Search

Concurrent infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) in patients positive for human immunodeficiency virus (HIV) is relatively common. The treatment of co-infected individuals is rather complex because the anti-viral therapy may be associated with drug-resistance, hepatotoxicity and lack of response. Herein, we present a summary of the available compounds and the recent recommendations concerning the therapeutic management of HIV/HBV and HIV/HCV co-infections. © 2012 Bentham Science Publishers. 12 9 890 904

Introduction: In adults with previously untreated chronic hepatitis C (CHC), the combination of peginterferon α-2a plus ribavirin produces a higher rate of sustained virological response (SVR) than interferon α-2b plus ribavirin, but it is still unproven whether this increase is cost effective. The objective of this study was to determine if the gain in SVR with peginterferon α-2a plus ribavirin is worth the incremental cost. Methods: We constructed a Markov model of disease progression in which cohorts of patients received peginterferon α-2a plus ribavirin or interferon α-2b plus ribavirin for 48 weeks (hepatitis C virus [HCV] genotype 1 and non-1 patients with fibrosis) or 24 weeks (genotype non-1 patients without fibrosis), and were followed for their expected lifetimes. The reference patient was a 45-year-old male with CHC without cirrhosis. The SVRs with peginterferon α-2a plus ribavirin and interferon α-2b plus ribavirin used to populate the model were 46% and 36% for patients infected with HCV genotype 1 and 76% and 61% for patients infected with HCV non-1 genotypes, respectively. QOL and costs for each health state were based on literature estimates and on Italian treatment patterns. Costs were in 2002 euros and benefits were discounted at 3%. Sensitivity analyses on key clinical and economic parameters were performed. The analysis was reported from the perspective of the Italian National Health Service. Results: In patients infected with HCV genotype 1, peginterferon α-2a plus ribavirin increased life-years (LYs) by 0.78 years and QALYs by 0.67 years, compared with interferon α-2b and ribavirin. The incremental cost per LY and QALY gained was €9433 and €10 894, respectively. In patients infected with HCV non-1 genotypes, peginterferon α-2a plus ribavirin increased LYs by 1.17 and QALY by 1.01 years, compared with interferon α-2b plus ribavirin. The incremental cost per LY and QALY gained was €3261 and €3766, respectively. Using genotype distribution estimates, the weighted average ICER for all genotypes was €6811 per LY gained and €7865 per QALY gained. Conclusion: Our model suggests that peginterferon α-2a plus ribavirin is cost effective compared with conventional interferon α-2b plus ribavirin for treatment of naive adults with CHC, regardless of HCV genotype, under a wide range of assumptions regarding treatment effectiveness and costs.

Bazal hücreli karsinom (BHK), insanlarda en sık görülen deri kanseri tipidir. BHK'ların tedavisinde cerrahi, halen altın standart olarak yerini korumaktadır. Buna rağmen, cerrahiye uygun olmayan ve kozmetik kaygıları olan bireylerde imikimod krem ve intralezyonel interferon (IFN) alfa2b gibi, daha az invaziv, cerrahi olmayan seçenekler de bulunmaktadır. Yalnız başına imikimod ya da imikimod ile kombine olarak interferon alfa-2b ile başarılı bir şekilde tedavi ettiğimiz değişik alt tiplerde 11 BHK vakasını sunduk. 2005-2010 yılları arasında polikliniğimizde histopatolojik olarak BHK oldukları kanıtlanmış, tek başına ya da IFN alfa-2b ile kombine olarak imikimod ile tedavi edilmiş çeşitli alt tiplerdeki hastalar bu rapora dahil edildi. Sunduğumuz 11 hastadan sadece 4 'ü (3 infiltratif, 1 solid tipler) topikal imikimoda ek olarak haftada 3 gün intralezyonel interferon alfa2b 3 milyon IU tedavisi de almıştı. Geri kalan 7 hasta sadece imikimod %5 krem kullanmıştı. Tüm hastalarda bu tedavi seçenekleri ile tam iyileşme sağlandığı görüldü. Bu olgulardaki gözlemlerimiz, İmikimodun sadece yüzeyel değil; infiltratif, solid, nodüler tip BHK'larda da etkili olduğunu düşündürmektedir. İmikimod, sadece yüzeyel değil, aynı zamanda, infiltratif, solid ve nodüler tip BHK'larda da etkili olduğunu düşündürmektedir. İntralezyonel interferon alfa-2b'nin de BHK'larda etkili olduğu ve imikimod ile kombine edildiğinde sinerjistik etki gösterdiği bilinmektedir. Basal cell carcinoma (BCC) is the most common type of skin cancer in humans. Surgery is still the gold standard for treating BCCs. However, there are also less-invasive, nonsurgical therapies such as imiquimod cream and intralesional interferon (IFN) alpha-2b for patients who are poor surgical candidates and who care about cosmetic outcomes. We report 11 patients with various subtypes of. BCC successfully treated with either imiquimod alone or in combination with interferon alfa-2b. In this paper, we present 11 patients with various subtypes of histopathologically proven BCCs, who were treated with imiquimod or combination of imiquimod and IFN alpha-2b, in our outpatient clinic between 2005 and 2010. Of 11 patients, only 4 patients (3 infiltrative, 1 solid types) had received intralesional interferon alpha-2b at a dose of 3 million IU, 3 times a week combined with topical imiquimod while 7 patients had received only 5% imiquimod cream. All patients were cured with these regimens. Imiquimod is found to be effective not only in superficial, but also in infiltrative, solid, and nodular types. Intralesional interferon alpha-2b is also known to be effective in BCCs and it has a synergistic effect when combined with imiquimod.

dikici, bunyamin/0000-0001-7572-6525 WOS: 000189072800002 PubMed: 14731120 Background and Aim: The aim of the present study was to compare the therapeutic efficacy of three different regimens in childhood chronic hepatitis B (CHB) infection. Methods: A total of 182 children with CHB infection were prospectively allocated to three random groups. Sixty-two patients in the first group received high-dose interferon (IFN)-alpha 2b (10 MU/m(2)) thrice/weekly alone for 6 months. In the second (n = 60) and third groups (n = 60), IFN-alpha was used for 6 months (5 MU/m(2)) thrice/weekly in combination with lamivudine (LAM) (4 mg/kg, maximum 100 mg/day) for 12 months. Lamivudine was started simultaneously with IFN in the second group, while it was started 2 months prior to IFN injections in the third group. Results: The initial mean alanine aminotransferase (ALT) values for the first, second and third groups were 109 +/- 93 IU/L, 101 +/- 64 IU/L and 92 +/- 42 IU/L, respectively (P > 0.05). At the end of the therapy, ALT values decreased to 82 +/- 111 IU/L, 38 +/- 41 IU/L and 29 +/- 16 IU/L in groups 1, 2 and 3, respectively. The mean ALT value of the first group was significantly different to the second and third groups (P = 0.046 and P = 0.002, respectively) at the end of the therapy and these differences were found to be sustained after 18 months. However, results in the second and third groups were similar (P > 0.05). There were no significant differences in HBeAg clearance and anti-HBe seroconversion at the initial stage, 12 months and 18 months between the three groups (P > 0.05). Hepatitis B virus (HBV) DNA clearance in the first group was different from the second and third groups, while the second and third groups had similar HBV DNA clearance ratios at 12 and 18 months. No significant difference was found in the complete response (normalization of ALT, clearance of HBV DNA and seroconversion of anti HBe) ratios of all groups (at 12 months: 28.8, 45.5, 35.8% and at 18 months 33.3, 49 and 34% in groups 1, 2 and 3, respectively, P > 0.05). Conclusions: Although the ALT normalization and HBV DNA clearance ratios of IFN plus LAM combination groups were better than the high-dose IFN-alpha monotherapy group, no significant difference was found in the complete response ratios of all three groups. (C) 2004 Blackwell Publishing Asia Pty Ltd.

We conducted a phase III study in patients with advanced colorectal carcinoma (ACC). The total number of patients randomized from October 1993 until July 1998 was 192, whereas therapy was started on 179 and 158 (82.3%) have been evaluable. The treatment schedules consisted of weekly bolus administration for 6 weeks of 5-fluorouracil (5-FU), 600 mg/m2 (arm I) versus 5-FU (500 mg/m2) intravenous bolus and interferon-alpha, 5 MU subcutaneously, three times a week (arm II) versus leucovorin 200 mg/m2 in 2-hour infusion and 5-FU 500 mg/m2 intravenous bolus at the midtime of leucovorin infusion (arm III) followed by a 2-week rest period. Treatment was continued for six cycles or until progression. This study failed to show any superiority of the modulated 5-FU versus single administration of 5-FU. There were no significant differences between the three arms in the overall response rate (10.3% versus 11.3% versus 12.9%, p = 0.95), the time to tumor progression (median, 3.9 versus 3.8 versus 6.0 months, p = 0.59), or survival duration (median, 14.7 versus 12.4 versus 16.3 months, p = 0.71). The incidence of severe (grades III and IV) toxicity was significantly higher in patients in arm II and III (24.5% and 18.6%) versus arm I (6.0%) (p = 0.01). Because modulated 5-FU failed to show superiority versus 5-FU, new agents and new strategies are needed for the treatment of advanced colorectal carcinoma. Am J Clin Oncol

Possible prognostic variables for tumor response, time to progression (TTP), and survival in 141 patients with advanced colorectal cancer treated with fluorouracil and leucovorin-based chemotherapy were analyzed. None of the variables examined for their possible influence on tumor response attained significance in the stepwise logistic regression. In the univariate analysis, variables found to be strongly associated with TTP were performance status (PS) (P = 0.0301), liver involvement (P = 0.030), and the initial values of WBC (P = 0.0319), lactic dehydrogenase (LDH; P = 0.0053), γ- glutamyl-transpeptidase (γ-GT; P = 0.0013), alkaline phosphatase (ALP; P = 0.0186), albumin (P = 0.0004), and carcinoembryonic antigen (CEA; P = 0.0014). In the Cox analysis, liver involvement (P = 0.0553), albumin (P = 0.0181), PS (P =0.0484), and ALP (P = 0.0553) were retained as independently significant variables. When only patients with liver metastases were included in the analysis, then only albumin (P

To confirm the positive results of a preliminary trial, 26 patients with mixed cryoglobulinaemia were enrolled in a controlled, randomised, crossover trial with interferon alfa-2b. A significant improvement was seen in the purpura score and alanine aminotransferase activities during six months' treatment, and was associated with a significant decrease in cryocrit and a returning to normal of the lymphocyte CD4/CD8 ratio (in eight of nine patients). No significant variations were seen during the six month period without interferon. Only six patients withdrew from treatment, three because of side effects and three because of poor compliance.

3 1 85 86