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Skeie L, Skrede T, Maeland A. A minority of tuberculosis cases occurring during HIV care is possibly preventable. J Int AIDS Soc 2010. [PMCID: PMC3112976 DOI: 10.1186/1758-2652-13-s4-p194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Mocroft A, Rockstroh J, Soriano V, Ledergerber B, Kirk O, Vinogradova E, Reiss P, Katlama C, Phillips AN, Lundgren JD, Losso M, Duran A, Vetter N, Karpov I, Vassilenko A, Clumeck N, De Wit S, Poll B, Machala L, Rozsypal H, Sedlacek D, Nielsen J, Lundgren J, Benfield T, Kirk O, Gerstoft J, Katzenstein T, Hansen ABE, Skinhøj P, Pedersen C, Zilmer K, Katlama C, Viard JP, Girard PM, Marc TS, Vanhems P, Pradier C, Dabis F, Dietrich M, Manegold C, Van Lunzen J, Stellbrink HJ, Staszewski S, Bickel M, Goebel FD, Fätkenheuer G, Rockstroh J, Schmidt R, Kosmidis J, Gargalianos P, Sambatakou H, Perdios J, Panos G, Banhegyi D, Mulcahy F, Yust I, Turner D, Burke M, Pollack S, Hassoun G, Sthoeger Z, Maayan S, Vella S, Chiesi A, Arici C, Pristerá R, Mazzotta F, Gabbuti A, Esposito R, Bedini A, Chirianni A, Montesarchio E, Vullo V, Santopadre P, Narciso P, Antinori A, Franci P, Zaccarelli M, Lazzarin A, Finazzi R, Monforte AD, Viksna L, Chaplinskas S, Hemmer R, Staub T, Reiss P, Bruun J, Maeland A, Ormaasen V, Knysz B, Gasiorowski J, Horban A, Prokopowicz D, Wiercinska-Drapalo A, Boron-Kaczmarska A, Pynka M, Beniowski M, Mularska E, Trocha H, Antunes F, Valadas E, Mansinho K, Matez F, Duiculescu D, Streinu-Cercel A, Vinogradova E, Rakhmanova A, Jevtovic D, Mokrás M, Staneková D, González-Lahoz J, Sánchez-Conde M, García-Benayas T, Martin-Carbonero L, Soriano V, Clotet B, Jou A, Conejero J, Tural C, Gatell JM, Miró JM, Blaxhult A, Karlsson A, Pehrson P, Ledergerber B, Weber R, Francioli P, Telenti A, Hirschel B, Soravia-Dunand V, Furrer H, Chentsova N, Barton S, Johnson AM, Mercey D, Phillips A, Johnson MA, Mocroft A, Murphy M, Weber J, Scullard G, Fisher M, Brettle R, Loveday C, Clotet B, Antunes F, Blaxhult A, Clumeck N, Gatell J, Horban A, Johnson A, Katlama C, Ledergerber B, Loveday C, Phillips A, Reiss P, Vella S, Lundgren J, Gjørup I, Kirk O, Friis-Moeller N, Mocroft A, Cozzi-Lepri A, Bannister W, Mollerup D, Podlevkareva D, Olsen CH, Kjær J. Are Specific Antiretrovirals associated with an Increased Risk of Discontinuation due to Toxicities or Patient/Physician Choice in patients with Hepatitis C Virus Coinfection? Antivir Ther 2005. [DOI: 10.1177/135965350501000704] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Liver damage associated with hepatitis C (HCV) may influence the likelihood of experiencing discontinuation due to toxicities or patient/physician choice (TOXPC) in patients taking combination antiretroviral therapy (cART). Little information to address this concern is available from clinical trials as patients with HCV are often excluded. Aims To compare incidence rates of discontinuation due to TOXPC associated with specific antiretrovial drugs in patients with or without HCV. Patients/methods A total of 4929 patients from EuroSIDA under follow-up from January 1999 on a specific nucleoside pair (zidovudine/lamivudine, didanosine/stavudine, stavudine/lamivudine, or other) with a third drug (abacavir, nelfinavir, indinavir, nevirapine, efavirenz, lopinavir/ ritonavir or other boosted-protease inhibitor (PI)-containing regimen) and with known HCV serostatus were studied for the incidence of discontinuation of any nucleoside pair or third drug due to TOXPC. Incidence rate ratios were derived from Poisson regression models. Results In total 1358 patients had HCV (27.5%). During 12 799 person-years of follow-up there were 2141 discontinuations due to TOXPC for nucleoside pairs and 2501 for third drugs. The incidence of discontinuation due to TOXPC was consistently higher in patients with HCV after stratification by nucleoside pair or third drug. After adjustment for CD4+ count, gender, exposure group, time on HAART, region and treatment regimen, there were few differences in the rate of discontinuation due to TOXPC in those with HCV compared with those without for any nucleoside pairs or third drugs. Similar results were seen when concentrating on discontinuation due to toxicities alone. Conclusions Although patients with HCV generally had higher rates of discontinuation due to TOXPC compared with patients without HCV, there was little evidence to suggest that this was associated with any specific nucleoside pair or third drug used as part of cART. Our results do not suggest that any specific component of cART is more poorly tolerated in patients with HCV or that the presence of HCV should influence the choice between antiretrovirals used as part of a cART regimen.
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Affiliation(s)
- Amanda Mocroft
- Royal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
| | | | | | | | - Ole Kirk
- Copenhagen HIV Program, Hvidovre Hospital, Copenhagen, Denmark
| | | | - Peter Reiss
- Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, the Netherlands
| | | | - Andrew N Phillips
- Royal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
| | - Jens D Lundgren
- Copenhagen HIV Program, Hvidovre Hospital, Copenhagen, Denmark
| | - M Losso
- Hospital JM Ramos Mejia, Buenos Aires
| | - A Duran
- Hospital JM Ramos Mejia, Buenos Aires
| | - N Vetter
- Pulmologisches Zentrum der Stadt Wien, Vienna
| | - I Karpov
- Belarus State Medical University, Minsk
| | | | - N Clumeck
- Saint-Pierre Hospital, Brussels; R Colebunders, Institute of Tropical Medicine, Antwerp
| | - S De Wit
- Saint-Pierre Hospital, Brussels; R Colebunders, Institute of Tropical Medicine, Antwerp
| | - B Poll
- Saint-Pierre Hospital, Brussels; R Colebunders, Institute of Tropical Medicine, Antwerp
| | | | | | | | | | | | | | - O Kirk
- Hvidovre Hospital, Copenhagen
| | | | | | | | | | | | - K Zilmer
- West-Tallinn Central Hospital, Tallinn
| | - C Katlama
- Hôpital de la Pitié-Salpétière, Paris
| | - J-P Viard
- Hôpital Necker-Enfants Malades, Paris
| | | | | | | | | | | | - M Dietrich
- Bernhard-Nocht-Institut for Tropical Medicine, Hamburg
| | - C Manegold
- Bernhard-Nocht-Institut for Tropical Medicine, Hamburg
| | | | | | | | - M Bickel
- JW Goethe University Hospital, Frankfurt
| | | | | | | | | | | | | | | | | | - G Panos
- A Filandras and E Karabatsaki, 1st IKA Hospital, Athens
| | | | | | - I Yust
- Ichilov Hospital, Tel Aviv
| | | | | | | | | | | | - S Maayan
- Hadassah University Hospital, Jerusalem
| | - S Vella
- Istituto Superiore di Sanita, Rome
| | - A Chiesi
- Istituto Superiore di Sanita, Rome
| | | | | | | | - A Gabbuti
- Ospedale S. Maria Annunziata, Florence
| | | | | | | | | | - V Vullo
- Università di Roma La Sapienza, Rome
| | | | | | | | | | | | | | | | | | - L Viksna
- Infectology Centre of Latvia, Riga
| | | | | | - T Staub
- Centre Hospitalier, Luxembourg
| | - P Reiss
- Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam
| | | | | | | | | | | | - A Horban
- Centrum Diagnostyki i Terapii AIDS, Warsaw
| | | | | | | | | | | | - E Mularska
- Osrodek Diagnostyki i Terapii AIDS, Chorzow
| | | | | | | | | | - F Matez
- Hospital Curry Cabral, Lisbon
| | - D Duiculescu
- Spitalul de Boli Infectioase si Tropicale: Dr. Victor Babes, Bucarest
| | | | | | | | - D Jevtovic
- The Institute for Infectious and Tropical Diseases, Belgrade
| | | | | | | | | | | | | | | | - B Clotet
- Hospital Germans Trias i Pujol, Badalona
| | - A Jou
- Hospital Germans Trias i Pujol, Badalona
| | - J Conejero
- Hospital Germans Trias i Pujol, Badalona
| | - C Tural
- Hospital Germans Trias i Pujol, Badalona
| | - JM Gatell
- Hospital Clinic i Provincial, Barcelona
| | - JM Miró
- Hospital Clinic i Provincial, Barcelona
| | | | - A Karlsson
- Karolinska University Hospital, Stockholm
| | - P Pehrson
- Karolinska University Hospital, Huddinge
| | | | | | - P Francioli
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - A Telenti
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - B Hirschel
- Hospital Cantonal Universitaire de Geneve, Geneve
| | | | | | | | - S Barton
- St. Stephen's Clinic, Chelsea and Westminster Hospital, London
| | - AM Johnson
- Royal Free and University College London Medical School, London (University College Campus)
| | - D Mercey
- Royal Free and University College London Medical School, London (University College Campus)
| | - A Phillips
- Royal Free and University College Medical School, London (Royal Free Campus)
| | - MA Johnson
- Royal Free and University College Medical School, London (Royal Free Campus)
| | - A Mocroft
- Royal Free and University College Medical School, London (Royal Free Campus)
| | - M Murphy
- Medical College of Saint Bartholomew's Hospital, London
| | - J Weber
- Imperial College School of Medicine at St. Mary's, London
| | - G Scullard
- Imperial College School of Medicine at St. Mary's, London
| | - M Fisher
- Royal Sussex County Hospital, Brighton
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Cozzi-Lepri A, Ruiz L, Loveday C, Phillips AN, Clotet B, Reiss P, Ledergerber B, Holkmann C, Staszewski S, Lundgren JD, Losso M, Duran A, Vetter N, Clumeck N, De Wit S, Poll B, Colebunders R, Machala L, Rozsypal H, Nielsen J, Lundgren J, Kirk O, Olsen CH, Gerstoft J, Katzenstein T, Hansen ABE, Skinhøj P, Pedersen C, Zilmer K, Rauka M, Katlama C, De Sa M, Viard JP, Marc TS, Vanhems P, Pradier C, Dietrich M, Manegold C, Van Lunzen J, Stellbrink HJ, Miller V, Staszewski S, Goebel FD, Salzberger B, Rockstroh J, Schmidt RE, Stoll M, Kosmidis J, Gargalianos P, Sambatakou H, Perdios J, Panos G, Banhegyi D, Mulcahy F, Yust I, Burke M, Pollack S, Hassoun J, Sthoeger Z, Maayan S, Vella S, Chiesi A, Arici C, Pristerá R, Mazzotta F, Gabbuti A, Esposito R, Bedini A, Chirianni A, Montesarchio E, Vullo V, Santopadre P, Narciso P, Antinori A, Franci P, Zaccarelli M, Lazzarin A, Castagna A, Monforte D, Viksna L, Rozentale B, Chaplinskas S, Hemmer R, Staub T, Reiss P, Bruun J, Maeland A, Ormaasen V, Knysz B, Gasiorowski J, Horban A, Prokopowicz D, Drapalo AW, Kaczmarska AB, Pynka M, Beniowski M, Trocha H, Smiatacz T, Antunes F, Mansinho K, Maltez F, Duiculescu D, Babes V, Cercel AS, Mokrás M, Staneková D, González-Lahoz J, Diaz B, García-Benayas T, Carbonero LM, Soriano V, Clotet B, Jou A, Conejero J, Tural C, Gatell JM, Miró JM, Zamora L, Blaxhult A, Karlsson A, Pehrson P, Ledergerber B, Weber R, Francioli P, Hirschel B, Schiffer V, Furrer H, Chentsova N, Barton S, Johnson AM, Mercey D, Youle M, Phillips A, Johnson MA, Mocroft A, Murphy M, Weber J, Scullard G, Fisher M, Brettle R, Loveday C, Clotet B, Ruiz L, Antunes F, Blaxhult A, Clumeck N, Gatell J, Horban A, Johnson A, Katlama C, Ledergerber B, Loveday C, Phillips A, Reiss P, Vella S, Lundgren J, Gjørup I, Kirk O, Moeller NF, Mocroft A, Lepri AC, Bannister W, Mollerup D, Nielsen M, Hansen A, Kristensen D, Kolte L, Hansen L, Kjær J. Thymidine Analogue Mutation Profiles: Factors Associated with Acquiring Specific Profiles and their Impact on the Virological Response to Therapy. Antivir Ther 2005. [DOI: 10.1177/135965350501000705] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Studies have suggested that HIV-1 may develop thymidine analogue mutations (TAMs) by one of two distinct pathways – the TAM1 pathway (including mutations 41L, 210W and 215Y) or the TAM2 pathway (including mutations 67N, 70R and 219E/Q) – under the pressure of a not fully suppressive thymidine-analogue-containing regimen. Methods Frozen plasma samples stored in the EuroSIDA repository were selected and sent to two central laboratories for genotypic analysis. We considered 733 patients with at least one genotypic test showing ≥1 TAMs (the first of these tests in chronological order was used). TAM1 and TAM2 genotypic profiles were defined in accordance with previous literature. Statistical modelling involved logistic regression and linear regression analysis for censored data. Results The observed frequencies of patterns classifiable as TAM1 or TAM2 profiles were markedly higher than the probabilities of falling into these classifications by chance alone. The chance of detecting a TAM2 profile increased by 25% per additional year of exposure to zidovudine. We found that mutations 67N and 184V were not associated with a particular TAM profile. In the presence of TAM2 profiles, the adjusted mean difference in the 6-month viral reduction was 0.96 log10 copies/ml (95% confidence interval: 0.20; 1.73) higher in patients who started stavudine-containing regimens instead of zidovudine-containing regimens. Conclusions This study provides evidence that the suggested TAM clustering is a real phenomenon and that it may be driven by which thymidine analogue the patients has used. In patients with TAM2-resistant viruses, stavudine appears to retain greater viral activity than zidovudine.
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Affiliation(s)
| | - Lidia Ruiz
- IrsiCaixa Foundation, Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain
| | - Clive Loveday
- International Clinical Virology Center (ICVC), High Wycombe, UK
| | | | - Bonaventura Clotet
- IrsiCaixa Foundation, Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain
| | - Peter Reiss
- Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, Switzerland
| | | | | | - Jens D Lundgren
- Copenhagen HIV Programme, Hvidovre University Hospital, Denmark
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Cabrera C, Cozzi-Lepri A, Phillips AN, Loveday C, Kirk O, Ait-Khaled M, Reiss P, Kjær J, Ledergerber B, Lundgren JD, Clotet B, Ruiz L, Losso M, Duran A, Vetter N, Clumeck N, Hermans P, Sommereijns B, Colebunders R, Machala L, Rozsypal H, Nielsen J, Lundgren J, Benfield T, Kirk O, Gerstoft J, Katzenstein T, Røge B, Skinhøj P, Pedersen C, Zilmer K, Katlama C, De Sa M, Viard JP, Saint-Marc T, Vanhems P, Pradier C, Dietrich M, Manegold C, van Lunzen J, Stellbrink HJ, Miller V, Staszewski S, Goebel FD, Salzberger B, Rockstroh J, Kosmidis J, Gargalianos P, Sambatakou H, Perdios J, Panos G, Karydis I, Filandras A, Banhegyi D, Mulcahy F, Yust I, Burke M, Pollack S, Ben-Ishai Z, Bentwich Z, Maayan S, Vella S, Chiesi A, Arici C, Pristerá R, Mazzotta F, Gabbuti A, Esposito R, Bedini A, Chirianni A, Montesarchio E, Vullo V, Santopadre P, Narciso P, Antinori A, Franci P, Zaccarelli M, Lazzarin A, Finazzi R, D'Arminio Monforte A, Viksna L, Chaplinskas S, Hemmer R, Staub T, Reiss P, Bruun J, Maeland A, Ormaasen V, Knysz B, Gasiorowski J, Horban A, Prokopowicz D, Wiercinska-Drapalo A, Boron-Kaczmarska A, Pynka M, Beniowski M, Trocha H, Antunes F, Mansinho K, Proenca R, Duiculescu D, Streinu-Cercel A, Mikras M, González-Lahoz J, Diaz B, García-Benayas T, Martin-Carbonero L, Soriano V, Clotet B, Jou A, Conejero J, Tural C, Gatell JM, Miró JM, Blaxhult A, Karlsson A, Pehrson P, Ledergerber B, Weber R, Francioli P, Telenti A, Hirschel B, Soravia-Dunand V, Furrer H, Chentsova N, Barton S, Johnson AM, Mercey D, Phillips A, Loveday C, Johnson MA, Mocroft A, Pinching A, Parkin J, Weber J, Scullard G, Fisher M, Brettle R. Baseline Resistance and Virological Outcome in Patients with Virological Failure who Start a Regimen Containing Abacavir: Eurosida Study. Antivir Ther 2004. [DOI: 10.1177/135965350400900509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To investigate the ability of several HIV-1 drug-resistance interpretation systems, as well as the number of pre-specified combinations of abacavir-related mutations, to predict virological response to abacavir-containing regimens in antiretroviral therapy-experienced, abacavir-naive patients starting an abacavir-containing regimen in the EuroSIDA cohort. Patients and methods A total of 100 HIV-infected patients with viral load (VL) >500 copies/ml who had a plasma sample available at the time of starting abacavir (baseline) were included. Resistance to abacavir was interpreted by using eight different commonly used systems that consisted of rules-based algorithms or tables of mutations. Correlation between baseline abacavir-resistance mutations and month 6 virological response was performed on this population using a multivariable linear regression model accounting for censored data. Results The baseline VL was 4.36 log10 RNA copies/ml [interquartile range (IQR): 3.65–4.99 log10 RNA copies/ml] and the median CD4 cell count was 210 cells/μl (IQR: 67–305 cells/μl). Our patients were pre-exposed to a median of seven antiretrovirals (2–12) before starting abacavir therapy. The median (range) number of abacavir mutations (according to the International AIDS Society-USA) detected at baseline was 3.5 (0–8). Overall, the Kaplan–Meier estimate of the median month 6 VL decline was 0.86 log10 RNA copies/ml [95% confidence intervals (95% CI): 0.45–1.24]. The VL in those patients ( n=31) who intensified treatment by adding only abacavir decreased by a median 0.20 log10 RNA copies/ml (95% CI: -0.18; +0.94). The proportion of patients who harboured viruses fully resistant to abacavir among the eight genotypic resistance interpretation algorithms ranged from 12% [Agence Nationale de Recherches sur le SIDA (ANRS)] to 79% [Stanford HIV RT and PR Sequence Database (HIVdb)]. Some interpretation systems showed statistically significant associations between the predicted resistance status and the virological response while others showed no consistent association. The number of active drugs in the regimen was associated with greater virological suppression (additional month 6 VL reduction per additional sensitive drug=0.51, 95% CI: 0.15–0.88, P=0.006); baseline VL was also weakly associated (additional month 6 VL reduction per log10 higher=0.30, 95% CI: -0.02; +0.62, P=0.06). In contrast, the number of drugs previously received was associated with diminished viral reduction (additional month 6 VL reduction per additional drug=-0.14, 95% CI: -0.28; 0.00, P=0.05). Conclusions Our results revealed a high degree of variability among several genotypic resistance interpretation algorithms currently in use for abacavir. Therefore, the interpretation of genotypic resistance for predicting response to regimens containing abacavir remains a major challenge.
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Affiliation(s)
| | - Cecilia Cabrera
- IrsiCaixa Foundation & Lluita contra la SIDA Foundation, Badalona, Spain
| | | | | | - Clive Loveday
- International Clinical Virology Centre (ICVC), Buckinghamshire, UK
| | - Ole Kirk
- EuroSIDA Coordinating Centre, Hvidovre University Hospital, Hvidovre, Denmark
| | | | - Peter Reiss
- Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, the Netherlands
| | - Jesper Kjær
- EuroSIDA Coordinating Centre, Hvidovre University Hospital, Hvidovre, Denmark
| | | | - Jens D Lundgren
- EuroSIDA Coordinating Centre, Hvidovre University Hospital, Hvidovre, Denmark
| | - Bonaventura Clotet
- IrsiCaixa Foundation & Lluita contra la SIDA Foundation, Badalona, Spain
| | - Lidia Ruiz
- IrsiCaixa Foundation & Lluita contra la SIDA Foundation, Badalona, Spain
| | - M Losso
- Hospital JM Ramos Mejia, Buenos Aires. Argentina
| | - A Duran
- Hospital JM Ramos Mejia, Buenos Aires. Argentina
| | - N Vetter
- Pulmologisches Zentrum der Stadt Wien, Vienna. Austria
| | - N Clumeck
- Saint-Pierre Hospital, Brussels; Belgium
| | - P Hermans
- Saint-Pierre Hospital, Brussels; Belgium
| | | | | | - L Machala
- Faculty Hospital Bulovka, Prague. Czech Republic
| | - H Rozsypal
- Faculty Hospital Bulovka, Prague. Czech Republic
| | - J Nielsen
- Hvidovre Hospital, Copenhagen; Denmark
| | | | | | - O Kirk
- Hvidovre Hospital, Copenhagen; Denmark
| | | | | | - B Røge
- Rigshospitalet, Copenhagen
| | | | | | - K Zilmer
- Tallinn Merimetsa Hospital, Tallinn. Estonia
| | - C Katlama
- Hôpital de la Pitié-Salpêtière, Paris; France
| | - M De Sa
- Hôpital de la Pitié-Salpêtière, Paris; France
| | - J-P Viard
- Hôpital Necker-Enfants Malades, Paris
| | | | | | | | - M Dietrich
- Bernhard-Nocht-Institut for Tropical Medicine, Hamburg; Germany
| | - C Manegold
- Bernhard-Nocht-Institut for Tropical Medicine, Hamburg; Germany
| | | | | | - V Miller
- JW Goethe University Hospital, Frankfurt
| | | | | | | | | | | | | | | | - J Perdios
- Athens General Hospital, Athens; Greece
| | | | | | | | | | - F Mulcahy
- St James's Hospital, Dublin. Ireland
| | - I Yust
- Ichilov Hospital, Tel Aviv; Israel
| | - M Burke
- Ichilov Hospital, Tel Aviv; Israel
| | | | | | | | - S Maayan
- Hadassah University Hospital, Jerusalem
| | - S Vella
- Istituto Superiore di Sanita, Rome; Italy
| | - A Chiesi
- Istituto Superiore di Sanita, Rome; Italy
| | | | | | | | - A Gabbuti
- Ospedale S Maria Annunziata, Florence
| | | | | | | | | | - V Vullo
- Università di Roma La Sapienza, Rome
| | | | | | | | | | | | | | | | | | - L Viksna
- Infectology Centre of Latvia, Riga. Latvia
| | | | - R Hemmer
- Centre Hospitalier, Luxembourg. Luxembourg
| | - T Staub
- Centre Hospitalier, Luxembourg. Luxembourg
| | - P Reiss
- Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam. Netherlands
| | - J Bruun
- Ullevål Hospital, Oslo. Norway
| | | | | | - B Knysz
- Medical University, Wroclaw; Poland
| | | | - A Horban
- Centrum Diagnostyki i Terapii AIDS, Warsaw
| | | | | | | | | | | | | | - F Antunes
- Hospital Santa Maria, Lisbon; Portugal
| | | | | | - D Duiculescu
- Spitalul de Boli Infectioase si Tropicale Dr Victor Babes, Bucharest; Romania
| | | | - M Mikras
- Derrer Hospital, Bratislava. Slovakia
| | | | - B Diaz
- Hospital Carlos III, Madrid; Spain
| | | | | | | | - B Clotet
- Hospital Germans Trias i Pujol, Barcelona
| | - A Jou
- Hospital Germans Trias i Pujol, Barcelona
| | - J Conejero
- Hospital Germans Trias i Pujol, Barcelona
| | - C Tural
- Hospital Germans Trias i Pujol, Barcelona
| | - JM Gatell
- Hospital Clinic i Provincial, Barcelona
| | - JM Miró
- Hospital Clinic i Provincial, Barcelona
| | | | | | | | | | | | - P Francioli
- Centre Hospitalier Universitaire Vaudois, Lausanne; Switzerland
| | - A Telenti
- Centre Hospitalier Universitaire Vaudois, Lausanne; Switzerland
| | - B Hirschel
- Hospital Cantonal Universitaire de Geneve, Geneve
| | | | | | | | - S Barton
- St Stephen's Clinic, Chelsea and Westminster Hospital, London; United Kingdom
| | - AM Johnson
- Royal Free and University College London Medical School, London University College Campus
| | - D Mercey
- Royal Free and University College London Medical School, London University College Campus
| | - A Phillips
- Royal Free and University College Medical School, London Royal Free Campus
| | - C Loveday
- Royal Free and University College Medical School, London Royal Free Campus
| | - MA Johnson
- Royal Free and University College Medical School, London Royal Free Campus
| | - A Mocroft
- Royal Free and University College Medical School, London Royal Free Campus
| | - A Pinching
- Medical College of Saint Bartholomew's Hospital, London
| | - J Parkin
- Medical College of Saint Bartholomew's Hospital, London
| | - J Weber
- Imperial College School of Medicine at St Mary's, London
| | - G Scullard
- Imperial College School of Medicine at St Mary's, London
| | - M Fisher
- Royal Sussex County Hospital, Brighton
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5
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Bjøro K, Bell H, Hellum KB, Skaug K, Raknerud N, Sandvei P, Døskeland B, Maeland A, Lund-Tønnesen S, Myrvang B. Effect of combined interferon-alpha induction therapy and ribavirin on chronic hepatitis C virus infection: a randomized multicentre study. Scand J Gastroenterol 2002; 37:226-32. [PMID: 11843062 DOI: 10.1080/003655202753416920] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The efficacy of interferon-alpha (IFN) induction in combination with ribavirin for chronic hepatitis C virus (HCV) infection is not known. METHODS A total of 256 treatment-naive HCV RNA-positive patients with biopsy-confirmed chronic hepatitis were enrolled in a randomized multicentre study. The patients received either standard combination therapy with 3 MIU interferon-alpha2b thrice weekly for 26 weeks or 6 MIU interferon-alpha2b daily for 4 weeks and 3 MIU 3/7 days for 22 weeks. All patients received ribavirin 1000 mg or 1200 mg (weight dependent) daily during the 26-week treatment period. Patients were monitored for HCV RNA during and following treatment. RESULTS The sustained virological response rates (26 weeks after end of treatment) were 54% and 47% for patients receiving IFN induction/ribavirin and standard IFN/ribavirin, respectively (P = 0.35). Among patients infected with genotype 1a/1b, the sustained response rates were 32% and 35%. In patients infected with genotype 2b/3a IFN induction/ribavirin led to a sustained response rate of 80% as compared to 65% in the standard combination therapy group (P = 0.073). Steatosis was more frequently seen in liver biopsies from patients infected with genotype 3a as compared to genotypes la/lb. Among genotype 1a/1b infected patients. steatosis was a highly significant predictor of failure to achieve sustained virological response. Logistic regression analysis (multivariate analysis) showed that independent predictors of sustained virological response were low age, female gender, genotype 2b/3a and HCV RNA negativity at 2 weeks. CONCLUSIONS IFN induction in combination with ribavirin does not increase the sustained virological response rate among patients infected with HCV. Absence of steatosis is an independent predictor of sustained virological response in patients infected with genotypes 1a/1b.
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Affiliation(s)
- K Bjøro
- Medical Depts., National Hospital, Aker Hospital, Central Hospital, Akershus, Oslo, Norway.
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6
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Mocroft A, Phillips AN, Friis-Møller N, Colebunders R, Johnson AM, Hirschel B, Saint-Marc T, Staub T, Clotet B, Lundgren JD, Ledergerber B, Antunes F, Blaxhult A, Clumeck N, Gatell JM, Horban A, Johnson AM, Katlama C, Loveday C, Phillips A, Reiss P, Vella S, Vetter N, Clumeck N, Hermans P, Sommereijns B, Colebunders R, Machala L, Rozsypal H, Nielsen J, Lundgren J, Benfield T, Kirk O, Gerstoft J, Katzenstein T, Røge B, Skinhøj P, Pedersen C, Katlama C, Rivière C, Viard JP, Saint-Marc T, Vanhems P, Pradier C, Dietrich M, Manegold C, van Lunzen J, Miller V, Staszewski S, Goebel FD, Salzberger B, Rockstroh J, Kosmidis J, Gargalianos P, Sambatakou H, Perdios J, Panos G, Karydis I, Filandras A, Banhegyi D, Mulcahy F, Yust I, Turner D, Pollack S, Ben-Ishai Z, Bentwich Z, Maayan S, Vella S, Chiesi A, Arici C, Pristerá R, Mazzotta F, Gabbuti A, Esposito R, Bedini A, Chirianni A, Montesarchio E, Vullo V, Santopadre P, Narciso P, Antinori A, Franci P, Zaccarelli M, Lazzarin A, Finazzi R, Monforte AD, Hemmer R, Staub T, Reiss P, Bruun J, Maeland A, Ormaasen V, Knysz B, Gasiorowski J, Horban A, Prokopowicz D, Wiercinska-Drapalo A, Boron-Kaczmarska A, Pynka M, Beniowski M, Trocha H, Antunes F, Mansinho K, Proenca R, González-Lahoz J, Diaz B, García-Benayas T, Martin-Carbonero L, Soriano V, Clotet B, Jou A, Conejero J, Tural C, Gatell JM, Miró JM, Blaxhult A, Heidemann B, Pehrson P, Ledergerber B, Weber R, Francioli P, Telenti A, Hirschel B, Soravia-Dunand V, Barton S, Johnson AM, Mercey D, Phillips A, Loveday C, Johnson MA, Mocroft A, Pinching A, Parkin J, Weber J, Scullard G, Fisher M, Brettle R, Lundgren J, Gjørup I, Kirk O, Friis-Moeller N, Mocroft A, Cozzi-Lepri A, Mollerup D, Nielsen M, Hansen A, Kristensen D, Aabolt S, Cimposeu P, Hansen L, Kjær J. Response to Antiretroviral Therapy among Patients Exposed to Three Classes of Antiretrovirals: Results from the Eurosida Study. Antivir Ther 2002. [DOI: 10.1177/135965350200700103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is an increasing proportion of HIV-positive patients exposed to all licensed classes of antiretrovirals, and the response to salvage regimens may be poor. Among over 8500 patients in EuroSIDA, the proportion of treated patients exposed to nucleosides, protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitor (NNRTI) increased from 0% in 1996 to 47% in 2001. Four-hundred-and-thirteen patients, who had failed virologically two highly active antiretroviral therapy (HAART) regimens and experienced all three main drug classes, started a salvage regimen of at least three drugs, in which at least one new PI or NNRTI was included. Median viral load was 4.7 log copies/ml [Interquartile range (IQR) 4.2–5.2], CD4 lymphocyte count 150/mm3 (IQR 60–274/mm3) and follow-up 14 months. Of these patients, 283 (69%) subsequently experienced at least a 1 log decline in viral load and 202 (49%) achieved a viral load <500 copies/ml. Conversely, the CD4 count halved from the baseline value in 88 (21%), and 45 (11%) experienced a new AIDS-defining disease. In multivariable analyses, a 1 log viral load reduction was related to baseline viral load [relative hazard (RH) 1.27 per 1 log higher; P=0.008], a previous viral load of less than 500 copies/ml (RH 1.69; P=0.002), more recent initiation of the regimen (RH 1.36 per year more recent; P=0.02), number of new drugs in the regimen (RH 1.20 per drug; P=0.02), time since start of antiretroviral therapy (RH 0.94 per extra year; P=0.035) and time spent on HAART with viral load >1000 copies/ml (RH 0.96 per extra month; P=0.0001). Analysis of factors associated with CD4 count decline and new AIDS disease also indicated improved outcomes in more recent times and a tendency for a better response in those starting more new drugs, but no relationship with the total number of drugs. Outcomes in people starting salvage regimens appear to depend on the number of new drugs started but not on the total number of drugs being used.
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Affiliation(s)
- A Mocroft
- Royal Free Centre for HIV Medicine, Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
| | - AN Phillips
- Royal Free Centre for HIV Medicine, Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
| | - N Friis-Møller
- EuroSIDA Coordinating Centre, Hvidovre Hospital, Hvidovre, Denmark
| | | | - AM Johnson
- Royal Free Centre for HIV Medicine, Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
| | - B Hirschel
- Hospital Cantonal Universitaire de Geneve, Geneva, Switzerland
| | | | - T Staub
- Centre Hospitalier, Luxembourg
| | - B Clotet
- Hospital Germans Trias I Pujol, Barcelona, Spain
| | - JD Lundgren
- EuroSIDA Coordinating Centre, Hvidovre Hospital, Hvidovre, Denmark
| | | | | | | | | | | | | | | | | | | | | | | | | | - N Vetter
- Pulmologisches Zentrum der Stadt Wien, Vienna
| | | | | | | | | | | | | | | | | | | | - O Kirk
- Hvidovre Hospital, Copenhagen
| | | | | | - B Røge
- Rigshospitalet, Copenhagen
| | | | | | - C Katlama
- Hôpital de la Pitié-Salpétière, Paris
| | - C Rivière
- Hôpital de la Pitié-Salpétière, Paris
| | - J-P Viard
- Hôpital Necker-Enfants Malades, Paris
| | | | | | | | - M Dietrich
- Bernhard-Nocht-Institut for Tropical Medicine, Hamburg
| | - C Manegold
- Bernhard-Nocht-Institut for Tropical Medicine, Hamburg
| | | | - V Miller
- JW Goethe University Hospital, Frankfurt
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - I Yust
- Ichilov Hospital, Tel Aviv
| | | | | | | | | | - S Maayan
- Hadassah University Hospital, Jerusalem
| | - S Vella
- Istituto Superiore di Sanita, Rome
| | - A Chiesi
- Istituto Superiore di Sanita, Rome
| | | | | | | | - A Gabbuti
- Ospedale S. Maria Annunziata, Florence
| | | | | | | | | | - V Vullo
- Università di Roma La Sapienza, Rome
| | | | | | | | | | | | | | | | | | | | - T Staub
- Centre Hospitalier, Luxembourg
| | - P Reiss
- Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam
| | | | | | | | | | | | - A Horban
- Centrum Diagnostyki i Terapii AIDS, Warsaw
| | | | | | | | - M Pynka
- Medical University, Szczecin
| | | | | | | | | | | | | | - B Diaz
- Hospital Carlos III, Madrid
| | | | | | | | - B Clotet
- Hospital Germans Trias i Pujol, Badalona
| | - A Jou
- Hospital Germans Trias i Pujol, Badalona
| | - J Conejero
- Hospital Germans Trias i Pujol, Badalona
| | - C Tural
- Hospital Germans Trias i Pujol, Badalona
| | - JM Gatell
- Hospital Clinic i Provincial, Barcelona
| | - JM Miró
- Hospital Clinic i Provincial, Barcelona
| | | | | | | | | | | | - P Francioli
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - A Telenti
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - B Hirschel
- Hospital Cantonal Universitaire de Geneve, Geneve
| | | | - S Barton
- St Stephen's Clinic, Chelsea and Westminster Hospital, London
| | - AM Johnson
- Royal Free and University College London Medical School, London (University College Campus)
| | - D Mercey
- Royal Free and University College London Medical School, London (University College Campus)
| | - A Phillips
- Royal Free and University College Medical School, London (Royal Free Campus)
| | - C Loveday
- Royal Free and University College Medical School, London (Royal Free Campus)
| | - MA Johnson
- Royal Free and University College Medical School, London (Royal Free Campus)
| | - A Mocroft
- Royal Free and University College Medical School, London (Royal Free Campus)
| | - A Pinching
- Medical College of St Bartholomew's Hospital, London
| | - J Parkin
- Medical College of St Bartholomew's Hospital, London
| | - J Weber
- Imperial College School of Medicine at St Mary's, London
| | - G Scullard
- Imperial College School of Medicine at St Mary's, London
| | - M Fisher
- Royal Sussex County Hospital, Brighton
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7
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Ormaasen V, Maeland A. [Tuberculosis among HIV-infected persons in Norway]. Tidsskr Nor Laegeforen 2001; 121:3425-30. [PMID: 11826791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND HIV-infected persons have a considerably higher risk of developing active tuberculosis than immunocompetent individuals. Tuberculosis is the only opportunistic infection among HIV-infected persons that presents a potential health risk to the general population. MATERIAL AND METHODS We present a review on this topic based on relevant literature and clinical experience. RESULTS Treatment options are limited because of interactions between rifamycins and protease inhibitors and non-nucleoside analogues. When concomitant therapy against HIV infection and tuberculosis is indicated, we suggest a first-line regimen of rifabutin combined with either indinavir or nelfinavir. For patients without severe immunodeficiency, anti-retroviral therapy can be postponed until the end of the initial phase of the anti-tuberculosis treatment. INTERPRETATION Treatment of concurrent HIV infection and tuberculosis is complex and may involve multiple drug regimens. Treating the latent infection could in many cases prevent active tuberculosis. All HIV-infected persons should be evaluated with respect to active tuberculosis and latent infection.
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Affiliation(s)
- V Ormaasen
- Infeksjonsmedisinsk avdeling Medisinsk divisjon Ullevål sykehus 0407 Oslo.
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8
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Bell H, Hellum K, Harthug S, Myrvang B, Ritland S, Maeland A, von der Lippe B, Bjøro K, Skaug K, Gutigard BG, Raknerud N, Simmonds P. Treatment with interferon-alpha2a alone or interferon-alpha2a plus ribavirin in patients with chronic hepatitis C previously treated with interferon-alpha2a. CONSTRUCT Group. Scand J Gastroenterol 1999; 34:194-8. [PMID: 10192200 DOI: 10.1080/00365529950173087] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Preliminary results from combination therapy with interferon-alpha and ribavirin (IFN/Rib) in patients with chronic hepatitis C have been promising, with up to 50% sustained hepatitis C virus (HCV) RNA response. The aim of this study was to investigate whether a sustained HCV RNA response could be obtained with combination therapy in patients who were non-responders or relapsers after IFN treatment. METHODS In a multicenter study we randomized 53 HCV RNA-positive patients into 2 treatment groups. They all had biopsy-confirmed chronic hepatitis C, and all were recruited from a previous IFN study: 26 were previous non-responders and 27 responders with relapse. Group A received interferon-alpha2a, 4.5 MIU thrice weekly for 6 months, and group B received ribavirin, 1000-1200 mg/day, in combination with the same dose of interferon-alpha2a for 6 months. Median Knodell index was 5.0 in both groups. Genotype 1 was found in 24 (45%), type 2 in 3 (6%), and type 3 in 26 (49%). RESULTS Sustained clearance of HCV viremia 6 months after interferon-alpha2a treatment stop was obtained in 12 of 53 patients (23%): 6 of 27 in the IFN group (22%) and 6 of 26 (23%) in the IFN/Rib group (NS). Nine of 27 (33%) former responders with relapse, compared with 3 of 26 (12%) non-responders, obtained a sustained HCV RNA response (P = 0.054). In previous relapse patients sustained loss of viremia was more frequent in genotype 3 (50%) than in genotype 1 (11%) patients (P = 0.022). CONCLUSIONS In a group of previous IFN-alpha2a-treated chronic HCV patients we obtained a similar sustained clearance of viremia when retreated either with IFN-alpha2a alone or with a combination of IFN-alpha2a and ribavirin for 6 months. Previous relapse patients with HCV genotype 3 obtained sustained loss of viremia significantly more often (50%) than type-patients (11%). Previous IFN responders with relapse responded better than previous non-responders.
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Affiliation(s)
- H Bell
- Dept. of Medicine, Aker University Hospital, Oslo, Norway
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9
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Brantsaeter AB, Hoel T, Kristianslund TI, Maeland A. [Tularemia after tick bite in Vestfold]. Tidsskr Nor Laegeforen 1998; 118:1191-3. [PMID: 9567695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Direct contact with rodents or their faeces is a well-known risk factor for contracting tularaemia in Norway. Both insects and ticks can act as vectors of tularaemia, but transmission by this route has not previously been described in this country. We report three cases of serologically confirmed ulceroglandular tularaemia on a small island in Southern Norway, an area in which tularaemia has not previously been known to occur. Tick bites preceded infection in two of the patients. The third patient may also have become infected through a tick or insect bite. Diagnosis was made late in all cases, causing a delay in appropriate treatment. Two of the patients were successfully treated with ciprofloxacin. Our experience and previous reports suggest that quinolones should be considered as the first choice of drugs in the treatment of tularaemia in Norway.
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Affiliation(s)
- A B Brantsaeter
- Infeksjonsmedisinsk avdeling, Medisinsk klinikk, Ullevål sykehus, Oslo
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10
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Jarvis LM, Bell H, Simmonds P, Hawkins A, Hellum K, Harthug S, Maeland A, Ritland S, Myrvang B, von der Lippe B, Raknerud N, Skaug K. The effect of treatment with alpha-interferon on hepatitis G/GBV-C viraemia. The CONSTRUCT Group. Scand J Gastroenterol 1998; 33:195-200. [PMID: 9517532 DOI: 10.1080/00365529850166941] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatitis G virus (HGV) or GBV-C is frequently detected in patients co-infected with hepatitis C virus (HCV). This study investigated host and virologic factors influencing the response to HGV/GBV-C to alpha-interferon treatment. METHODS HGV/GBV-C was detected and quantified by nested polymerase chain reaction. The influence of variables such as liver biopsy appearance, liver function abnormalities, and response of HCV to interferon treatment was monitored. RESULTS Fourteen of the 25 HGV/GBV-C-infected patients treated with interferon (3-6 MIU three times a week for 6 months) became non-viraemic during treatment, although all relapsed after treatment withdrawal at 6 months, with no net change in virus load between 0 and 12 months. CONCLUSIONS Predictive factors for clearance of HGV/GBV-C viraemia by interferon were pre-treatment severity of liver disease (median Knodell score of 4, compared with 7 for non-responders; P = 0.030) and alanine aminotransferase levels (median, 114, 182 for non-responders; P = 0.039). Clearance was associated with the treatment response of HCV. Nine of 13 who cleared HGV/GBV-C also cleared HCV, compared with 3 of 11 HGV/GBV-C non-responders; P = 0.05). The shared susceptibility of HGV/GBV-C and HCV to interferon treatment suggests a link between the mechanism of clearance of the two viruses.
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Affiliation(s)
- L M Jarvis
- Dept. of Medical Microbiology, University of Edinburgh, UK
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11
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Nordøy I, Krarup HB, Bell H, Christensen PB, Elgjo K, von der Lippe B, De Muckadell OS, Maeland A, Ring-Larsen H, Samdal HH, Simmonds P, Skaug K, Tage-Jensen U, Schrumpf E. Interferon-alpha 2b therapy in low-activity hepatitis C: a pilot study. Scand J Gastroenterol 1997; 32:1256-60. [PMID: 9438325 DOI: 10.3109/00365529709028156] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Many patients with chronic hepatitis C have long periods of normal or near-normal liver enzyme levels, even though histologic alterations have been confirmed. The recommendation today is not to treat this patient group. METHODS In a pilot study 23 hepatitis C virus (HCV) RNA-positive patients with alanine aminotransferase (ALAT) levels less than 1.5 times upper normal limits for at least 6 months on more than three occasions and with histologic liver abnormalities compatible with chronic hepatitis C were treated with 3 MU of interferon-alpha 2b three times a week for 6 months. RESULTS Nine patients (39%) became HCV RNA-negative in serum during treatment, but only two (8.7%) remained so after 6 months' follow-up. Significantly more patients with genotype other than type 1 became HCV RNA-negative than patients with genotype 1 during treatment (P = 0.005). CONCLUSIONS Patients with low-activity chronic hepatitis C have a response to interferon-alpha treatment similar to that of patients with increased ALAT levels. Genotype seems to influence the rate of response.
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Affiliation(s)
- I Nordøy
- Medical Dept. A, Rikshospitalet, Oslo, Norway
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12
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Jensenius M, Maeland A, Kvale D, Farstad IN, Vene S, Bruu AL. [Q-fever imported into Norway]. Tidsskr Nor Laegeforen 1997; 117:3937-40. [PMID: 9441420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Q fever is an important zoonosis that occurs throughout the world. In contrast to most other European countries, there has been no evidence of endemic Q fever in Norway up to now. The disease is caused by Coxiella burnetii, a rickettsia-like bacterium. Humans are infected mainly by inhalation of contaminated aerosols from cattle, sheep and goats. Clinical manifestations are protean, ranging from asymptomatic infection to life-threatening endocarditis. In this article we present the first four cases of serological proven acute Q fever imported into Norway. The patients were Norwegian tourists who had visited Bhutan, the Canary Islands, and Morocco. Two patients had fever with maculopapular exanthema, one had pneumonia, and one had biopsy-proven granulomatous hepatitis. Three were treated with tetracyclines. All four patients recovered well.
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Affiliation(s)
- M Jensenius
- Medisinsk avdeling, Lovisenberg diakonale sykehus, Oslo
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13
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Jensenius M, Maeland A, Vene S. [Endemic typhus imported to Norway]. Tidsskr Nor Laegeforen 1997; 117:2447-9. [PMID: 9265302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Murine typhus, caused by Rickettsia typhi, is an important zoonosis in all parts of the world. The disease is transmitted from rodents to humans by fleas. In this article we describe the first three cases of serologically proven murine typhus imported into Norway during the 1990s. The patients were Norwegian tourists who had visited respectively Guinea-Bissau, Crete and Thailand. They all became acutely ill with fever, chills and severe headache 1-10 days after return to Norway. None of them had a rash. Two patients were admitted to hospital, and one was treated with ciprofloxacin for suspected typhoid fever. All the patients recovered without sequelae. The diagnosis of murine typhus was based on detection of IgM-anti-bodies against R typhi in serum samples during reconvalescence.
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Affiliation(s)
- M Jensenius
- Medisinsk avdeling, Lovisenberg Diakonale Sykehus, Oslo
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14
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Maeland A. [Screening of pregnant women for toxoplasma infection]. Tidsskr Nor Laegeforen 1997; 117:1184-5. [PMID: 9148496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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15
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Bell H, Hellum K, Harthug S, Maeland A, Ritland S, Myrvang B, von der Lippe B, Raknerud N, Skaug K, Gutigard BG, Skjaerven R, Prescott LE, Simmonds P. Genotype, viral load and age as independent predictors of treatment outcome of interferon-alpha 2a treatment in patients with chronic hepatitis C. Construct group. Scand J Infect Dis 1997; 29:17-22. [PMID: 9112292 DOI: 10.3109/00365549709008658] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Patients with chronic hepatitis C respond differently when treated with interferon. We randomized 116 patients with chronic hepatitis C in order to compare two dosage regimens of recombinant interferon alpha 2a:3 MIU x 3 per week for 6 months (arm A) or 6 MIU x 3 per week for 3 months and then 3 MIU x 3 per week for 3 months (arm B). There were no significant differences concerning outcome between the two dose regimens: sustained clearance of HCV viremia 6 months after the end of treatment was obtained in 12/59 (20%) in group A compared with 18/57 (32%) in group B (p = 0.24). In patients with genotype 1a, 4/31 (13%), in genotype 1b, none of 9 (0%), 9/15 (60%) in genotype 2, and 17/58 (29%) in genotype 3, showed sustained clearance of HCV viremia 6 months after the end of treatment (p = 0.002). In a stepwise logistic regression analysis, only pretreatment viral load (p = 0.0001), genotype (p = 0.001) and age (p = 0.04) were identified as independent predictors of sustained clearance of HCV viremia. Liver histology as assessed by Knodell index was significantly improved in patients with sustained HCV RNA response 6 months after the end of treatment (5.2 +/- 2.2 vs 2.6 +/- 2.2, p < 0.001), but not in responders with relapse or in non-responders. In conclusion, stepwise logistic regression analysis showed that viral load, HCV genotype and age were the only independent predictors for sustained HCV RNA response.
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Affiliation(s)
- H Bell
- Department of Medicine, Aker University Hospital, Oslo, Norway
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16
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Schrumpf E, Bjøro K, Bell H, Harthug S, Hellum KB, Myrvang B, Maeland A, Ritland S. [Treatment of hepatitis C]. Tidsskr Nor Laegeforen 1996; 116:1792-4. [PMID: 8693463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Hepatitis C virus (HCV) has been a major cause of post transfusion hepatitis, and is still an important cause of chronic liver disease throughout the world. How to treat patients with chronic HCV infection has been brought into focus in recent years, and a substantial amount of data has been obtained about the development of hepatitis C with and without treatment. This survey considers the diagnosis of hepatitis C, and present treatment modalities and their potential. The patients most likely to respond to treatment are described, and the authors finally discuss why treatment of hepatitis C still should take place in controlled studies.
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Affiliation(s)
- E Schrumpf
- Medisinsk avdeling A Rikshospitalet, Oslo
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Bell H, Hellum K, Harthug S, Maeland A, Ritland S, Myrvang B, von der Lippe B, Raknerud N, Skaug K, Prescott L, Simmonds P. Prevalence of hepatitis C genotypes among patients with chronic hepatitis C in Norway. Construct Group. Scand J Infect Dis 1996; 28:357-9. [PMID: 8893398 DOI: 10.3109/00365549609037919] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Among 116 patients with biopsy-confirmed chronic hepatitis C (Riba 2 or Riba 3 positive) in a multicenter study in southern Norway on interferon, we determined hepatitis C virus genotype by restriction fragment length polymorphism (RFLP) of the 5' NCR. The RFLP method was supplemented by and compared with a serological typing method based on the detection of type-specific antibody to peptide from the NS-4 region. A total of 102/106 (96%) patient sera showed detectable type-specific antibody to NS-4 peptides and corresponded in all cases, except two, to the genotype detected by polymerase chain reaction. Combining the results from RFLP genotyping and serotyping, genotype 1 was found in 40 (35%) (27 with 1a and 10 with 1b, 3 subtypes not determined), genotype 2 in 15 (13%) (subtype 2b in 14 and 1 subtype not determined), and genotype 3 in 58 (50%) of patients. The low mean age of the patients (34 years), the low prevalence of cirrhosis (3.5%), the short duration of the disease, and a high prevalence of intravenous-drug abusers may account for the low prevalence of infection with genotype 1b (9%). The epidemiological features of hepatitis C patients are markedly different from patient groups described in southern Europe in terms of risk factors, age, and genotype distribution.
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Affiliation(s)
- H Bell
- Department of Medicine, Aker University Hospital, Oslo, Norway
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Bjøro K, Krarup H, Bell H, Christophersen P, Evensen S, Frøland SS, Laursen A, B vd Lippe B, Maeland A, Ranek L. Two dose regimens of recombinant interferon-alpha-2b in chronic hepatitis C virus infection. Biochemistry, hepatitis C virus RNA, and liver histology as response indices. Scand J Gastroenterol 1995; 30:1119-24. [PMID: 8578174 DOI: 10.3109/00365529509101617] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recombinant interferon remains the cornerstone of treatment of chronic hepatitis C virus (HCV) infection. Still, evaluation of treatment on the basis of response indicators and long-term effect of the treatment raises several questions. METHODS Seventy-four patients with chronic HCV infection were randomized to a high (3 MIU, 3/7 days) or low (1 MIU, 3/7 days) dose of recombinant interferon-alpha-2b for 48 weeks after a 4-week course of 3 MIU, 3/7 days. Response to treatment was assessed by means of liver enzymes (transaminases), HCV RNA, and liver histology. RESULTS The higher maintenance dose was associated with a significantly higher rate of sustained alanine aminotransferase (ALAT) response (45% versus 19%) and with a significantly better chance of becoming HCV RNA-negative during therapy (47% versus 23%). In the high maintenance dose group 14 of the 29 (48%) patients with available HCV RNA data were negative at the 3-month follow-up, compared with 4 of 27 (15%) in the low maintenance dose group. Significantly more patients had improved liver biopsy findings after interferon in the high maintenance dose group (79%) than in the low maintenance dose group (36%). There was a close correlation between ALAT response and HCV RNA response. Of 17 patients who were HCV RNA-negative 3 months after the end of treatment, 10 remained HCV RNA-negative 2-4 years later. CONCLUSION The study demonstrates a higher response rate as assessed by biochemistry, HCV RNA, and liver histology in the higher dose group.
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Affiliation(s)
- K Bjøro
- Medical Dept. A, Rikshospitalet, Oslo, Norway
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Sandven P, Bjørneklett A, Maeland A. Susceptibilities of Norwegian Candida albicans strains to fluconazole: emergence of resistance. The Norwegian Yeast Study Group. Antimicrob Agents Chemother 1993; 37:2443-8. [PMID: 8285631 PMCID: PMC192406 DOI: 10.1128/aac.37.11.2443] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
All Candida albicans isolates in Norwegian microbiological laboratories in 1991 judged clinically important (except vaginal isolates) were collected. The isolates were tested for susceptibility to fluconazole with an agar dilution test and a commercially available agar diffusion test. A total of 212 strains (95%) were susceptible to fluconazole, and MICs for most of the strains (92%) were < or = 1.56 micrograms/ml. The agar diffusion test using a 15-micrograms tablet and a 48-h incubation period separated resistant from susceptible strains with a wide margin. The only exception was a strain for which the MIC was 6.25 micrograms/ml. The difference in zone size between the resistant and the susceptible populations of strains was 11 mm. Accordingly, it appears that the agar diffusion test is an appropriate method for detecting fluconazole resistance. The 12 fluconazole-resistant isolates originated from eight AIDS patients with oral or esophageal Candida infections. Seven of the patients had been given fluconazole for 1 month or more, often as self medication. Four had infections that were clinically resistant to fluconazole; one additional patient responded only when the dose was increased. All isolates recovered from these patients were analyzed by multilocus enzyme electrophoresis. The 12 C. albicans isolates belonged to five electrophoretic types, but three of four patients attending one hospital had isolates belonging to one electrophoretic type. One possible explanation for this finding could be that a nosocomial spread of resistant strains has occurred.
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Affiliation(s)
- P Sandven
- Department of Bacteriology, National Institute of Public Health, Oslo, Norway
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Abstract
Twenty-four blood donors found positive for the first-generation hepatitis C antibody (anti-HCV) test (Ortho EIA-I) and 88 of their recipients over the period from 1972 to 1990 were retrospectively investigated with different first- and second-generation anti-HCV tests. The aim of the study was to identify the infective donors and to evaluate the tests. Seven donors, who probably were infective carriers of HCV, were also second-generation test (EIA-II) positive, compared to only 3 out of 17 noninfective donors. Among the infected recipients, 14 out of 29 (48%) were positive for the second-generation test only. The second-generation test identified the infective donors in our study and was more sensitive than the first-generation test. We therefore recommend that blood donors are screened with EIA-II. Positive test results should be confirmed by the recombinant immunoblot assay (RIBA-II), and persons with positive or not conclusive RIBA-II should not be accepted as blood donors.
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Affiliation(s)
- J Larsen
- Blood Bank, Ullevaal Hospital, Oslo, Norway
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Maeland A. [Cutaneous leishmaniasis]. Tidsskr Nor Laegeforen 1991; 111:3512-4. [PMID: 1796438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Cutaneous leishmaniasis is endemic in certain tropical and sub-tropical regions, and is sometimes encountered as an imported disease in Norway. The disease is characterized by chronic and painless, but often disfiguring, ulcers that regress after some months to years, leaving atrophic scars. Diagnosis is established by demonstrating amastigote Leishmania bodies by microscopy of Giemsa-stained smears from the periphery of the lesions. This report presents six cases seen in our department in the course of the last 14 years.
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Affiliation(s)
- A Maeland
- Infeksjonsmedisinsk avdeling, Ullevål sykehus, Oslo
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Larsen J, Hetland G, Skaug K, Maeland A. [Viral hepatitis and blood transfusion]. Tidsskr Nor Laegeforen 1991; 111:825-8. [PMID: 1850559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Our findings show that hepatitis B-virus was transmitted by blood from two hepatitis B-surface-antigen (HBsAg)-negative but hepatitis B-coreantibody (anti-HBc)-positive donors. Blood donors and recipients were also tested for antibodies against the recently identified hepatitis C-virus (HCV). We found that two anti-HCV-positive donors with no known history of clinical hepatitis were chronic, infective carriers of HCV. The prevalence of anti-HCV in our blood donor population was 0.47% and ALT and anti-HBc testing was of no help for tracing the anti-HCV positives. We recommend that, in addition to HBsAg screening at each donation, donors are tested for anti-HBc and anti-HCV once. Individuals with a history of parenteral virus hepatitis should not be accepted as blood donors.
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Affiliation(s)
- J Larsen
- Blodbank og immunologisk avdeling, Ullevål sykehus, Oslo
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Larsen J, Skaug K, Maeland A, Hetland G, Stoervold G. Infective, chronic carriers of hepatitis C virus among blood donors with no history of clinical hepatitis. Transfus Med 1991; 1:13-6. [PMID: 9259821 DOI: 10.1111/j.1365-3148.1991.tb00003.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We investigated the infectivity of three hepatitis C virus antibody (anti-HCV) positive blood donors with either hepatitis B core antibodies (anti-HBc) (Nos 1 and 2) or raised alanine aminotransferase (ALT) (No. 3). The 57 recipients of blood products from these donors during the period 1971-1990 were identified and the living 23 were tested for anti-HCV. Among these, 11 out of 14 (78%) recipients from Nos 1 and 2, and 1 out of 9 (11%) recipients from No. 3 were anti-HCV positive. The former donors had high titres of anti-C100-3 and high rating scores in the HCV recombinant immunoblot assay (RIBA). They were evidently infective, chronic carriers of HCV but had no clinical signs or medical history of hepatitis. The latter donor had low titres of anti-C100-3 and a low RIBA rating score. She had clinical signs of chronic hepatitis and persistently elevated ALT, but only one of her recipients was anti-HCV positive.
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Affiliation(s)
- J Larsen
- Blood Bank, Ullevaal Hospital, Oslo, Norway
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Maeland A. [Acute HIV disease]. Tidsskr Nor Laegeforen 1988; 108:1619-20, 1654. [PMID: 3413748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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26
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Maeland A. [Fungemia. Case records from Ullevål Hospital]. Tidsskr Nor Laegeforen 1983; 103:1063-6. [PMID: 6879546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Bruun JN, Digranes A, Bøe J, Maeland A. Treatment of Salmonella carriers with pivmecillinam alone or in combination with pivampicillin: experience with three patients. Scand J Infect Dis 1983; 15:21-4. [PMID: 6302830 DOI: 10.3109/inf.1983.15.issue-1.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
3 patients with salmonella infections who continued to excrete salmonella in fecal samples for more than 6 months were treated with pivmecillinam alone or in combination with pivampicillin. Mecillinam alone cured 1 of the carriers, but was without success in the 2 others. One of these patients was cured after treatment with pivmecillinam and pivampicillin. In the last patient salmonella excretion ceased after treatment with pivmecillinam, pivampicillin and probenecid. The choice of treatment was based upon in vitro demonstration of synergism between mecillinam and ampicillin. In the last patient the final treatment was chosen after studies of the bactericidal effect of the patient's serum during various regimes.
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Abstract
The aim of this study was to elucidate the mechanisms by which sucrose improves growth in a hypertonic medium for isolating aerobes from blood. Clinical blood cultures were made routinely in duplicate in plain broth consisting of brain heart infusion broth with sodium polyanetholesulfonate, gelatin, and penicillinase and the same broth with 20% sucrose added. The growth patterns of Staphylococcus aureus and Enterobacteriaceae from plain and from hypertonic broth were correlated with the presence or absence of antimicrobial therapy in patients when the blood cultures were collected. In S. aureus bacteremias, 58.7% of the positive cultures collected during treatment of patients with beta-lactam antibiotics showed earlier growth or growth only in hypertonic broth, compared with 16.7% of the cultures taken during treatment with other antimicrobial agents (P less than 0.05) and 17.6% of the cultures made in antibiotic-free intervals (P less than 0.01). In the group of cultures yielding growth of Enterobacteriaceae, growth occurred earlier or solely in hypertonic broth in 28.9% of the cultures taken during treatment with beta-lactam antibiotics, compared with 15.7% of the cultures taken during treatment with other antimicrobial agents and 21.6% of the cultures collected in antibiotic-free intervals (differences not statistically significant). It is concluded that treatment with beta-lactam antibiotics is an important reason for the improved growth of S. aureus from hypertonic broth, but other factors are also involved.
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Maeland A. [Bacteremia at Ullvål Hospital 1977-1979. Types of bacteria and antibiotic sensitivity]. Tidsskr Nor Laegeforen 1981; 101:1284-6. [PMID: 7268739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Maeland A, Eng J. [Campylobacter - a new cause of enteritis]. Tidsskr Nor Laegeforen 1980; 100:614-5. [PMID: 7385120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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