8 results on '"Dussaix, E."'
Search Results
2. Herpes simplex virus-associated acute liver failure: a difficult diagnosis with a poor prognosis.
- Author
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Ichai P, Roque Afonso AM, Sebagh M, Gonzalez ME, Codés L, Azoulay D, Saliba F, Karam V, Dussaix E, Guettier C, Castaing D, and Samuel D
- Subjects
- Acyclovir therapeutic use, Adolescent, Adult, Antibodies, Viral analysis, Biopsy, Diagnosis, Differential, Female, Follow-Up Studies, Herpes Simplex drug therapy, Herpes Simplex pathology, Humans, Liver Failure, Acute etiology, Liver Failure, Acute surgery, Liver Transplantation, Male, Middle Aged, Retrospective Studies, Simplexvirus immunology, Treatment Outcome, Herpes Simplex complications, Liver Failure, Acute pathology
- Abstract
We report 5 cases of acute liver failure related to herpes simplex (HSV) infection in 1 immunocompetent and 4 immunosuppressed patients. One patient was too ill for liver transplantation indication. Three patients, among the 4 listed, underwent liver transplantation. Three patients died 11 days to 1 year after transplantation and 2 patients died 2 to 3 days after admission. All presented with fever and none with skin lesions. The diagnosis of HSV-related hepatitis was made antemortem in only 2 patients on the basis of positive blood cultures and/or immunohistochemic findings. In the remaining patients, HSV diagnosis was made retrospectively on further histologic and virologic investigations. Primary HSV infection was certain or likely in all cases, including an HSV2 superinfection of an anti-HSV1-positive patient and two HSV superinfections of hepatitis B virus (HBV)-related chronic liver disease. In these latter patients, HSV diagnosis was totally unsuspected, despite fever. HSV superinfection has significantly contributed to liver dysfunction aggravation and death. In conclusion, the diagnosis of HSV hepatitis is difficult to establish in the absence of specific clinical signs. This may suggest the need for early administration of acyclovir in patients with suspected HSV hepatitis, without waiting for virologic confirmation. Diagnosis methods providing fast results (real-time polymerase chain reaction [PCR]) should be implemented.
- Published
- 2005
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3. Frequent compartmentalization of hepatitis C virus variants in circulating B cells and monocytes.
- Author
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Ducoulombier D, Roque-Afonso AM, Di Liberto G, Penin F, Kara R, Richard Y, Dussaix E, and Féray C
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- Adult, Aged, Amino Acid Sequence, Entropy, Female, Humans, Immunoglobulin G metabolism, Male, Middle Aged, Phylogeny, Plasma, RNA, Viral blood, Viral Proteins genetics, B-Lymphocytes virology, Genetic Variation, Hepacivirus genetics, Monocytes virology
- Abstract
Differences in the composition of the hepatitis C virus (HCV) quasispecies between plasma and blood mononuclear cells (BMC) strongly suggest that BMCs support viral replication. We examined the frequency of such compartmentalization, the cell types involved, the constraints exerted on the different variants, and the role of immunoglobulin-complexed variants. We screened the hypervariable region (HVR1) of HCV isolates from 14 HBsAg- and HIV-seronegative patients with chronic HCV infection. HCV RNA was amplified and cloned from plasma, the immunoglobulin G (IgG)-bound fraction, and total and sorted BMCs (CD19+, CD8+, CD4+, and CD14+ cells). Compartmentalization was estimated using a matrix correlation test. The ratio of nonsynonymous/synonymous substitutions (d(N)/d(S) ratio) was calculated for each compartment. HCV RNA was detected in 3/3 BMC, 11/11 CD19+, 10/11 CD14+, 4/11 CD8+ and 0/11 CD4+ cell samples. HVR1 sequences were significantly different between plasma and at least one cellular compartment in all nine cases analyzed, and between B cells (CD19+) and monocytes (CD14+) in all five available cases. IgG-bound variants were distinct from cellular variants. D(N)/d(S) ratios were similar (n = 3) or lower (n = 6) in cellular compartments compared with plasma and the IgG-bound fraction. In conclusion, HCV compartmentalization is a common phenomenon. B cells and monocytes harbor HCV variants showing a low rate of nonsynonymous mutations, a feature that might contribute to the persistence of HCV infection.
- Published
- 2004
- Full Text
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4. Fatal disseminated Kaposi's sarcoma following human herpesvirus 8 primary infections in liver-transplant recipients.
- Author
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Marcelin AG, Roque-Afonso AM, Hurtova M, Dupin N, Tulliez M, Sebagh M, Arkoub ZA, Guettier C, Samuel D, Calvez V, and Dussaix E
- Subjects
- Adolescent, Adult, Aged, Antibodies, Viral analysis, Child, Fatal Outcome, Female, Herpesviridae Infections metabolism, Herpesviridae Infections pathology, Humans, Immunohistochemistry, Lymph Nodes metabolism, Lymph Nodes pathology, Male, Middle Aged, Retrospective Studies, Tissue Donors, Treatment Outcome, Herpesviridae Infections complications, Herpesviridae Infections transmission, Herpesvirus 8, Human immunology, Herpesvirus 8, Human isolation & purification, Liver Transplantation adverse effects, Sarcoma, Kaposi virology
- Abstract
Human herpesvirus 8 (HHV-8) is associated with the development of Kaposi's sarcoma (KS) and rare lymphoproliferative disorders in immunosuppressed patients. The risk of HHV-8 transmission by liver transplantation and the clinical manifestations of primary infection in this setting have yet to be determined. In order to evaluate this risk, we measured the seroprevalence of HHV-8 among 122 liver donors and their respective recipients before and after transplantation. Molecular methods and immunohistochemical analyses were performed to study the features of HHV-8 infection. Antibodies to HHV-8 were detected in sera of 4 donors before transplantation (3.3%) and of 3 recipients (2.4%). None of the 3 recipients, who were HHV-8 seropositive before transplantation, developed a KS during the follow-up. Four primary HHV-8 infections were detected among the 4 HHV-8 seronegative recipients who received a liver from an HHV-8 positive donor. Among these 4 recipients, 2 particularly immunosuppressed patients developed symptomatic diseases and died a few months after transplantation, harboring disseminated KS and HHV-8 positive lymphoproliferation. In these 2 patients, HHV-8 DNA genome sequences were detectable in peripheral blood mononuclear cells and other tissues with high viremia levels before and at the beginning of HHV-8-related diseases. In conclusion, in liver transplantation recipients, HHV-8 primary infection can be associated with fatal outcome. This study raises the question of screening liver donors for HHV-8--even in low HHV-8 infection prevalence countries--not systematically to exclude the graft but to monitor, clinically and biologically, patients who received a graft from an HHV-8-infected donor.
- Published
- 2004
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5. Viral and clinical factors associated with the fulminant course of hepatitis A infection.
- Author
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Rezende G, Roque-Afonso AM, Samuel D, Gigou M, Nicand E, Ferre V, Dussaix E, Bismuth H, and Féray C
- Subjects
- Acetaminophen administration & dosage, Adolescent, Adult, Computer Systems, Factor V analysis, Female, Genotype, Hepatic Encephalopathy mortality, Hepatitis A genetics, Hepatitis A surgery, Hepatitis A virology, Humans, Liver Transplantation, Male, Middle Aged, Multivariate Analysis, Polymerase Chain Reaction, RNA, Viral blood, RNA, Viral isolation & purification, Retrospective Studies, Sex Characteristics, Viral Load, Hepatic Encephalopathy physiopathology, Hepatic Encephalopathy virology, Hepatitis A complications
- Abstract
Fulminant hepatitis is a severe complication of hepatitis A virus infection. Its mechanism is unknown. Liver transplantation can be necessary, but spontaneous recovery is frequent. There are no data on the level of viral replication according to the clinical form of hepatitis A. We reviewed the files of 50 patients with acute hepatitis A. Nineteen patients had fulminant hepatitis (defined by encephalopathy and factor V <50%), and, from them, 10 patients underwent transplantation. Hepatitis A virus (HAV) RNA was quantified by real-time PCR on sera obtained at admission. The genotype was determined by phylogenetic analysis of HAV RNA. HAV RNA was detected in serum by RT-PCR in 39 out of 50 patients. Encephalopathy and low factor V level were significantly related to female gender, HAV PCR negativity (9/19 vs. 5/31, respectively; P =.03), a low serum HAV RNA level (log, 3.6 +/- 0.6 vs. 4.4 +/- 0.9, respectively; P =.02), genotypes other than IA, and acetaminophen intake. In multivariate analysis, low or undetectable HAV viral load and a high bilirubin level were independently associated with both low factor V levels and fulminant hepatitis and also with death or transplantation. In conclusion, HAV-related liver failure is due to an excessive host response associated with a marked reduction in viral load. Serum HAV RNA assay could be of help in the management of severe hepatitis A.
- Published
- 2003
- Full Text
- View/download PDF
6. HBV DNA persistence 10 years after liver transplantation despite successful anti-HBS passive immunoprophylaxis.
- Author
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Roche B, Feray C, Gigou M, Roque-Afonso AM, Arulnaden JL, Delvart V, Dussaix E, Guettier C, Bismuth H, and Samuel D
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- Adult, DNA, Viral analysis, DNA, Viral blood, Female, Follow-Up Studies, Hepatitis B Surface Antigens genetics, Hepatitis B virus genetics, Hepatitis B virus growth & development, Hepatitis B, Chronic mortality, Humans, Liver virology, Liver Cirrhosis diagnosis, Liver Cirrhosis immunology, Liver Cirrhosis therapy, Male, Middle Aged, Multivariate Analysis, Secondary Prevention, Survival Rate, Treatment Outcome, Virus Replication, Hepatitis B virus isolation & purification, Hepatitis B, Chronic diagnosis, Hepatitis B, Chronic therapy, Immunoglobulins administration & dosage, Liver Transplantation
- Abstract
Long-term immunoprophylaxis with hepatitis B immune globulin (HBIG) is widely accepted for the prevention of recurrent hepatitis B virus (HBV) infection after liver transplantation in HBV-infected patients without viral replication. We report long-term results of HBIG administration in 284 hepatitis B surface antigen (HBsAg)-positive transplant patients. In protocol 1, 259 patients were given HBIG with the goal of maintaining the anti-HBs antibody (Ab) titer over 100 IU/L. After December 1993, 25 HBV DNA-positive patients received HBIG, with a target anti-HBs Ab titer over 500 IU/L, combined with posttransplantation antiviral therapy (protocol 2). At 10 years, 44 patients without recurrence were tested for the presence of HBV DNA in serum using real-time polymerase chain reaction (PCR); 28 were also tested in liver and peripheral blood mononuclear cells (PBMC). The overall 5- and 10-year posttransplantation actuarial rates of HBV recurrence were 24.2% and 25.4%, respectively. The 5-year recurrence rate in protocol 2 patients was 11.8%. On multivariate analysis, predictors of lower HBV recurrence risk were absence of serum HBV DNA before transplantation (P <.0001), acute liver disease (P =.0037), HDV superinfection (P =.012), and protocol 2 therapy (P <.0001). Low-level HBV DNA was detected by PCR in 45.4% of patients without HBV recurrence at 10 years. Overall actuarial 10-year survival was 74.4%. In conclusion, we confirm the efficacy of long-term HBIG immunoprophylaxis. Combination prophylaxis with HBIG and antiviral therapy is effective in patients with viral replication. Although there were only a few cases of HBV recurrence after 5 years, HBV DNA remained present in 45% of patients at 10 years.
- Published
- 2003
- Full Text
- View/download PDF
7. Better efficacy of a 12-month interferon alfa-2b retreatment in patients with chronic hepatitis C relapsing after a 6-month treatment: a multicenter, controlled, randomized trial. Le Groupe D'étude et De Traitement du Virus De L'hépatite C (Get.Vhc).
- Author
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Payen JL, Izopet J, Galindo-Migeot V, Lauwers-Cances V, Zarski JP, Seigneurin JM, Dussaix E, Voigt JJ, Selves J, Barange K, Puel J, and Pascal JP
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- Adult, Alanine Transaminase blood, Antiviral Agents adverse effects, Antiviral Agents therapeutic use, Drug Administration Schedule, Female, Genotype, Hepacivirus genetics, Hepatitis C, Chronic metabolism, Hepatitis C, Chronic virology, Humans, Interferon alpha-2, Interferon-alpha adverse effects, Interferon-alpha therapeutic use, Male, Middle Aged, RNA, Viral analysis, Recombinant Proteins, Recurrence, Retreatment, Viral Load, Antiviral Agents administration & dosage, Hepatitis C, Chronic therapy, Interferon-alpha administration & dosage
- Abstract
We studied the efficacy of three interferon alfa-2b (IFN-2b) regimens for the retreatment of patients with chronic hepatitis C (CHC) with prior complete response followed by relapse. Consecutive patients with CHC who had a complete biochemical response but relapse after a first course of 6 months of IFN with 3 million units (MU) given subcutaneously three times per week were enrolled in the study. Six to 24 months after the end of the first treatment, the patients were randomly assigned to receive IFN with either the same regimen (group 1), a regimen of 12 months with 3 MU (group 2), or a regimen of 6 months with 10 MU (group 3). Sustained biochemical response was defined as normal serum alanine transaminase (ALT) values during the follow-up and sustained virological response as a clearance of hepatitis C virus (HCV) RNA from the serum at the end of follow-up (6 months' posttreatment). Histological improvement was defined as a decrease of 1 point in Metavir score between the first liver biopsy and a biopsy performed at 6 months' postretreatment. Two hundred forty-seven patients were randomized: 75 to group 1, 91 to group 2, and 81 to group 3. In an intent-to-treat analysis, 12%, 36.3%, and 18.5% of patients had a sustained biochemical response after retreatment in groups 1, 2, and 3, respectively (P <.001); 13. 8%, 32.4%, and 17.2% of patients had a sustained virological response after retreatment in groups 1, 2, and 3, respectively (P <. 05). A low viral load and patients in group 2 were independently associated with a sustained biochemical response. A low Knodell score index before treatment, patients with a high level of ALT before retreatment, genotype 3, low viral load, and patients in group 2 were independently associated with sustained virological response. Younger age, a high level of ALT, a low level of gamma-glutamyl transferase before retreatment, low viral load, and patients in group 2 were independently associated with sustained biochemical and virological response. Among the 80 patients with repeated liver biopsies, 47.6% had improved histological activity scores; this improvement was associated with a sustained biochemical and virological response. In patients with CHC initially treated with 3 MU of IFN given subcutaneously three times per week over a 6-month period, and who subsequently developed a relapse after a biochemical response, retreatment with a regimen of 3 MU of IFN given three times per week for 12 months produced better biochemical and virological sustained response rates than regimens involving a higher dose or a shorter duration of retreatment. The biochemical and virological sustained response was associated with histological improvement.
- Published
- 1998
- Full Text
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8. Long-term longitudinal study of intrahepatic hepatitis C virus replication after liver transplantation.
- Author
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Di Martino V, Saurini F, Samuel D, Gigou M, Dussaix E, Reynès M, Bismuth H, and Féray C
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- Adult, Disease Progression, Dose-Response Relationship, Drug, Female, Hepacivirus genetics, Hepatitis C drug therapy, Hepatitis C physiopathology, Hepatitis C, Chronic etiology, Humans, Liver metabolism, Longitudinal Studies, Male, Middle Aged, Postoperative Period, Prednisone administration & dosage, Prednisone therapeutic use, Prognosis, RNA, Viral blood, RNA, Viral metabolism, Hepacivirus growth & development, Liver virology, Liver Transplantation, Virus Replication physiology
- Abstract
Recurrence of hepatitis C after liver transplantation is common and can lead to severe liver diseases. Although immunosuppression and high levels of viremia suggest a direct pathogenicity of hepatitis C virus (HCV), the relations between viral replication and long-term histological course are still unknown. Thirty-three patients with a mean histological follow-up of 3.5 years (3 months - 8.6 years) were analyzed. Nineteen patients were infected by genotype 1b. Liver HCV RNA was determined in parallel with the quantitation of an internal control (28S ribosomal RNA) by competitive polymerase chain reaction (PCR). Lobular hepatitis (LH) and chronic active hepatitis (CAH) occurred in 27 and 19 patients, respectively. Levels of liver HCV RNA determined in 84 biopsies were higher in cases of LH than in the other patterns (82 +/- 123 vs. 19 +/- 38; P < .01) and were unrelated to the genotype. Progression from LH to CAH was associated with a highly significant decrease of liver HCV RNA (P = .006), which was not observed in patients with stable histology. Among patients with CAH, those infected by genotype 1b had more severe liver damage and lower levels of liver HCV RNA than others (P = .04). Multivariate analysis showed that high levels of liver HCV RNA at the time of the first posttransplantation biopsy was an independent predictor of CAH (P = .01). After liver transplantation, the progression to CAH together with a decrease of liver HCV RNA suggests that a host's response is involved in the long-term viral pathogenicity. This response may be stronger and liver disease more severe in patients with high levels of replication at the time of LH and in those infected by genotype 1b.
- Published
- 1997
- Full Text
- View/download PDF
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