BACKGROUND Chronic hepatitis C(CHC)is a health burden with consequent morbidity and mortality.Liver biopsy is the gold standard for evaluating fibrosis and assessing disease severity and prognostic purposes post-treat...BACKGROUND Chronic hepatitis C(CHC)is a health burden with consequent morbidity and mortality.Liver biopsy is the gold standard for evaluating fibrosis and assessing disease severity and prognostic purposes post-treatment.Noninvasive altern-atives for liver biopsy such as transient elastography(TE)and diffusion-weighted magnetic resonance imaging(DW-MRI)are critical needs.AIM To evaluate TE and DW-MRI as noninvasive tools for predicting liver fibrosis in children with CHC.METHODS This prospective cross-sectional study initially recruited 100 children with CHC virus infection.Sixty-four children completed the full set of investigations including liver stiffness measurement(LSM)using TE and measurement of apparent diffusion coefficient(ADC)of the liver and spleen using DW-MRI.Liver biopsies were evaluated for fibrosis using Ishak scoring system.LSM and liver and spleen ADC were compared in different fibrosis stages and correlation analysis was performed with histopathological findings and other laboratory parameters.RESULTS Most patients had moderate fibrosis(73.5%)while 26.5%had mild fibrosis.None had severe fibrosis or cirrhosis.The majority(68.8%)had mild activity,while only 7.8%had moderate activity.Ishak scores had a significant direct correlation with LSM(P=0.008)and were negatively correlated with both liver and spleen ADC but with no statistical significance(P=0.086 and P=0.145,respectively).Similarly,histopatho-logical activity correlated significantly with LSM(P=0.002)but not with liver or spleen ADC(P=0.84 and 0.98 respectively).LSM and liver ADC were able to significantly discriminate F3 from lower fibrosis stages(area under the curve=0.700 and 0.747,respectively)with a better performance of liver ADC.CONCLUSION TE and liver ADC were helpful in predicting significant fibrosis in children with chronic hepatitis C virus infection with a better performance of liver ADC.展开更多
AIM:To evaluate serum complement C4a and its relation to liver fibrosis in children with chronic hepatitis C virus(HCV)infection.METHODS:The study included 30 children with chronic HCV infection before receiving antiv...AIM:To evaluate serum complement C4a and its relation to liver fibrosis in children with chronic hepatitis C virus(HCV)infection.METHODS:The study included 30 children with chronic HCV infection before receiving antiviral therapy.Chronic HCV infection was defined by positive anti-HCV,a positive polymerase chain reaction for HCV-RNA for more than 6 mo with absence of any associated liver disease.A second group of 30 age-and sex-matched healthy children served as controls.Serum C4a levels were measured by enzyme-linked immunosorbent assay.Liver fibrosis stage and inflammatory grade were assessed using Ishak scoring system.Serum C4a levels were compared according to different clinical,laboratory and histopathological parameters.Statistical significance for quantitative data was tested by MannWhitney U non-parametric tests.For qualitative data,significance between groups was tested by 2test.Correlation was tested by Spearman’s test.Results were considered significant if P value≤0.05.RESULTS:The age of the patients ranged from 3.5to 18 years and that of controls ranged from 4 to 17years.C4a mean levels were merely lower in patients(153.67±18.69 mg/L)than that in the controls(157.25±11.40 mg/L)with no statistical significance(P=0.378).It did not differ significantly in patients with elevated vs those with normal transaminases(152.25±16.62 vs 155.36±21.33;P=0.868)or with different HCV viremia(P=0.561).Furthermore,there was no statistical significant difference in serum levels between those with no/mild fibrosis and those with moderate fibrosis(154.65±20.59 vs 152.97±17.72;P=0.786)or minimal and mild activity(155.1±21.93 vs 152.99±17.43;P=0.809).Though statistically not significant,C4a was highest in fibrosis score 0(F0),decreasing in F1 and F2 to be the lowest in F3.When comparing significant fibrosis(Ishak score≥3)vs other stages,C4a was significantly lower in F3 compared to other fibrosis scores(143.55±2.33 mg/L vs 155.26±19.64 mg/L;P=0.047)and at a cutoff value of less than 144.01 mg/L,C4a could discriminate F3 with 76.9%sensitivity and75%specificity from other stages of fibrosis.CONCLUSION:Serum complement C4a did not correlate with any of transaminases,HCV viremia or with the histopathological scores.Although C4a decreased with higher stages of fibrosis,this change was not significant enough to predict individual stages of fibrosis.Yet,it could predict significant fibrosis with acceptable clinical performance.展开更多
AIM: To investigate the safety and efficacy of a Hansenula-derived PEGylated (polyethylene glycol) interferon (IFN)-alpha-2a (Reiferon Retard) plus ribavirin customized regimen in treatment-naïve and previ...AIM: To investigate the safety and efficacy of a Hansenula-derived PEGylated (polyethylene glycol) interferon (IFN)-alpha-2a (Reiferon Retard) plus ribavirin customized regimen in treatment-naïve and previously treated (non-responders and relapsers) Egyptian children with chronic hepatitis C infection.展开更多
Hepatitis C virus(HCV) genotype(GT) 4 represents 12%-15%(15-18 million) of total global HCV infection. It is prevalent in Northern and Equatorial Africa and the Middle East, and is also present in some countries in Eu...Hepatitis C virus(HCV) genotype(GT) 4 represents 12%-15%(15-18 million) of total global HCV infection. It is prevalent in Northern and Equatorial Africa and the Middle East, and is also present in some countries in Europe. GT-4(and subtype 4a in particular) dominates the HCV epidemic in Egypt. In underdeveloped countries, risk factors associated with HCV infection may be due to unsafe medical practices or other factors such as familial transmission, mother's HCV status, or illiteracy. HCV prevention and control programs should include health education, increased community awareness towards the disease, controlling infection distribution in healthcare centers, proper sterilization of medical and dental instruments, and ensuring safe supply of blood and blood-products. Response rates to a 48-wk combined pegylated-interferon(PEG-IFN) and ribavirin(RBV) treatment range from 40%-69%, and HCV-GT-4 has been considered better than GT-1 but worse than GT-2 and GT-3 in treatment with PEG-IFN/RBV. However, with the introduction of the HCV-GT-1 effective protease inhibitors boceprevir and telaprevir in 2011, HCV-GT-4 became the "most difficult(GT) to treat". Recently, the direct-acting antivirals(DAAs) with pan- genotypic activities simeprevir, sofosbuvir, and daclatasvir have been recommended in triple regimens with PEG-IFN/RBV for the treatment of HCV-GT-4. An IFN-free regimen will be available for treatment of all genotypes of HCV in the near future. To date, several DAAs have been developed and are currently being evaluated in various combinations in clinical trials. As new regimens and new agents are being approved by the Food and Drug Administration, we can expect the guidelines for HCV treatment to be changed. The availability of shorter, simpler, and more tolerable treatment regimens can reduce the morbidity and mortality associated with HCV infection. With such a large number of therapeutic agents available, we can end up with a range of choices that we can select from to treat patients.展开更多
基金Egyptian Ministry for Scientific Research,Science,Technology&Innovation Funding Authority(STDF),No.HCV-3506.
文摘BACKGROUND Chronic hepatitis C(CHC)is a health burden with consequent morbidity and mortality.Liver biopsy is the gold standard for evaluating fibrosis and assessing disease severity and prognostic purposes post-treatment.Noninvasive altern-atives for liver biopsy such as transient elastography(TE)and diffusion-weighted magnetic resonance imaging(DW-MRI)are critical needs.AIM To evaluate TE and DW-MRI as noninvasive tools for predicting liver fibrosis in children with CHC.METHODS This prospective cross-sectional study initially recruited 100 children with CHC virus infection.Sixty-four children completed the full set of investigations including liver stiffness measurement(LSM)using TE and measurement of apparent diffusion coefficient(ADC)of the liver and spleen using DW-MRI.Liver biopsies were evaluated for fibrosis using Ishak scoring system.LSM and liver and spleen ADC were compared in different fibrosis stages and correlation analysis was performed with histopathological findings and other laboratory parameters.RESULTS Most patients had moderate fibrosis(73.5%)while 26.5%had mild fibrosis.None had severe fibrosis or cirrhosis.The majority(68.8%)had mild activity,while only 7.8%had moderate activity.Ishak scores had a significant direct correlation with LSM(P=0.008)and were negatively correlated with both liver and spleen ADC but with no statistical significance(P=0.086 and P=0.145,respectively).Similarly,histopatho-logical activity correlated significantly with LSM(P=0.002)but not with liver or spleen ADC(P=0.84 and 0.98 respectively).LSM and liver ADC were able to significantly discriminate F3 from lower fibrosis stages(area under the curve=0.700 and 0.747,respectively)with a better performance of liver ADC.CONCLUSION TE and liver ADC were helpful in predicting significant fibrosis in children with chronic hepatitis C virus infection with a better performance of liver ADC.
基金Supported by National Liver Institute,Menofiya University,Egypt
文摘AIM:To evaluate serum complement C4a and its relation to liver fibrosis in children with chronic hepatitis C virus(HCV)infection.METHODS:The study included 30 children with chronic HCV infection before receiving antiviral therapy.Chronic HCV infection was defined by positive anti-HCV,a positive polymerase chain reaction for HCV-RNA for more than 6 mo with absence of any associated liver disease.A second group of 30 age-and sex-matched healthy children served as controls.Serum C4a levels were measured by enzyme-linked immunosorbent assay.Liver fibrosis stage and inflammatory grade were assessed using Ishak scoring system.Serum C4a levels were compared according to different clinical,laboratory and histopathological parameters.Statistical significance for quantitative data was tested by MannWhitney U non-parametric tests.For qualitative data,significance between groups was tested by 2test.Correlation was tested by Spearman’s test.Results were considered significant if P value≤0.05.RESULTS:The age of the patients ranged from 3.5to 18 years and that of controls ranged from 4 to 17years.C4a mean levels were merely lower in patients(153.67±18.69 mg/L)than that in the controls(157.25±11.40 mg/L)with no statistical significance(P=0.378).It did not differ significantly in patients with elevated vs those with normal transaminases(152.25±16.62 vs 155.36±21.33;P=0.868)or with different HCV viremia(P=0.561).Furthermore,there was no statistical significant difference in serum levels between those with no/mild fibrosis and those with moderate fibrosis(154.65±20.59 vs 152.97±17.72;P=0.786)or minimal and mild activity(155.1±21.93 vs 152.99±17.43;P=0.809).Though statistically not significant,C4a was highest in fibrosis score 0(F0),decreasing in F1 and F2 to be the lowest in F3.When comparing significant fibrosis(Ishak score≥3)vs other stages,C4a was significantly lower in F3 compared to other fibrosis scores(143.55±2.33 mg/L vs 155.26±19.64 mg/L;P=0.047)and at a cutoff value of less than 144.01 mg/L,C4a could discriminate F3 with 76.9%sensitivity and75%specificity from other stages of fibrosis.CONCLUSION:Serum complement C4a did not correlate with any of transaminases,HCV viremia or with the histopathological scores.Although C4a decreased with higher stages of fibrosis,this change was not significant enough to predict individual stages of fibrosis.Yet,it could predict significant fibrosis with acceptable clinical performance.
基金Supported by Yassin Abdel-Ghaffar Charity Center for LiverDisease and Research,Cairo,Egypt,in collaboration with the National Liver Institute,Menofiya University,Egypt and Cairo University Pediatric Hospital,Cairo,EgyptAntiviral medications(PEG-IFN-alpha-2a and ribavirin)and HCV genotyping were of-fered as donation from Yassin Abdel-Ghaffar Charity Center for Liver Disease and Research,Cairo,Egypt
文摘AIM: To investigate the safety and efficacy of a Hansenula-derived PEGylated (polyethylene glycol) interferon (IFN)-alpha-2a (Reiferon Retard) plus ribavirin customized regimen in treatment-naïve and previously treated (non-responders and relapsers) Egyptian children with chronic hepatitis C infection.
文摘Hepatitis C virus(HCV) genotype(GT) 4 represents 12%-15%(15-18 million) of total global HCV infection. It is prevalent in Northern and Equatorial Africa and the Middle East, and is also present in some countries in Europe. GT-4(and subtype 4a in particular) dominates the HCV epidemic in Egypt. In underdeveloped countries, risk factors associated with HCV infection may be due to unsafe medical practices or other factors such as familial transmission, mother's HCV status, or illiteracy. HCV prevention and control programs should include health education, increased community awareness towards the disease, controlling infection distribution in healthcare centers, proper sterilization of medical and dental instruments, and ensuring safe supply of blood and blood-products. Response rates to a 48-wk combined pegylated-interferon(PEG-IFN) and ribavirin(RBV) treatment range from 40%-69%, and HCV-GT-4 has been considered better than GT-1 but worse than GT-2 and GT-3 in treatment with PEG-IFN/RBV. However, with the introduction of the HCV-GT-1 effective protease inhibitors boceprevir and telaprevir in 2011, HCV-GT-4 became the "most difficult(GT) to treat". Recently, the direct-acting antivirals(DAAs) with pan- genotypic activities simeprevir, sofosbuvir, and daclatasvir have been recommended in triple regimens with PEG-IFN/RBV for the treatment of HCV-GT-4. An IFN-free regimen will be available for treatment of all genotypes of HCV in the near future. To date, several DAAs have been developed and are currently being evaluated in various combinations in clinical trials. As new regimens and new agents are being approved by the Food and Drug Administration, we can expect the guidelines for HCV treatment to be changed. The availability of shorter, simpler, and more tolerable treatment regimens can reduce the morbidity and mortality associated with HCV infection. With such a large number of therapeutic agents available, we can end up with a range of choices that we can select from to treat patients.
