Economic impact and complications of treated and untreated hepatitis C virus patients in Turkey

Onur Başer (MEF Author)Background: According to the Turkish Ministry of Health’s guidelines,standard double therapy, a combination of pegylated interferon-alphaand ribavirin, was the only treatment option for patients withhepatitis C virus (HCV) infection until the end of 2011. Objective: Theprimary objective was to compare risk-adjusted clinical and economicoutcomes between treated and untreated patients with HCV infection.Methods: Patients with HCV infection were identified from theTurkish National Health Insurance Database (2009–2011) using International Classification of Diseases, 10th Revision, Clinical Modification codes.The first prescription date was designated as the index date. Mortalityand hepatocellular carcinoma (HCC) rates and health care costs oftreated and untreated patients were compared using propensity scorematching. Baseline demographic and clinical factors were controlledin the models. Subgroup analysis was conducted for patient groupswith and without a cirrhosis diagnosis. Results: Out of 12,990 patientsincluded in the study, 1,583 were treated for HCV infection. Out of2,467 patients who had a cirrhosis diagnosis, 231 were treated,whereas out of 10,523 patients without cirrhosis, 1,352 patients weretreated. Treated patients were younger, less likely to be diagnosedwith comorbid conditions, and less likely to reside in Central orEastern Anatolia. After adjusting for baseline demographic andclinical factors, mortality (2.27% vs. 5.31%; P o 0.001) and HCC rates(0.69% vs. 1.96%; P o 0.001) were found to be lower for treatedpatients. Differences were more significant among patients diagnosedwith cirrhosis. Treated patients incurred higher risk-adjusted annualcosts (€6172 vs. €1680; P o 0.001), mainly because of pharmaceuticalcosts (€4918 vs. €583; P o 0.001). Conclusions: HCV infection treatment, although costly, significantly reduces mortality and HCC ratesin Turkey.Scopus - Affiliation ID: 60105072PMID: 2969815

Spontaneous HBsAg seroconversion after severe flare of chronic hepatitis B infection

The results of the acute exacerbations of hepatitis B virus are varied from silent to severe acute hepatitis. HBsAg seroconversion induced by either antiviral drugs or occurred spontaneously, as a targeted end point of HBV infection management is infreaquent. The affect of the severe hepatitic flare on HBsAg seroconversion was reported before, however the predictive markers of HBsAg seroconversion are not clear yet. The reasons of the spontaneously HBV re-activations, or its usual results are not known well. We, herein reported a case, with the high serum HBV DNA titer during an acute spontaneously induced severe exacerbation of HBV infection which spontaneously resulted in total HBV recovery

Fetuin-A mRNA expression is elevated in NASH compared with NAFL patients

Abstract Fetuin-A is a pro-inflammatory protein expressed by hepatocytes. Its course in morbidly obese patients with NAFLD (non-alcoholic fatty liver disease) following weight loss by BAS (bariatric surgery) has not been fully elucidated yet. In the present study, we prospectively examined the effects of weight loss on various metabolic factors at 4 weeks and 6 months after surgery. Blood and liver tissues were retrieved from 108 morbidly obese NAFLD patients before/during BAS, and 50 of these individuals met the criteria for NASH (non-alcoholic steatohepatitis). Fetuin-A expression was measured by qPCR (quantitative real-time PCR), Western blotting and immunohistochemistry. Hepatocyte apoptosis was quantified via M30 (caspase-cleaved cytokeratin-18 fragments). Plasma concentrations of adiponectin and fetuin-A were determined by ELISA. Serum-derived parameters were additionally taken at 4 weeks and 6 months post-operatively. In addition, primary human hepatocytes were treated with NEFA (non-esterified fatty acid) to investigate changes in fetuin-A. BMI (body mass index) decreased significantly from 53.0 + − 1.1 to 36.4 + − 1.9 kg/m 2 in the NAFL group and from 53.3 + − 1.1 to 37.6 + − 1.2 kg/m 2 in the NASH group (P < 0.0001) at 6 months post-surgery. This was associated with diminishing M30 and M65 (total cytokeratin-18) levels over 6 months after surgery. Adiponectin levels increased continuously in NASH patients, whereas NAFL patients plateaued at 4 weeks post-operatively. Hepatic fetuin-A mRNA and protein expression was elevated before surgery-induced weight loss. However, plasma concentrations of fetuin-A increased signficantly in NASH patients 4 weeks post-operatively. Treatment of hepatocytes with NEFA led to up-regulation of fetuin-A expression. BAS probably has a beneficial effect on NAFLD, as indicated by reduced hepatocyte apoptosis and improved adipokine profiles. In addition, fetuin-A expression is more prominent in NASH