scholarly journals Successful Treatment with Crushed Sofosbuvir/Velpatasvir of a Patient with Decompensated Cirrhosis C and Thrombocytopenia

2021 ◽  
pp. 729-735
Author(s):  
Aiko Murayama ◽  
Kazuto Tajiri ◽  
Chiharu Kanegane ◽  
Jun Murakami ◽  
Yuka Hayashi ◽  
...  
Keyword(s):  
Marked Decrease ◽  
Antiviral Treatment ◽  
Intractable Epilepsy ◽  
Hcv Infection ◽  
Refractory Ascites ◽  
Decompensated Cirrhosis ◽  
Decompensated Liver Cirrhosis ◽  
Type C ◽  
Gastric Feeding ◽  
To Receive

A 36-year-old woman with decompensated liver cirrhosis type C was referred to our hospital to receive antiviral treatment for hepatitis C virus (HCV). She had been diagnosed with intractable epilepsy and cerebral palsy at birth and was managed by central venous nutrition and nasal gastric feeding. At age 34 years, she was diagnosed with thrombocytopenia, probably associated with HCV infection. She showed refractory ascites for several months and was therefore administered crushed sofosbuvir/velpatasvir tablets via a nasal gastric tube. Her HCV infection was successfully eradicated, her ascites disappeared, and thrombocytopenia improved with a marked decrease in platelet-associated IgG.

scholarly journals The Denver Tube Combined with Antiviral Drugs In the Treatment of HBV-related Cirrhosis with Refractory Ascites: A Report of Three Cases

2014 ◽  
Vol 3 (1) ◽  
pp. 42-45
Author(s):  
Xiao-jin Wang ◽  
Li-qin Shi ◽  
Qing-chun Fu ◽  
Liu-da Ni ◽  
Feng Zhou ◽  
...  
Keyword(s):  
Antiviral Treatment ◽  
Systemic Circulation ◽  
Antiviral Drugs ◽  
Refractory Ascites ◽  
Term Survival ◽  
Before And After ◽  
To Receive ◽  
Denver Shunt

Abstract Treatment of nucleos(t)ide antiviral drugs for decompensated HBV-related cirrhosis can significantly improve the prognosis. But those patients with refractory ascites possibly deteriorate due to the complications of ascites before any benefit from anti-viral drugs could be observed. Therefore, it is important to find a way to help the patients with HBV-related cirrhosis and refractory ascites to receive the full benefits from antiviral therapy. Peritoneovenous shunt (PVS) using Denver tube enables ascites to continuously bypass into systemic circulation, thereby reducing ascites and albumin input and improving quality of life. We report herein 3 cases of decompensated HBV-related cirrhosis with refractory ascites, PVS using Denver tube was combined with lamivudine for antiviral treatment before and after. Then, ascites was alleviated significantly or disapeared and viral responsed well. All patients achieved a satisfactory long-term survival from 6.7 to 14.7 years. It was suggested that the Denver shunt could be used as an adjuvant method to antiviral drugs for decompensated HBV-related cirrhosis with refractory ascites to help the patients reap the full benefits and maximize efficacy of antiviral treatment.

scholarly journals Evolution of arterial hypertension in patients with hepatitis C virus cirrhosis after antiviral treatment

2020 ◽  
Vol 7 (9) ◽  
pp. 1302
Author(s):  
Letitia Toma ◽  
Adriana Mercan-Stanciu ◽  
Anca Zgura ◽  
Nicolae Bacalbasa ◽  
Camelia Diaconu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Liver Cirrhosis ◽  
Liver Disease ◽  
Hepatitis C ◽  
Arterial Hypertension ◽  
Vascular Resistance ◽  
Antiviral Treatment ◽  
Hcv Infection ◽  
Decompensated Cirrhosis ◽  
Abrupt Decrease

Background: Chronic hepatitis C (HCV) infection has direct and indirect manifestations that promote vascular resistance. On the other hand, HCV infection leads to liver cirrhosis and complications such as cardiomyopathy, characterized by a hyperdynamic state with low peripheral vascular resistance. The aim of this paper is to study the evolution of arterial hypertension in patients with liver cirrhosis, after the cure of HCV infection.Methods: This is a prospective observational cohort study including 261 hypertensive patients with compensated HCV cirrhosis who underwent direct-acting antiviral treatment. Blood pressure was monitored at the initiation of antiviral therapy and at 3, 6 and 12 months follow-up. Screening for cirrhosis complications was performed and patients were also monitored by electrocardiography, liver and kidney function tests, serum lipids and N-terminal pro-B-type natriuretic peptide.Results: Virologic response after antiviral treatment led to a better control of arterial hypertension with a decrease of 24 hours mean blood pressure by 15% (p=0.04, CI 95%). In patients with stable liver disease serum levels of N-terminal pro-B-type natriuretic peptide slowly decreased at 6 and 12 months (p=0.02, p=0.03), while in patients with cirrhosis decompensation the levels increased. Also, patients with decompensated cirrhosis presented lower blood pressure values and required discontinuation of antihypertensive drugs.Conclusions: Curing HCV infection may lead to a better control of blood pressure in patients with compensated liver disease. However, an abrupt decrease in blood pressure may be a clinical sign of progressive liver disease and cirrhotic cardiomyopathy.

Porto-pulmonary hypertension in decompensated cirrhosis and refractory ascites

2001 ◽  
Vol 120 (5) ◽  
pp. A377-A377
Author(s):  
F BENJAMINOV ◽  
K SNIDERMAN ◽  
S SIU ◽  
P LIU ◽  
M PRENTICE ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Refractory Ascites ◽  
Decompensated Cirrhosis

Genetic polymorphisms as the predictors of response to antiviral treatment in chronic hepatitis C virus infection

2011 ◽  
Vol 152 (22) ◽  
pp. 876-881
Author(s):  
Alajos Pár
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Genetic Polymorphisms ◽  
Chronic Hepatitis C ◽  
Genome Wide Association Study ◽  
Antiviral Treatment ◽  
Hcv Infection ◽  
Snp Analysis ◽  
Chronic Hcv

The review discusses the genetic polymorphisms involved in the pathogenesis of hepatitis C virus (HCV) infection, that may determine the outcome of disease. In this field earlier both certain major histocompatibility complex (MHC) alleles and some cytokine gene variants have also been studied. Recently, the genome-wide association study (GWAS) and targeted single nucleotide polymorphism (SNP) analysis have revealed that a variant in the promoter region of interleukin-28B (IL-28B) gene is strongly linked to viral clearance and it may be the strongest pretreatment predictor of treatment response in chronic hepatitis C. Last year it was shown that two genetic variants leading to inosine triphosphatase deficiency protect against haemolytic anemia in patients receiving ribavirin during antiviral treatment for chronic HCV infection. Orv. Hetil., 2011, 152, 876–881.

scholarly journals Hepatitis C Virus Prevalence and Risk Factors in a Village in Northeastern Romania—A Population-Based Screening—The First Step to Viral Micro-Elimination

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 651
Author(s):  
Laura Huiban ◽  
Carol Stanciu ◽  
Cristina Maria Muzica ◽  
Tudor Cuciureanu ◽  
Stefan Chiriac ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Antiviral Treatment ◽  
Population Based ◽  
Hcv Infection ◽  
World Health ◽  
Hcv Rna ◽  
Virus Eradication ◽  
Tertiary Center

(1) Background: The World Health Organization adopted a strategy for the Global Health Sector on Viral Hepatitis in 2016, with the main objective of eliminating hepatitis C virus (HCV) by 2030. In this work, we aimed to evaluate the prevalence of HCV infection and risk factors in a Romanian village using population-based screening as part of the global C virus eradication program. (2) Methods: We conducted a prospective study from March 2019 to February 2020, based on a strategy as part of a project designed to educate, screen, treat and eliminate HCV infection in all adults in a village located in Northeastern Romania. (3) Results: In total, 3507 subjects were invited to be screened by rapid diagnostic orientation tests (RDOT). Overall, 2945 (84%) subjects were tested, out of whom 78 (2.64%) were found to have positive HCV antibodies and were scheduled for further evaluation in a tertiary center of gastroenterology/hepatology in order to be linked to care. In total, 66 (85%) subjects presented for evaluation and 55 (83%) had detectable HCV RNA. Of these, 54 (98%) completed antiviral treatment and 53 (99%) obtained a sustained virological response. (4) Conclusions: The elimination of hepatitis C worldwide has a higher chance of success if micro-elimination strategies based on mass screening are adopted.

scholarly journals French hepatitis C care cascade: substantial impact of direct-acting antivirals, but the road to elimination is still long

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Cécile Brouard ◽  
Josiane Pillonel ◽  
Marjorie Boussac ◽  
Victor de Lédinghen ◽  
Antoine Rachas ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Antiviral Treatment ◽  
Hcv Infection ◽  
World Health ◽  
Direct Acting Antivirals ◽  
Substantial Impact ◽  
Chronic Hcv Infection ◽  
Chronic Hcv ◽  
Direct Acting ◽  
The Impact

Abstract Background Hepatitis C virus (HCV) elimination by 2030, as targeted by the World Health Organization (WHO), requires that 90% of people with chronic infection be diagnosed and 80% treated. We estimated the cascade of care (CoC) for chronic HCV infection in mainland France in 2011 and 2016, before and after the introduction of direct-acting antivirals (DAAs). Methods The numbers of people (1) with chronic HCV infection, (2) aware of their infection, (3) receiving care for HCV and (4) on antiviral treatment, were estimated for 2011 and 2016. Estimates for 1) and 2) were based on modelling studies for 2011 and on a virological sub-study nested in a national cross-sectional survey among the general population for 2016. Estimates for 3) and 4) were made using the National Health Data System. Results Between 2011 and 2016, the number of people with chronic HCV infection decreased by 31%, from 192,700 (95% Credibility interval: 150,900-246,100) to 133,500 (95% Confidence interval: 56,900-312,600). The proportion of people aware of their infection rose from 57.7 to 80.6%. The number of people receiving care for HCV increased by 22.5% (representing 25.7% of those infected in 2016), while the number of people on treatment increased by 24.6% (representing 12.1% of those infected in 2016). Conclusions This study suggests that DAAs substantially impact CoC. However, access to care and treatment for infected people remained insufficient in 2016. Updating CoC estimates will help to assess the impact of new measures implemented since 2016 as part of the goal to eliminate HCV.

scholarly journals Hepatic Stress Response in HCV Infection Promotes STAT3-Mediated Inhibition of HNF4A-miR-122 Feedback Loop in Liver Fibrosis and Cancer Progression

Cancers ◽  
2019 ◽  
Vol 11 (10) ◽  
pp. 1407 ◽  
Author(s):  
Aydin ◽  
Kurt ◽  
Song ◽  
Lin ◽  
Osman ◽  
...  
Keyword(s):  
Stress Response ◽  
Cancer Progression ◽  
Antiviral Treatment ◽  
Hcv Infection ◽  
Infection Model ◽  
Related Factor ◽  
Nuclear Factor ◽  
Survival Signaling ◽  
Chronic Hcv ◽  
Hepatic Stress

Hepatitis C virus (HCV) infection compromises the natural defense mechanisms of the liver leading to a progressive end stage disease such as cirrhosis and hepatocellular carcinoma (HCC). The hepatic stress response generated due to viral replication in the endoplasmic reticulum (ER) undergoes a stepwise transition from adaptive to pro-survival signaling to improve host cell survival and liver disease progression. The minute details of hepatic pro-survival unfolded protein response (UPR) signaling that contribute to HCC development in cirrhosis are unknown. This study shows that the UPR sensor, the protein kinase RNA-like ER kinase (PERK), mediates the pro-survival signaling through nuclear factor erythroid 2-related factor 2 (NRF2)-mediated signal transducer and activator of transcription 3 (STAT3) activation in a persistent HCV infection model of Huh-7.5 liver cells. The NRF2-mediated STAT3 activation in persistently infected HCV cell culture model resulted in the decreased expression of hepatocyte nuclear factor 4 alpha (HNF4A), a major liver-specific transcription factor. The stress-induced inhibition of HNF4A expression resulted in a significant reduction of liver-specific microRNA-122 (miR-122) transcription. It was found that the reversal of hepatic adaptive pro-survival signaling and restoration of miR-122 level was more efficient by interferon (IFN)-based antiviral treatment than direct-acting antivirals (DAAs). To test whether miR-122 levels could be utilized as a biomarker of hepatic adaptive stress response in HCV infection, serum miR-122 level was measured among healthy controls, and chronic HCV patients with or without cirrhosis. Our data show that serum miR-122 expression level remained undetectable in most of the patients with cirrhosis (stage IV fibrosis), suggesting that the pro-survival UPR signaling increases the risk of HCC through STAT3-mediated suppression of miR-122. In conclusion, our data indicate that hepatic pro-survival UPR signaling suppresses the liver-specific HNF4A and its downstream target miR-122 in cirrhosis. These results provide an explanation as to why cirrhosis is a risk factor for the development of HCC in chronic HCV infection.

scholarly journals Challenges of transferring rural adults with chronic HCV infection for further HCV RNA confirmation and free DAAs treatment: a success story of the interdisciplinary collaboration approach

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Wei Li ◽  
Te-Sheng Chang ◽  
Shu-Zhi Chang ◽  
Ching-Hwa Chen ◽  
Mei-Yen Chen
Keyword(s):  
Rural Areas ◽  
Medical Records ◽  
Interdisciplinary Collaboration ◽  
Antiviral Treatment ◽  
Hcv Infection ◽  
Hcv Rna ◽  
National Health Insurance System ◽  
Health Clinics ◽  
Chronic Hcv ◽  
Prospective Study Design

Abstract Background Chronic hepatitis C virus (HCV), which is a concern in many countries, is the leading cause of liver cancer around the world. Since Taiwan launched its national health insurance system in 1995, it has managed to extend health coverage to 99% of the Taiwanese population, providing free but limited antiviral treatment each year since 2017. However, many people in rural areas are unaware that they have chronic HCV; nor do they realize that new drugs with high cure rates could drastically reduce their health burden. The aim of this study is to explore the implementation facilitators of and barriers to inviting potentially infected patients in rural areas to be transferred for HCV ribonucleic acid (RNA) confirmation and new drug treatment. Methods A descriptive and prospective study design with an interdisciplinary collaboration approach was implemented. After five elements of referral were developed, telephone counseling was conducted between August 2018 and May 2019 in Yunlin, Taiwan. The elements of referral developed by the research team were: (1) forming and coordinating physicians’ schedules, (2) recruiting and training volunteers, (3) training the nursing staff, (4) raising funds or resources, and (5) connecting with village leaders. Thereafter, we collaborated with two district health centers, a private local hospital, and health clinics. Based on the medical records provided by these agencies, community adults that were HCV antibody (anti-HCV) positive were invited to join the program. Results Of the 1795 adults who were serum anti-HCV positive, 1149 (64%) accepted transfer to a qualified hospital; of these, 623 (54.2%) had an HCV infection. 552 (88.6%) of those infected started receiving direct-acting antivirals (DAAs) treatment. The top four barriers to accepting transfer were: (1) they perceived themselves to be healthy (n = 98, 32.3%); (2) mistrust of treatment/healthcare (n = 60, 20.2%); (3) limited transportation to the hospital (n = 52, 17.5%); and (4) work conflict (n = 30, 10.1%). Conclusion An interdisciplinary collaboration approach significantly contributed to the invitation of CHC patients, as well as their acceptance of HCV RNA confirmation and free DAAs treatment. Using anti-HCV data from previous medical records for case-finding and collaborating with a hospital and health clinics proved to be an efficient strategy.

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