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Stavris C, Retornaz F, Bourlière M, Penaranda G, Ansaldi C, Chiche L, Halfon P. Dépistage prospectif de la fibrose hépatique à l’aide du Fib-4 calculé automatiquement lors d’un bilan biologique chez 29 707 sujets français. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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2
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Djaogol T, Fontaine H, Baudoin M, Protopopescu C, Marcellin F, Dorival C, Bourlière M, Delarocque-Astagneau E, Carrat F, Carrieri P. Sustained virological response to Do hepatitis C DAA treatments in migrants and non-migrants groups. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Although the efficacy of direct acting antivirals (DAA) against hepatitis C (HCV) has been widely proven, data lack on their effectiveness in the most vulnerable groups. In France, despite universal health coverage, migrants cumulate vulnerabilities including delays in screening that may affect both access to care and treatment effectiveness. We tested whether DAA-treated migrants had sustained virological response (SVR) rates comparable to not-migrants.
Methods
We used data collected in chronic HCV-infected patients of the ANRS CO22 HEPATHER cohort, receiving a first treatment with DAA, with follow-up from 2012 until 2022. SVR was measured by PCR, 12 weeks after the end of treatment. The main covariate was a 4-category variable comparing migrants and non-migrants, with or without other vulnerability conditions (including drug use, unhealthy alcohol use, living in poverty, being a man who have sex with men). We used a Poisson regression model to assess the relationship between this covariate and SVR after adjustment for significant predictors and potential confounders.
Results
The analysis included 5,080 individuals, of which 17% classified as migrants with at least one vulnerability, 10% as migrants with no vulnerability, 39% as non-migrants with at least one vulnerability and 35% as non-migrants with no vulnerability. Median [IQR] age was 57 [51-65] years, 56% of individuals were men, and 96% had SVR. The multivariable analysis showed no significant difference between the 4-category covariate and SVR. In addition, we found that SVR rates increased steadily during follow-up.
Conclusions
This is the first analysis exploring differences in SVR rates among migrants and not-migrants. The lack of significant differences found despite the power of the study suggests that migrants respond to DAA treatment as well as any other group of HCV-infected patients. These data can help advocating better screening and access to treatment for HCV-infected migrants in France.
Key messages
No significant differences were observed between migrants and non-migrants in terms of effectiveness of DAA treatment. These findings can help improving access to HCV care for migrants.
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Affiliation(s)
| | - H Fontaine
- AP-HP, Hôpital Cochin, Unité d’Hépatologie, Paris, France
| | - M Baudoin
- SESSTIM UMR 1252, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - C Protopopescu
- SESSTIM UMR 1252, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - F Marcellin
- SESSTIM UMR 1252, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - C Dorival
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
| | - M Bourlière
- Department of Hepatology and Gastroenterology, Hôpital Saint Joseph, P, France
| | - E Delarocque-Astagneau
- UMR1181, Biostatistique, Biomathématique, Pharmaco-épidémiologie et Maladies Infectieuses (B2PHI), Institut Pasteur, Inserm, Université de Versailles-Saint-Quentin-en-Yvelines (UVSQ), Paris, France
| | - F Carrat
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
| | - P Carrieri
- SESSTIM UMR 1252, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
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Salvetat N, Van der Laan S, Vire B, Chimienti F, Cleophax S, Bronowicki JP, Doffoel M, Bourlière M, Schwan R, Lang JP, Pujol JF, Weissmann D. RNA editing blood biomarkers for predicting mood alterations in HCV patients. J Neurovirol 2019; 25:825-836. [PMID: 31332697 PMCID: PMC6920238 DOI: 10.1007/s13365-019-00772-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 03/13/2019] [Accepted: 06/03/2019] [Indexed: 12/19/2022]
Abstract
Treatment-emergent depression is a common complication in patients with chronic hepatitis C virus (HCV) infection undergoing antiviral combination therapy with IFN-α and ribavirin. It has recently been shown that changes in A-to-I RNA editing rates are associated with various pathologies such as inflammatory disorders, depression and suicide. Interestingly, IFN-α induces gene expression of the RNA editing enzyme ADAR1-1 (ADAR1a-p150) and alters overall RNA editing activity. In this study, we took advantage of the high prevalence of pharmacologically induced depression in patients treated with IFN-α and ribavirin to test the interest of RNA editing–related biomarkers in white blood cells of patients. In this 16-week longitudinal study, a small cohort of patients was clinically evaluated using standard assessment methods prior to and during antiviral therapy and blood samples were collected to analyse RNA editing modifications. A-I RNA editing activity on the phosphodiesterase 8A (PDE8A) gene, a previously identified RNA editing hotspot in the context of lupus erythematosus, was quantified by using an ultra-deep next-generation sequencing approach. We also monitored gene expression levels of the ADAR enzymes and the PDE8A gene during treatment by qPCR. As expected, psychiatric evaluation could track treatment-emergent depression, which occurred in 30% of HCV patients. We show that PDE8A RNA editing is increased in all patients following interferon treatment, but differently in 30% of patients. This effect was mimicked in a cellular model using SHSY-5Y neuroblastoma cells. By combining the data of A-I RNA editing and gene expression, we generated an algorithm that allowed discrimination between the group of patients who developed a treatment-emergent depression and those who did not. The current model of drug-induced depression identified A-I RNA editing biomarkers as useful tools for the identification of individuals at risk of developing depression in an objective, quantifiable biological blood test.
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Affiliation(s)
- N Salvetat
- ALCEDIAG, Sys2Diag / CNRS UMR9005, Parc Euromédecine Cap Delta, 1682 Rue de la Valsière, 34184, Montpellier Cedex 4, France.
| | - S Van der Laan
- ALCEDIAG, Sys2Diag / CNRS UMR9005, Parc Euromédecine Cap Delta, 1682 Rue de la Valsière, 34184, Montpellier Cedex 4, France
| | - B Vire
- ALCEDIAG, Sys2Diag / CNRS UMR9005, Parc Euromédecine Cap Delta, 1682 Rue de la Valsière, 34184, Montpellier Cedex 4, France
| | - F Chimienti
- ALCEDIAG, Sys2Diag / CNRS UMR9005, Parc Euromédecine Cap Delta, 1682 Rue de la Valsière, 34184, Montpellier Cedex 4, France
| | - S Cleophax
- Biocortech, rue de la Croix Jarry, 75013, Paris, France.,Etablissement Français du Sang, 2 avenue Ile de France, 95300, Pontoise, France
| | - J P Bronowicki
- Hepato-Gastroenterology, Hopital Brabois- CHU Nancy, 54511, Vandoeuvre-les-Nancy, France
| | - M Doffoel
- Université de Strasbourg, Hopital Universitaire de Strasbourg, 67000, Strasbourg, France
| | - M Bourlière
- Hepato-Gastroenterology, Hopital Saint Joseph, 13285, Marseille, France
| | - R Schwan
- Hepato-Gastroenterology, Hopital Brabois- CHU Nancy, 54511, Vandoeuvre-les-Nancy, France
| | - J P Lang
- Université de Strasbourg, Hopital Universitaire de Strasbourg, 67000, Strasbourg, France.,Les Toises, Centre de psychiatrie et psychothérapie, Lausanne, Switzerland
| | - J F Pujol
- ALCEDIAG, Sys2Diag / CNRS UMR9005, Parc Euromédecine Cap Delta, 1682 Rue de la Valsière, 34184, Montpellier Cedex 4, France.,Biocortech, rue de la Croix Jarry, 75013, Paris, France
| | - D Weissmann
- ALCEDIAG, Sys2Diag / CNRS UMR9005, Parc Euromédecine Cap Delta, 1682 Rue de la Valsière, 34184, Montpellier Cedex 4, France.,Biocortech, rue de la Croix Jarry, 75013, Paris, France
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4
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Rosenthal E, Fougerou-Leurent C, Renault A, Carrieri MP, Marcellin F, Garraffo R, Teicher E, Aumaitre H, Lacombe K, Bailly F, Billaud E, Chevaliez S, Dominguez S, Valantin MA, Reynes J, Naqvi A, Cotte L, Metivier S, Leroy V, Dupon M, Allegre T, De Truchis P, Jeantils V, Chas J, Salmon-Ceron D, Morlat P, Neau D, Perré P, Piroth L, Pol S, Bourlière M, Pageaux GP, Alric L, Zucman D, Girard PM, Poizot-Martin I, Yazdanpanah Y, Raffi F, Pabic EL, Tual C, Pailhé A, Amri I, Bellissant E, Molina JM. Efficacy, safety and patient-reported outcomes of ledipasvir/sofosbuvir in NS3/4A protease inhibitor-experienced individuals with hepatitis C virus genotype 1 and HIV coinfection with and without cirrhosis (ANRS HC31 SOFTRIH study). HIV Med 2017; 19:227-237. [PMID: 29214737 DOI: 10.1111/hiv.12571] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Studies evaluating the efficacy and safety of the fixed-dose combination ledipasvir (LDV)/sofosbuvir (SOF) in patients coinfected with HIV-1 and hepatitis C virus (HCV) have mainly included treatment-naïve patients without cirrhosis. We aimed to evaluate the efficacy and safety of this combination in treatment-experienced patients with and without cirrhosis. METHODS We conducted a multicentre, open-label, double-arm, nonrandomized study in patients coinfected with HIV-1 and HCV genotype 1 with and without cirrhosis, who had good viral suppression on their antiretroviral regimens. All patients were pretreated with a first-generation NS3/4A protease inhibitor (PI) plus pegylated interferon/ribavirin. Patients received a fixed-dose combination of LDV/SOF for 12 weeks, or for 24 weeks if cirrhosis was present. The primary endpoint was a sustained virological response (SVR) 12 weeks after the end of therapy. Secondary endpoints included safety, pharmacokinetics and patient-reported outcomes. RESULTS Of the 68 patients enrolled, 39.7% had cirrhosis. Sixty-five patients [95.6%; 95% confidence interval (CI): 87.6-99.1%; P < 0.0001] achieved an SVR, with similar rates of SVR in those with and without cirrhosis. Tolerance was satisfactory, with mainly grade 1 or 2 adverse events. Among patient-reported outcomes, only fatigue significantly decreased at the end of treatment compared with baseline [odds ratio (OR): 0.36; 95% CI: 0.14-0.96; P = 0.04]. Mean tenofovir area under the plasma concentration-time curve (AUC) at week 4 was high, with mean ± SD AUC variation between baseline and week 4 higher in cirrhotic than in noncirrhotic patients (3261.57 ± 1920.47 ng/mL vs. 1576.15 ± 911.97 ng/mL, respectively; P = 0.03). Mild proteinuria (54.4%), hypophosphataemia (50.0%), blood bicarbonate decrease (29.4%) and hypokalaemia (13.2%) were reported. The serum creatinine level was not modified. CONCLUSIONS LDV/SOF provided a high SVR rate in PI-experienced subjects coinfected with HCV genotype 1 and HIV-1, including patients with cirrhosis.
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Affiliation(s)
- E Rosenthal
- Internal Medicine Department, CHU de Nice, Hôpital Archet 1, Nice, France
| | - C Fougerou-Leurent
- Pharmacology Department, CHU Rennes, Rennes, France.,Inserm, CIC1414, Rennes, France
| | - A Renault
- Inserm, CIC1414, Rennes, France.,Pharmacology Laboratory, Faculté de Médecine, Univ Rennes 1, Rennes, France
| | - M P Carrieri
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Inserm, IRD, Aix Marseille Univ, Marseille, France.,Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - F Marcellin
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Inserm, IRD, Aix Marseille Univ, Marseille, France.,Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - R Garraffo
- Clinical Pharmacology and Toxicology Department, CHU de Nice, Nice, France
| | - E Teicher
- Infectious Diseases Department, APHP, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - H Aumaitre
- Infectious and Tropical Diseases Department, Hôpital de Perpignan, Perpignan, France
| | - K Lacombe
- Infectious Diseases Department, APHP, Hôpital Saint Antoine, Paris, France
| | - F Bailly
- Hepatology Department, HCL, Hôpital de la Croix-Rousse, Lyon, France
| | - E Billaud
- Infectious Diseases Department, CHU Nantes, Nantes, France
| | - S Chevaliez
- Virology Department, APHP, Hôpital Henri Mondor, Créteil, France
| | - S Dominguez
- Clinical Immunology Department, APHP, Hôpital Henri Mondor, Créteil, France
| | - M A Valantin
- Infectious Diseases Department, APHP, Hôpital La Pitié Salpêtrière, Paris, France
| | - J Reynes
- Infectious Diseases Department, CHU Montpellier, Montpellier, France
| | - A Naqvi
- Infectious Diseases Department, CHU de Nice, Hôpital Archet 1, Nice, France
| | - L Cotte
- Infectious Diseases Department, HCL, Hôpital de la Croix-Rousse, Lyon, France
| | - S Metivier
- Hepatogastroenterology Department, CHU Toulouse, Toulouse, France
| | - V Leroy
- Hepatogastroenterology Department, CHU Grenoble, Grenoble, France
| | - M Dupon
- Infectious Diseases Department, CHU Bordeaux, Bordeaux, France
| | - T Allegre
- Hemato Oncology Department, CH du Pays d'Aix, Aix-en-Provence, France
| | - P De Truchis
- Infectious Diseases Department, APHP, Hôpital R Poincaré, Garches, France
| | - V Jeantils
- Infectious Diseases Department, APHP, Hôpital J Verdier, Bondy, France
| | - J Chas
- Infectious and Tropical Diseases Department, APHP, Hôpital Tenon, Paris, France
| | - D Salmon-Ceron
- Infectious Diseases Department, APHP, Hôpital Cochin, Paris, France
| | - P Morlat
- Internal Medicine and Infectious Diseases Department, CHU Bordeaux, Bordeaux, France
| | - D Neau
- Infectious and Tropical Diseases Department, CHU Bordeaux, Bordeaux, France
| | - P Perré
- Internal Medicine Department, CHD Vendée, La Roche sur Yon, France
| | - L Piroth
- Infectious Diseases Department, CHU Dijon, Dijon, France
| | - S Pol
- Hepato-Gastroenterology Department, APHP, Hôpital Cochin, Paris, France
| | - M Bourlière
- Hepatogastroenterology Department, Hôpital Saint Joseph, Marseille, France
| | - G P Pageaux
- Hepatogastroenterology Department, CHU Montpellier, Montpellier, France
| | - L Alric
- Internal Medicine Department, CHU Toulouse, Toulouse, France
| | - D Zucman
- Internal Medicine Department, Hôpital Foch, Suresne, France
| | - P M Girard
- Infectious Diseases Department, APHP, Hôpital Saint Antoine, Paris, France
| | - I Poizot-Martin
- Immuno and Clinical Hematology department, APHM Sainte-Marguerite, Aix Marseille Univ, Marseille, France.,Inserm U912 (SESSTIM), Marseille, France
| | - Y Yazdanpanah
- Infectious and Tropical Diseases Department, APHP, Hôpital Bichat, Paris, France
| | - F Raffi
- Infectious Diseases Department, CHU Nantes, Nantes, France
| | - E Le Pabic
- Pharmacology Department, CHU Rennes, Rennes, France.,Inserm, CIC1414, Rennes, France
| | - C Tual
- Pharmacology Department, CHU Rennes, Rennes, France.,Inserm, CIC1414, Rennes, France
| | - A Pailhé
- Unité de Recherche Clinique et Fondamentale sur les Hépatites Virales, ANRS (France Recherche Nord & Sud Sida-hiv Hépatites), Paris, France
| | - I Amri
- Unité de Recherche Clinique et Fondamentale sur les Hépatites Virales, ANRS (France Recherche Nord & Sud Sida-hiv Hépatites), Paris, France
| | - E Bellissant
- Pharmacology Department, CHU Rennes, Rennes, France.,Inserm, CIC1414, Rennes, France.,Pharmacology Laboratory, Faculté de Médecine, Univ Rennes 1, Rennes, France
| | - J M Molina
- Hepatogastroenterology Department, APHP, Hôpital Saint Louis, Paris, France
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Adhoute X, Sellier F, Fontaine H, Castellani P, Bourlière M. Carcinome hépatocellulaire et traitements antiviraux contre le VHB et le VHC. ONCOLOGIE 2017. [DOI: 10.1007/s10269-017-2710-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bourlière M, Manns M, Brown D, Kwoal P. HEP-08 - Sécurité et tolérance de l’association elbasvir/grazoprévir (EBV/GZR) chez des patients infectés par le VHC : analyse poolée d’essais de phase 2/3. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30385-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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7
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Foster GR, Ferenci P, Asselah T, Mantry P, Dufour JF, Bourlière M, Forton D, Maevskaya M, Wright D, Yoshida EM, García-Samaniego J, Oliveira C, Wright M, Warner N, Sha N, Quinson AM, Stern JO. Open-label study of faldaprevir plus peginterferon and ribavirin in hepatitis C virus genotype 1-infected patients who failed placebo plus peginterferon and ribavirin. J Viral Hepat 2016; 23:227-31. [PMID: 26572686 DOI: 10.1111/jvh.12485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 08/25/2015] [Indexed: 12/09/2022]
Abstract
Faldaprevir, a hepatitis C virus (HCV) NS3/4A protease inhibitor, was evaluated in HCV genotype 1-infected patients who failed peginterferon and ribavirin (PegIFN/RBV) treatment during one of three prior faldaprevir trials. Patients who received placebo plus PegIFN/RBV and had virological failure during a prior trial were enrolled and treated in two cohorts: prior relapsers (n = 43) and prior nonresponders (null responders, partial responders and patients with breakthrough; n = 75). Both cohorts received faldaprevir 240 mg once daily plus PegIFN/RBV for 24 weeks. Prior relapsers with early treatment success (ETS; HCV RNA <25 IU/mL detectable or undetectable at week 4 and <25 IU/mL undetectable at week 8) stopped treatment at week 24. Others received PegIFN/RBV through week 48. The primary efficacy endpoint was sustained virological response (HCV RNA <25 IU/mL undetectable) 12 weeks post treatment (SVR12). More prior nonresponders than prior relapsers had baseline HCV RNA ≥ 800,000 IU/mL (80% vs 58%) and a non-CC IL28B genotype (91% vs 70%). Rates of SVR12 (95% CI) were 95.3% (89.1, 100.0) among prior relapsers and 54.7% (43.4, 65.9) among prior nonresponders; corresponding ETS rates were 97.7% and 65.3%. Adverse events led to faldaprevir discontinuations in 3% of patients. The most common Division of AIDS Grade ≥ 2 adverse events were anaemia (13%), nausea (10%) and hyperbilirubinaemia (9%). In conclusion, faldaprevir plus PegIFN/RBV achieved clinically meaningful SVR12 rates in patients who failed PegIFN/RBV in a prior trial, with response rates higher among prior relapsers than among prior nonresponders. The adverse event profile was consistent with the known safety profile of faldaprevir.
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Affiliation(s)
- G R Foster
- Department of Hepatology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - P Ferenci
- Department of Medicine III, University Hospital Vienna, Vienna, Austria
| | - T Asselah
- Service d'Hépatologie, AP-HP, University Paris-Diderot and INSERM U773, CRB3, Hôpital Beaujon, Clichy, France
| | - P Mantry
- Department of Hepatology, The Liver Institute at Methodist Dallas Medical Center, Dallas, TX, USA
| | - J-F Dufour
- Department of Hepatology, University Clinic for Visceral Surgery and Medicine and University of Bern, Bern, Switzerland
| | - M Bourlière
- Département d'Hépato-gastroentérologie, Hôpital Saint Joseph, Marseille, France
| | - D Forton
- Department of Gastroenterology and Hepatology, St George's Hospital, London, UK
| | - M Maevskaya
- Hepatology Department, First Moscow State Medical University, Moscow, Russia
| | - D Wright
- Central Texas Clinical Research, Austin, TX, USA
| | - E M Yoshida
- University of British Columbia, Vancouver, BC, Canada
| | - J García-Samaniego
- Liver Unit, Hospital Universitario La Paz/Carlos III CIBERehd, Madrid, Spain
| | - C Oliveira
- Department of Radiology, Hospital Infante D. Pedro, Aveiro, Portugal
| | - M Wright
- Wellcome Trust Clinical Research Facility, Southampton, UK
| | - N Warner
- Boehringer Ingelheim Ltd., Bracknell, UK
| | - N Sha
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - A-M Quinson
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - J O Stern
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
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8
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Rosenthal E, Fougerou-Leurent C, Renault A, Morlat P, Naqvi A, Teicher E, Lacombe K, Aumaitre H, Bailly F, Bellissant E, Bourlière M, Molina J. Ledipasvir/sofosbuvir chez les patients co-infectés par le VIH et un VHC de génotype 1 prétraités par un inhibiteur de la protéase NS3/A4 du VHC (étude ANRS HC31 SOFTRIH). Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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9
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Rüeger S, Bochud PY, Dufour JF, Müllhaupt B, Semela D, Heim MH, Moradpour D, Cerny A, Malinverni R, Booth DR, Suppiah V, George J, Argiro L, Halfon P, Bourlière M, Talal AH, Jacobson IM, Patin E, Nalpas B, Poynard T, Pol S, Abel L, Kutalik Z, Negro F. Impact of common risk factors of fibrosis progression in chronic hepatitis C. Gut 2015; 64:1605-15. [PMID: 25214320 DOI: 10.1136/gutjnl-2014-306997] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 08/22/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The natural course of chronic hepatitis C varies widely. To improve the profiling of patients at risk of developing advanced liver disease, we assessed the relative contribution of factors for liver fibrosis progression in hepatitis C. DESIGN We analysed 1461 patients with chronic hepatitis C with an estimated date of infection and at least one liver biopsy. Risk factors for accelerated fibrosis progression rate (FPR), defined as ≥ 0.13 Metavir fibrosis units per year, were identified by logistic regression. Examined factors included age at infection, sex, route of infection, HCV genotype, body mass index (BMI), significant alcohol drinking (≥ 20 g/day for ≥ 5 years), HIV coinfection and diabetes. In a subgroup of 575 patients, we assessed the impact of single nucleotide polymorphisms previously associated with fibrosis progression in genome-wide association studies. Results were expressed as attributable fraction (AF) of risk for accelerated FPR. RESULTS Age at infection (AF 28.7%), sex (AF 8.2%), route of infection (AF 16.5%) and HCV genotype (AF 7.9%) contributed to accelerated FPR in the Swiss Hepatitis C Cohort Study, whereas significant alcohol drinking, anti-HIV, diabetes and BMI did not. In genotyped patients, variants at rs9380516 (TULP1), rs738409 (PNPLA3), rs4374383 (MERTK) (AF 19.2%) and rs910049 (major histocompatibility complex region) significantly added to the risk of accelerated FPR. Results were replicated in three additional independent cohorts, and a meta-analysis confirmed the role of age at infection, sex, route of infection, HCV genotype, rs738409, rs4374383 and rs910049 in accelerating FPR. CONCLUSIONS Most factors accelerating liver fibrosis progression in chronic hepatitis C are unmodifiable.
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Affiliation(s)
- S Rüeger
- Department of Medical Genetics, University of Lausanne, Lausanne, Switzerland Institute of Social and Preventive Medicine, University Hospital and University of Lausanne, Lausanne, Switzerland Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - P-Y Bochud
- Infectious Diseases Service, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - J-F Dufour
- Department of Hepatology, University of Berne, Berne, Switzerland
| | - B Müllhaupt
- Department of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland
| | - D Semela
- Department of Gastroenterology, Canton Hospital St Gallen, St Gallen, Switzerland
| | - M H Heim
- Department of Gastroenterology and Hepatology, University Hospital of Basel, Basel, Switzerland
| | - D Moradpour
- Department of Gastroenterology and Hepatology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - A Cerny
- Epatologia, Clinica Moncucco, Lugano, Switzerland
| | | | - D R Booth
- Institute for Immunology and Allergy Research, Westmead Millennium Institute, University of Sydney, Sydney, Australia
| | - V Suppiah
- Institute for Immunology and Allergy Research, Westmead Millennium Institute, University of Sydney, Sydney, Australia Storr Liver Unit, Westmead Millennium Institute and Westmead Hospital, University of Sydney and University of Sydney Medical Foundation, Sydney, Australia
| | - J George
- Storr Liver Unit, Westmead Millennium Institute and Westmead Hospital, University of Sydney and University of Sydney Medical Foundation, Sydney, Australia
| | - L Argiro
- Laboratoire d'Immunologie et de Génétique des Maladies Parasitaires, INSERM-UMR 906/Université de la Méditerranée, Marseilles, France
| | - P Halfon
- Laboratoire Alphabio, Hôpital Ambroise Paré, Marseilles, France
| | - M Bourlière
- Service d'Hépato-gastroentérologie, Hôpital Saint-Joseph, Marseilles, France
| | - A H Talal
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, USA
| | - I M Jacobson
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, USA
| | - E Patin
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM, U980, Imagine Institute, Paris, France University Paris Descartes, Paris, France
| | - B Nalpas
- University Paris Descartes, Paris, France Département d'Hépatologie, INSERM Unité 1016, Groupe Hospitalier Cochin-Hôtel Dieu-Broca, Paris, France
| | - T Poynard
- Université Pierre et Marie Curie, Service d'Hépato-gastroentérologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - S Pol
- University Paris Descartes, Paris, France Département d'Hépatologie, INSERM Unité 1016, Groupe Hospitalier Cochin-Hôtel Dieu-Broca, Paris, France
| | - L Abel
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM, U980, Imagine Institute, Paris, France University Paris Descartes, Paris, France St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, New York, USA
| | - Z Kutalik
- Institute of Social and Preventive Medicine, University Hospital and University of Lausanne, Lausanne, Switzerland Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - F Negro
- Clinical Pathology, University Hospitals of Geneva, Geneva, Switzerland Department of Gastroenterology and Hepatology, University Hospitals of Geneva, Geneva, Switzerland
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10
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Abstract
Worldwide, 50-70 million subjects are infected with an hepatitis C virus (HCV) genotype 2, 3, 4, 5 or 6. In these patients, the combination of PEG-INF-α and ribavirin remains the currently approved standard-of-care treatment. The identification of different potential therapeutic targets in the HCV life cycle has led to the development of both direct antiviral agents (DAAs) and reagents targeting host functions essential for viral replication. DAAs comprise so far first-generation, second-wave and second-generation NS3/4A protease inhibitors (PIs), nucleos(t)ide (NIs) and non-nucleoside inhibitors of the NS5B RNA polymerase and NS5A complex inhibitors. The main host-protein-directed antiviral agents are cyclophilin inhibitors and silibinin. Whereas the launch of first-generation PIs was a major landmark in the management of genotype 1 (GT-1)-infected patients, these drugs are inactive in most non-GT-1-infected patients. Several of these and other drugs have now reached phase II and even phase III clinical stage development. The purpose of this article is to provide an overview of the clinical results recently reported for the treatment for non-GT-1 HCV infection with a focus on the most promising new compounds and combinations.
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Affiliation(s)
- C Wartelle-Bladou
- Department of Hepatology, Saint Luc Hospital, CHUM, Montréal, Canada
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11
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Halfon P, Pénaranda G, Carrat F, Bedossa P, Bourlière M, Ouzan D, Renou C, Tran A, Rosenthal E, Wartelle C, Delasalle P, Cacoub P. Influence of insulin resistance on hepatic fibrosis and steatosis in hepatitis C virus (HCV) mono-infected compared with HIV-HCV co-infected patients. Aliment Pharmacol Ther 2009; 30:61-70. [PMID: 19292832 DOI: 10.1111/j.1365-2036.2009.03995.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Insulin resistance (IR), the major feature of the metabolic syndrome, is also common in patients with chronic HCV infection. Liver fibrosis and steatosis are known potential outcome of chronic hepatitis B or C infection. Studies have shown that HIV positive individuals co-infected with HCV have more rapid live disease progression than those with HIV alone. Few data have reported the influence of IR on steatosis and fibrosis in the context of HIV-HCV coinfection. AIM To test the association among insulin resistance (IR), liver fibrosis and liver steatosis in HIV-HCV and HCV-infected patients. PATIENTS AND METHODS A total of 170 HIV-HCV-infected patients matched by age, gender and genotype with 170 HCV mono-infected patients were included. Patients were considered to be IR when the homeostasis model assessment of IR >2. Significant fibrosis was considered if METAVIR >or=F2 and significant steatosis if >or=10%. RESULTS Insulin resistance was independently associated in HCV patients with fibrosis [odds ratio (OR) = 2.04 (95% CI 1.02-4)], a body mass index (BMI) >25 kg/m(2) [OR = 3.33 (1.47-7.69)] and steatosis [OR = 3.33 (1.67-6.67)]. Fibrosis >or=F2 was associated in HCV patients with high liver activity grade (>or=A2) [OR = 8.33 (3.85-16.67)], male gender [OR = 3.03 (1.33-7.14)] and IR [OR = 2.44 (1.15-5)]. In HIV-HCV patients, >or=A2 [OR = 5.56 (1.64-20)] was associated with fibrosis. Steatosis >or=10% was associated in HCV patients with IR [OR = 3.13 (1.59-6.25) and >or=F2 (OR = 2.22 (1.15-4.17)]. In HIV-HCV, a BMI >25 kg/m(2) [OR = 3.85 (1.64-9.10)], >or=A2 [OR = 2.16 (1.02-4.55); P = 0.044] and nucleoside reverse transcriptase inhibitor [OR = 3.61 (1.19-10.96); P = 0.023] were independently associated with significant liver steatosis. CONCLUSIONS Insulin resistance is associated with liver fibrosis and steatosis in HCV mono-infected, but not in HIV-HCV co-infected patients. Significant liver fibrosis is associated with IR independent of liver steatosis only in HCV mono-infected patients.
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Affiliation(s)
- P Halfon
- Laboratoire Alphabio, Marseille, France.
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12
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Couzigou P, Marcellin P, Pol S, Bronowicki JP, Benhamou Y, Mathurin P, Trepo C, Zarski J, Habersetzer F, Bourlière M, Heathcote J, Rousseau F. Ténofovir disoproxil sous forme de fumarate (TDF) pour le traitement de l’hépatite B chronique chez des patients AgHBe-positif : résultats à 72 semaines et données à 24 semaines après remplacement d’adéfovir dipivoxil par TDF (étude 103). Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.10.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Pol S, Marcellin P, Habersetzer F, Bronowicki JP, Trepo C, Benhamou Y, Hézode C, Mathurin P, Couzigou P, Bourlière M, Zarski JP, Rousseau F. Ténofovir disoproxil sous forme de fumarate (TDF) pour le traitement de l’hépatite B chronique chez des patients AgHBe-négatif : résultats à 72 semaines et données à 24 semaines après remplacement d’adéfovir dipivoxil par TDF (étude 102). Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.10.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Chossegros P, Mélin P, Hézode C, Bourlière M, Pol S, Fhima A, Filoche B, Trépo C, Couzigou P, Ouzan D, Gagnon A. A French prospective observational study of the treatment of chronic hepatitis C in drug abusers. ACTA ACUST UNITED AC 2008; 32:850-7. [PMID: 18805662 DOI: 10.1016/j.gcb.2008.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Revised: 06/09/2008] [Accepted: 07/17/2008] [Indexed: 11/26/2022]
Abstract
The objective of this prospective, multicenter, observational study was to evaluate healthcare for hepatitis C virus (HCV)-infected drug abusers in France and to determine predictors of successful therapeutic intervention. A total of 170 drug users were recruited from 40 French centers. Three centers recruited 66 participants (38.8%), and one to eight patients each were enrolled from 37 other centers (n=104). A sustained viral response (SVR) was seen in 65 (38.2%) patients. SVR rates were significantly higher in compliant than in non-compliant patients (43.5% versus 23.9%; P=0.019), in patients from high- rather than low-recruiting centers (54.5% versus 27.9%; P<0.001) and in patients receiving Buprenorphine rather than methadone (48.1% versus 21.8%; P=0.001). In patients, who completed both the treatment and follow-up (n=94), SVR rate was 57.4%. Buprenorphine substitution therapy and genotypes 2 or 3 HCV infection were associated with significantly higher rates of SVR (P<0.01, for both comparisons). In conclusion, successful care of hepatitis requires an active treatment policy of every center toward drug addicts. Additional studies are needed to explore the difference in SVR with methadone versus Buprenorphine therapy.
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Affiliation(s)
- P Chossegros
- UHSI, centre hospitalier Lyon-Sud, hospices civils de Lyon, chemin Grand-Revoyet, Pierre-Bénite, France.
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15
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Bourlière M, Pénaranda G, Adhoute X, Oules V, Castellani P. Combining non-invasive methods for assessment of liver fibrosis. ACTA ACUST UNITED AC 2008; 32:73-9. [DOI: 10.1016/s0399-8320(08)73996-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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16
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Hayem C, Bourlière M, Barbaza MO, Cotton C, Pau D, Pinta A, Montestruc F, Vray M. Utilisation du Peginterferon alpha-2a chez 2101 patients atteints d’hépatite C chronique : méthodologie et résultats de la cohorte HEPATYS. Rev Epidemiol Sante Publique 2008. [DOI: 10.1016/j.respe.2008.06.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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17
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Abstract
New antiviral drugs, therapeutic vaccines and immunotherapies are interesting therapeutic option for treatment of chronic hepatitis B. Tenofovir disoproxil fumarate and clevudine are very effective in suppressing viral load with lack of resistance at short term. However antiviral drug rarely eliminate the virus. Immunotherapies by inducing HBV - specific T-cell responses may contribute to virus control. Adoptive T-cell therapy is an interesting approach to eliminate persistently infected cells. Therapeutic vaccines with either protein-based or DNA vaccines induce an HBV - specific T-cell responses leading to a more often transient decrease of viral load. Combination of antiviral drug and therapeutic vaccines may be an interesting therapeutic option. However additional larger scale and more systematic studies of the understanding of HBV specific T-cell response have to be performed in order to select which patient can benefit of such therapies.
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Affiliation(s)
- M Bourlière
- Service d'Hépato-Gastroentérologie, Hôpital saint joseph, 26, bd de Louvain, 13008 Marseille, France
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18
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Renou C, Moreau X, Pariente A, Cadranel JF, Maringe E, Morin T, Causse X, Payen JL, Izopet J, Nicand E, Bourlière M, Penaranda G, Hardwigsen J, Gerolami R, Péron JM, Pavio N. A national survey of acute hepatitis E in France. Aliment Pharmacol Ther 2008; 27:1086-93. [PMID: 18346187 DOI: 10.1111/j.1365-2036.2008.03679.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Few data are available on the incidence, risk factors and contamination pathways involved in acute indigenous hepatitis E in developed countries. AIMS To draw up an overall picture of hepatitis E cases, to confirm whether or not the majority of the cases were indigenous and to attempt to identify the risk factors and contamination pathways involved in hepatitis E. METHODS This study was performed in the framework of a national network (ANGH) including 96 participating centres. The 19 centres with at least one case of acute HEV reported a total number of 53 cases. RESULTS A decreasing South-to-North geographic gradient was observed. A nonspecific clinical profile was observed in many cases. Acute hepatitis E was of indigenous origin in 90% of the patients. The most relevant and/or frequent possible risk factors among the 47 indigenous metropolitan cases were water consumption from a personal water supply, uncooked shellfish consumption and the recent acquisition of a pet pig. CONCLUSIONS This national survey confirmed that acute indigenous hepatitis E is an emerging disease in developed countries such as France, and suggests that various risk factors are responsible for acute indigenous hepatitis E contamination in non-endemic countries.
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Affiliation(s)
- C Renou
- Hôpital de Jour, Hôpital d'Hyères, BP 82, 83407 Hyères Cedex, France.
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19
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Sallée M, Crétel E, Jean R, Chiche L, Bourlière M, Poullin P, Lefèvre P, Durand JM. Thrombotic thrombocytopenic purpura complicating interferon therapy in chronic C hepatitis. ACTA ACUST UNITED AC 2008; 32:145-6. [DOI: 10.1016/j.gcb.2007.12.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Roulot D, Bourcier V, Grando V, Deny P, Baazia Y, Fontaine H, Bailly F, Castera L, De Ledinghen V, Marcellin P, Poupon R, Bourlière M, Zarski JP, Roudot-Thoraval F. Epidemiological characteristics and response to peginterferon plus ribavirin treatment of hepatitis C virus genotype 4 infection. J Viral Hepat 2007; 14:460-7. [PMID: 17576387 DOI: 10.1111/j.1365-2893.2006.00823.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [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: 01/03/2023]
Abstract
Hepatitis C virus genotype 4 (HCV-4) infection is progressing in Europe, where epidemiology and sustained virological response (SVR) seem to be different than in the Middle East. We analysed epidemiological features and SVR rates in a retrospective study of 1532 HCV-4-infected patients, including 1056 patients infected in France, 227 immigrants infected in Egypt and 249 in sub-Saharan Africa. SVR rates were assessed in 242 naive patients of the 1532, who received peginterferon plus ribavirin for 48 weeks. HCV subtype 4a or 4d was the most common among patients infected in France, where the predominant route of transmission was intravenous drug abuse. The 4a subtype was largely predominant (93%) among patients infected in Egypt, where transmission was mostly because of parenteral treatment for schistosomiasis. More than seven different subtypes and no predominant route of infection were found in patients infected in sub-Saharan Africa. Liver fibrosis was significantly less severe in patients infected in France and Africa than in patients infected in Egypt. SVR rates were higher in patients infected in Egypt, compared with those infected in France or Africa (54.9%, 40.3% and 32.4%, respectively, P < 0.05). An overall better response was observed in patients infected with the 4a subtype. In multivariate analysis, two factors were associated independently with SVR: the Egyptian origin of transmission and the absence of severe fibrosis. In conclusion, the distribution of HCV-4 subtypes varies with the geographical origin of transmission and affects the SVR following antiviral treatment.
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Affiliation(s)
- D Roulot
- Service d'Hépatogastroentérologie, Hôpital Jean Verdier, Bondy, France.
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21
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Branger S, Schleinitz N, Veit V, Martaresche C, Bourlière M, Roblin X, Garcia S, San Marco M, Camoin L, Durand JM, Harlé JR. Étude de l'association hépatite auto-immune et antiphospholipides. Rev Med Interne 2007; 28:218-24. [PMID: 17331625 DOI: 10.1016/j.revmed.2006.12.005] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Revised: 12/01/2006] [Accepted: 12/11/2006] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Only few series have reported the association of autoimmune hepatitis with antiphospholipid antibodies. The aim of our study is to investigate the frequency of these antibodies in a series of autoimmune hepatitis and to search for a correlation with clinical, biological or histological characteristics. MATERIAL AND METHODS Antiphospholipid were investigated in 24 patients with well defined autoimmune hepatitis. Characteristics were compared between antiphopholipids positive and negative patients. Characteristics of our patients were also compared toward cases collected in a literature review. RESULTS The frequency of antiphospholipid antibodies is of 70.8% in our series. Four patients had a well defined antiphospholid syndrome. Seven patients had a systemic lupus erythematosus in the antiphospholipid group whereas none in the antiphospholipid negative group. The frequency of the different antiphopholipid antibodies was: IgG ACL (52.9%), IgM APE (52.9%), ACC (43.7%), IgG Abeta2GP1 (41.2%). We found no correlation between hypergammaglobulinemia and the presence or the isotype of antiphospholipid antibodies. Clinical presentation and outcome as biological and histological parameters were similar in both groups. CONCLUSION Our study report a high frequency of antiphospholipids antibodies in autoimmune hepatitis patients. However we found no clinical, biological or histological correlation with the presence of antiphospholipids. Further longitudinal studies on larger cohorts should clarify the association between antiphospholipid antibodies and autoimmune hepatitis and potential therapeutic issues.
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Affiliation(s)
- S Branger
- Service de médecine interne du Professeur-Harlé, CHU de La-Conception, 147, boulevard Baille, 13005 Marseille, France.
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22
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Poynard T, Halfon P, Castera L, Charlotte F, Le Bail B, Munteanu M, Messous D, Ratziu V, Benhamou Y, Bourlière M, De Ledinghen V. Variability of the area under the receiver operating characteristic curves in the diagnostic evaluation of liver fibrosis markers: impact of biopsy length and fragmentation. Aliment Pharmacol Ther 2007; 25:733-9. [PMID: 17311607 DOI: 10.1111/j.1365-2036.2007.03252.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [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: 12/13/2022]
Abstract
BACKGROUND The area under the receiver operating characteristic (ROC) curve is widely used as an estimate of the diagnostic value for fibrosis markers. Biopsy length and fragmentation are known as risk factors of false positive or false negative of biopsy but their quantitative impact on area under the receiver operating characteristic curve variability has not been assessed. AIM To assess these relationships to better compare the fibrosis markers. METHODS The area under the ROC curves of FibroTest for the diagnosis of fibrosis was estimated in patients with chronic hepatitis C using an integrated database including 1312 patients with FibroTest and biopsy. To take into account the biopsy length, we used two adjustment factors: one in which an observed area under the ROC curve could be adjusted according to the relative area under the receiver operating characteristic curve of a biopsy of a given length vs. the entire liver and one taking into account the prevalence of each fibrosis stage defining advanced and non-advanced fibrosis. RESULTS The mean biopsy length was smaller for cirrhosis (F4, 16 mm) vs. F3, (18 mm, P=0.01) and F0 (19 mm, P=0.01). The mean number of fragments was higher for cirrhosis (F4=4.1 fragments) vs. all the other stages (F0=1.9, F1=1.9, F2=1.9, F3=2.3; P<0.001 vs. F4). The FibroTest area under the ROC curves for the diagnosis of advanced fibrosis, adjusted for stages' prevalence, ranged from 0.80 to 0.98 depending on biopsy length and fragmentation, respectively. CONCLUSION The comparison of the area under the ROC curves of fibrosis markers should take into account the biopsy length and fragmentation.
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Affiliation(s)
- T Poynard
- APHP Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
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23
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Bonny C, Fontaine H, Poynard T, Hézode C, Larrey D, Marcellin P, Bourlière M, Bronowicki JP, Merle P, Zarski JP, Sapey T, Guillemard C, Ughetto S, Henquell C, Nicolas C, Roche C, Randl K, Bommelaer G, Abergel A. Effectiveness of interferon plus ribavirin combination in the treatment of naive patients with hepatitis C virus type 5. A French multicentre retrospective study. Aliment Pharmacol Ther 2006; 24:593-600. [PMID: 16907892 DOI: 10.1111/j.1365-2036.2006.03018.x] [Citation(s) in RCA: 22] [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: 01/02/2023]
Abstract
AIM To assess the rate of sustained virological response in naïve hepatitis C virus-type 5 patients treated by standard interferon or pegylated-interferon [corrected] (peg-interferon) and ribavirin combination for 48 weeks. PATIENTS AND METHODS A total of 87 hepatitis C virus patients were included from 12 centres in France; 28 patients received interferon plus ribavirin and 59 were treated with peg-interferon plus ribavirin. RESULTS Baseline characteristics were: mean age 58 +/- 11 years, sex ratio 1, 66% had metavir fibrosis score >or=F2, 21% were cirrhotics and 53% had pretherapeutic viral load >or=800,000 IU/mL. Sustained virological response was achieved in 64% and 58% of hepatitis C virus-5 patients treated with interferon and peg-interferon, respectively (NS). In adherent patients, sustained virological response was obtained in 75% of patients. Sustained virological response in hepatitis C virus-5 patients (60%) was significantly higher than sustained virological response in hepatitis C virus-1 patients (37%) (P = 0.0499) and not significantly different from sustained virological response in hepatitis C virus-2-3 patients (63%) (P = 0.8098). CONCLUSIONS Combination therapy is effective in 60% of hepatitis C virus-5-infected patients. Sustained virological response seems better in hepatitis C virus-5 patients than in hepatitis C virus-1 patients, and is similar to that of hepatitis C virus-2-3 patients. More studies are needed to determine optimal duration of treatment in hepatitis C virus-5 patients.
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Affiliation(s)
- C Bonny
- Service d'Hépato-Gastroentérologie, Hôtel-Dieu, Clermont-Ferrand, France.
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24
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Poynard T, Halfon P, Castera L, Ratziu V, Imbert-Bismut F, Naveau S, Thabut D, Lebrec D, Zoulim F, Munteanu M, Bourlière M, De Lédinghen V. CA 16-Méta-analyses du fibrotest (FT) pour le diagnostic de fibrose dans les 4 maladies du foie les plus fréquentes. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/s0399-8320(06)73426-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Halfon P, Bourlière M, Pénaranda G, Cacoub P. [Serum markers of non-invasive fibrosis in chronic hepatitis C virus infection]. Rev Med Interne 2006; 27:751-61. [PMID: 16815598 DOI: 10.1016/j.revmed.2006.03.037] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 01/05/2006] [Accepted: 03/27/2006] [Indexed: 12/25/2022]
Abstract
UNLABELLED MATTER: Liver biopsy is recommended for the management of patients infected by hepatitis C virus (HCV) and is currently the gold standard in assessing liver histology. It's an invasive test prone to complications with a morbidity rate of 0.3 to 0.6% and a mortality rate up to 0.05%. Since the last decade, researchers developed non invasifs biomarkers of liver fibrosis as an alternative to liver biopsy. These scores are based on different algorithms with various combinations of biomarkers issued from extra-cellular matrix, serum and cells. CURRENT EVENTS The diagnostic performance of these scores, estimated by the AUROC for significant fibrosis (>F2), in patients with chronic hepatitis C reach 0.78 to 0.90 for the most accurate. In HIV-HCV co-infected patients and patients with hepatitis C cirrhosis the diagnostic performance of these scores reach 0.74 to 0.88 and 0.73 to 0.97 respectively. PERSPECTIVES Liver fibrosis biomarkers constitutes an alternative to liver biopsy due to their non invasive approach, their easy reproducibility and accuracy. However, these scores must be used only after a validation in multicentric independent studies. The future is based on the comparison and validation of these scores after laboratory methods standardization.
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Affiliation(s)
- P Halfon
- Laboratoire de virologie Alphabio, 23, rue de Friedland,13006 Marseille, France.
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26
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Halfon P, Bourlière M, Pol S, Benhamou Y, Ouzan D, Rotily M, Khiri H, Renou C, Pénaranda G, Saadoun D, Thibault V, Serpaggi J, Varastet M, Tainturier MH, Poynard T, Cacoub P. Multicentre study of hepatitis B virus genotypes in France: correlation with liver fibrosis and hepatitis B e antigen status. J Viral Hepat 2006; 13:329-35. [PMID: 16637864 DOI: 10.1111/j.1365-2893.2005.00692.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [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: 12/16/2022]
Abstract
The clinical significance of hepatitis B virus (HBV) genotypes is still under debate. The aims of this study were to assess the distribution of HBV genotypes in France and to identify the associations between HBV genotypes and patient demographics, severity of liver disease and HBeAg status in patients referred to tertiary care centres. This was a French, multicentre, retrospective study on 262 patients with chronic HBV infection. HBV genotypes were determined using INNO-LiPA. Liver fibrosis damage was evaluated by histological analysis of biopsy samples. Patients were mainly male (74%), of Caucasian (65%), Asian (17%) or African (18%) ethnicity and 36% were HBeAg positive. All A-G genotypes were found, the most frequent being genotypes D (27%) and A (24%), followed by E (13%) and C (12%), and B (7%). Mixed genotypes were detected in 16% of the cases. Genotype A was associated with sexual contact (P < 0.001) and genotype D with transfusion (P < 0.001) and HBe antibody positivity (P = 0.03).The distribution of HBV genotypes differed with regard to the ethnicity, and may reflect migration patterns. Genotypes A and D were the most frequent in France. Genotype A was associated with HBeAg positivity and genotype D with HBe antibody positivity. In our European patients, we find no clear association between a given HBV genotype and liver disease severity.
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Affiliation(s)
- P Halfon
- Alphabio Laboratory, Marseille, France.
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Payan C, Roudot-Thoraval F, Marcellin P, Bled N, Duverlie G, Fouchard-Hubert I, Trimoulet P, Couzigou P, Cointe D, Chaput C, Henquell C, Abergel A, Pawlotsky JM, Hezode C, Coudé M, Blanchi A, Alain S, Loustaud-Ratti V, Chevallier P, Trepo C, Gerolami V, Portal I, Halfon P, Bourlière M, Bogard M, Plouvier E, Laffont C, Agius G, Silvain C, Brodard V, Thiefin G, Buffet-Janvresse C, Riachi G, Grattard F, Bourlet T, Stoll-Keller F, Doffoel M, Izopet J, Barange K, Martinot-Peignoux M, Branger M, Rosenberg A, Sogni P, Chaix ML, Pol S, Thibault V, Opolon P, Charrois A, Serfaty L, Fouqueray B, Grange JD, Lefrère JJ, Lunel-Fabiani F. Changing of hepatitis C virus genotype patterns in France at the beginning of the third millenium: The GEMHEP GenoCII Study. J Viral Hepat 2005; 12:405-13. [PMID: 15985012 DOI: 10.1111/j.1365-2893.2005.00605.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [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: 12/25/2022]
Abstract
This cross-sectional study aimed to investigate, during a short period between 2000 and 2001, in a large population of patients with chronic hepatitis C, the epidemiological characteristics of hepatitis C virus (HCV) genotypes in France. Data from 26 referral centres, corresponding to 1769 patients with chronic hepatitis C were collected consecutively during a 6-month period. HCV genotyping in the 5'-non-coding region (NCR) was performed in each center using the line probe assay (LiPA, in 63% of cases), sequencing (25%) or primer-specific polymerase chain reaction (PCR) (12%). HCV genotypes 1a, 1b, 2, 3, 4, 5, non-subtyped 1 and mixed infection were found in 18, 27, 9, 21, 9, 3, 11 and 1% of our population, respectively. HCV genotype distribution was associated with gender, age, source and duration of infection, alanine aminotransferase (ALT) levels, cirrhosis, alcohol consumption, hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coinfection. In multivariate analysis, only the source of infection was the independent factor significantly associated with genotype (P = 0.0001). In conclusion, this study shows a changing pattern of HCV genotypes in France, with i.v. drug abuse as the major risk factor, an increase of genotype 4, and to a lesser extent 1a and 5, and a decrease of genotypes 1b and 2. The modification of the HCV genotype pattern in France in the next 10 years may require new therapeutic strategies, and further survey studies.
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Affiliation(s)
- C Payan
- Laboratoire de Virologie, CHU Angers, France.
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Bourlière M. [Severe hepatopathies in HIV patients. Epidemiology and diagnosis]. Med Mal Infect 2004; 34 Spec No 2:1-3. [PMID: 15801529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- M Bourlière
- Service d'hepato-gastro-entérologie, hôpital Saint-Joseph, 26, boulevard de Louvain, 13008 Marseille, France.
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Halfon P, Pol S, Bourlière M, Courcambeck J, Cacoub P. [Nucleoside analogues resistance in the treatment of chronic hepatitis B virus infection]. Rev Med Interne 2003; 24:786-93. [PMID: 14656638 DOI: 10.1016/s0248-8663(03)00070-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
SUBJECT Chronic hepatitis B virus (HBV) infection is usually treated by interferon alpha. However, a sustained response after stopping treatment is only obtained in 30% of patients. ACTUALITY New therapeutic nucleoside analogs have been developed, i.e. lamivudine, famciclovir, adefovir, entecavir, clevudine. However, as in HIV infection, clearance of the original hepatitis B virus with emergence of distinct resistant mutants have been observed during or after treatment with most nucleoside analogs. In this review, the underlying mechanisms of resistance and the characterisation of HBV mutants are described to optimize the best therapeutic regimen. PERSPECTIVES Treatment of chronic HBV infection, as most of other chronic viral infection, should be based on combination therapy with a special search for the appearance of HBV mutant resistant.
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Affiliation(s)
- P Halfon
- Département de virologie, laboratoire Alphabio, Marseille, France
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Abstract
Patients infected with hepatitis C virus genotype 4 (HCV-4) respond to interferon alpha (IFN) as poorly as those infected with genotype 1. However, there is no information on the viral dynamics of HCV-4. Interferon-ribavirin treatment was administered to untreated patients infected with HCV-4. Viral load was assessed with Versant 3.0. Viral dynamics parameters were estimated based on the bi-phasic model for HCV during IFN treatment. Viral kinetics of HCV-4 follow a bi-phasic decline pattern also. The mean effectiveness of IFN in blocking production of HCV-4 was a decline of 77.8% during the first day of treatment. The half-life of free virions was estimated at 3.5 h and that of infected cells from 1.9 to over 70 days. The viral dynamics parameters of HCV-4 appear similar to those of HCV-1 and slower than those of HCV-2. HCV-4 infected patients should be grouped with those with HCV-1 when therapeutic schemes are considered in relation to genotype.
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Affiliation(s)
- P Halfon
- Alphabio Laboratory, Virological Department, Marseille, France.
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31
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Portal I, Bourlière M, Halfon P, De Lédinghen V, Couzigou P, Bernard PH, Blanc F, Caroli-Bosc F, Arpurt JP, Vetter D, Mathieu-Chandelier C, Chazouillères O, Thiefin G, Pol S, Sogni P, Abergel A, Bailly F, Picon M, Debonne JM, Zamora C, Alleman I, Moreau X, Doll F, Eugène C, Ducloux S, Larrey D, Ouzan D, Grimaud JC, Gouvernet J, Botti G, Gérolami V, Khiri H, Gérolami A, Gauthier AP, Botta-Fridlund D. Retreatment with interferon and ribavirin vs interferon alone according to viraemia in interferon responder-relapser hepatitis C patients: a prospective multicentre randomized controlled study. J Viral Hepat 2003; 10:215-23. [PMID: 12753341 DOI: 10.1046/j.1365-2893.2003.00426.x] [Citation(s) in RCA: 5] [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: 12/09/2022]
Abstract
Low pretreatment viral load has consistently been shown to be an independent predictor of sustained response (SR) in patients with chronic hepatitis C infection. We assessed the efficacy of interferon (IFN) plus ribavirin vs IFN alone in low viraemic patients (<2 millions copies/mL) who had relapsed to a previous course of IFN and the efficacy of 24 vs 48 week combination therapy in high viraemic patients. Two hundred and ninety-seven patients were randomly assigned to one of the four regimens after stratification on pretreatment viral load. All patients received IFN-alpha2b (6 million units thrice weekly for 24 weeks and 3 million units thrice weekly for 24 weeks). Patients with low viraemia received either IFN-alpha2b alone for 48 weeks (R1: 42 patients) or IFN-alpha2b plus ribavirin (600 mg/day) for 24 weeks and IFN-alpha2b alone for the next 24 weeks (R2: 48 patients). Patients with high viral load received either IFN-alpha2b plus ribavirin for 24 weeks and then IFN-alpha2b alone for the next 24 weeks (R3: 104 patients) or IFN-alpha2b plus ribavirin for 48 weeks (R4: 103 patients). In low viraemic patients the rate of SR was 37.7% in group R1 and 59.6% in group R2 (P < 0.05). In high viraemic patients, the rate of SR was 44.7% in group R3 and 51.4% in group R4 (P: NS). Thirty-one patients discontinued treatment (10.4%) without difference regarding treatment regimen. In the regimen using ribavirin we found no difference in terms of SR between patients receiving a dose of ribavirin below 10.6 mg/kg/day (55%) or over 10.6 mg/kg/day (58%). Histological improvement occurred in 70.2% of patients regardless of the regimen. Logistic regression showed that genotype 2 and 3, Knodell score <6 and alanine aminotransferase pretreatment level >3 x upper limit of normal were significantly and independently correlated with SR. In low viraemic patients who relapsed to a previous IFN treatment, combination therapy using high-dose IFN and low-dose ribavirin is better than high-dose IFN alone. In high viraemic patients there was no benefit in increasing the duration of combination therapy from 24 to 48 weeks. In this study, it was found that low dose of ribavirin can be used safely and there is no effect of ribavirin dose on SR.
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Affiliation(s)
- I Portal
- Department of Hepato-gastroenterology, Hospital La Conception, 13008 Marseille, France
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Cacoub P, Bourlière M, Hausfater P, Charlotte F, Khiri H, Toci S, Piette JC, Poynard T, Halfon P. Lower expression of CD81 B-cell receptor in lymphoproliferative diseases associated with hepatitis C virus infection. J Viral Hepat 2003; 10:10-5. [PMID: 12558906 DOI: 10.1046/j.1365-2893.2003.00380.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [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: 12/09/2022]
Abstract
Chronic hepatitis C virus (HCV) infection is frequently associated with type II mixed cryoglobulinaemia (MC), a benign lymphoproliferative disease (LPD). More recently, HCV has been implicated as a possible aetiologic factor of B-cell non-Hodgkin lymphoma (B-NHL). CD81, a B-cell surface receptor, has been proposed as a receptor for HCV binding and entry in circulating B cells. The stimulation of CD81 complex enables B cells to respond to lower concentrations of antigen and finally induces B-cell proliferation. We studied the phenotypic expression of CD81, CD19 and CD5 on circulating B cells in HCV patients LPD-positive or LPD-negative. Sixty-two patients were anti-HCV antibody positive. Among HCV positive patients, 44 were HCV RNA positive with an histologically proven chronic active hepatitis of whom 10 had a B-NHL, 14 an MC and 24 no extrahepatic manifestation. Eighteen patients were HCV RNA negative with evidence of resolved infection. A control group included 40 healthy subjects. Peripheral blood mononuclear cells (PBMC) were stained for surface expression of CD81, CD19 and CD5 using monoclonal antibodies, and were analyzed by flow cytometry. The percentage of PBMC expressing CD81, CD19 and CD5 receptors were compared between the groups by univariate analysis. Logistic regression model variables were then evaluated to correlate the presence of an LPD with HCV infection characteristics (i.e. age, gender, genotype, duration of infection, HCV RNA positivity, liver histological lesions), or phenotypic expression of CD81, CD19 and CD5 receptors on PBMC. HCV antibody-positive compared with HCV-negative subjects had a higher expression of CD19 receptor (23 +/- 13 vs 13 +/- 1%, P = 0.003). Among HCV RNA positive-patients, LPD+ compared with LPD- patients had a lower expression of CD81 (58 +/- 28 vs 82 +/- 18%, P = 0.001) and CD5 receptor (66 +/- 16 vs 74 +/- 13%, P = 0.04). In multivariate analysis, the expression of CD81 receptor was a negative (OR = 0.15, 95% CI = 0.04-0.64, P = 0.01) and CD19 receptor a positive (OR = 4.81, 95% CI =1.29-17.88, P = 0.02) predictive factor for an LPD. We found two negative predictive factors for HCV RNA positivity, i.e. age (OR = 0.23, 95% CI. = 0.08-0.62, P = 0.003) and the expression of CD81 receptor (OR = 0.34, 95% CI = 0.13-0.89, P = 0.02). In patients with a chronic active HCV infection, the presence of a lymphoproliferative disease, either MC or B-NHL, is associated with lower expression of CD81 and higher expression of CD19 receptor on peripheral B cells.
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Affiliation(s)
- P Cacoub
- Service de médecine interne, Hopital La Pitié-Salpêtrière, Bd de l'Hôpital, Paris Cedex, France.
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Abstract
Different isolates of hepatitis C virus (HCV) show nucleotide sequence variability throughout the genome. Detection of antibodies to recombinant proteins derived from hepatitis C virus genotype 1, the prototype HCV clone HCV-PT, constitutes the main method for screening HCV infection. The influence of the genomic variability on the serological diagnosis of HCV by enzyme immunoassay remains poorly defined. The aim of this study was to assess the serological reactivity of a panel of well characterized French HCV isolates typed by sequence analysis from patients with chronic hepatitis. The 73 sera samples were tested in three third generation EIA tests and three confirmatory assays. HCV isolates were determined by RT-PCR and sequencing in NS5B region of the genome. The 73 sera were positive in the three EIA tests. The three confirmatory tests showed a weaker reactivity with NS5 protein whatever the genotype, and a lower reactivity in NS4 antigens of non-type 1 sequences, particularly for genotype 3. Even though the reactivity of the antigens differed among the HCV isolates, the 73 isolates from genotype 1-6 were reactive with the three commercial screening assays. These results demonstrate that using a single test is adequate in the routine diagnosis of HCV infection in clinical laboratory, as recommended by the last French and European consensus conference.
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Affiliation(s)
- P Halfon
- Alphabio Laboratory, Hôpital Ambroise Paré, Marseille, France.
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Bourlière M, Barberin JM, Rotily M, Guagliardo V, Portal I, Lecomte L, Benali S, Boustière C, Perrier H, Jullien M, Lambot G, Loyer R, LeBars O, Daniel R, Khiri H, Halfon P. Epidemiological changes in hepatitis C virus genotypes in France: evidence in intravenous drug users. J Viral Hepat 2002; 9:62-70. [PMID: 11851904 DOI: 10.1046/j.1365-2893.2002.00319.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.4] [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
Hepatitis C virus (HCV) genotypes are distributed differently depending on geography and route of infection. We characterized the distribution of genotypes in a large cohort of patients with chronic hepatitis C in the South-east of France and evaluated the relative prevalence according to time of acquisition. One thousand, one hundred-and-eighty-three patients who were anti-HCV-positive were studied. HCV genotype distribution has changed significantly from the 1960s to 2000. The prevalence of genotype 1b decreased from 47% before 1978 to 18.8% in the 1990s while the prevalence of genotype 1a and 3a increased during the same period from 18% and 15.3% to 28.8% and 26.3%, respectively. The logistic regression model showed that genotype 1a was significantly more common in patients infected through intravenous drug injection odds ratio ((OR): 2.08, P < 0.01) and after 1990 (OR: 1.98, P < 0.05). Genotype 1b was significantly less frequent in patients infected through intravenous drug injection (OR: 0.17, P < 0.001) and has decreased since 1978 (OR: 0.27, P < 0.001). Genotype 3a was independently associated with intravenous drug injection (OR: 6.1, P < 0.001) and tattooing (OR: 8.01, P < 0.001) and was more frequent in the 1979-90 period (OR: 2.05 and 1.74, P < 0.001 and P < 0.05). Our results show a modification of HCV genotypes distribution over the last four decades due to an increase of intravenous drug use (IVDU) contamination and an evolution of HCV genotypes distribution only in IVDU population characterized by a decrease of genotype 1b, an increase of genotype 3a from 1970 to 1990 and a higher increase of genotype 1a which is currently the predominant genotype in our population.
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Affiliation(s)
- M Bourlière
- Department of Gastroenterology and Liver Unit, Hôpital Saint Joseph, France.
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Roudot-Thoraval F, Abergel A, Allaert F, Bourlière M, Desmorat H, Fagnani F, Fontanges T, Hanana A, Pol S, Zarski JP, Rousseaux C, Gandossi C, Samelson L, Dole S, Dantin S, Eberlé F, Saint-Marc-Girardin MF, Abelsour L. [Hepavir, the first observational study of one cohort of patients treated with alpha-2a interferon, monotherapy. Evaluation of asthenia and its social consequences]. Gastroenterol Clin Biol 2001; 25:1061-6. [PMID: 11910986] [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] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVES The aim of this observational study in patients with chronic hepatitis C and treated with interferon alpha-2a was to assess 1) monitoring in everyday practice, 2) the acceptability of treatment and 3) the intensity of fatigue. METHODS Three hundred and fifty four patients were enrolled by physicians in both teaching and general hospitals, or private practice. Before treatment, clinical, epidemiological, and virological data were collected as well as a self-evaluation of fatigue using a visual analogic scale. Clinical follow-up was assessed every 3 months during treatment and 6 months after the end of treatment and included an evaluation of fatigue and the number of workdays missed due to sickness. RESULTS Two hundred and nineteen men and 135 women, mean age 45 +/- 13, were included. The epidemiological, histological and virological features of this group were similar to those patients usually treated for chronic hepatitis C. Before treatment, the mean measurement of fatigue was 41 on a scale from 0 (perfect form) to 100 (exhausted). Fatigue was unrelated to age, source of infection, biological activity, or histological score. It worsened in patients who stopped interferon after 3 or 6 months, but was stable in patients who continued treatment for 12 months. Fatigue decreased after the end of treatment and was unrelated to treatment response. The need to stop work was strongly related to the intensity of fatigue and the number of workdays missed due to sickness represented nearly two months out of three in 25% of active patients during the first quarter and in 15% of patients thereafter. 61% of patients self-injected interferon (mainly previous drug users) whereas 30% of patients used nurse care throughout treatment. CONCLUSION This study not only provides a realistic evaluation of fatigue in patients with chronic hepatitis C, before, during and after treatment, but also highlights its social and economic consequences. It shows the need for further cost-effectiveness studies on new therapeutic strategies using combined treatments.
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Halfon P, Halimi G, Bourlière M, Ouzan D, Durant J, Khiri H, Mercier L, Gerolami V, Cartouzou G. Integrity of the NS5A (amino acid 2209 to 2248) region in hepatitis C virus 1b patients non-responsive to interferon therapy. Liver 2000; 20:381-6. [PMID: 11092256 DOI: 10.1034/j.1600-0676.2000.020005381.x] [Citation(s) in RCA: 11] [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: 11/23/2022]
Abstract
BACKGROUND/AIMS In hepatitis C virus-1b, it has been suggested that an amino acid stretch (aa 2209-2248) of the carboxy terminal half of the non-structural 5A (NS5A) region participates in the response to interferon treatment. We tested the hypothesis that absence of mutations in the NS5A (aa 2209-2248) sequence is required for interferon resistance. We also investigated the importance of different HCV-1b isolates in interferon response in France. METHODS We determined the NS5A sequences of 70 patients with chronic hepatitis C before IFN therapy and then compared them with HCV-J prototype sequence. The isolates were determined by NS5B sequencing, the "gold standard" method for genotyping and subtyping. Pre-therapeutic viral load was also measured. RESULTS No sustained virological response was observed in the patients without amino acid substitutions in the NS5A (aa 2209-2248) sequence, and in the patients with HCV-J isolates. Viral load was significantly higher in the patients with no amino acid substitutions in the NS5A (aa 2209-2248) sequence. CONCLUSIONS In HCV-lb infected patients, an HCV-J strain with no amino acid substitution in the NS5A (aa 2209 2248) region indicates a poor prognosis for response to IFN therapy. The low interferon response rate in HCV-lb infection in Europe is probably not due to a difference between isolates.
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Affiliation(s)
- P Halfon
- Laboratoire Alphabio, Hôpital de la Conception, Marseilles, France.
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Bourlière M, Halfon P, Quentin Y, David P, Mengotti C, Portal I, Khiri H, Benali S, Perrier H, Boustière C, Jullien M, Lambot G. Covert transmission of hepatitis C virus during bloody fisticuffs. Gastroenterology 2000; 119:507-11. [PMID: 10930386 DOI: 10.1053/gast.2000.9303] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [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: 12/02/2022]
Abstract
Hepatitis C virus (HCV) is transmitted primarily through direct percutaneous exposure to infected blood. Sporadic HCV cases exist and may represent more than 10% of HCV transmission. We report the first case of documented transmission of HCV during a fight from a person who unknowingly had chronic HCV infection to a person who subsequently contracted acute hepatitis C. Patient-to-patient transmission was ascertained by sequence analysis of part of the NS5B genome and phylogenetic analysis. This case report suggests that sporadic HCV infection may be a result of blood exposure. This example of transmission could have a major impact in sports such as boxing or rugby. We suggest that in any fight, single use or nondisposable material should be used to dry blood to avoid such contamination.
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Affiliation(s)
- M Bourlière
- Department of Hepatogastroenterology, Hôpital Saint Joseph, Marseille, France.
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Pol S, Nalpas B, Bourlière M, Couzigou P, Tran A, Abergel A, Zarski JP, Berthelot P, Bréchot C. Combination of ribavirin and interferon-alfa surpasses high doses of interferon-alfa alone in patients with genotype-1b-related chronic hepatitis C. Hepatology 2000; 31:1338-44. [PMID: 10827161 DOI: 10.1053/jhep.2000.8089] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [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: 12/07/2022]
Abstract
The purpose of this study was to compare interferon-alfa alone (12-month course with high initial doses) with a combination of interferon-alfa and ribavirin in patients infected with genotype 1b. Three hundred and seven patients were randomized into 3 groups to receive 6 mega units (MU) of interferon-alfa-2b subcutaneously 3 times weekly for 6 months followed by 3 MU for 6 months (n = 95, group A); 10 MU for 3 months followed by 6 MU for 3 months, followed by 3 MU for 6 months (n = 83, group B); or the group-A schedule in combination with ribavirin (n = 129, group C) for 4 (n = 46), 6 (n = 44), or 12 months (n = 39). Negative polymerase chain reaction (PCR) was more frequent in group C than in groups A or B after 3 months of treatment (P <.006), at the end of treatment (P =.017), and at the end of follow-up (32.8%, 16.9%, and 14.1%, respectively, P <.003). A complete response (negative PCR and normal alanine transaminase) was higher in group C than in the other groups and when comparing 12- to 4- and 6-month combination therapy at the end of treatment (P =.05) and of follow-up (45.2% vs. 25.4%, respectively, P =.05). The greater efficacy of the combination was related to the higher rate of primary virological response and also to a decrease in the percentage of breakthrough and of relapse. In 1b-infected patients, the combination of high doses of interferon-alfa (6 MU) and ribavirin for 12 months appears to be the best therapy, with a high rate of sustained response.
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Affiliation(s)
- S Pol
- Unité d'Hépatologie et INSERM U-370, Hôpital Necker-Enfants Malades, Paris, France.
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Babany G, Bourlière M, Chevalier H, Chousterman M, Couzigou P, Desmorat H, Dhumeaux D, Doffoël M, Gournay J, Loiseau D, Mercet P, Moussalli J, Trépo C, Tucat G, Doan Tran D, Saint-Marc-Girardin MF. [Do general practitioners want to manage chronic hepatitis C and take part in hepatitis C health networks? A national survey]. Gastroenterol Clin Biol 1999; 23:1289-95. [PMID: 10642617] [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] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
OBJECTIVES To assess information that general practitioners had on hepatitis C and on the hepatitis C network in hospitals and private practice. METHODOLOGY A national telephone survey of 604 general practitioners was conducted between March 18 and 23, 1998. RESULTS Screening and management of hepatitis C was important for 89% and 97% of general practitioners. Screening was performed in relation to the relative risk (IV drug users 89%, blood transfusion before 1991 88%). General practitioners wanted more information on treatment (54%), patient counselling (42%) and the potential risks of the disease (42%). Of 604 general practitioners, 6% were involved in a hepatitis C network, while 21% were involved in another network (drug users 9%, AIDS 8%). Of the 94% general practitioners who were not part of the network, 33% were willing to join a hepatitis C network. Only 56% were aware of a hepatitis C network (press article 30%, mailing 17% or local meeting 12%). The difficulties for the involvement of general practitioners were: lack of time, topics not adapted to daily practice and geographic constraints (74%), too few patients in their practice (52%), no need (38%), the idea itself of a network and lack of information (28%). CONCLUSION General practitioners screen patients at risk of hepatitis C. They want to be better informed about treatment, patient counselling, and the potential risks of hepatitis C. They are less involved in hepatitis C networks than in other networks (drug, AIDS). However, one third of general practitioners would like to be involved in a hepatitis C network. These results could be useful for implementing post-graduate courses and general practitioner training.
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Affiliation(s)
- G Babany
- Produits Roche, Neuilly-sur-Seine; Service d'Hépato-Gastroentérologie, Hôpital Saint-Joseph, Marseille; Taylor Nelson SOFRES Healthcare; Services d'Hépato-Gastoentérologie, Centre Hospitalie
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Bourlière M. [Hepatitis C today]. Soins 1999:33-6. [PMID: 10857435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Pol S, Couzigou P, Bourlière M, Abergel A, Combis JM, Larrey D, Tran A, Moussalli J, Poupon R, Berthelot P, Bréchot C. A randomized trial of ribavirin and interferon-alpha vs. interferon-alpha alone in patients with chronic hepatitis C who were non-responders to a previous treatment. Multicenter Study Group under the coordination of the Necker Hospital, Paris, France. J Hepatol 1999; 31:1-7. [PMID: 10424277 DOI: 10.1016/s0168-8278(99)80157-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [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: 12/04/2022]
Abstract
BACKGROUND/AIM Fifty percent of patients infected with hepatitis C virus (HCV) show no response to alpha-interferon, and no alternative therapy has thus far proven to be effective. Therapeutic combination with ribavirin and alpha-interferon has shown promising results in naive patients and in relapsers, but based on limited series, it was reported to be inefficient in non-responders. The aim of our study was therefore to explore and compare, in a randomized trial, the tolerance and potential efficacy of alpha-interferon alone with a sequential combination of ribavirin and the same alpha-interferon regimen in those patients. METHODS Sixty-four non-responder patients were randomized in the alpha2b-interferon group (a 6-month course at a dosage of 6 MU followed by a 6-month course of 3 MU three times weekly subcutaneously) and 62 in the "combination" group (sequential combination of the same alpha2b-interferon therapy preceded by a 2-month course of ribavirin which was then associated for 2 months with alpha2b-interferon at a daily dosage of 1.0 or 1.2 g). RESULTS Treatment withdrawal was necessary for six patients from the alpha-interferon and eight patients from the combination group. Normalization of aminotransferase activities was significantly more frequent after the 4-month course of ribavirin with 2 months of interferon than after 2 months of interferon alone (52.8 vs. 26.2%, p<0.01), but this difference was not maintained after ribavirin withdrawal. Disappearance of serum HCV RNA (PCR) was significantly more frequent at the end of treatment in the combination group (24.5 vs. 7.7%, p=0.02), but did not differ 6 months after the end of therapy (9.8 and 8.3%, respectively). The long-term response was not associated with liver status (cirrhosis vs. absence of cirrhosis) or genotype. Mean viremia was significantly lower in long-term responders than in non-responders or relapsers in both groups (p<0.001 for the interferon group and p<0.05 for the combination group), but the large extent of viral load precluded reliable prediction. The pre- and post-treatment hepatitis activity index did not differ between the two groups. While a crude histopathological improvement in the hepatitis activity index for a given patient was more frequently observed in the combination group (69.2 vs. 35.9%, p<0.01), improvement as defined by a decrease of at least 2 in the hepatitis activity index was significant only for lobular necrosis and degeneration. CONCLUSIONS This study demonstrates the efficacy of the combination of ribavirin/alpha-interferon in non-responders. Indeed, (i) it is fairly tolerated; (ii) it increases the rate of the initial biological response, and of the virological response by decreasing breakthrough, though this benefit is not sustained; and (iii) it induces a significant histological improvement in necrosis. A simultaneous and prolonged combination of ribavirin/alpha-interferon should be further evaluated in non-responders.
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Affiliation(s)
- S Pol
- Assistance Publique/Hôpitaux de Paris, Necker, France
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Halfon P, Quentin Y, Roquelaure B, Sarles J, Halimi G, Gerolami V, Khiri H, Bourlière M, Cartouzou G. Mother-to-infant transmission of hepatitis C virus: molecular evidence of superinfection by homologous virus in children. J Hepatol 1999; 30:970-8. [PMID: 10406172 DOI: 10.1016/s0168-8278(99)80248-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [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: 12/04/2022]
Abstract
BACKGROUND/AIM Vertical transmission of hepatitis C virus (HCV) is well established but its incidence is low. To assess the molecular evidence of mother-to-infant transmission or intrafamilial transmission of HCV, the NS5 B region and the hypervariable region 1 (HVR1) of the E2/NS1 region of the HCV genome from each member of a family were investigated. METHODS A 35-year-old mother with chronic hepatitis C virus infection and her four infected boys were studied. The same HCV 1a genotype was found in all five. Phylogenetic analysis was done by the neighbor-joining, the maximum likelihood, and the maximum parsimony methods. RESULTS Comparison of the phylogenetic trees in the NS5B and HVR1 regions showed that the sequences in the children were more closely related to the population of variants of their own mother than to any genotype la sequence available in the databases. However, four HVR1 clones from two brothers (E2 and E3) had a strong homology, but were significantly divergent from the variants of the mother. CONCLUSIONS These results suggest that a cluster of HCV strains exists in the family and that E3 could have been superinfected by E2 HCV strains and reciprocally. In conclusion, phylogenetic analysis through variable regions of the genome suggests that at least two modes of transmission are involved in this family: perinatal and horizontal.
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Affiliation(s)
- P Halfon
- Laboratoire de Biochimie, Hôpital de la Conception, CNRS, Marseilles, France.
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Halfon P, Bourlière M, Halimi G, Khiri H, Bertezene P, Portal I, Botta-Fridlund D, Gauthier AP, Jullien M, Feryn JM, Gerolami V, Cartouzou G. Assessment of spontaneous fluctuations of viral load in untreated patients with chronic hepatitis C by two standardized quantitation methods: branched DNA and Amplicor Monitor. J Clin Microbiol 1998; 36:2073-5. [PMID: 9650965 PMCID: PMC104981 DOI: 10.1128/jcm.36.7.2073-2075.1998] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [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: 02/08/2023] Open
Abstract
Quantitation of hepatitis C virus (HCV) RNA in serum has been used to predict and monitor the efficacy of interferon therapy in chronic HCV infection. We prospectively studied the fluctuation of viremia by a longitudinal follow-up of HCV RNA levels for 2 months in six untreated patients. Spontaneous fluctuations of HCV RNA ranged from 2.8- to 5.7-fold with branched DNA assay and from 2.9- to 5.6-fold with Monitor. These large spontaneous fluctuations (up to 0.75 log), observed daily, weekly, and monthly, raise doubt about the clinical value of a single assessment of pretherapeutic viremia.
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Affiliation(s)
- P Halfon
- Alphabio Laboratory, Department of Biochemistry, Hôpital de la Conception, Marseille, France.
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Renou C, Halfon P, Bourlière M, Halimi G, Cartouzou G, Gérolami V, Raabe JJ, Rifflet H, Ouzan D. Étude moléculaire de la transmission du virus de l'hépatite C entre époux virémiques. Rev Med Interne 1998. [DOI: 10.1016/s0248-8663(98)90045-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rotily M, Vernay-Vaisse C, Bourlière M, Galinier-Pujol A, Rousseau S, Obadia Y. HBV and HIV screening, and hepatitis B immunization programme in the prison of Marseille, France. Int J STD AIDS 1997; 8:753-9. [PMID: 9433949 DOI: 10.1258/0956462971919228] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [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
This study estimated the prevalence of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) serological markers among inmates and evaluated inmates' compliance with an HBV immunization programme. During the mandatory consultation at the sexually transmitted disease (STD) clinic of the Marseille Prison (HIV counselling, and syphilis/HIV screening), physicians offered serological testing (anti-HBs, anti-HBc, HbsAg, anti-HIV) and Engerix B vaccination to each entrant. The number participating in the survey is 391/411 (89%); 75% were aged 18 to 35 years and 79% were men; 42% reported having had multiple sexual partners during the last 12 months. Report of an intravenous drug user (IDU) sexual partner was more frequent among women than men (22% vs 8%). Injecting drug use over lifetime was reported by 23%; 27% declared having shared their injection equipment during the last 12 months. 124/267 (32%) had an HBV marker: anti-HBs + only (immunized): 2.3%; anti-HBs + and anti-HBc +: 21.7%; anti-HBc + only: 6.4%; HBsAg +: 1.3%. The HIV seroprevalence was 6% (21% among IDUs). This survey underlines the high HBV and HIV seroprevalence among prisoners and the high proportion of inmates at risk for these infections. There is an urgent need for immunization and education programmes in this population. It demonstrates an HBV immunization programme is feasible and accepted by inmates and staff members.
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Affiliation(s)
- M Rotily
- Observatoire Régional de la Santé PACA, INSERM U 379, Marseille, France
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Rotily M, Vernay-Vaisse C, Bourlière M. Three quarters of one French prison population needed immunisation against hepatitis B. BMJ 1997; 315:61. [PMID: 9233352 PMCID: PMC2127053 DOI: 10.1136/bmj.315.7099.61] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Ouzan D, Desmorat H, Bourlière M, Baldini E, Boyer N, Fontanges T, Mathieu-Chandelier C, Jacques JP, Baesjou S, Rouhier D, Louvet H, Hanslik B, Beorchia S, Antoni M, Brunerie M, Corcos D, Richard-Molard B, Pierrugues R, Caucanas J, Jouanolle H, Khiri ZAH, Brichetti A, Halfon P. Étude multicentrique contrôlée de traitement par Pinterféron α2b de l'hépatite chronique C. L'administration d'une dose d'attaque (5 MU) 6 mois puis d'entretien (3 MU) 6 mois augmente-t-elle le taux de réponse durable ? Rev Med Interne 1997. [DOI: 10.1016/s0248-8663(97)80294-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Rotily M, Loubière S, Nixon J, Bourlière M, Halfon P, Moatti JP. [Should hepatitis C be screened? Socioeconomic analysis of different screening strategies for chronic hepatitis C in French population]. Gastroenterol Clin Biol 1997; 21:S33-40. [PMID: 9161512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- M Rotily
- INSERM U 379, Institut Paoli-Calmettes, Marseille
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