Protease inhibitors-based therapy induces acquired spherocytic-like anemia and ineffective erythropoiesis in chronic HCV patients

Background & Aims: The addition of protease inhibitors, boceprevir (BOC)or telaprevir (TRV), to peg-interferon and ribavirin (PR) increases the incidenceof anaemia in patients with chronic hepatitis C virus (HCV) infection.Although genetic variants in inosine triphosphatase (ITPA) gene have beenlinked to the haemolytic anaemia induced by PR, the mechanism sustainingsevere anaemia during triple therapy is still unknown. This study aims to elucidatethe molecular mechanisms underlying anaemia in chronic HCVpatients with combined therapy. Methods: We studied 59 patients withchronic HCV genotype-1: 29 treated with TRV/PR and 30 with BOC/PR. Weevaluated biochemical and haematological parameters, red cell index at baseline,4, 12, 16 and 24 weeks of treatment; in a subgroup, we performed functionalstudies: osmotic fragility, red cell membrane protein separation, massspectrometry analysis, quantification of erythroid microparticles release.IL28B and ITPA polymorphisms were also evaluated. Results: We foundearly acute normochromic normocytic haemolytic anaemia (4\u20138 weeks) followedby a late macrocytic hypo-regenerative anaemia with inappropriatelow reticulocyte count (12\u201324 weeks). Studies on red cells revealed: (i) presenceof spherocytes; (ii) increased osmotic fragility; (iii) abnormalities in redcell membrane protein composition; (iv) reduced membrane-cytoskeletonstability; (v) increased release of erythroid microparticles. ITPA polymorphismsimpacted only the early phase of anaemia. Conclusions: The bimodalpattern of anaemia in chronic HCV patients on triple therapy might bebecause of acquired spherocytic-like anaemia in the early phase, followed byhyporegenerative anaemia, most likely related to the combined effects of PRand TRV or BOC on erythropoiesis

Real-life data on potential drug-drug interactions in patients with chronic hepatitis C viral infection undergoing antiviral therapy with interferon-free DAAs in the PITER Cohort Study

Background There are few real-life data on the potential drug-drug interactions (DDIs) between anti-HCV direct-acting antivirals (DAAs) and the comedications used. Aim To assess the potential DDIs of DAAs in HCV-infected outpatients, according to the severity of liver disease and comedication used in a prospective multicentric study. Methods Data from patients in 15 clinical centers who had started a DAA regimen and were receiving comedications during March 2015 to March 2016 were prospectively evaluated. The DDIs for each regimen and comedication were assigned according to HepC Drug Interactions (www.hep-druginteractions.org). Results Of the 449 patients evaluated, 86 had mild liver disease and 363 had moderate-to-severe disease. The use of a single comedication was more frequent among patients with mild liver disease (p = 0.03), whereas utilization of more than three drugs among those with moderate-to-severe disease (p = 0.05). Of the 142 comedications used in 86 patients with mild disease, 27 (20%) may require dose adjustment/closer monitoring, none was contraindicated. Of the 322 comedications used in 363 patients with moderate-to-severe liver disease, 82 (25%) were classified with potential DDIs that required only monitoring and dose adjustments; 10 (3%) were contraindicated in severe liver disease. In patients with mild liver disease 30% (26/86) used at least one drug with a potential DDI whereas of the 363 patients with moderate-to-severe liver disease, 161 (44%) were at risk for one or more DDI. Conclusions Based on these results, we can estimate that 30-44% of patients undergoing DAA and taking comedications are at risk of a clinically significant DDI. This data indicates the need for increased awareness of potential DDI during DAA therapy, especially in patients with moderate-to-severe liver disease. For several drugs, the recommendation related to the DDI changes from "dose adjustment/closer monitoring" in mild to moderate liver disease, to "the use is contraindicated" in severe liver disease

CDM circuit simulation of a HV Operational Amplifier realized in 0.35μm Smart Power technology

CDM circuit simulations feasibility on complex smart power circuits is presented in this work and applied to a high voltage operational amplifier. Simulation results are validated by means of measurements on dedicated test circuits and failure analysis. Pre-requisites for simulations and device model improvements are deeply investigated by means of vf-TLP measurements

Novel 190V LIGBT-based ESD protection for 0.35\u3bcm Smart Power technology realized on SOI substrate

A novel ESD protection implementation based on LIGBT component is presented for 0.35 mum Smart Power HV devices on SOI substrate. A Single Stage LIGBT was designed, characterized and simulated. SOA boundaries are investigated in TLP regime. ESD performances improvements achieved using LIGBT devices are highlighted and a comparison with NDRIFTMOS-based active clamps is presented