C-hepatiitin hoito : kenelle ja milloin?

Teema : hepatologi

B-hepatiitin kantajan raskaus

Teema : hepatologia. English summaryPeer reviewe

Randomized Trial of Peginterferon alfa-2b and Ribavirin for 48 or 72 Weeks in Patients with Hepatitis C Virus Genotype 1 and Slow Virologic Response

The benefit of extending treatment duration with peginterferon (PEG-IFN) and ribavirin (RI3V) from 48 weeks to 72 weeks for patients with chronic hepatitis C genotype 1 infection has not been well established. In this prospective, international, open-label, randomized, multicenter study, 1,428 treatment-nave patients from 133 centers were treated with PEG-IFN alfa-26 (1.5 mu g/kg/week) plus RBV (800-1,400 mg/day). Patients with detectable hepatii is C virus (HCV) RNA and a >= 2-logio drop in IICV RNA levels at week 12 (slow responders) were randomized 1:1 to receive 48 weeks (n = 86) or 72 weeks (n = 73) of treatment. Sustained virologic response (SVR) rates were 43% in slow responders treated for 48 weeks and 48% in slow responders treated for 72 weeks (P = 0.644). Relapse rates were similar in slow responders treated for 48 or 72 weeks (47% versus 33%, P = 0.169). The safety profile was similar in both treatment arms; serious adverse events leading to discontinuation of treatment were observed in 3.5% of slow responders treated for 48 weeks and 8.2% of those treated for 72 weeks. Among slow responders with aPeer reviewe

Hepatologia erikoisalana : hepatologian koulutusta lisättävä - myös Suomessa

Teema : hepatologi

Interaction Between Alcohol Use and Metabolic Risk Factors for Liver Disease : A Critical Review of Epidemiological Studies

Coexistence of alcohol use and metabolic risk-the 2 commonest population risk factors for nonviral chronic liver disease-is a growing concern. Clinical evidence and mechanistic evidence point to considerable supraadditive interaction effects for the development and progression of chronic liver disease between hazardous alcohol use and metabolic abnormalities including obesity, diabetes, and the metabolic syndrome (MetS). Intermittent binge drinking once monthly or more often seems to be associated with progression of liver disease even when average alcohol intake is within the currently allowed limits for a diagnosis of nonalcoholic fatty liver disease (NAFLD), and supraadditive interaction between binge drinking and the MetS has been reported. There are contradictory findings regarding the association between low alcohol use and liver steatosis, but, clearly, the mechanisms of alcoholic hepatotoxicity extend beyond simple fat accumulation. The presence of liver steatosis seems to amplify alcoholic hepatotoxicity. Recent longitudinal studies of NAFLD subjects report low alcohol use associated with both increased fibrosis progression and an elevated risk for liver cancer and severe liver disease. There is no clear safe limit of alcohol intake in the presence of NAFLD or metabolic risk. The interaction effects between alcohol and metabolic dysfunction merit increased attention in public health policy, individual counseling, and risk stratification. Based on current evidence, a strict dichotomization of liver disease into either pure alcoholic or nonalcoholic may be inappropriate.Peer reviewe