The Kinetics of Virological and Biochemical Responses in the Treatment of Chronic Hepatitis C by Dual Antiviral Therapy - Zdravlje, medicina, lijecenje, zdravstveni portal

The Kinetics of Virological and Biochemical Responses in the Treatment of Chronic Hepatitis C by Dual Antiviral Therapy

The Kinetics of Virological and Biochemical Responses in the Treatment of Chronic Hepatitis C by Dual Antiviral Therapy

Azra Husic-Selimovic, Zora Vukobrat-Bijedic, Jasminko Huskic, Nina Bijedic

Med Arh. 2012; 66(5): 300-303

 View PDF Fulltext

Abstract

Introduction: Infection with hepatitis C is often manifested by a mild clinical course, and in many patients it is revealed incidentally, during routine laboratory tests. Progression of the disease often takes 10-20 years with specified high risk of fibrosis and hepatocellular carcinoma. Material and methods: The group of subjects with chronic liver disease of viral C etiology was consisted of 50 patients of both sexes, 38 (75%) were male and 13 (25%) females, aged 20-65 years. Patients were selected according to genotype hepatitis C viral infection and subsequently treated according to two current therapeutic protocols. All patients had prior therapy and after completion of treatment using standard methods of laboratory tests were done the following: functional hepatic tests, serological analysis, nucleic acid detection of hepatitis C virus polymerase chain reaction (PCR), quantitatively and qualitatively with the genotyping of the virus C, which determines the length of therapy. In determining the stage of chronic liver disease, histopathological examination of liver tissue samples obtained by biopsy of the liver was done and we analyzed the fibrosis and architectural changes. Results: By analyzing the HCV RNA PCR values at the beginning and end of treatment we tested the effect of treatment on PCR with paired samples t-test logarithm values of the PCR and came to the conclusion that the values after treatment are significantly lower with threshold of significance of 0.01. The results showed that the value of PCR before and after therapy, or achieved a response at the end of therapy, which achieved 77% of patients. The values of ALT in the group of patients with CHC were significantly higher than the values in the group of patients after the therapy. AST values in the patients with CHC were significantly higher than the values in the group of patients after therapy. There was a moderate correlation between ALT values at baseline and ALT values upon completion of treatment (0.5061). There was no correlation between HCV RNA PCR and ALT and AST. Conclusion: Upon completion of antiviral treatment response at the end of treatment achieved 77% of patients, regardless of the genotype of the virus. Also, regardless of the genotype of the virus antiviral therapy led to statistically significant reduction of AST and ALT, indicating a direct effect of combination therapy on virological and biochemical response with no significant link between these two studied parameters.

REFERENCES

1. Chun BY, Dobson AJ, Heller RF. The impact of diabetes on survival among patients with first myocardial infarction. Diabetes Care. 1997; 20: 704-708. [DOI via Crossref] [Pubmed]

2. Miettinen H, Lehto S, Salomaa V. et al. Impact of diabetes on mortality after the first myocardial infarction. The FINMONICA myocardial infarction register study group. Diabetes Care. 1998; 21: 69-75. [DOI via Crossref] [Pubmed]

3. Franklin K, Goldberg RJ, Spencer F. et al. GRACE investigators. Implications of diabetes in patients with acute coronary syndromes. The Gobal Registry of Acute Coronary Events. Arch Intern Med. 2004; 164: 1457-1463. [DOI via Crossref] [Pubmed]

4. Timmer JR, OttervangerJP, Thomas K. et al. Zwolle myocardial infarction study group. Long-term, cause-specific mortality after myocardial infarction in diabetes. Eur Heart J. 2004; 25: 926-931. [DOI via Crossref] [Pubmed]

5. Melchior T, Kober L, Madsen CR. et al. TRACE study group. Accelerating impact of diabetes mellitus on mortality in the years following an acute myocardial infarction. Eur Heart J. 1999; 20: 973-978. [DOI via Crossref] [Pubmed]

6. Mukamal KJ, Nesto RW, Cohen MC. et al. Impact of diabetes on long-term survival after acute myocardial infarction. Comparability of risk with prior myocardial infarction. Diabetes Care. 2001; 24: 1422-1427. [DOI via Crossref] [Pubmed]

7. Behar S, Boyko V, Reicher-Reiss H. et al. Ten-year survival after acute myocardial infarction: comparison of patients with and without diabetes. SPRINT study group. Secondary Prevention Reinfarction Israeli Nifedipine Trial. Am Heart J. 1997; 133: 290-296. [DOI via Crossref] [DOI via Crossref]

8. Donnan PT, Boyle DI, Broomhall J. et al. Prognosis following first acute myocardial infarction in type 2 diabetes: a comparative population study. Diabet Med. 2002; 19: 48-55. [DOI via Crossref] [Pubmed]

9. Koek HL, Soedamah-Muthu SS, Kardaun JWPF. et al. Short- and long-term mortality after acute myocardial infarction: comparison of patients with and without diabetes mellitus, Eur J Epidemiol. 2007; 22(12): 883-888. [DOI via Crossref] [Pubmed] [PMC Free Fulltext]

10. Maser RE, Lenhard MJ. Cardiovascular autonomic neuropathy due to diabetes mellitus: clinical manifestations, consequences and treatment, The Journal of Clinical Endocrinology &Metabolism. 2005; 90(10): 5896-5903. [DOI via Crossref] [DOI via Crossref]

11. Miettinen H, Lehto S, Salomaa V. et al. Impact of diabetes on mortality after the first myocardial infarction: The FINMONICA Myocardial Infarction Register Study Group. Diabetes Care. 1998; 21: 69-75. [DOI via Crossref] [Pubmed]

12. Ewing DJ, Martyn CN, Young RJ. et al. The value of cardiovascular autonomic function tests:10 years experience in diabetes. Diabetes Care. 1985; 8: 491-498. [DOI via Crossref] [Pubmed]

13. Ewing DJ, Neilson JMM, Shapiro CM. et al. Twenty four hour heart rate variability: effects of posture, sleep and time of day in healthy controls and comparison with bedside tests of autonomic function in diabetic patients Br Heart J. 1991; 65: 239-244. [DOI via Crossref] [DOI via Crossref]

14. Valensi P, Sachs RN, Harfouche B. et al. Predictive value of cardiac autonomic neuropathy in diabetic patients with or without silent myocardial ischemia. Diabetes Care. 2001; 24: 339-343. [DOI via Crossref] [Pubmed]

15. Milan Study on Atherosclerosis and Diabetes. (MiSAD) Group: prevalence of unrecognized silent myocardial ischemia and its association with atherosclerotic risk factors in noninsulin-dependent diabetes mellitus. Am J Cardiol. 1997; 79: 134-139. [DOI via Crossref] [DOI via Crossref]

16. The Diabetes Control and Complications Trial Research Group The effect of intensive diabetes therapy on measures of autonomic nervous system function in the Diabetes Control and Complications Trial (DCCT). Diabetologia. 1998; 41: 416-423. [DOI via Crossref] [DOI via Crossref]

17. Larsen JR, Sjoholm H, Berg TJ. et al. Eighteen years of fair glycemic control preserves cardiac autonomic function in type 1 diabetes. Diabetes Care. 2004; 27: 963-966. [DOI via Crossref] [Pubmed]

18. Ohkubo Y, Kishikawa H, Araki E. et al. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract. 1995; 28: 103-117. [DOI via Crossref] [DOI via Crossref]

19. Manzella D, Grella R, Esposito K. et al. Blood pressure and cardiac autonomic nervous system in obese type 2 diabetic patients: effect of metformin administration. Am J Hypertens. 2004; 17: 223-227. [DOI via Crossref] [Pubmed]

20. Behar S, Boyko V, Reicher-Reiss H. et al. Ten-years survival after acute myocardial infarction: comparison of patients with and without diabetes. SPRINT Study Group. Secondary Prevention Reinfarction Israeli Nifedipine Trial. Am Heart J. 1997; 133: 3290-3296.

21. Gottlieb SS, McCarter RJ, Vogel RA. Effect of beta-blockade on mortality among high-risk and low-risk patients after myocardial infarction. N Engl J Med. 1998; 339: 489-497. [DOI via Crossref] [Pubmed]

22. Ebbehoj E, Poulsen PL, Hansen KW. et al. Effects on heart rate variability of metoprolol supplementary to on going ACE-inhibitor treatment in type I diabetic patients with abnormal albuminuria. Diabetologia. 2002; 45: 965-975. [DOI via Crossref] [Pubmed]

23. Casella G, Savonitto S, Chiarella F. et al. BLITZ-1 Study Investigators. Clinical characteristics and outcome of diabetic patients with acute myocardial infarction. Data from the BLITZ-1 study. Ital Heart J. 2005; 6: 374-383. [Pubmed]

24. Mak KH, Moliterno DJ, Granger CB. et al. Influence of diabetes mellitus on clinical outcome in the thrombolytic era of acute myocardial infarction. GUSTO-I Investigators. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries. J Am Coll Cardiol. 1997; 30: 171-179. [DOI via Crossref] [DOI via Crossref]

25. Weitzman S, Wang C, Rosamond WD. et al. ARIC (Atherosclerosis Risk in Communities) Surveillance Study. Is diabetes an independent risk factor for mortality after myocardial infarction? The ARIC (Atherosclerosis Risk in Communities) Surveillance Study. Acta Diabetol. 2004; 41: 77-83. [DOI via Crossref] [Pubmed]

26. Lowel H, Koenig W, Engel S. et al. The impact of diabetes mellitus on survival after myocardial infarction: can it be modified by drug treatment? Results of a population-based myocardial infarction register follow-up study. Diabetologia. 2000; 43: 218-226. [Pubmed]

27. Ishihara M, Sato H, Kawagoe T. et al. Impact of diabetes mellitus on long term survival after acute myocardial infarction in patients with single vessel disease. Heart. 2001; 86: 133-138. [DOI via Crossref] [Pubmed] [PMC Free Fulltext]

28. Crowley A, Menon V, Lessard D. et al. Sex differences in survival after acute myocardial infarction in patients with diabetes mellitus (Worcester Heart Attack Study). Am Heart J. 2003; 146: 824-831. [DOI via Crossref] [DOI via Crossref]

29. Vaccarino V, Parsons L, Every NR. et al. Impact of history of diabetes mellitus on hospital mortality in men and women with first acute myocardial infarction. The National Registry of Myocardial Infarction 2 Participants. Am J Cardiol. 2000; 85: 1486-1489. [DOI via Crossref] [DOI via Crossref]

30. Pyorala K, Lehto S, De Bacquer D. et al. EUROASPIRE I Group; EUROASPIRE II Group. Risk factor management in diabetic and non-diabetic patients with coronary heart disease. Findings from the EUROASPIRE I AND II surveys. Diabetologia. 2004; 47: 1257-1265.

31. Gaede P, Vedel P, Larsen N. et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003; 348: 383-393.

Leave a reply

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>