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Objectives. We evaluated the efficacy of a hepatitis care coordination intervention to improve linkage to hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccination and clinical evaluation of hepatitis C virus (HCV) infection among methadone maintenance patients. Methods. We conducted a randomized controlled trial of 489 participants from methadone maintenance treatment programs in San Francisco, California, and New York City from February 2008 through June 2011. We randomized participants to a control arm (n = 245) and an intervention arm (n = 244), which included on-site screening, motivational-enhanced education and counseling, on-site vaccination, and case management services. Results. Compared with the control group, intervention group participants were significantly more likely (odds ratio [OR] = 41.8; 95% confidence interval [CI] = 19.4, 90.0) to receive their first vaccine dose within 30 days and to receive an HCV evaluation within 6 months (OR = 4.10; 95% CI = 2.35, 7.17). A combined intervention adherence outcome that measured adherence to HAV-HBV vaccination, HCV evaluation, or both strongly favored the intervention group (OR = 8.70; 95% CI = 5.56, 13.61). Conclusions. Hepatitis care coordination was efficacious in increasing adherence to HAV-HBV vaccination and HCV clinical evaluation among methadone patients. [ABSTRACT FROM AUTHOR]

Background. Current treatment of chronic hepatitis C with pegylated interferon and ribavirin has the ability to eliminate viral infection in about half of the patients treated. Therapeutic options, for those with remaining chronic hepatitis, will remain limited until novel antivirals become available in the future. Consensus interferon is currently available and has demonstrated clinical efficacy with superior invitro antiviral activity, but the maximum tolerated dose is not defined. Methods. We assessed the efficacy of daily high-dose (24 ug) consensus interferon with weight-based (1000-1200 mg daily) ribavirin in HCV genotype 1-infected non-responder patients. Results. Six adverse events were documented in five patients, and the trial was terminated with no subject achieving viral clearance. Conclusions. The occurrence of serious adverse events effectively defined the upper limit of acceptable dose, while also revealing that this dose did not offer enhanced sustained viral clearance. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The efficacy of combination therapy with pegylated interferon (PEG IFN) α plus ribavirin (RBV) in the retreatment of chronic hepatitis C (CHC) in patients who previously failed combination standard IFN plus RBV or IFN monotherapy has not been well established. METHODS: Three hundred and twenty-one CHC patients including virologic nonresponders to combination IFN plus RBV (n = 219) or IFN monotherapy (n = 47), and relapsers to combination therapy (n = 55) were randomized to receive PEG IFN α-2b 1.5 μg/kg per wk plus RBV 800 mg per day (Regimen A, n = 160) or PEG IFN α-2b 1.0 μg/kg per wk plus RBV 1,000–1,200 mg per day (Regimen B, n = 161) for 48 wks. RESULTS: Sustained virologic response (SVR) occurred in 16% of the overall study population (Regimen A vs B, 18% vs 13%, p= 0.21), in 8% of the combination therapy nonresponders (10% vs 6%, p= 0.35), in 21% of the IFN monotherapy nonresponders (16% vs 27%, p= 0.35), and in 42% of the combination therapy relapsers (50% vs 32%, p= 0.18). In nonresponders to prior combination therapy, HCV ribonucleic acid levels <100,000 copies/mL at the end of the prior treatment course were associated with an increased SVR compared with levels ≥100,000 copies/mL (21% vs 5%, p= 0.002). In the overall study population, genotype 1 patients had lower SVR rates than others (14% vs 33%, p= 0.01), and African Americans had lower SVR than Caucasians (4% vs 18%, p= 0.01). CONCLUSION: Combination therapy with PEG IFN α-2b plus RBV is more effective in patients who relapsed after combination standard IFN plus RBV than in nonresponders to either combination therapy or IFN monotherapy. There was no significant effect of dosing regimen. [ABSTRACT FROM AUTHOR]

Most cases of cytomegalovirus colitis occur in adults with severe immune deficiency. Only a few cases involving immunocompetent patients have been reported. We describe the first case reported in English, of cytomegalovirus colitis in an immunocompetent patient with preceding amebiasis. Eight previous cases have been reported of cytomegalovirus colitis occurring after colonic mucosal injury in immunocompetent patients. Similar to our case, all eight of these cases resolved without the use of antiviral therapy. This suggests that disruption of colonic mucosa may predispose immunocompetent patients to cytomegalovirus colitis, and that the colitis may become self-limited once the preceding intestinal damage resolves. [ABSTRACT FROM AUTHOR]

Background: Treatment with pegylated interferon (peginterferon) and ribavirin for 48 weeks is more effective than conventional interferon and ribavirin in patients with chronic hepatitis C. Objective: To assess the efficacy and safety of 24 or 48 weeks of treatment with peginterferon-α2a plus a low or standard dose of ribavirin. Design: Randomized, double-blind trial. Setting: 99 international centers. Patients: 1311 patients with chronic hepatitis C. Intervention: Peginterferon-α2a, 180 g/wk, for 24 or 48 weeks plus a low-dose (800 mg/d) or standard weight-based dose (1000 or 1200 mg/d) of ribavirin. Measurement: Sustained virologic response: undetectable HCV RNA concentration at the end of treatment and during 12 to 24 weeks of follow-up. Results: Overall and in patients infected with HCV genotype 1, 48 weeks of treatment was statistically superior to 24 weeks and standard-dose ribavirin was statistically superior to low-dose ribavirin. In patients with HCV genotype 1, absolute differences in sustained virologic response rates between 48 and 24 weeks of treatment were 11.2% (95% CI, 3.6% to 18.9%) and 11.9% (CI, 4.7% to 18.9%), respectively, between standard- and low-dose ribavirin. Sustained virologic response rates for peginterferon-α2a and standard-dose ribavirin for 48 weeks were 63% (CI, 59% to 68%) overall and 52% (CI, 46% to 58%) in patients with HCVgenotype 1. In patients with HCV genotypes 2 or 3, the sustained virologic response rates in the 4 treatment groups were not statistically significantly different. Conclusion: Treatment with peginterferon-α2a and ribavirin may be individualized by genotype. Patients with HCV genotype 1 require treatment for 48 weeks and a standard dose of ribavirin; those with HCV genotypes 2 or 3 seem to be adequately treated with a low dose of ribavirin for 24 weeks. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Interferon combined with ribavirin has efficacy in the treatment of patients with chronic hepatitis C virus (HCV) infection. However, its utility in patients who have not responded to prior interferon therapy is not clear. Furthermore, the effect of using an increased dose of interferon in combination with ribavirin in patients with chronic hepatitis C resistant to conventional doses of interferon is not known. The aim of our study was to evaluate the effect of high-dose interferon in combination with ribavirin on the efficacy of treating patients with chronic hepatitis C resistant to interferon monotherapy in a large multicenter trial. METHODS: We randomized 154 patients with chronic hepatitis C who failed to achieve a sustained response with prior interferon therapy to receive either 3 or 5 MU of interferon α-2b and ribavirin (1000-1200 mg/day) for 12 months. There were 119 patients who had not responded and 35 who initially responded but relapsed after prior interferon mono-therapy. Serum HCV RNA levels were measured at entry, 6, and 12 months of treatment and at the end of a 6-month follow-up period. RESULTS: The mean age of the subjects was 47 yr (range 28-68 yr), and 110 (71.4%) were men. One hundred thirty-two patients (86%) had HCV genotype 1, whereas 21(14%) had cirrhosis. Eighty-one subjects (53%) were randomized to receive 3 MU of interferon α-2b. Fifteen of 35 relapse subjects (43%) and 12 of 119 prior nonresponder entrants (10%) achieved a sustained virological response to the 12-month course of treatment. Overall, 11 of 81 patients (14%) receiving 3 MU, and 16 of 73 patients (22%) receiving 5 MU of interferon maintained an undetectable HCV RNA level after cessation of therapy. The difference in sustained response rates between the two interferon dosage groups did not reach statistical significance (p = 0.09). However, among the nonresponder patients alone, there was an increased sustained response in the high-dose interferon group compared with the standard interferon dose group (15.5% vs 4.9%, p = 0.055). Twenty-six patients discontinued therapy before 6 months, including 10 patients (12.3%) in the 3-MU and 16 patients (21.9%) in the 5-MU groups (p = 0.17). CONCLUSIONS: Sustained virological response to combined interferon a-2b and ribavirin was significantly higher in relapse patients than those who did not respond to prior interferon monotherapy. Although, when all treated patients were analyzed, there was no significant difference in sustained response between subjects receiving 3 and 5 MU of interferon, among the prior nonresponder patients, treatment with 5 MU of interferon with ribavirin resulted in a slightly increased response compared with treatment with the standard interferon dosage. The tolerability of the treatment regimens was comparable. [ABSTRACT FROM AUTHOR]

Abstract: Data on sociodemographic status, health beliefs, knowledge of hepatitis B, experience with prior vaccinations, health locus of control, and desire to receive hepatitis B vaccine were assessed in 1,500 hospital employees. Twenty per ¢ of the variance of the decision to accept vaccine could be explained; beliefs about the safety and efficacy of vaccine influenced acceptance most. Beliefs concerning the likelihood of contracting hepatitis B and the chance of becoming severely ill were less important determinants of vaccine acceptance. Additional factors studied, including knowledge, experience with vaccinations, and sociodemographic status, were important independent determinants of health beliefs. We conclude that the beliefs of health care providers, particularly regarding the safety and efficacy of hepatitis B vaccine, have a major impact on their decision to accept or reject vaccine. Health education interventions may be most effective when addressing beliefs about vaccine safety and efficacy. (Am J Public Health 1986; 76:252-255.) INSET: May Conference in Canada to Focus on Menopause. [ABSTRACT FROM AUTHOR]

The immunologie features of diseases associated with primary biliary cirrhosis (PBC) such as Sjögren's syndrome, scleroderma, rheumatoid arthritis and others are reviewed. Immunologic abnormalities involving both humoral and cell mediated immunity have been found in PBC. The morphologic and immunologie data have been used to propose a pathogenetic mechanism for PBC. Recent studies of penicillamine indicate that the drug may influence liver copper content and the deposition of immune complexes. [ABSTRACT FROM AUTHOR]

We report a case of fulminant hepatic necrosis occurring in the setting of acetaminophen overdose and chronic alcohol use. The pathology of severe acute toxicity is documented with a surgical biopsy. Follow-up liver biopsy 4 yr later documents hepatic regeneration without cirrhosis. Maintenance of the hepatic reticulin framework in the face of acute hepatic necrosis was well documented, and may be a useful prognostic feature indicating a potential for the maintenance of normal hepatic architecture following regeneration. [ABSTRACT FROM AUTHOR]

Abstract: We reported earlier on 1,500 hospital employees whose desire for hepatitis B vaccine was assessed. We followed 229 of these subjects to measure the effect of a voluntary educational intervention on desire for vaccine. Acceptance of vaccine declined in 37 per ¢ of subjects and increased in 13 per ¢. One of the extraneous influences on demand for vaccine may have been high-profile media coverage of the AIDS (acquired immune deficiency syndrome) epidemic. [ABSTRACT FROM AUTHOR]

Placement of a transjugular intrahepatic portosystemic shunt is a well accepted treatment in the management of gastroesophageal variceal bleeding. Although morbidity and mortality associated with the use of transjugular intrahepatic portosystemic shunts have dramatically decreased, complications still occur. We report a case of fatal fungemia resulting from an infected transjugular intrahepatic portosystemic shunt stent. [ABSTRACT FROM AUTHOR]

Presents a case study of severe thrombocytopenia that occurred in patients with chronic hepatitis during interferon treatment. Clinical history of the patients; Management of the disease; Overview of thrombocytopenia.