Firdous Siddiqui

Impact of weight-based ribavirin with peginterferon alfa-2b in african americans with hepatitis C virus genotype 1

WIN‐R (Weight‐based dosing of pegINterferon alfa‐2b and Ribavirin) was a multicenter, randomized, open‐label, investigator‐initiated trial involving 236 community and academic sites in the United States, comparing response to pegylated interferon (PEG‐IFN) alfa‐2b plus a flat or weight‐based dose of ribavirin (RBV) in treatment‐naive patients with chronic hepatitis C and compensated liver disease. Patients were randomized to receive PEG‐IFN alfa‐2b at 1.5 μg/kg/week plus flat‐dose (800 mg/day) or weight‐based‐dose RBV (800 mg/day for weight <65 kg, 1000 mg/day for 65‐85 kg, 1200 mg/day for >85‐105 kg, or 1400 mg/day for >105‐<125 kg). Sustained virologic response (SVR; undetectable [<125 IU/mL] hepatitis C virus [HCV] RNA at end of follow‐up) in patients ≥65 kg was the primary end point. Low SVR rates have been reported among African American individuals, in whom there is a preponderance of HCV genotype 1. This subanalysis of WIN‐R was conducted to evaluate the efficacy of weight‐based dosing among African American individuals with genotype 1 infection enrolled in the trial. Of 362 African American patients in the primary efficacy analysis, 188 received RBV flat dosing and 174 received weight‐based dosing. SVR rates were higher (21% versus 10%; P = 0.0006) and relapse rates were lower (22% versus 30%) in the weight‐based‐dose group than in the flat‐dose group. Safety and rates of drug discontinuation were similar between the 2 groups. Conclusion: Weight‐based dosing of RBV is more effective than flat dosing in combination with PEG‐IFN alfa‐2b in African American individuals with HCV genotype 1. Even with weight‐based dosing, response rates in African American individuals are lower than reported in other ethnic groups. (HEPATOLOGY 2007.)

Prevalence of hepatitis A virus and hepatitis B virus immunity in patients with polymerase chain reaction-confirmed hepatitis C: Implications for vaccination strategy

OBJECTIVES:Administration of vaccine for hepatitis A virus (HAV) and hepatitis B virus (HBV) is recommended for patients with chronic hepatitis C (CHC) because of the potential for increased severity of acute hepatitis superimposed on existing liver disease. The aim of this study is to determine the prevalence of antibodies directed against HAV and HBV in patients with CHC, analyze demographic and risk factors associated with this prevalence, and develop a cost-effective vaccination strategy.METHODS:We reviewed records from 1092 CHC patients. Demographics and information regarding risk factors were obtained by history and questionnaire administered to all patients. The costs of vaccination and antibody testing were determined, based on standard laboratory and clinic charges at our institution. HAV and HBV markers were correlated to race, age, and risk factors.RESULTS:Of the total population studied (n = 1092), 72% were African-Americans, 27% white, and 1% others. Of 671 CHC patients tested for anti-HAV IgG, 252 (38%) were positive. Of 743 CHC patients tested for HBV antibodies (anti-hepatitis B core IgG or anti-hepatitis B surface), 494 (67%) were positive. African-Americans are more likely to have antibodies to HAV and HBV (67% and 75%, respectively) compared to whites (27% and 20%). The prevalence of anti-HAV was 76% in patients >60 yr, 34% in the 40- to 60-yr-old age group, and 21% in patients <40 yr. The highest prevalence of HBV antibodies was found in patients between the ages of 40–60 yr. No HCV risk factors were associated with increased HAV risk. In CHC patients with HBV antibodies, however, illicit injection drug use was the predominant risk factor.CONCLUSIONS:The prevalence of anti-HAV in patients with CHC was found to be similar to that of the general population in the United States (33% according to recent Centers for Disease Control data), consistent with the hypothesis that the two infections do not share risk factors. Because the prevalence of HAV immunity is low in CHC patients <40 yr, empiric HAV vaccination is cost effective. If two doses of vaccine are to be given, however, antibody testing of all HCV patients is indicated. In the subset of patients >60 yr of age or who are African-American, where the prevalence of HAV exposure is considerably higher, it would be cost effective to check the antibody (

Ultrasound diagnosis of fatty liver in patients with chronic liver disease: A retrospective observational study

36.00), before vaccination (

Intermediate-term outcomes of hepatitis C-positive compared with hepatitis C-negative deceased-donor renal allograft recipients

97.00). The prevalence of HBV antibodies, however, is significantly increased in patients with CHC compared with the general population (5.3% per the Centers for Disease Control), likely as a result of exposure to similar parenteral risk factors. HBV antibody testing (

Zinc Toxicity From Massive and Prolonged Coin Ingestion in an Adult

26.00 per test) should, therefore, be undertaken in all CHC patients who are hepatitis B surface antigen negative, as this approach is cost-effective compared to empiric HBV vaccination (

Acute and Chronic Hepatitis B

438.00 for a three injection course).

Symptomatic gastric sarcoidosis and the role of steroids

Objectives Hepatic ultrasound (US) is readily available and physicians usually trust the results of an US report suggesting fatty liver, but there are conflicting reports on its accuracy, especially in patients with chronic liver disease (CLD). Therefore, we retrospectively examined liver biopsies in patients with CLD and compared the histologic results to the hepatic US findings. Methods Liver biopsies were graded for fat (grades 0 to 3), inflammation (grades 0 to 4), and fibrosis (stages 0 to 4) in 131 patients with CLD (89% had chronic hepatitis C). Hepatic US interpretations were grouped into 3 categories—“normal,” “fatty liver,” and “nonspecific.” A secondary analysis was performed using 3 sonographic categories based on the echogenicity: normal, “increased echogenicity,” and “heterogenous.” The US results were then compared with the liver biopsy results. Results A normal US report was associated with many false negatives, as 25% of these patients had fat (grades 1 to 3) on biopsy; furthermore, 46% had “significant fibrosis” (stages 2 to 4) or “significant inflammation” (grades 2 to 4). A “fatty liver” interpretation correctly identified fat on biopsy in 36.4% and “significant fat” (grades 2 to 3) in 11.4%, but 66% had significant fibrosis or significant inflammation. An US with increased echogenicity correctly identified fat in 43.5% and significant fat in 19.4%, but 69.4% had significant fibrosis or significant inflammation. The sensitivity of an US ranged from 11.4% to 88.2% and the specificity ranged from 40.4% to 86.2%, depending on the degree of steatosis on biopsy and the sonographic interpretation being considered. Conclusions US is inaccurate for diagnosing hepatic steatosis in patients with CLD. Echogenic abnormalities are more likely to be the result of fibrosis or inflammation in this setting.

Percutaneous Liver Biopsy Is Safe in Chronic Hepatitis C Patients With End-Stage Renal Disease

BACKGROUND Prior studies have yielded conflicting results concerning the impact of HCV on renal transplant outcomes. METHODS We examined outcomes in comparable groups of predominantly African American hepatitis C virus (HCV)-positive (n = 34) and HCV-negative (n = 111) kidney transplant patients receiving contemporary immunosuppression. RESULTS There was no difference in patient survival or acute rejection, but new-onset diabetes (NODM) was increased and graft survival decreased in the HCV-positive group, with increased graft loss secondary to noncompliance and Type I MPGN. The incidence of NODM among patients undergoing early corticosteroid withdrawal was 11% in both groups, while among those on prednisone, it was 47% in HCV-positive versus 25% in HCV-negative recipients. CONCLUSIONS Deceased-donor HCV-positive renal allograft recipients have equivalent patient but decreased graft survival. Noncompliance and Type I MPGN play a role in producing this negative effect on graft outcome. Steroids may be required for HCV to exert its diabetogenicity in kidney transplant patients.

Demographics of a large cohort of urban chronic hepatitis C patients

Acquired copper deficiency anemia is rare in humans. This report describes a 38-year-old schizophrenic man with metal pica, especially coins, who presented with symptomatic anemia. Two hundred seventy-five coins were surgically removed from the gastrointestinal tract of this patient during the course of his hospitalization. Some of the post-1981 pennies, which consist primarily of zinc, showed severe corrosion because of their prolonged contact with acidic gastric juice. The patient presented with clinical manifestations consistent with the local corrosive as well as the systemic effects of zinc intoxication. His treatment and outcome are presented. The effects of zinc intoxication on hematologic and other organ systems and on copper absorption are discussed.

T1976 Defining the Etiology in Patients Referred for Elevated Serum Aminotransferases in an Urban Community

Hepatitis B virus (HBV) infection is a serious worldwide public health problem with an estimated 300 to 350 million people, approximately 5% of the world population, exhibiting evidence of chronic infection [1]. Using two large databases to measure the health burden of HBV in the United States (US), Kim et al. [2] found that age-adjusted mortality had increased from 0.1 per 100,000 to 0.4 per 100,000 between the years 1979 and 1998. Newly acquired HBV infection in the United States occurred in approximately 78,000 individuals in the year 2001, a significant decrease from the 300,000 cases per annum reported in the mid-1980s [2,3]. The greatest decline occurred among persons 10 to 19 years old (72.5%), followed by those 20 to 29 years old (70.6%) and 30 to 39 years old (53.4%) (P < 0.001 for each age group, 1982 to 1988 vs 1994 to 1998) [4]. In 2001, HBV infection accounted for 40% of the acute viral hepatitis cases reported in the United States [3], and approximately 4.9% of the US population had been infected with HBV, with an estimated 1 to 1.25 million carriers [3].