| 1. |
- Sangfelt, Per, et al.
(författare)
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Lamivudine and famciclovir combination therapy with or without addition of interferon-alpha-2b for HBeAg-positive chronic hepatitis B : a pilot study
- 2002
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 34:7, s. 505-511
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Tidskriftsartikel (refereegranskat)abstract
- Lamivudine and famciclovir combination therapy has been used in patients with chronic HBeAg-positive hepatitis B to enhance the antiviral effect and reduce the risk of development of resistance. Interferon-alpha (IFN-alpha) can theoretically be added to the regimen to further improve the antiviral effect. Twenty patients with HBeAg-positive chronic hepatitis B were given lamivudine and famciclovir combination therapy for 24 weeks. After 12 weeks of treatment, patients were randomized on a 1:1 basis to either the addition of IFN-alpha 2b or no addition for the last 3 months of therapy. The decline in HBV DNA levels, the loss of HBeAg and the HBeAg seroconversion rate were assessed. Patients with loss of HBeAg and/or development of anti-HBe were followed up for at least 1 y after stopping treatment. Four of 19 patients (21%) had lost HBeAg and/or developed anti-HBe 24 weeks after stopping treatment, 1 of whom had received additional IFN-alpha. During long-term follow-up post-treatment, 2/19 patients (10.5%) had a durable HBeAg seroconversion. The mean HBV DNA level declined by 5 logs during the first 12 weeks of treatment. Addition of IFN-alpha during the last 3 months of treatment did not result in any further decline in HBV DNA levels compared with the non-IFN-alpha-treated group, nor in any increase in the HBeAg seroconversion rate. In conclusion, lamivudine and famciclovir combination treatment induced seroconversion from HBeAg to anti-HBe in 4/19 patients, 2 of whom became long-term responders. Addition of IFN-alpha did not improve the seroconversion rate.
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| 2. |
- Sangfelt, Per, et al.
(författare)
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Serum ALT levels as a surrogate marker for serum HBV DNA levels in HBeAg-negative pregnant women
- 2004
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 36:3, s. 182-185
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Tidskriftsartikel (refereegranskat)abstract
- In Stockholm, Sweden, the majority of pregnant women positive for hepatitis B surface antigen (HBsAg) are hepatitis Be antigen (HBeAg) negative. Newborns to HBeAg positive mothers receive vaccination and hepatitis B immunoglobulin (HBIg). Newborns to HBeAg negative mothers receive vaccine and HBIg only if the mothers have elevated ALT levels. The aim of this study was to retrospectively evaluate ALT levels as a surrogate marker for HBV DNA levels in HBeAg negative carrier mothers. Altogether 8947 pregnant women were screened for HBV markers from 1999 to 2001 at the Virology Department, Karolinska Hospital. Among mothers screened 192 tested positive for HBsAg (2.2%). 13 of these samples could not be retrieved. Of the remaining 179 sera, 8 (4%) tested positive for HBeAg and 171 (95.5%) were HBeAg negative. Among the HBeAg negative mothers, 9 had HBV DNA levels > 10(5) copies/ml, and of these 7 had normal ALT levels indicating low sensitivity of an elevated ALT level as a surrogate marker for high HBV DNA level. Furthermore, no correlation was found between ALT and HBV DNA levels. Hence, it is concluded that the use of ALT as a surrogate marker for high viral replication in HBeAg negative mothers could be questioned.
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| 3. |
- Wejstål, Rune, et al.
(författare)
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Chronic hepatitis C : updated Swedish consensus
- 2003
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 35:8, s. 445-451
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Tidskriftsartikel (refereegranskat)abstract
- In 1999 a Swedish national expert panel published recommendations for the treatment of chronic hepatitis C (HCV) infection. Recently, pegylated interferon (peg-IFN) products have been introduced, and an increased knowledge concerning treatment of acute HCV and HCV-human immunodeficiency virus (HIV) coinfection has been gained. As a result of this, an update of the Swedish recommendations was developed following an expert meeting in October 2002. The panel now recommends the use of peg-IFN together with ribavirin as the standard treatment. Owing to the excellent response rates in HCV genotype 2 and 3 infections, these patients can be treated for 24 weeks without preceding liver biopsy. For patients with genotype 1 infection (with a slightly below 50% sustained response rate after 48 weeks treatment) and only mild histological disease, treatment can be postponed until future better treatment options become available. In patients who fail to achieve a 99% reduction (2 log drop) in viral titre after 12 weeks of treatment, discontinuation of therapy is recommended. Patients previously treated with IFN monotherapy and not having achieved a sustained virological response are recommended the same combination treatment as treatment-naive patients. IFN monotherapy is recommended in patients with acute hepatitis C. For children with chronic HCV infection, combination treatment is mainly recommended in clinical trials. For HCV-HIV coinfected patients, combination treatment is recommended and preferably given when blood CD4 counts are above 350/ml and before antiretroviral treatment (ART) is needed. Concurrent ART or prominent liver fibrosis requires frequent monitoring because of the increased risk for mitochondrial toxicity and liver failure.
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| 4. |
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