCHZ should not be considered a contraindication to antiviral therapy for HCV. (Source: Schizophrenia Bulletin)

Hepatitis C and diabetes: one treatment for two diseases?

Liver International — Tue, 22 Dec 2009 00:00:00 +0100

Epidemiological data clearly indicate a link between chronic hepatitis C (CHC) and disturbed glucose homeostasis. The prevalences of both type 2 diabetes mellitus (T2DM) and insulin resistance (IR) are higher among those chronically infected with hepatitis C when compared with the general population and those with other causes of chronic liver disease. Both IR and diabetes are associated with adverse outcomes across all stages of CHC including the liver transplant population. The adverse effects that directly influence patient outcome are reduced responsiveness to antiviral therapy, more rapid progression of fibrosis to cirrhosis and a higher incidence of hepatocellular carcinoma. Although both viral and host factors are known to contribute to IR (and therefore the risk of T2DM), there is ...

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Primary Influenza Viral Pneumonia

Critical Care — Mon, 21 Dec 2009 00:00:00 +0100

Primary influenza pneumonia has a high mortality rate during pandemics, not only in immunocompromised individuals and patients with underlying comorbid conditions, but also in young, healthy adults. Clinicians should maintain a high index of suspicion for this diagnosis in patients presenting with influenza-like symptoms that progress quickly (2-5 days) to respiratory distress and extensive pulmonary involvement. The sensitivity of rapid diagnostic techniques in identifying infections with the pandemic 2009 H1N1v influenza strain is currently suboptimal. The most reliable real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) molecular testing is available in limited clinical settings. Despite 6 months of pandemic circulation, most novel H1N1v pandemic strains remain susceptib...

Characterization of potential antiviral resistance mutations in hepatitis B virus reverse transcriptase sequences in treatment-naïve Chinese patients.

Antiviral Research — Mon, 21 Dec 2009 00:00:00 +0100

Characterization of potential antiviral resistance mutations in hepatitis B virus reverse transcriptase sequences in treatment-naïve Chinese patients. Antiviral Res. 2009 Dec 21; Authors: Liu BM, Li T, Xu J, Li XG, Dong JP, Yan P, Yang JX, Yan L, Gao ZY, Li WP, Sun XW, Wang YH, Jiao XJ, Hou CS, Zhuang H Full-length hepatitis B virus (HBV) reverse transcriptase (RT) sequences were amplified and sequenced among 192 nucleos(t)ide analogue (NA)-naïve Chinese patients with chronic hepatitis B. Deduced amino acids (AAs) at 42 previously-reported potential NA resistance (NAr) mutation positions in RT region were analyzed. Patients were found with either B-genotype (28.65%) or C-genotype (71.35%) infections. Rt53, rt91, rt124, rt134, rt221, rt224, rt238 and rt256 were identif...

HCV drug discovery aimed at viral eradication

Journal of Viral Hepatitis — Fri, 18 Dec 2009 00:00:00 +0100

Summary. Hepatitis C virus (HCV) causes significant morbidity and mortality worldwide with nearly 3% of the world population infected by this virus. Fortunately, this virus does not establish latency, and hence it may be possible to eradicate it. HCV is strongly associated with liver cirrhosis and hepatocellular carcinoma and is currently treated with pegylated interferon-alpha (peg-IFN-alpha) and ribavirin. Unfortunately, these limited treatment options often produce significant side effects, and currently, complete eradication of virus with combined drug modalities has not yet been achieved for the majority of chronically HCV-infected individuals. Restricted treatment options, lack of a universal cure for HCV and the link between chronic infection, liver cirrhosis and hepatocellular carc...

Clinical Management of Pandemic (H1N1) Infection.

Chest — Fri, 18 Dec 2009 00:00:00 +0100

Authors: Hui DS, Lee N, Chan PK Antiviral therapy and vaccination are important strategies for controlling pandemic (H1N1) 2009 influenza but efficacy depends on the timing of administration and is often limited by shortage of supply. Patients with dyspnea, tachypnea, evidence of hypoxemia and pulmonary infiltrates on chest radiograph should be hospitalized. Patients with severe illness or underlying medical conditions that increase the risk of more severe disease should be treated with oseltamivir or zanamivir as soon as possible, without waiting for the results of laboratory tests. Lung protective ventilation strategy with a low tidal volume and adequate pressure, in addition to a conservative fluid management approach, is recommended when treating adult patients with acute respirato...

HIV/hepatitis B virus co-infection: current challenges and new strategies

Journal of Antimicrobial Chemotherapy — Tue, 15 Dec 2009 15:00:26 +0100

Chronic hepatitis B virus (HBV) infection, which affects 7%–10% of HIV-infected patients, is associated with an increased frequency of AIDS-related and non-AIDS-related clinical endpoints, such as end-stage liver diseases including cirrhosis and hepatocellular carcinoma. Broad access to a very efficient antiviral therapy containing nucleos(t)ide analogues with dual activity against HBV and HIV reverse transcriptases has initiated a transition in the paradigm of HBV control in the context of HIV-induced immunosuppression. The control of viral replication is not currently such a problem, but preventing the emergence of HBV polymerase and surface gene mutants after prolonged exposure to nucleos(t)ides and their consequences in terms of HBV vaccine escape are the next long-term challenge...

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Pre-emptive antiviral therapy in living donor liver transplantation for hepatitis C: observation based on a single-center experience

Transplant International — Tue, 15 Dec 2009 00:00:00 +0100

Reports of large series in living donor liver transplantation (LDLT) for hepatitis C virus infection (HCV) are scarce. Between 1996 and 2008, 105 LDLTs were performed at the University of Tokyo for HCV. Rapid induction of antiviral treatment with interferon (IFN) and ribavirin (RBV) was attempted per protocol regardless of the clinical presentation of recurrent HCV (pre-emptive treatment approach). Treatment was continued for 12 months after serum HCV-RNA became negative (ETR: end-of-treatment response) and judged as a sustained viral response (SVR) after another 6 months of negative results without treatment. A fixed treatment period was not defined unless an ETR was achieved (no-stopping approach). Flexible dose adjustments were allowed. Ninety-five patients were eligible for pre-emptive...

Exam 1: Antiviral Therapy Reduces Risk of Hepatocellular Carcinoma in Patients With Hepatitis C–Related Cirrhosis

Clinical Gastroenterology and Hepatology — Mon, 14 Dec 2009 00:00:00 +0100

(Source: Clinical Gastroenterology and Hepatology)

Clinical relevance and public health significance of hepatitis B virus genomic variations.

World Journal of Gastroenterology : WJG — Fri, 11 Dec 2009 09:33:02 +0100

Authors: Cao GW Ten hepatitis B virus (HBV) genotypes (A-J) and 34 HBV subgenotypes have been identified so far. HBV genotypes and subgenotypes have distinct geographical distributions, and have been shown to differ with regard to clinical outcome, prognosis, and response to interferon treatment. Infection with subgenotype A2 is frequently associated with high viral load, resulting in acute infection via horizontal transmission. Genotypes A and B are more sensitive to interferon treatment than genotypes D and C, respectively. Genotype B is more frequent in acute hepatitis than genotype C, whereas genotype C (C2) is more frequently associated with an increased risk of hepatocellular carcinoma (HCC), mostly cirrhotic, as compared with genotype B (B2). Genotype mixture is associated with ...

Functional pathway analysis of genes associated with response to treatment for chronic hepatitis C

Journal of Viral Hepatitis — Wed, 09 Dec 2009 00:00:00 +0100

This study elucidates molecular pathways deregulated in patients with CH-C with negative predictors of response to antiviral therapy. Sixty-eight patients with CH-C who underwent a full course of treatment with PEG-IFN-[alpha] + RBV were included in the study. Pretreatment blood samples were collected in PAXgene[trade] RNA tubes. EVR, complete EVR (cEVR), and SVR rates were 76%, 57% and 41%, respectively. Total RNA was extracted from pretreatment peripheral blood mononuclear cells, quantified and used for one-step RT-PCR to profile 154 mRNAs. The expression of mRNAs was normalized with six 'housekeeping' genes. Differentially expressed genes were separated into up and downregulated gene lists according to the presence or absence of a risk factor and subjected to KEGG Pathway Painter which ...

Critical issues in the treatment of hepatitis C virus infection in methadone maintenance patients

NeLM - Liver disease — Tue, 08 Dec 2009 00:00:00 +0100

Source: DARE Area: Evidence > Disease Focused Reviews CRD Summary: This review assessed medical care for hepatitis C virus infected methadone maintenance patients, concluding that there was support for antiviral therapy in methadone maintenance patients with hepatitis C virus infection. However, given the lack of reporting of the review process and the paucity of good quality studies, the results should be treated with caution. [The included studies assessed interferon, ribavirin and peginterferon at different doses and frequencies; buprenorphine-maintained patients were also included. ] CRD Commentary: The review addressed a clear question, undertook a search of three databases for studies and presented brief inclusion criteria. The literature search was restricted to publications in...

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NVHR: New Data Finding Fewer Than 1 In 5 Hepatitis C Patients Receiving Antiviral Therapy Is 'Wake-Up Call' For Washington

Health News from Medical News Today — Tue, 01 Dec 2009 09:00:00 +0100

New peer-reviewed data finding that fewer than one-fifth of the nearly 4 million Americans infected with chronic hepatitis C virus have received anti-viral therapy in recent years should be a wake-up call that Congress needs to move urgently on bipartisan legislation to support new state-based detection, research, and surveillance efforts, the National Viral Hepatitis Roundtable (NVHR) said today... (Source: Health News from Medical News Today)

NVHR: New Data Finding Fewer Than 1 In 5 Hepatitis C Patients Receiving Antiviral Therapy Is 'Wake-Up Call' For Washington

Liver Disease / Hepatitis News From Medical News Today — Tue, 01 Dec 2009 09:00:00 +0100

NVHR: New Data Finding Fewer Than 1 In 5 Hepatitis C Patients Receiving Antiviral Therapy Is 'Wake-Up Call' For Washington

Liver Disease / Hepatitis News From Medical News Today — Tue, 01 Dec 2009 09:00:00 +0100

Acute viral hepatitis (C - genotype 6a and B) acquired during kidney transplantation by two patients and review of the literature.

Clinical Nephrology — Tue, 01 Dec 2009 00:00:00 +0100

Authors: Rogachev B, Vorobiov M, Shnaider A, Hausmann M, Zlotnik M, Basok A, Two patients were contaminated by hepatitis during kidney transplantation from unrelated living donors, performed abroad in 2006. One patient died from fulminant hepatitis C (the first case of virus genotype 6a diagnosed in Israel) 2 months after transplantation and the other developed acute hepatitis B with YMDD to YVDD mutation necessitating life-long antiviral therapy. The dilemma of antiviral therapy in transplant recipients is discussed in this paper. Patients awaiting kidney transplantation by far outnumber the kidneys available for cadaver transplantation. International trade with living non-related kidneys has therefore become common. Comorbid conditions, although significant, are often ignored. After...

Chronic hepatitis C: hepatic iron content does not correlate with response to antiviral therapy.

Revista do Instituto de Medicina Tropical de Sao Paulo — Tue, 01 Dec 2009 00:00:00 +0100

Authors: Pereira Pda S, Souza E Silva IS, Uehara SN, Emori CT, Lanzoni VP, Silva AE, Ferraz ML The complex interaction between hepatitis C virus infection, iron homeostasis and the response to antiviral treatment remains controversial. The aim of this study was to evaluate the influence of hepatic iron concentration (HIC) on the sustained virological response (SVR) to antiviral therapy in patients with chronic hepatitis C. A total of 50 patients who underwent pretreatment liver biopsy with assessment of HIC by graphite furnace atomic absorption spectroscopy and were subsequently submitted to antiviral treatment with interferon/peginterferon and ribavirin were included in the study. Patients with alcoholism, history of multiple blood transfusion, chronic kidney disease, hemolytic anemia...

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CDC Commentary -- 2009 H1N1: Who Should Receive Antiviral Therapy?

Medscape Today Headlines — Mon, 30 Nov 2009 20:20:08 +0100

In this video blog, Anthony Fiore, MD, MPH, offers guidance on which patients are at highest risk for H1N1 influenza and when to prescribe antiviral therapy. Centers for Disease Control and Prevention (CDC) (Source: Medscape Today Headlines)

Enteroviruses

Medicine — Mon, 30 Nov 2009 16:03:41 +0100

Abstract: The human enteroviruses are ubiquitous small non-enveloped RNA viruses that are important causes of aseptic meningitis, myocarditis, hand, foot and mouth disease, acute haemorrhagic conjunctivitis, herpangina, and Bornholm disease (pleurodynia), as well as non-specific febrile and respiratory illnesses, and rash. They include the coxsackieviruses, echoviruses and polioviruses. The polioviruses cause paralytic poliomyelitis, which has almost been eliminated through the use of live and inactivated poliovirus vaccine. Neonatal enterovirus infection can be particularly severe. Laboratory diagnosis of enterovirus infections has been greatly improved in recent years by replacing viral culture and serology with enterovirus-specific polymerase chain reaction; this is now part of routine ...

The impact of a managed care network on attendance, follow-up and treatment at a hepatitis C specialist centre

Journal of Viral Hepatitis — Mon, 30 Nov 2009 00:00:00 +0100

This study provides evidence that the collaboration of health care professionals within a network can have a radical effect in improving access to care in a traditionally hard to reach population. This has been achieved with little additional resource, but rather working smarter with existing staff. (Source: Journal of Viral Hepatitis)

Use of epoetin beta during combination therapy of infection with hepatitis c virus with ribavirin improves a sustained viral response

Journal of Medical Virology — Mon, 30 Nov 2009 00:00:00 +0100

The aim of the study was to evaluate the effects of epoetin-beta on anemia and sustained viral response in patients with chronic hepatitis C receiving treatment with pegylated interferon and ribavirin. Forty-two Caucasian patients with chronic hepatitis C infection, treated with pegylated interferon [alpha]-2a or [alpha]-2b plus ribavirin, who experienced at least a 2 log decline in HCV-RNA in the first month of therapy and a [ge]2.5 g/dl hemoglobin drop from baseline, were recruited. They were divided into two groups: 22 patients received epoetin-beta 30,000 U administered s.c. q.w. (group A) and 20 patients received a reduced ribavirin dose of 600 mg daily (group B). The end-of-treatment response was 95.4% (21/22) in group A and 80% (16/20) (P = 0.2) in group B. Sustained viral response ...

Inhibition of Bovine herpesvirus multiplication in MDBK cells by small interfering RNAs.

Acta Virologica — Sat, 28 Nov 2009 11:00:04 +0100

Authors: Narute PS, Raut AA, Saini M, Rai A, Gupta PK Small interfering RNA (siRNA) mediated gene silencing is a promising approach in antiviral therapy. To investigate the antiviral effects of siRNAs on Bovine herpesvirus 1 (BoHV-1) multiplication, we designed and in vitro synthesized two siRNAs (siRNA-1 and siRNA-2) targeting the UL25 gene that is essential for BHV-1 multiplication. siRNA-1 and siRNA-2 inhibited the BoHV-1 multiplication in MDBK cells to a different extent, namely by 11% and 40%, respectively, as demonstrated by virus titers (TCID50/ml) determined in cell culture. This indicates that, in general, siRNAs can inhibit BHV-1 multiplication in vitro and could be used also against a BHV-1 infection in vivo following optimization of their application. Keywords: siRNAs; Bovi...

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Antiviral Therapy To Treat Hepatitis C Is Declining In The US, An Alarming Trend

Health News from Medical News Today — Thu, 26 Nov 2009 09:00:00 +0100

Researchers from the University of Michigan determined that only 663,000 of the approximately 3.9 million Americans with hepatitis C virus (HCV) infection received antiviral therapy between 2002 and 2007. Treatment rates appear to be declining, in part because only half of the patients know they are infected. (Source: Health News from Medical News Today)

Antiviral Therapy To Treat Hepatitis C Is Declining In The US, An Alarming Trend

Liver Disease / Hepatitis News From Medical News Today — Thu, 26 Nov 2009 09:00:00 +0100

New developments in antiviral therapy for chronic hepatitis B

Vox Sanguinis — Wed, 25 Nov 2009 00:00:00 +0100

Chronic hepatitis B affects approximately 400 million people in the world with a substantial disease burden like liver cirrhosis and hepatocellular carcinoma (HCC). Treatment for chronic hepatitis B has improved dramatically in the last decade, resulting in more patients achieving a state of inactive disease. Currently two treatment strategies are available; treatment with peginterferon (peg-IFN) or nucleos(t)ide analogues with the aim to suppress hepatitis B virus (HBV) DNA to subsequently avoid the development of cirrhosis and HCC. Unfortunately, treatment with peg-IFN can be suboptimal with important adverse effects and nucleos(t)ide analogues provoke resistance. At present, no new promising compounds attacking the HBV life cycle are in development. However, for prediction of sustained ...

Antiviral Therapy for Hepatitis C Declining in the US; More Deaths Will Occur as a Result

Medscape Gastroenterology Headlines — Tue, 24 Nov 2009 17:32:17 +0100

Antiviral therapy for hepatitis C virus has improved dramatically in the last 2 decades, but the number of infected individuals getting treatment has dropped from 126,040 in 2002 to 82,279 in 2007. Medscape Medical News (Source: Medscape Gastroenterology Headlines)

Infectious Causes of Chronic Immune Thrombocytopenia

Hematology/Oncology Clinics of North America — Tue, 24 Nov 2009 13:46:34 +0100

Persistent thrombocytopenia may be the consequence of chronic infections with hepatitis C virus (HCV), human immunodeficiency virus (HIV), and Helicobacter pylori, and should be considered in the differential diagnosis of primary immune thrombocytopenia (ITP). Studies have shown that on diagnosis of infections, treatment of the primary disease often results in substantial improvement or complete recovery of the thrombocytopenia. In patients with thrombocytopenia due to HCV-related chronic liver disease, the use of eltrombopag, a thrombopoietin receptor agonist, normalizes platelet levels, thereby permitting the initiation of antiviral therapy. Antiviral therapy with highly active antiretroviral therapy for HIV has aided in platelet recovery, with a corresponding decrease in circulating vir...

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Alarming trend -- antiviral therapy to treat hepatitis C is declining in the US

EurekAlert! - Medicine and Health — Tue, 24 Nov 2009 05:00:00 +0100

This study, the first to analyze nationwide practice patterns for HCV treatment, is published in the December issue of Hepatology, a journal of the American Association for the Study of Liver Diseases. (Source: EurekAlert! - Medicine and Health)

Alarming trend: Antiviral therapy to treat hepatitis C is declining in the US

ScienceDaily Headlines — Tue, 24 Nov 2009 05:00:00 +0100

Researchers have determined that only 663,000 of the approximately 3.9 million Americans with hepatitis C virus (HCV) infection received antiviral therapy between 2002 and 2007. If this disturbing trend continues, by 2030 less than 15 percent of liver-related deaths from HCV will be prevented by antiviral therapy. (Source: ScienceDaily Headlines)

Development of a novel monoclonal antibody with reactivity to a wide range of Venezuelan equine encephalitis virus strains

Virology Journal — Thu, 19 Nov 2009 00:00:00 +0100

Conclusions: A monoclonal antibody possessing reactivity to a wide range of VEEV strains may be of benefit as a generic antiviral therapy. However, humanisation of the murine antibody will be required before it can be tested in humans.Crown Copyright (c) 2009 (Source: Virology Journal)

Treatment of Chronic Hepatitis C in a Patient Affected by Systemic Sclerosis

Gastroenterology Research and Practice — Tue, 17 Nov 2009 14:15:49 +0100

The currently recommended treatment for patients infected with hepatitis C virus (HCV) is pegilated interferon α (IFN α) plus ribavirin. Despite the numerous benefits of this therapy, there is an increasing concern regarding his tolerance. Among the most common side effects, interferon may trigger the onset or exacerbation of autoimmune diseases. When chronic hepatitis C coexists with an autoimmune disorder, it is not clear whether using interferon is better than avoiding it. We evaluated the disease state of a 55-year old female affected by sistemic sclerosis (SSc), during and after therapy with IFNα pegilated plus ribavirin for chronic HCV infection. We were worried about the potential worsening of the autoimmune disease during the therapy, but we were confident t...

Pegasys 135mcg and 180mcg solution for injection in Pre-filled Syringe (peginterferon alfa-2a) - Revised SPC

NeLM - SPC Changes — Tue, 17 Nov 2009 00:00:00 +0100

Source: eMC (electronic Medicines Compendium) Area: Other Library Updates > SPC Changes Revised SPC includes changes to: Section 4.4 (Special warnings and precautions for Use) - Psychiatric and Central Nervous System: homicidal ideation now included. Pancytopenia and bone marrow suppression have been reported in the literature to occur within 3 to 7 weeks after the administration of a peginterferon and ribavirin concomitantly with azathioprine. This myelotoxicity was reversible within 4 to 6 weeks upon withdrawal of HCV antiviral therapy and concomitant azathioprine and did not recur upon reintroduction of either treatment alone (see section 4.5). Section 4.5 (Interaction with other medicinal products and other forms of interaction) - Ribavirin, by having an inhibitory effect ...

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Pioglitazone improves virological response to peginterferon α-2b/ribavirin combination therapy in hepatitis C genotype 4 patients with insulin resistance

Liver International — Tue, 17 Nov 2009 00:00:00 +0100

Insulin resistance (IR) affects sustained virological response (SVR). The use of insulin-sensitizing agents has been proposed to improve therapy outcome. The safety and efficacy of pioglitazone on insulin sensitivity and SVR in treatment-naïve patients with chronic hepatitis C (CHC) genotype 4 with IR receiving standard antiviral therapy were evaluated in a randomized-controlled study. Ninety-seven previously untreated patients with CHC and IR [homeostasis model assessment (HOMA>2)] were randomly assigned into two arms; (arm A; n=48) were given pioglitazone 30 mg/day combined with peginterferon (Peg-IFN)-[alpha]-2b/ribavirin (RBV) for 48 weeks, and (arm B; n=49) were given standard of care (Peg-IFN-[alpha]-2b/RBV for 48 weeks); HOMA index and hepatitis C virus RNA (HCV RNA) levels were me...

Retinoic acid inducible gene I activates innate antiviral response against human parainfluenza virus type 3

Virology Journal — Tue, 17 Nov 2009 00:00:00 +0100

Human parainfluenza virus type 3 (HPIV3) is a respiratory paramyxovirus that infects lung epithelial cells to cause high morbidity among infants and children. To date, no effective vaccine or antiviral therapy exists for HPIV3 and therefore, it is important to study innate immune antiviral response induced by this virus in infected cells. Type-I interferons (IFN, interferon-alpha/beta) and tumor necrosis factor-alpha (TNF activated by NF-kappa B) are potent antiviral cytokines that play an important role during innate immune antiviral response. A wide-spectrum of viruses utilizes pattern recognition receptors (PRRs) like toll-like receptors (TLRs) and RLH (RIG like helicases) receptors such as RIGI (retinoic acid inducible gene -I) and Mda5 to induce innate antiviral response. Previously i...

Early antiviral therapy key for H1N1: WHO

CBC | Health — Thu, 12 Nov 2009 19:15:54 +0100

Pregnant women, young children and those with underlying a risk factor should start to take an antiviral at the first hint of having the flu, the World Health Organization says in updated guidelines for doctors. (Source: CBC | Health)

Newer trends in the management of genital herpes

Indian Journal of Dermatology, Venereology and Leprology — Thu, 12 Nov 2009 14:01:24 +0100

Nath Amiya Kumar, Thappa Devinder MohanIndian Journal of Dermatology, Venereology, and Leprology 2009 75(6):566-574Management of genital herpes is complex. Apart from using the standard antivirals, an ideal management protocol also needs to address various aspects of the disease, including the psychological morbidity. Oral acyclovir, valacyclovir or famciclovir are recommended for routine use. Long-term suppressive therapy is effective in reducing the number of recurrences and the risk of transmission to others. Severe or disseminated disease may require intravenous therapy. Resistant cases are managed with foscarnet or cidofovir. Genital herpes in human immunodeficiency virus-infected individuals usually needs a longer duration of antiviral therapy along with continuation of highly active...

Rapid antiviral therapy helps fight H1N1: WHO

CBC | Health — Thu, 12 Nov 2009 13:41:07 +0100

The World Health Organization is urging rapid treatment with antiviral drugs to combat severe cases of swine flu. The UN agency says at-risk people like pregnant women should start treatment as soon as possible after symptoms start. (Source: CBC | Health)

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Late Varicella-Zoster Virus Dendriform Keratitis in Patients With Histories of Herpes Zoster Ophthalmicus

American Journal of Ophthalmology — Wed, 11 Nov 2009 00:00:00 +0100

Conclusions: Late dendriform lesions associated with HZO are foci of productive VZV infection. Lesions can be treated effectively with topical or systemic antiviral agents. Patients can have multiple recurrences of dendriform lesions despite treatment. (Source: American Journal of Ophthalmology)

Antiviral therapy of chronic hepatitis C in patients with advanced liver disease and after liver transplantation

Medical Microbiology and Immunology — Mon, 09 Nov 2009 19:13:57 +0100

Abstract Chronic infection with the hepatitis C virus (HCV) represents one of the major causes for end-stage liver disease worldwide. Although liver transplantation offers an effective treatment, HCV reinfection of the transplanted graft is a critical and almost inevitable complication with major influence on graft- and patient survival. Pre-transplant antiviral therapy in advanced liver disease is limited by poor tolerance and only applicable to mildly decompensated patients but was able to show promising results in patients reaching negative viral load when undergoing transplantation. Prophylactic therapy with HCV antibodies during the anhepatic phase has not been shown to be effective in studies to date. Antiviral therapy after transplantation but before evidence of rei...

Hepatitis B: Management of suboptimal response to oral antiviral therapy

Current Hepatitis Reports — Mon, 09 Nov 2009 07:01:46 +0100

This article summarizes recent findings on clinical implications and treatment recommendations to avoid and manage viral resistance and suboptimal treatment success. Content Type Journal ArticleDOI 10.1007/s11901-009-0025-7Authors Christian Markus LangeBernd KronenbergerStefan Zeuzem, Klinikum der J. W. Goethe-Universität Frankfurt am Main Medizinische Klinik 1, Theodor-Stern-Kai 7 60590 Frankfurt am Main Germany Journal Current Hepatitis ReportsOnline ISSN 1541-0706Print ISSN 1540-3416 Journal Volume Volume 8 Journal Issue Volume 8, Number 4 / November, 2009 (Source: Current Hepatitis Reports)

Current treatment of chronic HBV infection: A North American perspective

Current Hepatitis Reports — Mon, 09 Nov 2009 07:01:45 +0100

Abstract Chronic hepatitis B virus (HBV) infection remains a major cause of liver disease and hepatocellular carcinoma worldwide. Although less prevalent in the United States than in other areas of the world, HBV infection results in a significant disease burden in many American immigrant communities. Seven treatments are approved by the US Food and Drug Administration for the treatment of chronic HBV infection: interferon-α (standard interferon-α2b or pegylated interferon-α2a), and the nucleos(t)ide analogues lamivudine, adefovir dipivoxil, entecavir, telbivudine, and tenofovir disoproxil fumarate. There is preliminary evidence that the disease burden from HBV infection may be diminishing in the United States, reflecting not only HBV vaccine progress but also more than...

Quantitative HBsAg titer as predictor of response to therapy

Current Hepatitis Reports — Mon, 09 Nov 2009 07:01:43 +0100

This article critically reviews the most recent data regarding the value of measurements of HBsAg concentrations in predicting response in patients with hepatitis B e antigen (HBeAg)-positive and HBeAg-negative CHB treated with different antiviral agents. Content Type Journal ArticleDOI 10.1007/s11901-009-0024-8Authors Emilia HadziyannisDimitrios VassilopoulosStephanos J. Hadziyannis, Henry Dunant Hospital Department of Medicine and Hepatology 107 Messogion Avenue 115 26 Athens Greece Journal Current Hepatitis ReportsOnline ISSN 1541-0706Print ISSN 1540-3416 Journal Volume Volume 8 Journal Issue Volume 8, Number 4 / November, 2009 (Source: Current Hepatitis Reports)

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Developments in Immunologic Assays for Respiratory Viruses

Clinics in Laboratory Medicine — Wed, 04 Nov 2009 16:51:33 +0100

This article discusses the major immunologic methods employed for respiratory virus diagnosis, recent developments in immunoassays and sample collection, and current test algorithms. (Source: Clinics in Laboratory Medicine)

Viral Infections of the Central Nervous System: A Case-Based Review.

Clin Med Res — Wed, 04 Nov 2009 00:00:00 +0100

Authors: Big C, Reineck LA, Aronoff DM Three patients with viral infections of the central nervous system (CNS) were evaluated on an inpatient infectious diseases consultation service within a two-week period. These cases, caused by herpes simplex virus, varicella zoster virus and enterovirus, highlight the importance of viral pathogens in causing debilitating infections of the CNS and provide examples of the utility of molecular diagnostics in evaluating patients with encephalitis and meningitis. The importance of antiviral therapy is particularly underscored by these cases, as is the variability in response of patients to such agents. PMID: 19889944 [PubMed - as supplied by publisher] (Source: Clin Med Res)

HCC Risk Remains High Following at Least 12 Months of Antiviral Therapy in Cirrhotic Patients With Chronic Hepatitis B

Clinical Care Options Hepatitis - HBV — Tue, 03 Nov 2009 12:00:00 +0100

Capsule Summary - A multivariate analysis identified cirrhosis, older age, and male sex as independent predictors of hepatocellular carcinoma incidence in patients receiving at least 12 months of oral antiviral therapy, most of which was lamivudine based. (Source: Clinical Care Options Hepatitis - HBV)

HCC Risk Remains High Following at Least 12 Months of Antiviral Therapy in Cirrhotic Patients With Chronic Hepatitis B

Clinical Care Options Hepatitis - HCV — Tue, 03 Nov 2009 12:00:00 +0100

Treatment of erythrodermic psoriasis in HCV+ patient with adalimumab

Dermatologic Therapy — Tue, 03 Nov 2009 00:00:00 +0100

Erythrodermic psoriasis is a severe and disabling variant of psoriasis. The authors present the case of a 48-year-old man with psoriasis and hemophilia presented with a history of hepatitis C virus (HCV) infection treated with pegylated interferon alpha-2a and ribavirin therapy. At the end of antiviral therapy, skin manifestation progressively worsened, becoming erythrodermic, with lack of efficacy of steroid therapy. The authors decided to start biological therapy with induction dose of adalimumab (Humira, Abbott Laboratories, Abbott Park, Chicago, IL) 80 mg at Week 0 and 40 mg weekly. In our case, this resulted in a highly effective and safe treatment. (Source: Dermatologic Therapy)

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Candida esophagitis complicated by an esophago-airway fistula: Report of a case

Surgery Today — Mon, 02 Nov 2009 17:57:11 +0100

Abstract Candida esophagitis rarely involves life-threatening complications, such as necrosis, perforation, or fistula formation between the esophagus and the airway. We herein report a case of Candida esophagitis complicated by esophagobronchial and esophagopulmonary fistulas. The patient in our study was a 70-year-old man with a 3-month history of dysphagia. Based on endoscopy and histological findings, he was diagnosed with a coinfection of Candida spp. and herpes simplex virus. Antifungal and antiviral therapy was administered without success. The esophagopulmonary fistula formation and a lung abscess were identified 7 months later. The patient was deemed intolerable to an esophagectomy due to his poor general condition, thus necessitating a two-stage operation. A cer...

Pandemic H1N1 2009 influenza: Clinical management guidelines

NeLM - News — Mon, 02 Nov 2009 00:00:00 +0100

Source: Department of Health (DH) Area: News These documents update provisional guidance for the clinical management of patients with symptoms of influenza-like illness, severe influenza and complications, provided in 2007 by the British Infection Society, British Thoracic Society and Health Protection Agency in collaboration with the Department of Health [Pandemic flu: clinical management of patients with an influenza-like illness during an influenza pandemic. Thorax 2007;62;1-46]. The management guideline for adults and children includes recommendations for both primary and secondary care, on assessment and management, antiviral therapy, and empiric antibiotics. In addition there is guidance for secondary care on influenza-related pneumonia, cardiovascular disease and s...

Antiviral Therapy Reduces Risk of Hepatocellular Carcinoma in Patients With Hepatitis C Virus–Related Cirrhosis

Clinical Gastroenterology and Hepatology — Mon, 02 Nov 2009 00:00:00 +0100

Conclusions: The risk of HCC is reduced among patients with HCV who achieve an SVR with antiviral therapy. Maintenance therapy with IFN does not reduce HCC risk among patients who do not respond to initial therapy.View this article's video abstract at www.cghjournal.org. (Source: Clinical Gastroenterology and Hepatology)

The First Case of Severe Novel H1N1 Influenza Successfully Rescued by Extracorporeal Membrane Oxygenation in Taiwan.

J Formos Med Assoc — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Kao TM, Wang CH, Chen YC, Ko WJ, Chang SC During the novel influenza A (H1N1) pandemic, some patients developed acute respiratory distress syndrome or severe cardiopulmonary failure despite the use of conventional management. Extracorporeal membrane oxygenation (ECMO) support may successfully rescue these severely ill patients. Here, we report the first case of severe novel H1N1 infection with multiorgan failure that was successfully treated with antiviral therapy and ECMO in Taiwan. A 32-year-old man had acute onset of fever, dry cough, rhinorrhea, and sore throat 2 days after returning from Dongguan, China. He attended Hospital A and chest radiography revealed bilateral lung consolidation. Rapid influenza antigen testing was negative. He was intubated 2 days later due to hyp...

Pediatric influenza.

Pediatric Nursing — Sun, 01 Nov 2009 00:00:00 +0100

This article will review the virological, clinical, and epidemiological features of seasonal influenza, as well as discuss seasonal influenza vaccination and antiviral therapy. PMID: 20166462 [PubMed - in process] (Source: Pediatric Nursing)

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Cutaneous Herpes Zoster and Implantable Pulse Generator

Neuromodulation — Thu, 29 Oct 2009 00:00:00 +0100

Conclusion. He had excellent recovery of HZ lesions and related pain after specific antiviral therapy. The importance of a correct diagnosis of this unusual complication is outlined in order to minimize the risk of debilitating chronic HZ-associated pain. (Source: Neuromodulation)

An antiviral leash for HIV?

The Scientist — Thu, 29 Oct 2009 00:00:00 +0100

A protein that tethers HIV and other viruses to the cell membrane could be co-opted as a new type of antiviral therapy (Source: The Scientist)

Recurrence of hepatocellular carcinoma and hepatitis B reinfection in hepatitis B surface antigen-positive patients after liver transplantation

Liver Transplantation — Wed, 28 Oct 2009 00:00:00 +0100

In conclusion, pre-OLT HCC and HCC recurrence after transplantation were associated with HBV reinfection and with decreased patient survival. Hepatitis B immunoglobulin and antiviral therapy was only partially effective in preventing HBV reinfection in patients with HCC recurrence. Liver Transpl 15:1525-1534, 2009. © 2009 AASLD. (Source: Liver Transplantation)

Treatment modalities for hypersplenism in liver transplant recipients with recurrent hepatitis C.

World Journal of Gastroenterology : WJG — Wed, 28 Oct 2009 00:00:00 +0100

In this report we review the two treatment options, their associated outcomes and complications. PMID: 19859992 [PubMed - in process] (Source: World Journal of Gastroenterology : WJG)

Hepatitis C comorbidities affecting the course and response to therapy.

World Journal of Gastroenterology : WJG — Wed, 28 Oct 2009 00:00:00 +0100

Authors: El-Zayadi AR Several studies have demonstrated that the outcome of chronic hepatitis C (CHC) infection is profoundly influenced by a variety of comorbidities. Many of these comorbidities have a significant influence on the response to antiviral therapy. These comorbidities negatively affect the course and outcome of liver disease, often reducing the chance of achieving a sustained virological response with PEGylated interferon and ribavirin treatments. Comorbidities affecting response to antiviral therapy reduce compliance and adherence to inadequate doses of therapy. The most important comorbidities affecting the course of CHC include hepatitis B virus coinfection, metabolic syndrome, and intestinal bacterial overgrowth. Comorbidities affecting the course and response to ther...

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Hepatitis C virus infection after liver transplantation is associated with lower levels of activated CD4+CD25+CD45RO+IL-7r[alpha]high T cells

Liver Transplantation — Wed, 28 Oct 2009 00:00:00 +0100

The expression of interleukin 7 receptor alphahigh (IL-7R[alpha]high) discriminates between activated CD25+CD45RO+CD4+ T cells [IL-7R[alpha]high and forkhead box P3-negative (FoxP3-)] and regulatory T cells (IL-7R[alpha]low and FoxP3+). The IL-7R[alpha]highCD25+CD45RO+CD4+FoxP3- T cell population has been shown to be expanded in the blood and tissues of patients after kidney transplantation and to contain alloreactive T cells (activated T cells). In the present study, we analyzed the distribution of IL-7R[alpha]highCD25+CD45RO+CD4+FoxP3- T cells in the blood of 53 patients after liver transplantation. The IL-7R[alpha]highCD25+CD45RO+CD4+FoxP3- T cell population was significantly expanded (P < 0.0001) in stable transplant recipients versus healthy donors. However, the magnitude of the expan...

FDA authorises emergency use of IV antiviral peramivir for 2009 H1N1 influenza (swine flu)

NeLM - News — Mon, 26 Oct 2009 00:00:00 +0100

Source: FDA Area: News In response to a request from the US Centers for Disease Control and Prevention, the FDA has issued an emergency use authorisation (EUA) for the investigational IV antiviral peramivir, in certain adult and paediatric patients with confirmed or suspected 2009 H1N1 influenza infection who are admitted to a hospital. Specifically, IV peramivir is authorised only for use in those patients for whom therapy with an IV drug is clinically appropriate, based on one or more of the following: . The patient is not responding to either oral or inhaled antiviral therapy . Drug delivery by a route other than an IV route is not expected to be dependable or feasible . For adults only, when the clinician judges IV therapy is appropriate due to oth...

Aging of Hepatitis C Virus (HCV)-Infected Persons in the United States: A Multiple Cohort Model of HCV Prevalence and Disease Progression

Gastroenterology — Mon, 26 Oct 2009 00:00:00 +0100

Conclusions: Prevalence of hepatitis C cirrhosis and its complications will continue to increase through the next decade and will mostly affect those older than 60 years of age. Current treatment patterns will have little effect on these complications, but wider application of antiviral treatment and better responses with new agents could significantly reduce the impact of this disease in coming years. (Source: Gastroenterology)

Antiviral Completion Rates and Sustained Viral Response in Hepatitis C Patients With and Without Preexisting Major Depressive Disorder [ORIGINAL RESEARCH REPORTS]

Psychosomatics — Fri, 23 Oct 2009 17:47:50 +0100

CONCLUSION: Patients with MDD can be safely and effectively treated with antiviral therapy. (Source: Psychosomatics)

Partial splenic embolization and peg-IFN plus RBV in liver transplanted patients with hepatitis C recurrence: safety, efficacy and long-term outcome

Clinical Transplantation — Thu, 22 Oct 2009 23:00:00 +0100

Bárcena R, Moreno A, Foruny JR, Blázquez J, Graus J, Riesco JM, Blesa C, García-Hoz F, Sánchez J, Gil-Grande L, Nuño J, Fortún J, Rodriguez-Sagrado MA, Moreno A. Partial splenic embolization and peg-IFN plus RBV in liver transplanted patients with hepatitis C recurrence: safety, efficacy and long-term outcome.Clin Transplant 2009 DOI: 10.1111/j.1399-0012.2009.01081.x© 2009 John Wiley & Sons A/S.Abstract: Background: There is limited information on the long-term outcome in liver transplant (LT) subjects undergoing partial splenic embolization (PSE) prior to full dose pegylated interferon/ribavirin (peg-IFN/RBV).Methods: Retrospective review of eight LT subjects after PSE and antiviral therapy.Results: Baseline platelets and neutrophils were (Source: Clinical Transplantation)

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[Correspondence] Pregnancy and H1N1 infection

LANCET — Thu, 22 Oct 2009 23:00:00 +0100

Denise Jamieson and colleagues highlight high morbidity and mortality rates in pregnant women infected with the H1N1 influenza virus. Admission rates were 41% and the median time from symptom onset to receipt of antiviral therapy was 9 days. Could earlier initiation of antiviral treatment have resulted in a better outcome? (Source: LANCET)

Predictive value of on-treatment response during full-dose antiviral therapy of patients with hepatitis C virus cirrhosis and portal hypertension

Journal of Internal Medicine — Wed, 21 Oct 2009 23:00:00 +0100

Conclusion. Full-dose antiviral therapy with PEG-IFN and ribavirin can be safely carried out even in patients with compensated, fully established cirrhosis and portal hypertension. Selecting patients on the basis of HCV genotype and viral load, and application of on-treatment stopping rule may help rationalize treatment in patients who are unlikely to obtain SVR. (Source: Journal of Internal Medicine)

Prophylactic vitrectomy for acute retinal necrosis

Japanese Journal of Ophthalmology — Wed, 21 Oct 2009 19:41:28 +0100

Conclusions Prophylactic vitrectomy is effective in preventing the development of RRD in eyes where necrotic lesions do not extend beyond the midperiphery (zone 2). Content Type Journal ArticleCategory Clinical InvestigationDOI 10.1007/s10384-009-0698-zAuthors Tomoka Ishida, Komagome Hospital Department of Ophthalmology, Tokyo Metropolitan Cancer and Infectious Disease Center Tokyo JapanYoshiharu Sugamoto, Tokyo Medical and Dental University Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences Tokyo JapanSunao Sugita, Tokyo Medical and Dental University Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences Tokyo JapanManabu Mochizuki, Tokyo Medical and Dental University Department of Oph...

A new tool linking human cytomegalovirus drug resistance mutations to resistance phenotypes.

Antiviral Research — Wed, 21 Oct 2009 00:00:00 +0100

Authors: Chevillotte M, von Einem J, Meier BM, Lin FM, Kestler HA, Mertens T Drug resistant strains of human cytomegalovirus (HCMV) in patients at risk may increasingly develop into a problem in the clinical setting. Genotypic resistance testing is becoming the method of choice, but requires previous phenotypic characterisation of each newly found mutation. In order to facilitate the interpretation of the patient's CMV sequence data, a web based search tool was generated that links the sequence to a database containing all published UL97 (protein kinase) and UL54 (DNA polymerase) mutations and corresponding antiviral drug susceptibility phenotypes. It is reasonable to assume that HCMV drug resistance testing will provide relevant data for an adjustment of therapy and on prognosis of cl...

Platelet serotonin (5-HT) levels in interferon-treated patients with hepatitis C and its possible association with interferon-induced depression

Journal of Hepatology — Wed, 21 Oct 2009 00:00:00 +0100

Background & Aims: Interferon-associated depression is a frequent side effect of antiviral therapy for chronic hepatitis C. The aim of the present study was to investigate the correlation between platelet serotonin (5-hydroxytryptamine, 5-HT) concentrations and IFN-induced depression.Methods: The study represents a secondary analysis of a previously published trial on the efficacy of SSRI medication in HCV patients on IFN therapy. Ninety-three patients were longitudinally assessed for depression and platelet serotonin. Evaluation time points were: prior to IFN therapy, at weeks 4, 12, and 24 of IFN treatment, and 4weeks after antiviral treatment. Depression was assessed using the Hospital Anxiety and Depression Scale (HADS). Platelet serotonin concentrations were measured by ELISA.Results:...

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[Reflection and Reaction] Controlling hepatitis C with immunotherapy

The Lancet Infectious Diseases — Sun, 18 Oct 2009 23:00:00 +0100

We read with great interest Daniel P Webster and colleagues' Review of the development of new treatments for hepatitis C. The authors emphasised the promise of new selective inhibitors of hepatitis C virus (HCV) and their acceptable side-effect profiles. However, the clinical trial of specifically targeted antiviral therapy for HCV showed that it often leads to new mutant viruses and it is unclear whether the response can be sustained off-therapy. Therefore, more effective and tolerable treatments, such as new immune-based treatments, are being actively developed to complement or replace standard treatments of HCV. (Source: The Lancet Infectious Diseases)

Pediatric Supplement: Recommendations for use of antiviral medications for 2009 H1N1 influenza in children and adolescents

CDC Swine Flu Updates — Fri, 16 Oct 2009 22:00:00 +0100

This document provides clinician guidance regarding use of antiviral medications for the management of 2009 H1N1 influenza in children and adolescents. Questions and answers regarding high risk groups, considerations for antiviral therapy, pharmaceutical considerations, and considerations for post-exposure chemoprophylaxis. Additional resources are included. (Source: CDC Swine Flu Updates)

Successful antiviral therapy determines a significant decrease in squamous cell carcinoma antigen-associated (SCCA) variants' serum levels in anti-HCV positive cirrhotic patients*

Journal of Viral Hepatitis — Mon, 12 Oct 2009 23:00:00 +0100

Summary. Aberrant squamous cell carcinoma antigen (SCCA) expression is an early event in hepatocarcinogenesis, and increasing serum levels of SCCA variants IgM immune complexes (SCCA-IgM IC) have been found in cirrhotic patients developing hepatocellular carcinoma (HCC). We longitudinally evaluated a cohort of cirrhotic patients with hepatitis C virus infection (HCV) who underwent pegylated interferon (PEG-IFN) and ribavirin treatment. SCCA-IgM IC levels were assessed in the sera of 33 cirrhotic patients with HCV (21 males, median age 57 years) before, at the end and at 6-month and 1-year follow-up after treatment with PEG-IFN and ribavirin. SCCA-IgM IC serum levels (arbitrary units/mL, AU/mL) were evaluated according to treatment outcome: sustained virological response (SVR) vs nonrespons...

Splenectomy and antiviral treatment for thrombocytopenic patients with chronic hepatitis C virus infection

Journal of Viral Hepatitis — Mon, 12 Oct 2009 23:00:00 +0100

Summary. Thrombocytopenic patients with chronic hepatitis C virus (HCV) infection are poor candidates for antiviral treatment with interferon (IFN), but no standard treatment for thrombocytopenia has yet been established. We evaluated the safety of splenectomy and its efficacy for the initiation and continuation of antiviral therapy. From March 2003 to April 2006, 10 patients (mean age 62.5 years) with HCV-related cirrhosis, low platelet count (≦106 000/mm3) and splenomegaly (spleen size ≧10 cm) underwent splenectomy. Platelet counts significantly increased at 4[ndash]8 weeks after splenectomy [pre: 64 200 ± 6900/mm3vs post 209 000 ± 40 600/mm3 (P = 0.004)]. No severe operative complications were observed. All patients subsequently received antiviral therapy. Of the eight p...

Antiviral therapy for chronic hepatitis B: Challenges in Hong Kong

Journal of Hepatology — Wed, 07 Oct 2009 00:00:00 +0100

I read with great interest the review article by Prof. Liaw published in a recent issue of this journal . The article highlighted the reality and difficulties many patients and clinicians in Asian countries are now facing in the treatment of chronic hepatitis B. Although the more recent antiviral agents (entecavir and tenofovir) have strong antiviral potency and very low risk of drug resistance, these drugs may not be available to all patients in need. This is due to the restricted reimbursement criteria in place in different countries as well as the low income of the population in some areas. (Source: Journal of Hepatology)

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Two- and three-dimensional QSAR studies on benzyl amide-ketoacid inhibitors of HIV integrase and their reduced analogues

Medicinal Chemistry Research — Tue, 06 Oct 2009 12:57:13 +0100

Abstract The discovery of clinically relevant inhibitors of HIV-integrase for antiviral therapy has proven to be a challenging task. Ketoacid-derived inhibitors selectively inhibit the strand transfer reaction of HIV-integrase. To elucidate the structural properties required for HIV-integrase inhibitory activity, we present here the results of two- and three-dimensional (2D and 3D) QSAR studies of a series of 24 benzyl amide derivatives. The 2D-QSAR studies were performed using three methods: the multiple linear regression method (MLR), giving r 2 = 0.9340 and q 2 = 0.8471; the partial least squares method, with r 2 = 0.9291 and q 2 = 0.7896; and principle component analysis, giving r 2 = 0.6496 and q 2 = 0.38...

Structure-based virtual screening for novel inhibitors of Japanese encephalitis virus NS3 helicase/nucleoside triphosphatase

FEMS Immunology and Medical Microbiology — Mon, 05 Oct 2009 00:00:00 +0100

Japanese encephalitis (JE) is a significant cause of human morbidity and mortality throughout Asia and Africa. Vaccines have reduced the incidence of JE in some countries, but no specific antiviral therapy is currently available. The NS3 protein of Japanese encephalitis virus (JEV) is a multifunctional protein combining protease, helicase and nucleoside 5'-triphosphatase (NTPase) activities. The crystal structure of the catalytic domain of this protein has recently been solved using a roentgenographic method. This enabled structure-based virtual screening for novel inhibitors of JEV NS3 helicase/NTPase. The aim of the present research was to identify novel potent medicinal substances for the treatment of JE. In the first step of studies, the natural ligand ATP and two known JEV NS3 helicas...

Factors and outcome in BK virus nephropathy in a Hispanic kidney transplant population

Transplant Infectious Disease — Sun, 04 Oct 2009 23:00:00 +0100

D. Pérez-Torres, J. Bertrán-Pasarell, E. Santiago-Delpín, M. González-Ramos, S. Medina-Mangual, L. Morales-Otero, Z. González-Caraballo. Factors and outcome in BK virus nephropathy in a Hispanic kidney transplant population.Transpl Infect Dis 2009. All rights reserved BK virus nephropathy (BKVN) is an increasingly recognized cause of kidney allograft loss and is thought to be related to the newer, more potent immunosuppressive agents. Conflicting information has been reported on risk factors for BK infection. To determine incidence, associated factors, and outcome of BKVN in our kidney transplant population in order to improve identification and management. Kidney transplants from January 2000 to December 2005 were retrospectively reviewed. Data were collected for patients with biopsy...

Hepatitis C virus/human immunodeficiency virus coinfection in hemophiliacs: high rates of sustained virologic response to pegylated interferon and ribavirin therapy

Journal of Thrombosis and Haemostasis — Sat, 03 Oct 2009 00:00:00 +0100

Conclusions: These results strongly support the use of anti-HCV therapy in HCV/HIV-coinfected hemophiliacs. (Source: Journal of Thrombosis and Haemostasis)

The Use of Cyclosporine for Recurrent Hepatitis C After Liver Transplant: A Randomized Pilot Study

Digestive Diseases and Sciences — Fri, 02 Oct 2009 05:49:59 +0100

Conclusions This randomized controlled pilot study is the first in vivo study evaluating cyclosporine versus tacrolimus in liver transplant recipients undergoing antiviral therapy. Change from tacrolimus to cyclosporine led to a modest HCV RNA drop and appeared to enhance the antiviral response of PEG/RBV. A larger randomized study is necessary to see if cyclosporine offers any advantage over tacrolimus. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10620-009-0981-3Authors Roberto J. Firpi, University of Florida Division of Gastroenterology, Hepatology and Nutrition Section of Hepatobiliary Diseases and Liver Transplantation Gainesville FL USAConsuelo Soldevila-Pico, University of Florida Division of Gastroenterology, Hepatology and Nutrition Sect...

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Antiviral Treatment of Patients with Recurrent Hepatitis C After Liver Transplantation with Pegylated Interferon

Digestive Diseases and Sciences — Fri, 02 Oct 2009 05:49:59 +0100

Conclusions The outcome of antiviral combination therapy for HCV reinfection after OLT can be best predicted by week-24 virologic response. The high SVR rates in patients with detectable HCV RNA at week 12 might suggest a prolonged treatment protocol in liver transplant recipients. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10620-009-0982-2Authors Sven C. Schmidt, Universitätsmedizin Berlin Klinik für Allgemein-, Viszeral-, und Transplantationschirurgie, Charité Campus Virchow-Klinikum Augustenburger Platz 1 13353 Berlin GermanyMarcus Bahra, Universitätsmedizin Berlin Klinik für Allgemein-, Viszeral-, und Transplantationschirurgie, Charité Campus Virchow-Klinikum Augustenburger Platz 1 13353 Berlin GermanySandra Bayraktar, Universitätsmed...

Clinical Evaluation of a colorimetric oligonucleotide chip for Genotyping Hepatitis C Virus.

Clinical Biochemistry — Thu, 24 Sep 2009 23:00:00 +0100

Conclusion: To our knowledge this oligonucleotide chip genotyping method offers a fast and convenient way to determine the genotype in large-scale settings. The tests can be easily adapted by a clinical diagnostic laboratory. PMID: 19786007 [PubMed - as supplied by publisher] (Source: Clinical Biochemistry)

Control of an Outbreak of Human Parainfluenza Virus 3 in Hematopoietic Stem Cell Transplant Recipients

Biology of Blood and Marrow Transplantation — Thu, 24 Sep 2009 00:00:00 +0100

Human parainfluenza virus 3 (HPIV3) infection can cause significant morbidity and mortality in patients undergoing hematopoietic stem cell transplantation (HSCT). There are no standard guidelines for the prevention and control of HPIV3 in the outpatient setting. After 2 HSCT inpatients diagnosed with HPIV3 were noted to have had multiple recent HSCT outpatient clinic (OPC) visits, an investigation of policy and procedures in the HSCT OPC was undertaken, and active surveillance for respiratory viral illness was instituted in the at-risk HSCT population. Between July 19 and August 30, 2005, 13 patients were diagnosed with HPIV3 infection. Morbidity in affected patients was significant, and mortality was high (38.5%) and not affected by antiviral therapy. Molecular typing identified several g...

CD81 expression in peripheral blood lymphocytes before and after treatment with interferon and ribavirin in HIV/HCV coinfected patients

HIV Medicine — Wed, 23 Sep 2009 23:00:00 +0100

CD81 is expressed on lymphocytes and confers HCV viral infectivity support. The aim of our study was to quantify CD81 expression in peripheral blood B- and T-cells of HCV/HIV-coinfected patients and healthy subjects to examine its association with several HCV virological characteristics and the therapeutic responsiveness to HCV antiviral treatment. We carried out a cross-sectional study on 122 naïve patients. For a duration of 48 weeks, 24 out of 122 patients underwent HCV antiviral therapy with interferon (IFN)-[alpha] and ribavirin. T- and B-cell subsets were analysed by flow cytometry. We found that HIV/HCV coinfected patients with HCV-RNA [ge]850 000 IU/mL had lower values of %CD19+CD81-CD62L+ and %CD19+CD62L+; and higher values of CD19+CD81+CD62L[minus] and CD19+CD81+ percentages and...

Clinical and virological survey of patients with hepatitis B surface antigen in an Italian region: Clinical considerations and disease burden

Journal of Medical Virology — Mon, 21 Sep 2009 23:00:00 +0100

The aim of this study was to determine the prevalence of hepatitis B virus (HBV) infection in an Italian region, Liguria (1,572,000 inhabitants), by means of a network of 12 referral centers for liver diseases. All patients with HBV surface antigen followed throughout 2006 were included. Personal data, infectious status with risk factors, other non-infectious risk factors for liver disease, clinical status, and treatment were the questionnaire. Four hundred forty-five patients (71% male) were evaluated. Their median age was 48 years (range 5-84), and 83.4% were of Italian origin. Community-acquired infection was the principal mode of HBV transmission (82.5%), followed by previous intravenous drug use (9.4%), perinatal transmission (6.3%), and transfusion-associated transmission (1.8%). Hep...

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Molecular mechanisms of insulin resistance in chronic hepatitis C.

World Journal of Gastroenterology : WJG — Sun, 20 Sep 2009 21:31:01 +0100

Authors: Douglas MW, George J It is now widely recognized that chronic hepatitis C (CHC) is associated with insulin resistance (IR) and type 2 diabetes, so can be considered a metabolic disease. IR is most strongly associated with hepatitis C virus (HCV) genotype 1, in contrast to hepatic steatosis, which is associated with genotype 3 infection. Apart from the well-described complications of diabetes, IR in CHC predicts faster progression to fibrosis and cirrhosis that may culminate in liver failure and hepatocellular carcinoma. More recently, it has been recognized that IR in CHC predicts a poor response to antiviral therapy. The molecular mechanisms for the association between IR and HCV infection are not well defined. This review will elaborate on the clinical associations between C...

Relationship between serum HBV DNA level and HBV-specific, nonspecific cytotoxic T lymphocytes and natural killer cells in patients with chronic hepatitis B.

Chinese Medical Journal — Sat, 19 Sep 2009 23:00:00 +0100

CONCLUSIONS: Serum HBV DNA level of patients with CHB is related to HBV specific CTL, nonspecific CTL and NK cells, which might result in inflammatory reaction of liver and cause more damage to liver function. Mechanism of HBV DNA level affecting the efficacy of anti-viral treatment may be related to the levels of HBV specific CTL and NK cells. PMID: 19781297 [PubMed - in process] (Source: Chinese Medical Journal)

The role of quantitative hepatitis B serology in the natural history and management of chronic hepatitis B

Hepatology International — Fri, 18 Sep 2009 06:48:41 +0100

Abstract Chronic hepatitis B (CHB) remains a serious clinical problem worldwide. Advances in molecular technology have enabled the development of sensitive assays for the detection and quantification of hepatitis B virus (HBV) nucleic acid and demonstrated a positive correlation between serum HBV DNA levels and disease progression. Assessment of specific serologic and virologic factors also plays a pivotal role in the diagnosis and effective management of individuals with CHB. Recent development of quantitative assays for intrahepatic HBV replicative intermediates, as well as hepatitis B e antigen and hepatitis B surface antigen, has spurred investigation into the relationship between these factors and response to antiviral therapy and disease progression. Recent findings ...

Iron depletion before HCV antiviral therapy: A pilot, randomized, controlled trial

Journal of Clinical Apheresis — Wed, 16 Sep 2009 23:00:00 +0100

It is not known whether iron depletion before pegylated IFN or combination treatment improves sustained virological response (SVR) rate in patients with chronic hepatitis C, despite its use in clinical practice in this setting. We aimed to investigate whether blood letting improves the efficacy (SVR) and tolerability of PEG-IFN[alpha]2b + Ribavirin in chronic hepatitis C patients. Patients with chronic hepatitis C and ferritin >100 ng/mL were randomized to: (1) repeated phlebotomies to obtain a ferritin level (Source: Journal of Clinical Apheresis)

Acute myocarditis in children: Current concepts and management

Current Treatment Options in Cardiovascular Medicine — Wed, 16 Sep 2009 12:31:20 +0100

Opinion statement The spectrum of presentation of pediatric myocarditis ranges from minor flu-like illness with chest pain to acute cardiogenic shock in a previously healthy child. A major change in the diagnostic evaluation of myocarditis is a shift in focus away from endomyocardial biopsy and histologic confirmation toward cardiac MRI for noninvasive diagnosis and prognostication of acute myocarditis. Cardiac MRI may be particularly useful in pediatric patients, considering the risks associated with biopsy in children. Some of the MRI characteristics seen in pediatric patients with acute myocarditis also may serve as predictors of outcome. The approach to managing myocarditis varies according to the severity of presentation; it is primarily supportive while spontaneous r...

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Triple antiviral therapy shows synergy for pandemic H1N1 in vitro

MD Consult: News: Top Stories — Wed, 16 Sep 2009 00:00:00 +0100

Read the full story on MD Consult: Triple antiviral therapy shows synergy for pandemic H1N1 in vitro (Source: MD Consult: News: Top Stories)

Facial herpes zoster infection precipitated by surgical manipulation of the trigeminal nerve during exploration of the posterior fossa: a case report

Journal of Medical Case Reports — Tue, 15 Sep 2009 23:00:00 +0100

Conclusions: Postoperative shingles precipitated by trigeminal nerve manipulation during surgery for trigeminal neuralgia can be a distressing and demoralizing experience for the patient. A careful preoperative history, early recognition, and prompt antiviral therapy is necessary. (Source: Journal of Medical Case Reports)

Impact of Genetic Polymorphisms in Cytomegalovirus Glycoprotein B on Outcomes in Solid‐Organ Transplant Recipients with Cytomegalovirus Disease

Clinical Infectious Diseases Latest Issue — Mon, 14 Sep 2009 18:55:17 +0100

Conclusions. No specific gB genotype appears to confer a specific CMV virulence advantage. However, mixed gB genotype infections are associated with higher viral loads and delayed viral clearance. (Source: Clinical Infectious Diseases Latest Issue)

Retreatment Benefits Some Hepatitis C Non-Responders

Modern Medicine — Tue, 08 Sep 2009 23:00:00 +0100

In patients with chronic hepatitis C infection who fail to respond to standard antiviral therapy, retreatment with either pegylated interferon alfa plus ribavirin or pegylated interferon alfa plus ribavirin in combination with antiviral therapies may lead to a sustained virologic response, according to a study in the September issue of Clinical Gastroenterology and Hepatology. (Source: Modern Medicine)

Adenovirus infections in solid organ transplant recipients.

Current Opinion in Organ Transplantation — Sun, 06 Sep 2009 23:00:00 +0100

Authors: Hoffman JA PURPOSE OF REVIEW: Adenoviruses are emerging as important viral pathogens in solid organ transplant recipients, impacting morbidity, graft survival and even mortality. This review will discuss the current understanding of the epidemiology, diagnosis and therapy of adenovirus infection in transplant recipients. RECENT FINDINGS: Advances in the field include the use of polymerase chain reaction in the diagnosis of adenoviral infection, a better understanding of the epidemiology, immune response and potential new therapies, including preemptive and adoptive immunotherapy strategies. Adenoviral infections appear to be common, especially in pediatric solid organ transplan. Generally well tolerated, some high-risk patients may develop disseminated disease causing graft fa...

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Surveillance for pediatric deaths associated with 2009 pandemic influenza A (H1N1) virus infection - United States, April-August 2009.

MMWR Morb Mortal Wkl... — Thu, 03 Sep 2009 23:00:00 +0100

Authors: Children aged <5 years or with certain chronic medical conditions are at increased risk for complications and death from influenza. Because of this increased risk, the Advisory Committee on Immunization Practices (ACIP) has prioritized influenza prevention and treatment for children aged <5 years and for those with certain chronic medical and immunosuppressive conditions. CDC monitors child influenza deaths through its influenza-associated pediatric mortality reporting system. As of August 8, 2009, CDC had received reports of 477 deaths associated with 2009 pandemic influenza A (H1N1) in the United States, including 36 deaths among children aged <18 years. To characterize these cases, CDC analyzed data from April to August 2009. The results of that analysis indicate...

A Comparative Study of Antiviral Therapy After Resection of Hepatocellular Carcinoma in the Immune-Active Phase of Hepatitis B Virus Infection

Annals of Surgical Oncology — Thu, 03 Sep 2009 06:33:31 +0100

Conclusion Although nucleoside analogs did not reduce short-term recurrence rate, they promoted postoperative viral clearance and increased residual liver volume, which significantly enhanced tolerance to subsequent therapy for disease recurrence. Content Type Journal ArticleCategory Hepatobiliary TumorsDOI 10.1245/s10434-009-0694-zAuthors Nan Li, Second Military Medical University Eastern Hepatobiliary Surgery Hospital Shanghai ChinaEric C. H. Lai, The Chinese University of Hong Kong Faculty of Medicine Hong Kong SAR ChinaJie Shi, Second Military Medical University Eastern Hepatobiliary Surgery Hospital Shanghai ChinaWei-Xing Guo, Second Military Medical University Eastern Hepatobiliary Surgery Hospital Shanghai ChinaJie Xue, Second Military Medical University Eastern...

During Hepatitis C Therapy Men Experience Sexual Dysfunction

Liver Disease / Hepatitis News From Medical News Today — Wed, 02 Sep 2009 13:00:00 +0100

Sexual impairment is common among men with chronic hepatitis C undergoing antiviral therapy, according to a new study in Gastroenterology, the official journal of the American Gastroenterological Association (AGA) Institute. This is the first time a study evaluating the combination therapy, peginterferon and ribavirin, has identified sexual dysfunction as a side effect. (Source: Liver Disease / Hepatitis News From Medical News Today)

Men experience sexual dysfunction during hepatitis C therapy

EurekAlert! - Medicine and Health — Tue, 01 Sep 2009 04:00:00 +0100

(American Gastroenterological Association) Sexual impairment is common among men with chronic hepatitis C undergoing antiviral therapy. (Source: EurekAlert! - Medicine and Health)

Men Experience Sexual Dysfunction During Hepatitis C Therapy

ScienceDaily Headlines — Tue, 01 Sep 2009 04:00:00 +0100

Sexual impairment is common among men with chronic hepatitis C undergoing antiviral therapy, according to a new study. (Source: ScienceDaily Headlines)

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Simultaneous quantitation of serum HBV DNA and HBeAg can distinguish between slow and fast viral responses to antiviral therapy in patients with chronic hepatitis B.

Revista do Instituto de Medicina Tropical de Sao Paulo — Tue, 01 Sep 2009 00:00:00 +0100

CONCLUSIONS: The first pattern is compatible with a viral response. A long-term HBeAg seropositivity with a slow and persistent decrease (Pattern III-A) is also compatible with a viral response and calls for a prolongation of anti-viral treatment. PMID: 19893978 [PubMed - in process] (Source: Revista do Instituto de Medicina Tropical de Sao Paulo)

Emerging antiviral drugs for hepatitis C virus.

Reviews on Recent Clinical Trials — Tue, 01 Sep 2009 00:00:00 +0100

Authors: Enomoto M, Tamori A, Kawada N Infection with hepatitis C virus (HCV) is a global health problem that affects approximately 170 million people worldwide. The current standard therapy with peginterferon alpha plus ribavirin for 48 weeks results in a sustained virologic response in less than 50% of patients with chronic hepatitis C genotype 1-the most prevalent type of HCV in North America and Europe. Development of new antiviral medicines has been hampered by the lack of an effective cell culture system and small-animal model. Herein we review recent progress in the development of new treatments under investigation in clinical trials, including specifically targeted antiviral therapy for HCV such as NS3/4A protease and NS5B polymerase inhibitors. PMID: 20028330 [PubMed - in ...

Favorable outcome of de novo hepatitis B infection after liver transplantation with lamivudine and adefovir therapy

Transplant Infectious Disease — Mon, 31 Aug 2009 23:00:00 +0100

F.K. Zhang, Y. Zhang, J.Y. Zhang, J.D. Jia, B.E. Wang. Favorable outcome of de novo hepatitis B infection after liver transplantation with lamivudine and adefovir therapy.Transpl Infect Dis 2009. All rights reservedAbstract: De novo hepatitis B virus (HBV) infection after orthotopic liver transplantation (OLT) always progresses to chronic hepatitis because of the patients' immunocompromised status, and only a few then acquire hepatitis B surface antigen (HBsAg) seroconversion even with efficient antiviral therapy. Here we reported the case of a liver transplant recipient with de novo HBV infection who had a favorable outcome after lamivudine (LAM) and adefovir dipivoxil (ADV) antiviral therapy. The patient received OLT because of end-stage primary biliary cirrhosis and was found to have de...

Flu Treatment for Upcoming Season Clarified

Internal Medicine News — Mon, 31 Aug 2009 23:00:00 +0100

VAIL, COLO. — The recommended antiviral therapy during the coming influenza season will depend on whether a patient has laboratory-confirmed novel influenza A(H1N1). In patients with confirmed novel influenza A(H1N1), or in patients with laboratory-confirmed influenza A(H3N2) or B, the first-line antiviral is oseltamivir (Tamiflu). However, in patients with a positive laboratory test for influenza A or seasonal A(H1N1), the preferred agent is zanamivir (Relenza), according to Centers for Disease Control and Prevention recommendations. (Source: Internal Medicine News)

Flu Treatment for Upcoming Season Clarified

Skin and Allergy News — Mon, 31 Aug 2009 23:00:00 +0100

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Antiviral Therapies for The Upcoming Flu Season Clarified

Ob.Gyn. News — Mon, 31 Aug 2009 23:00:00 +0100

Successful Antiviral and Antituberculosis Treatment With Pegylated Interferon-alfa and Ribavirin in a Chronic Hepatitis C Patient With Pulmonary Tuberculosis.

J Formos Med Assoc — Mon, 31 Aug 2009 23:00:00 +0100

We present the case of 55-year-old woman with chronic hepatitis C, who developed pulmonary tuberculosis after receiving 8 weeks of peginterferon alfa-2a plus ribavirin therapy. Antituberculous treatment was started and antiviral agents were given continually at adjusted doses. Her symptoms of cough with blood-tinged sputum improved 1 month after antituberculous therapy. Treatment for hepatitis C and pulmonary tuberculosis were completed after 6 months. At 6 months after antiviral therapy, a sustained virological response was achieved and follow-up chest radiography showed a marked regressive change. This is believed to be the first case report of complete remission from hepatitis C and pulmonary tuberculosis treated concurrently with antiviral and antituberculous agents. PMID: 19773215...

Treatment Recommendations for Upcoming Flu Season Clarified

Pediatric News — Mon, 31 Aug 2009 23:00:00 +0100

The natural history of hepatitis C cirrhosis after liver transplantation

Liver Transplantation — Thu, 27 Aug 2009 23:00:00 +0100

In conclusion, the results confirm an accelerated natural history of hepatitis C cirrhosis after liver transplantation and demonstrate poor survival after decompensation. The Model for End-Stage Liver Disease can stratify risk for decompensation and survival, whereas successful antiviral therapy may be protective. Liver Transpl 15:1063-1071, 2009. © 2009 AASLD. (Source: Liver Transplantation)