Alexandra L. Gibas

A Randomized, Controlled Trial of Interferon Alfa-2b Alone and after Prednisone Withdrawal for the Treatment of Chronic Hepatitis B

Abstract Background and Methods. Chronic hepatitis B is a common and often progressive liver disorder for which there is no accepted therapy. To assess the efficacy of treatment with interferon, we randomly assigned patients with chronic hepatitis B to one of the following regimens: prednisone for 6 weeks followed by 5 million units of recombinant interferon alfa-2b daily for 16 weeks; placebo followed by 5 million units of interferon daily for 16 weeks; placebo followed by 1 million units of interferon daily for 16 weeks; or observation with no treatment. Results. Hepatitis B e antigen and hepatitis B viral DNA disappeared from serum significantly more often in the patients given prednisone plus interferon (16 of 44 patients, or 36 percent) or 5 million units of interferon alone (15 of 41; 37 percent) than in the untreated controls (3 of 43; 7 percent; P<0.001); the difference between those given 1 million units of interferon (7 of 41; 17 percent) and the controls was not significant. The strongest indep...

Pathological diagnosis of chronic hepatitis C: A multicenter comparative study with chronic hepatitis B

BACKGROUND Hepatic histological responses described in hepatitis C virus (HCV) infection include bile duct damage, lymphoid follicles and/or aggregates in portal tracts, large- and small-droplet fat, Mallory body-like material in hepatocytes, liver cell dysplasia and multinucleation, and activation of sinusoidal inflammatory cells. The specificity of these lesions for HCV infection is uncertain. METHODS In two multicenter trials of recombinant interferon alfa therapy for chronic hepatitis C and B, the frequency of these eight lesions in pretherapy and posttherapy liver biopsy specimens was examined to determine the set of features, if any, that distinguishes HCV from hepatitis B virus (HBV) infection. The lesions were scored in 317 HCV biopsy specimens and 299 HBV specimens. RESULTS Stepwise logistic regression determined a set of three features more likely to be seen in HCV than in HBV infection: bile duct damage [odds ratio (OR), 4.7; 95% confidence interval (Cl), 1.8-12.3], lymphoid follicles and/or aggregates (OR, 2.4; 95% Cl, 1.2-4.7), and large-droplet fat (OR, 2.4; 95% Cl, 1.4-4.1). A fourth lesion, Mallory body-like material, was seen only in HCV biopsy specimens (OR, 71.6; 95% Cl, 4.4-996.1). CONCLUSIONS These four histological lesions are useful pathological parameters in the diagnosis of liver disease caused by HCV.

484 PREDICTORS OF SUSTAINED VIROLOGIC RESPONSE AMONG GENOTYPE 1 PREVIOUS NON-RESPONDERS AND RELAPSERS TO PEGINTERFERON/RIBAVIRIN WHEN RE-TREATED WITH BOCEPREVIR PLUS PEGINTERFERON ALFA-2B/RIBAVIRIN

483 IMPORTANCE OF HCVRNA ASSAY CHARACTERISTICS AND DIFFERENCES BETWEEN ASSAYS FOR RESPONSE GUIDED THERAPY OF CHRONIC HEPATITIS C V. Weich, S. Schwendy, B. Moller, N. Dikopoulos, P. Buggisch, J. Encke, G. Teuber, T. Goeser, R. Thimme, H. Klinker, W. Boecher, E. Schulte-Frohlinde, S. Zeuzem, T. Berg, C. Sarrazin. J.W. Goethe University Hospital, Frankfurt/Main, Uniklinik TU Munchen, Munchen, Leberzentrum Checkpoint, Berlin, Uniklinik Ulm, Ulm, Uniklinik Hamburg, Hamburg, Uniklinik Heidelberg, Heidelberg, Interdisziplinares Facharztzentrum, Frankfurt, Uniklinik Koln, Koln, Uniklinik Freiburg, Freiburg im Breisgau, Uniklinik Wurzburg, Wurzburg, Uniklinik Mainz, Mainz, Uniklinik Leipzig, Leipzig, Germany E-mail: viola.weich@kgu.de

Cure of Hemophilia A by Orthotopic Liver Transplantation

A patient with hemophilia A and transfusion-associated end-stage chronic liver disease underwent orthotopic liver transplantation. He had no requirement for exogenous factor VIII replacement during the 27 mo he survived. Although his hemophilia was cured, he had antibodies to the human immunodeficiency virus; ultimately he died of complications arising from acquired immunodeficiency syndrome. Liver transplantation for cirrhotic hemophiliacs can free them of the need for antihemophilic-factor therapy; however, application of this approach may be limited by the high prevalence of human immunodeficiency virus infection in multitransfused hemophiliacs.

Treatment of chronic hepatitis C with recombinant α-interferon. A multicentre randomized, controlled trial

To assess the efficacy of therapy with the antiviral agent interferon in chronic hepatitis C (non-A, non-B hepatitis), we randomly assigned 166 chronic hepatitis C patients to treatment with either 3 million or 1 million units of recombinant interferon alfa-2b three times weekly for 24 weeks, or to no treatment. The probability of normalization or near normalization of the serum alanine aminotransferase levels after 6 months of interferon therapy was 46% in patients treated with 3 million units of interferon (p less than 0.001) and 28% in those treated with 1 million units (p less than 0.02), but only 8% in untreated patients. Serum alanine aminotransferase levels became completely normal in 22 of the 26 patients (85%) who responded to treatment with 3 million units of interferon and 9 of the 16 patients (56%) who responded to treatment with 1 million units. The patients who received 3 million units of interferon had histological improvement because of the regression of lobular and periportal inflammation. Relapse within 6 months after the completion of treatment occurred in 51% of the patients treated with 3 million units of interferon and 44% of those treated with 1 million units. We conclude that a 24-week course of interferon therapy is effective in controlling disease activity in many patients with hepatitis C, although relapse after the cessation of treatment is common.

Cholelithiasis and Choledocholithiasis

Figure 1. Cholelithiasis and Choledocholithiasis. An endoscopic retrograde cholangiogram from a 20-year-old woman with pain in the right upper quadrant and jaundice reveals stones in the left and right hepatic ducts (open arrows) and the common bile duct (small arrows) and multiple stones in the gallbladder (large arrow). The common bile duct is dilated, but the intrahepatic ducts are normal. A sphincterotomy was performed, the stones were extracted, and the patient had an uneventful laparoscopic cholecystectomy the following day.