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      Pegylated-Interferon-Associated Retinopathy in Chronic Hepatitis Patients



      S. Karger AG

      Chronic hepatitis, Pegylated interferon, Retinopathy

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          Purpose: To investigate the clinical features of pegylated-interferon (PEG-IFN)-associated retinopathy in chronic hepatitis patients. Methods: We examined a consecutive case series of 46 patients who were treated with PEG-IFN for chronic hepatitis C or B between October 2007 and September 2008. All patients underwent regular ophthalmologic examinations every 3 weeks during the 6 months after treatment. Results: Ten of the 46 patients (21.73%) developed retinal abnormalities. PEG-IFN-associated retinopathy occurred a mean of 7.25 ± 10.28 weeks after treatment and manifested itself as cotton wool spots and retinal hemorrhages. All patients, except for 1 with a retinal vein occlusion, recovered without cessation of treatment. Conclusions: PEG-IFN-associated retinopathy in chronic hepatitis patients was reversible, and patients recovered without visual complications; however, 1 patient did present with an irreversible visual impairment. This type of retinopathy is usually asymptomatic, and clinicians should closely observe patients for 3 months after treatment.

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          Most cited references 19

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          Hepatitis C infection and risk of diabetes: a systematic review and meta-analysis.

          Several studies found hepatitis C (HCV) increases risk of Type II diabetes mellitus (DM). However, others found no or only sub-group specific excess risk. We performed meta-analyses to examine whether HCV infection does increase DM risk in comparison to the general population and in other sub-groups with increased liver disease rates including with hepatitis B (HBV). We followed standard guidelines for performance of meta-analyses. Two independent investigators identified eligible studies through structured keyword searches in relevant databases including PubMed. We identified 34 eligible studies. Pooled estimators indicated significant DM risk in HCV-infected cases in comparison to non-infected controls in both retrospective (OR(adjusted)=1.68, 95% CI 1.15-2.20) and prospective studies (HR(adjusted)=1.67, 95% CI 1.28-2.06). Excess risk was also observed in comparison to HBV-infected controls (OR(adjusted)=1.80, 95% CI 1.20-1.40) with suggestive excess observed in HCV+/HIV+ cases in comparison to HIV+ controls (OR(unadjusted)=1.82, 95% CI 1.27-2.38). Our finding of excess DM risk with HCV infection in comparison to non-infected controls is strengthened by consistency of results from both prospective and retrospective studies. The excess risk observed in comparison to HBV-infected controls suggests a potential direct viral role in promoting DM risk, but this needs to be further examined.
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            Grading and staging the histopathological lesions of chronic hepatitis: the Knodell histology activity index and beyond.

             Michael Brunt (1999)
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              Treatment predictors of a sustained virologic response in hepatitis B and C.

              Treatment predictors are important tools for the management of therapy in patients with chronic hepatitis B and C virus (HBV, HCV) infection. In chronic hepatitis B, several pretreatment parameters have been identified for prediction of virologic response to interferon alfa-based antiviral therapies or treatment with polymerase inhibitors. In interferon alfa and pegylated interferon alfa-treated patients, low baseline HBV DNA concentrations, HBV genotype A (B), and high baseline ALT levels are significantly associated with treatment response. In patients treated with nucleos(t)ide analogues, low baseline HBV DNA but not viral genotype is positively associated with virologic response. During treatment the best predictor of response is HBV DNA kinetics. Early viral suppression is associated with favourable virologic response and reduced risk for subsequent resistance mutations. For the current standard treatment with pegylated interferon alfa and ribavirin in patients with chronic hepatitis C, infection with HCV genotypes 2 and 3, baseline viral load below 400,000-800,000 IU/ml, Asian and Caucasian ethnicity, younger age, low GGT levels, absence of advanced fibrosis/cirrhosis, and absence of steatosis in the liver have been identified as independent pretreatment predictors of a sustained virologic response. After initiation of treatment, initial viral decline with undetectable HCV-RNA at week 4 of therapy (RVR) is the best predictor of sustained virologic response independent of HCV genotype.

                Author and article information

                S. Karger AG
                June 2010
                24 November 2009
                : 224
                : 4
                : 224-229
                Department of Ophthalmology, Chunchon Sacred Heart Hospital, Hallym University, Chunchon, Republic of Korea
                260228 Ophthalmologica 2010;224:224–229
                © 2009 S. Karger AG, Basel

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                Page count
                Figures: 1, Tables: 1, References: 27, Pages: 6
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