March 10, 2012

‘Women constitute 75% Auto Immune Hepatitis patients’

M_Id_274656_Dr_Diego_Vergani_and_Dr_Georgina_Vergani_in_Chandigarh

Smriti Sharma Vasudeva : Chandigarh , Sun Mar 11 2012, 04:45 hrs

THE INDIAN EXPRESS

While Hepatitis B and C have acquired almost an epidemic status in our country, Auto Immune Hepatitis is largely overlooked in the list of liver diseases. Known to mostly affect women, AIH incidentally does not have any specific symptoms, making it a potential threat for Indian population.

World renowned couple Dr Giorgina Mieli-Vergani, emeritus professor of paediatric hepatology, King’s College Hospital, London and her husband Dr Diego Vergani, emeritus professor of liver immunopathology, King’s College Hospital London, said, “AIH is a progressive inflammatory liver disorder affecting mainly females, characterised by the presence of auto antibodies. As a result, our body’s infection fighting mechanism cells start behaving just the opposite. By the time, it is diagnosed, much of the damage to the liver is already done.”

If left untreated, AIH generally progresses rapidly to cirrhosis and liver failure. The peak incidence of the disease is before puberty and 75 per cent of the patients are girls.

“In fact researches have established that patients of Hepatitis C are at greater risk of developing AIH and since India has a significant number of patients of Hepatitis C virus, therefore it assumes larger significance”, said Dr Giorgina.

Top identify AIH patients in this part of the country, already a team of experts at the department of Immunopathology, PGIMER is on board a project with the doctor couple. “The only hindrance is about transportation of samples. We are working out on a modalities for the smooth continuation of the research to find out the pathogenesis of Indian patients with this condition,” said Dr Diego.

Already, the two are working on a research to find a possible cure for AIH wherein regulatory cells from the body of the patient suffering from AIH are taken out and developed in a controlled environment to outnumber the count of antibodies responsible for AIH.

The duo has even received funding of one million pounds from the British government agency to carry out the research.” It may take a few years and already a PhD student working with us on the research is undergoing a year’s training at Boston for the purpose,” added the duo.

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Published on: 2012-03-10

The clearance of hepatitis C virus infection by interferon therapy significantly reduces the incidence of hepatocellular carcinoma and death in elderly chronic hepatitis patients. However, there are few reports concerning the efficacy and safety of pegylated interferon-alpha2b plus ribavirin combination therapy in elderly patients.

The aims of the present study were to examine the effect and safety of pegylated interferon-alpha2b plus ribavirin combination therapy in 427 patients with chronic hepatitis C infection. We compared the rates of sustained virological response--defined as the absence of detectable hepatitis C virus in serum 24 weeks after the treatment ended--and the treatment discontinuation rate between 319 younger patients aged <65 years and 108 elderly patients aged [greater than or equal to]65 years.

We also examined the factors contributing to a sustained virological response.

Results: There was no significant difference in the sustained virological response rate between younger patients and elderly patients according to their hepatitis C virus genotype (41.5% (100/241) and 40.7% (35/86) for genotype 1; P = 0.899, 89.7% (70/78) and 86.4% (19/22) for genotype 2; P = 0.703, respectively). There was also no significant difference in the treatment discontinuation rate between the two age groups (10.3% (33/319) and 13.9% (15/108), respectively; P = 0.378).

There were no serious adverse events requiring hospitalization. The factors contributing significantly to a sustained virological response in elderly patients were gender, hepatitis C virus genotype, platelet count, and the presence of a rapid or early virological response (undetectable hepatitis C virus in serum at weeks 4 or 12 of treatment, respectively).

However, upon multivariate analysis, the presence of an early virological response was the only significant factor (odds ratio: 0.115, 95% confidence interval: 0.040-0.330, P <0.001).

Conclusions: The efficacy and safety of pegylated interferon-alpha2b plus ribavirin combination therapy in elderly patients are not always inferior to those in younger patients. Obtaining an early virological response may be essential to achieve a sustained virological response in elderly patients with chronic hepatitis C infection.

Author: Hiroki NishikawaEriko IguchiYorimitsu KoshikawaSoichiro AkoTadashi InuzukaHaruhiko TakedaJun NakajimaFumihiro MatsudaAzusa SakamotoSinichiro HenmiKeiichi HatamaruTetsuro IshikawaSumio SaitoRyuichi KitaToru KimuraYukio Osaki

Credits/Source: BMC

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