Hepatitis: Langlet P

Colle I, Adler M, Brenard R, Henrion J, Langlet P, Michielsen P, Orlent H, Reynaert H, Sprengers D, Stärkel P, Van Damme P, Verslype C, Delwaide J, Anonymous00199. · Department of Hepatology and Gastroenterology, Ghent University Hospital, Ghent, De Pintelaan 185, 9000 Gent, Belgium. · Acta Gastroenterol Belg. · Pubmed #18330099 No free full text.

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Lasser L, Langlet P. · Dpt of Hepatogastroenterology, CHU Brugmann, Brussels. · Acta Gastroenterol Belg. · Pubmed #19198575 No free full text.

Abstract: Pegylated interferon plus ribavirin is the standard treatment for chronic hepatitis C (HCV). Even if genotype 2 and 3 patients only request a treatment of 24 weeks, this treatment remains very costly and difficult to tolerate due to numerous side effects. Recently several studies focused on the possibility of further reducing treatment duration in chronic HCV genotype 2 and 3 patients without compromising sustained virological response (SVR). Based on the available data, patients presenting a negative PCR at week 4 named a rapid virological response (RVR) probably are the best candidates to benefit from shorter treatment duration. In contrast patients without RVR should at least be treated for 24 weeks and retrospective data suggest that a more intensive or prolonged therapy for 48 weeks could be necessary. However, at this moment it remains impossible to propose general recommendations for all patients with genotype 2 and 3. Therefore more randomized prospective trials are needed to clarify several issues that are discussed in this review article.

Langlet P, Lasser L, Sidi B. · Services d'Hépato-gastroentérologie, C.H.U. Brugmann, Bruxelles. · Rev Med Brux. · Pubmed #16454152 No free full text.

Abstract: Chronic hepatitis C (VHC) is a worldwide public health issue. The mother-to-child transmission could be the main cause of hepatitis C infection in children. Despite the risk of histological injuries, chronic hepatitis C is not a contra-indication to pregnancy. In patients with VHC, there is no evidence that the outcome could be modified. In co-infected patients (VIH-VHC), a caesarean should be proposed taking into account the significant risk of mother-to-child transmission. Breast-feeding is not contra-indicated. Systematic screening of VHC, discussed in this article, could be proposed in woman planning a pregnancy.

Verslype C, Michielsen P, Adler M, Orlent H, Sprengers D, Delwaide J, D'heygere F, Langlet P, Brenard R, Colle I, Reynaert H, Stärkel P, Henrion J, Anonymous00136. · Department of Hepatology, University Hospital Gasthuisberg, Leuven, Belgium. · Acta Gastroenterol Belg. · Pubmed #16268417 No free full text.

Abstract: Infection with the hepatitis C virus (HCV) represents an important public health problem and is a leading cause of chronic hepatitis, cirrhosis and hepatocellular carcinoma. Chronic hepatitis C is a heterogeneous disease. Many patients have mild disease at presentation but not all of them will develop advanced liver disease. However, the identification of these patients with mild hepatitis C who will show progressive disease is difficult and is based on histological criteria and the assessment of co-factors (age, alcohol intake, steatosis). In addition, serum transaminases that are persistently normal on several occasions during 18 months may point to a more benign course. Patients with mild hepatitis C should not be excluded "a priori" from the possibility of being treated, as treatment with pegylated interferon and ribavirin is safe and effective in this group. Overall, the decision to initiate therapy should be individualized and based on the severity of the disease by liver biopsy, the potential of serious side effects, the probability of response and the motivation of the patient.

Langlet P, Mulkay JP, Holvoet J. · Department of Hepato-Gastroenterology, CHU Brugmann, Brussels. · Acta Gastroenterol Belg. · Pubmed #12148429 No free full text.

Abstract: Public hospitals in Belgium are taking care of a disfavoured people such as drug addicts, alcoholics, patients with low income and people referred by refugee centres. Many of these patients are at risk of hepatitis C. The medical and paramedical staff is facing numerous problems in taking care of these patients. Requests of hepatologists from public hospitals are a more effective psychosocial management, an increase of the framing in these hospitals, and a more rapid process of reimbursement of medication for treatment of hepatitis C, allowing to treat the patients according to international standards.

Horsmans Y, Collez I, Van Vlierberghe H, Langlet P, Adler M, Bourgeois N, Brenard R, Michielsen P, Goossens A, Bruckers L, Anonymous00024. · Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium. · Acta Gastroenterol Belg. · Pubmed #19198574 No free full text.

Abstract: BACKGROUND AND STUDY AIMS: The combination of Pegylated (PEG)interferon alpha-2b and ribavirin is considered to be the standard treatment for naïve chronic hepatitis C patients. Study aims are to evaluate the differences between standard interferon and PEG-interferon by conducting a multi-centre, controlled randomized trial comparing 3 groups. Group A : daily interferon alfa-2b at a dose of 4 MIU + ribavirin, Group B : PEG-interferon alfa-2b at a dose of 100 mcg/week + ribavirin; Group C: interferon alfa-2b at a dose of 3 MIU TIW + ribavirin PATIENTS AND METHODS: Multicentrer, open label study including naïve chronic Hepatitis C Virus patients randomised in three groups with a ratio of 2:2:1. Group A: daily interferon alpha-2b (4 MIU s.c. for patients > 65 kg or 0.06 MIU/kg < 65 kg) and ribavirin, group B: PEG-interferon alpha-2b (100 microg s.c. weekly for patients > 65 kg or 1.5 microg/kg weekly for patients < 65 kg) and ribavirin and group C (reference arm) : interferon alpha-2b (3MIU s.c. TWI) and ribavirin. The duration of the treatment was 48 weeks for all 3 groups, with a 6 month follow-up period. 336 patients were enrolled in the study and included in the intention-to-treat analysis; 78 never started treatment (35 in group A, 28 in group B and 15 in group C): 101 in group A, 98 in group B and 59 in group C. RESULTS: Demographic data, PCR results and reasons for early withdrawal have been statistically analysed. At baseline, the 3 groups did not show any statistical difference regarding age, gender, race, genotypes and METAVIR score. At week 24 on treatment, HCV ribonucleic acid RNA was undetectable in 87% in group A, in 79% in group B and in 69% in group C. At the end of treatment, 73% 74% and 58% respectively, had a negative PCR result. At week 24 of follow-up, these results were 71%, 64% and 48%, respectively. When comparing the efficacy of the daily interferon (+ ribavirin) and the PEG-interferon (+ ribavirin) regimen, no statistical difference was found (p = 0.32). In group A, 38% of drop-outs were due to adverse events compared to 37% in group B and 58% in group C. No statistical differences were observed regarding safety. CONCLUSION: Daily weight based interferon alpha-2b dosing and PEG interferon alpha-2b weighed based dosing once weekly both in combination with Ribavirin offer the same efficacy and safety rates.

Mesquita M, Lasser L, Langlet P. · Nephrology and Dialysis Unit, Department of Internal Medicine, CHU-Brugmann, Université Libre de Bruxelles, Belgium. · Clin Nephrol. · Pubmed #18793553 No free full text.

Abstract: Glomerulonephritis (GN) is an uncommon but well-described complication of chronic hepatitis B virus (HBV) infection. HBV-related membranous nephropathy (MN) may lead to renal failure in 1/3 of the patients and spontaneous remission is rare. There is no standard therapy for HBV-associated MN. We report a case of a 28-year-old man with HBV-associated MN due to pre-core HBV mutant with complete remission under an ongoing 7-year lamivudine monotherapy.

De Maeght S, Henrion J, Bourgeois N, de Galocsy C, Langlet P, Michielsen P, Reynaert H, Robaeys G, Sprengers D, Orlent H, Adler M. · CH Jolimont, Haine Saint Paul. · Acta Gastroenterol Belg. · Pubmed #18396742 No free full text.

Abstract: AIM OF THE STUDY: There is a lack of epidemiological data on hepatitis C (HCV) infected patients in Belgium. Therefore our purpose was to address this important question and to evaluate the feasibility of a national HCV observatory. PATIENTS AND METHODS: From November 2003 to November 2004, every new patient prospectively seen for HCV antibody positivity in 9 Belgian hospital centres was recorded and a standardised 10-items questionnaire was completed during the consultation, including a Quality of Live (QOL) visual analogue scale. RESULTS: Three hundred and eighteen consecutive patients were recruited. Fifty five percent were male with a median age of 45 y (11-87 y). The main risk factors for infection were IV drug use (27%), blood transfusion (23%), and invasive medical procedure (11%). On the QOL scale, ranging from 0 and 100, mean value was 61 +/- 31. Transaminases were abnormal in 66% with a median elevation 2 times above normal value. HCV RNA was positive in 87% with a viral load above 800 000 IU/ml in 42%. Genotype 1 was predominant (59%), followed by genotypes 3 (19%) and 4 (14%). A liver biopsy was performed in 190 patients, with minimal fibrosis (METAVIR F0-F1) in 43%, moderate fibrosis (F2) in 35% and advanced stages (F3-F4) in 22%. Antiviral treatment was not considered in 53% because of normal ALT (30%), old age (7%), minimal histological stage (6%) or patient refusal (4%). CONCLUSIONS: This study highlights the feasibility of a national HCV survey using a simple questionnaire. This pilot study could be generalised throughout Belgium, and, if repeated, could allow a regular assessment of the changes in epidemiology and management of HCV infection in our country.

Langlet P, Delwaide J. · Service de Gastro-entérologie, C.H.I.R.E.C., Site Clinique E. Cavell, Bruxelles. · Rev Med Brux. · Pubmed #17958019 No free full text.

Abstract: The presence of hyperferritinemia has to rule out acquired causes such as chronic inflammatory disorders, hemolytic anemia, liver diseases as hepatitis B or C, alcohol abuse and non alcoholic fatty liver disease, specially in patients with normal transferrine saturation. Genetic testing for hemochromatosis is systematically indicated in all patients with elevated transferrine saturation. When an iron overload is demonstrated in the absence of these classic causes, second-line genetic testing should be considered to exclude non HFE hemochromatosis. The aim of this paper is to propose a practical algorithm in the diagnosis of hyperferritinemia and to precise the diagnostic and therapeutic management of genetic hemochromatosis.