Hepatitis: Niederau C

Niederau C. · St. Josef Hospital Oberhausen, Klinik für Innere Medizin, Akademisches Lehrkrankenhaus der Universität Essen, Oberhausen. · Z Gastroenterol. · Pubmed #15314715 No free full text.

This publication has no abstract.

Niederau C, Kaden T. · Kath. Kliniken Oberhausen gGmbH, Klinik für Innere Medizin, St. Josef Hospital Oberhausen, Oberhausen. · MMW Fortschr Med. · Pubmed #18522354 No free full text.

This publication has no abstract.

Niederau C, Holtkamp G. · Kath. Kliniken Oberhausen gGmbH, Klinik für Innere Medizin, St. Josef Hospital Oberhausen, Akad. Lehrkrankenhaus der Universität Duisburg-Essen, Oberhausen. · MMW Fortschr Med. · Pubmed #18522353 No free full text.

This publication has no abstract.

Niederau C. · Klinik für Innere Medizin, St. Josef Hospital, Katholische Kliniken Oberhausen gGmbH, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Mülheimer Strasse 83, 46045, Oberhausen, Deutschland. · Internist (Berl). · Pubmed #18340426 No free full text.

Abstract: According to the new German guidelines therapy of chronic hepatitis B is recommended when HBV-DNA is >10.000 copies/ml and when GPT is >twice the ULN or biopsy shows inflammation/fibrosis. When patients are not suitable for interferon therapy, mono-therapy with adefovir, entecavir, telbivudine of lamivudine may be initiated provided that HBV-DNA is <1 Mio. copies/ml and cirrhosis is absent. When viral load is high, entecavir should be preferred. HBV-DNA need to be checked for early detection of non-response or resistance. When resistance is present, combination therapy is recommended.New studies warrant individualization of previous recommendation for therapy of hepatitis C because one can now early evaluate how successful and long the therapy shall be. When viral load is low and HCV-RNA becomes negative after 4 weeks, therapy may be shortened to 24 weeks. Without such rapid response HCV-RNA needs to be checked after 12 and 24 weeks: when HCV-RNA becomes negative only after 24 weeks, a prolongation of therapy might be advisable.

Manns MP, Wedemeyer H, Meyer S, Roggendorf M, Niederau C, Blum HE, Jilg W, Fleig WE, Anonymous00375, Anonymous00376. · Medizinische Hochschule Hannover, Abt. Gastroenterologie, Hepatologie und Endokrinologie, Hannover. · Z Gastroenterol. · Pubmed #15314713 No free full text.

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Niederau C. · Kinik für Innere Medizin, Germany. · Dtsch Med Wochenschr. · Pubmed #11894177 No free full text.

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Niederau C. · Klinik für Innere Medizin, St.-Josef-Hospital Oberhausen, Akademisches Lehrkrankenhaus, Universität Essen. · Med Klin (Munich). · Pubmed #11715332 No free full text.

Abstract: BACKGROUND: Chronic hepatitis C affects more than 500,000 people in Germany and is one of the most important chronic liver diseases. A large part of liver cirrhosis and cancer as well as most liver transplantations are today caused by hepatitis C. METHODS: The review analyzes the recent Medline-literature and own data about diagnosis and therapy of chronic hepatitis C with special emphasis on practical consequences of the new data. RESULTS AND DISCUSSION: In contrast to HBV, hepatitis C is usually not transmitted by sexual and perinatal means which leads to corresponding recommendations by official health care organizations. Diagnosis of chronic hepatitis C with antibody tests and HCV-RNA is today easy and reliable. HCV genotype and quantitative measurements of HCV-RNA should be done prior to antiviral therapy. Liver biopsy is necessary to determine the disease stage and the urgency for antiviral therapy. Young subjects with biochemical and histological inflammation should be treated. The standard therapy with pegylated interferon and ribavirin is able to eliminate HCV-RNA from serum in approximately 60% of the patients. In patients with genotype 1 and high virus load therapy can eliminate HCV-RNA in 30-40% while therapy is successful in > 90% of patients with genotype 3 and low virus load. There is increasing evidence that antiviral therapy causes beneficial effects on disease progression and cancer risk also in patients in whom HCV-RNA is not eliminated.

Witthöft T, Möller B, Wiedmann KH, Mauss S, Link R, Lohmeyer J, Lafrenz M, Gelbmann CM, Hüppe D, Niederau C, Alshuth U. · Medical Department I, Division of Gastroenterology, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany. · J Viral Hepat. · Pubmed #17927615 links to  free full text

Abstract: The combination treatment of peginterferon alpha-2a (PEG-IFN alpha-2a; Pegasys) plus ribavirin (RBV) is recommended as a standard care for HCV infections. Side effects and aspects of efficacy and safety have to be balanced. This study evaluates clinical practice data on safety and efficacy of HCV treatment with PEG-IFN in combination with RBV over 24 and 48 weeks. This study was a phase III, multi-centre, open-label study with two treatment groups: PEG-IFN in combination with RBV for 24 or 48 weeks. The allocation to the treatment groups was at the discretion of the investigator; 309 patients entered active treatment: 90 patients received PEG-IFN plus RBV for 24 weeks and 219 patients PEG-IFN plus RBV for 48 weeks. A sustained virological response (SVR) was achieved in 48.9% of all patients. Genotype 1 patients with a 48-week combination treatment achieved an SVR of 39.9%. In the 48-week group a low baseline viral load was associated with a higher SVR rate (47.0% vs. 32.4%). For genotype 2 or 3 patients, the SVR was 67.9%. For these patients there was no relevant difference between patients with low and high viral loads; 97.7% of the patients experienced at least one adverse event. The incidence of serious adverse events was distinctly lower in the 24-week group (4.4% vs. 10.5%). This investigation confirms the well-known risk-benefit ratio found in controlled studies in a clinical practice setting. The safety profile is similar and shows the highest incidence of adverse events in the first 12 weeks of treatment.

Erhardt A, Reineke U, Blondin D, Gerlich WH, Adams O, Heintges T, Niederau C, Häussinger D. · Department of Internal Medicine, Division of Gastroenterology, Hepatology, and Infectious Diseases, Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany. · Hepatology. · Pubmed #10706563 No free full text.

Abstract: In chronic replicative hepatitis B the significance of mutations in the basic core promoter (BCP), core upstream regulatory sequences (CURS) and negative regulatory element (NRE) for response to interferon (IFN) is unknown. A sequence analysis of the NRE, CURS, BCP, and precore region was performed from sera of 96 patients with chronic replicative hepatitis B (64 hepatitis B e antigen [HBeAg]-positive patients and 32 HBeAg-negative patients) treated with alfa-IFN (IFN-alpha). The overall sustained response (SR) rate to IFN was 30% with no significant difference between HBeAg-positive and HBeAg-negative patients. IFN responsiveness correlated to hepatitis B virus (HBV)-DNA levels, hepatitis B surface antigen (HBsAg) levels, the number of mutations in the complete BCP, especially nucleotide (nt) region 1753 to 1766 and mutations at nt 1762 and 1764. In HBeAg-positive hepatitis, SR to IFN was associated with a high number of mutations in the BCP (P <.04) and nucleotide region 1753 to 1766 (P <.015) as well as mutations at nucleotide 1764 (P <.007). In HBeAg-negative hepatitis, SR to IFN correlated with a low number of mutations in the BCP (P <.04) and nucleotide region 1753 to 1766 (P <.02) and a wild-type sequence at nt 1764 (P <.003). Prediction of IFN response was possible on the basis of nt 1764 in 77% of HBeAg-positive patients and 78% of HBeAg-negative patients. IFN response did not correlate with the occurrence of the 1896 mutation, mutations in the CURS or NRE, disease duration, ethnic origin of the patient, alanine transaminase (ALT) levels and HBV genotype. Our data suggest that HBV genome mutations located within the BCP are determinants of a response to IFN therapy.

Niederau C. · No affiliation provided · MMW Fortschr Med. · Pubmed #18522355 No free full text.

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Niederau C. · No affiliation provided · MMW Fortschr Med. · Pubmed #18522352 No free full text.

This publication has no abstract.

Niederau C, Lange S, Frühauf M, Thiel A. · Department of Internal Medicine, Katholische Kliniken Oberhausen gGmbH, St. Josef Hospital Oberhausen, Academic Teaching Hospital of the University of Duisburg-Essen, Oberhausen, Germany. · Liver Int. · Pubmed #18312288 No free full text.

Abstract: BACKGROUND/AIMS: Although physicians have looked for cutaneous signs of liver disease for more than a century, their prognostic value has never been evaluated systematically. METHODS: Therefore, cutaneous changes were prospectively recorded in all patients referred for liver biopsy from June 2000 to May 2004. Fibrosis was staged from F0 to F4 according to Desmet and Scheuer. The analysis included 744 patients, 520 of whom had chronic hepatitis C while the remaining had other diseases. RESULTS: By univariate analysis, the frequency of several skin changes was associated with the degree of fibrosis. In general, at fibrosis F0-1 skin changes were infrequent; they became more frequent at F2 and were frequent at F3-4. To analyse the predictive value of skin changes, patients with fibrosis F0-2 were compared with those with F3-4. Final logistic regression included spider naevi, palmar erythema, teleangiectasia, bleeding signs and dry skin as well as age and gender. When routine laboratory values were included in the analysis, prothrombin time, gamma-glutamyltransferase and albumin proved to be significant. Receiver operating characteristic (ROC) showed a good discrimination of fibrosis F0-2 from F3-4 by the modelled score on combining skin changes and laboratory tests: at the cost of 2% of non-diagnosed patients with F3-4, one might have saved 60% of biopsies. ROC was less useful in discriminating fibrosis F0-1 from F2-4. The discriminative power of skin changes was better than the laboratory values and the aspartate aminotransferase/platelet ratio. CONCLUSIONS: The results prove that it is quite useful to look for skin changes in patients with liver disease.

Hüppe D, Zehnter E, Mauss S, Böker K, Lutz T, Racky S, Schmidt W, Ullrich J, Sbrijer I, Heyne R, Schober A, John C, Hey KH, Bokemeyer B, Kallinowski B, Möller B, Pape S, Gutmann M, Alshuth U, Niederau C. · Gastroenterologische Gemeinschaftspraxis Herne, Herne. · Z Gastroenterol. · Pubmed #18188814 No free full text.

Abstract: Little is known about the epidemiology of chronic hepatitis C (CHC) in Germany and especially about the importance of transmission, duration of infection, genotypes, symptoms and quality of life of the patients. The current study prospectively evaluates epidemiological and clinical data of patients infected with the hepatitis C virus (HCV). Using online data entry, various characteristics of 10,326 untreated patients with CHC were documented from March 2003 until May 2006 in 352 centres all over Germany. Mean age of patients was 43.4 years. Patients infected by i.v. drug abuse were considerably younger (36.5 years) than the remaining patients (49.2 years). As indicated by their native language, 64.4% of the patients came from Germany and 19.2% from Russia. 61.7% were infected with genotype 1 and 34.9% with genotype 2 or 3. 45.5% of the patients had been infected by i.v. drug abuse. In at least 5.4% of the patients liver cirrhosis had been proved by biopsy. 63.5% of the patients felt an impairment of quality of life caused by CHC. In many patients infected with hepatitis C socio-economic issues are existent. This is reflected, i.e., in very high rates of unemployment in special subpopulations. Coinfections with hepatitis B and HIV occurred in 1.5% and 4.7%, respectively. Nearly 80% of patients were managed near their homes. The data of the 10 326 patients represent about 2% of all German patients with CHC. This database is up to now the largest of its kind and gives a representative insight into the epidemiological situation of CHC in Germany.

Niederau C, Bemba G, Kautz A. · Katholische Kliniken Oberhausen GmbH, St.-Josef-Hospital, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Oberhausen. · Z Gastroenterol. · Pubmed #18188813 No free full text.

Abstract: AIMS AND METHODS: The study of the Patient Support Group Deutsche Leberhilfe e.V. and the Federal Hepatitis Competence Net prospectively analysed questionnaires about quality of life (SF12) and socio-economical data of patients with chronic hepatitis C (CHC). A 1st questionnaire 3 1/2 years ago gathered information in 714 CHC patients all of whom now received a 2nd questionnaire which was sent back by 503 subjects (71%). RESULTS: Both mental and physical SF 12 scores remained markedly decreased compared with scores for the general population which approximate 50 points (p<0.001). When compared to values obtained 3S years ago, mental scores increased from 41.2 to 42.5 and physical scores from 41.9 to 42.9 (changes not significant by analysis of variance; p>0.05). However, in patients with negative HCV-RNA, physical and mental scores significantly increased by 6.9 and 4.0 points (p<0.01). In contrast, mental and physical scores decreased by 2.4 and 2.5 points during follow-up in patients with fibrosis (Metavir F2-4) (p<0.05). SF 12-scores closely correlated with degrees of inflammation and fibrosis (p<0.001, respectively). Quality of life was associated with socio-economical data and gradually increased with higher school graduation. A high percentage of patients with CHC were unemployed (18%); of patients aged 65 years, 25% were already retired; 60% of the retired subjects received a disability pension, 37% because of CHC. Unemployed patients had lower SF 12 scores than patients with a job. Subjects with public employers had significantly lower SF 12 scores than privately or self-employed subjects. Complications of CHC markedly reduced SF 12 scores. Just 37% of subjects had a life insurance and only 9% had an insurance of occupational invalidity (values 2-3-times lower than those in the general German population). Insurance applications for life and occupational invalidity had been denied in 17 and 53%, respectively; the denial values were even higher than in the 1st questionnaire. CONCLUSIONS: The prospective follow-up shows that quality of life continuously improves after elimination of HCV, whereas mental and physical health get increasingly worse with ongoing fibrosis. The analysis demonstrates that many CHC subjects have severe socio-economical problems leading to unemployment, early retirement and lack of appropriate insurances. These problems further reduce the quality of life in CHC.

Niederau C. · St. Josef Hospital, Klinik für Innere Medizin, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Oberhausen. · Med Klin (Munich). · Pubmed #17879015 No free full text.

Abstract: The new German and American guidelines on hepatitis B show similarities but also some discrepancies. In general, indication for therapy depends more on hepatitis B virus-(HBV-)DNA than alanine aminotransferase (ALT) values. Antivirals are recommended by German guidelines when HBV-DNA exceeds 10,000 copies/ml and ALT is increased more than twice the upper normal limit or when liver biopsy shows significant inflammation and fibrosis. By contrast, American guidelines recommend therapy only when HBV-DNA exceeds 100,000 copies/ml. American guidelines do not recommend lamivudine or telbivudine as initial monotherapy because of risk for resistance, but adefovir or entecavir. By contrast, according to German guidelines monotherapy with lamivudine, telbivudine, adefovir or entecavir may be initiated, if HBV-DNA is < 1 million copies/ml and cirrhosis is absent. Both guidelines recommend to monitor HBV-DNA even in the absence of therapy. Under antiviral therapy HBV-DNA should be measured more often than previously recommended to early identify lack of response and upcoming resistance. When resistance occurs, combination therapy is indicated. Risk for resistance is low as long as viral suppression is effective. In both guidelines liver biopsy should be considered when there are doubts on indication of therapy or selection of antiviral substances. In the presence of severe fibrosis and high HBV-DNA, antiviral substances should have high potency and low risk for resistance.

Buster EH, Hansen BE, Buti M, Delwaide J, Niederau C, Michielsen PP, Flisiak R, Zondervan PE, Schalm SW, Janssen HL, Anonymous00073. · Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands. · Hepatology. · Pubmed #17604363 No free full text.

Abstract: Chronic hepatitis B (CHB) patients with advanced fibrosis are often not considered for treatment with peginterferon (PEG-IFN) because IFN therapy may precipitate immunological flares, potentially inducing hepatic decompensation. We investigated the efficacy and safety of treating hepatitis B e antigen (HBeAg)-positive CHB patients with 52 weeks of PEG-IFN-alpha-2b (100 microg weekly) alone or in combination with lamivudine (100 mg daily). Seventy patients with advanced fibrosis (Ishak fibrosis score 4-6) and 169 patients without advanced fibrosis, all with compensated liver disease, participated in the study. Virologic response, defined as HBeAg seroconversion and hepatitis B virus (HBV) DNA < 10,000 copies/ml at week 78, occurred significantly more often in patients with advanced fibrosis than in those without (25% versus 12%, respectively; P = 0.02). Also patients with cirrhosis (n = 24) exhibited a virologic response more frequently than did patients without cirrhosis (30% versus 14%, respectively; P = 0.02). Improvement in liver fibrosis occurred more frequently in patients with advanced fibrosis (66% versus 26%, P < 0.001). HBV genotype A was more prevalent among patients with advanced fibrosis than among those without (57% versus 24%, P < 0.001). Most adverse events, including serious adverse events, were observed equally as frequently in patients with advanced fibrosis and those without. Fatigue, anorexia, and thrombocytopenia occurred more often in patients with advanced fibrosis than in those without (P < 0.01). Necessary dose reduction or discontinuation of therapy was comparable for both patient groups (P = 0.92 and P = 0.47, respectively). CONCLUSION: PEG-IFN is effective and safe for HBeAg-positive patients with advanced fibrosis. Because PEG-IFN therapy results in a high rate of sustained off-therapy response, patients with advanced fibrosis or cirrhosis but compensated liver disease should not be excluded from PEG-IFN treatment.

Niederau C, Fischer C, Kautz A. · Deutsche Leberhilfe e. V., Köln. · Z Gastroenterol. · Pubmed #17503314 No free full text.

Abstract: BACKGROUND: Little is known about socio-economical consequences and information status of patients with chronic hepatitis B virus (HBV) infection. AIMS AND METHODS: The present study prospectively analyzed questionnaires about socio-economical consequences and information status including the SF12 quality-of-life analysis in HBV-infected subjects. Overall 1500 questionnaires were distributed by clinics, practioners, patient support groups and internet; 255 questionnaires were sent back. Results were compared with a recent study in 714 HCV infected patients (Z Gastroenterol 2006; 44: 305-317). RESULTS: HBV-infected patients were younger (mean 46 vs. 52 years), more likely to be male (62 vs. 44%) and to come from abroad (30 vs. 9%) when compared with HCV-infected subjects. Only 1 and 4% of HBV- and HCV-infected subjects, respectively, considered the public information about hepatitis as good or very good, 73 and 77%, however, as bad or very bad. Mental and physical quality-of-life (SF12) was better in HBV- than in HCV-infected subjects, but reduced when compared with a sex- and age-matched general population (p < 0.001). Quality-of-life decreased with increases in HBV-DNA, fibrosis and inflammation. In both HBV- and HCV-infected subjects there were information deficits concerning the risks for infection; some of these were more pronounced in HBV-infected subjects when compared to HCV-infected ones. German subjects with HBV and HCV infection are in general well informed about their infection (73-87% knew ALT and histology results); however, HBV-infected subjects are less well informed in particular about viral load and HBeAg (59 and 30%) when compared with HCV infected subjects who knew HCV-RNA and genotype in 80-85%. CONCLUSIONS: The information deficits about viral load are of concern for HBV-infected subjects because these data are more important in HBV than in HCV infection. This lack of information likely reflects a lack of attentiveness towards HBV-DNA levels by the patients' physician. Both HBV- and HCV-infected subjects have problems at work and with various insurances; both have a reduced quality-of-life which correlates with viral load and degree of inflammation and fibrosis. Both populations consider the public information status about viral hepatitis to be bad.

Niederau C. · Katholische Kliniken Oberhausen gGmbH, Klinik für Innere Medizin, St. Josef Hospital, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Oberhausen, Germany. · Med Klin (Munich). · Pubmed #17497085 No free full text.

Abstract: BACKGROUND AND PURPOSE: Little is known about the epidemiology of chronic hepatitis B virus (HBV) infection in Germany. The present study analyzes demographic, socioeconomic and virologic data of a cohort of German HBV-infected patients. PATIENTS AND METHODS: As a project of the Hepatitis Competence Network, 250 outpatients with chronic HBV infection were included during the last 5 years. RESULTS: Mean age was 40.5+/-14.6 years; 63.2% were men. HBV-DNA was negative by polymerase chain reaction in 12.8%; alanine aminotransferase ALT) was normal in 56.3%; even at DNA levels>1 million copies/ml ALT was normal in 38% ("immunotolerance"). About one third of patients were born in Germany, Turkey or one of 34 other countries. The unemployment rate in migrants from Turkey and other countries was more than three times the rate of subjects born in Germany; this difference, however, is the same in non-HBV-infected subjects. In the total cohort HBeAg-negative subjects were more frequent than HBeAg-positive subjects (66.4% vs. 33.6%). About 40% of patients with a liver biopsy had significant fibrosis (F2-4). Multivariate regression showed that significant fibrosis was associated only with age and ALT, but not with HBV-DNA or other variables. 38.4% of subjects had antiviral therapy; the rate of therapy increased with increasing DNA and ALT. The majority of treated patients received lamivudine (58%), adefovir (31%), or both (5%). Only 3% each received interferon or other antivirals. CONCLUSION: The present cohort study shows that about two thirds of HBV-infected subjects who live in the Ruhrgebiet originate from migrants many of whom have significant economic problems. Special programs should be designed for migrants in order to detect HBV infection and to inform infected subjects about their individual and infectious risks.

Niederau C, Kapagiannidis C. · Katholische Kliniken Oberhausen gGmbH, Klinik für Innere Medizin, St. Josef Hospital Oberhausen, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Duisburg-Essen. · Med Klin (Munich). · Pubmed #16767568 No free full text.

Abstract: BACKGROUND AND PURPOSE: Little is known about the epidemiology of hepatitis C in Germany and in particular about the route of infection. The current study prospectively analyzed epidemiologic and clinical data of patients with chronic hepatitis C virus (HCV) infection. METHODS: A structured questionnaire was sent to primary care physicians in Germany. Of 13,287 questionnaires, 5,837 were sent back for analysis. RESULTS: Although the number of questionnaires sent out was proportional to the number of subjects living in the new and old states of Germany, only 9% were sent back from the new states; thus, the prevalence of hepatitis C is probably considerably lower in the new states compared with the old ones. The HCV-infected subjects originated from 92 different countries throughout the world: 63% were born in Germany, but 21% were from one of the former states of the USSR. Intravenous drug abuse was the most prevalent risk noted; there was a strong bias whereby physicians who cared for a large number of HCV-infected patients had a much higher proportion of subjects with i.v. drug abuse when compared to those who only cared for a few hepatitis C patients. In the latter group a history of infusion of blood products was approximately as frequent as a history of drug abuse. There was a high proportion of patients who had no risk factor for hepatitis C (25-42%). Fatigue was the most frequent symptom (nearly 60%), followed by loss of concentration and abdominal pain. The number of symptoms increased with a higher aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio and thus presumably with the stage of liver fibrosis. CONCLUSION: Hepatitis C should be excluded in all patients with elevated liver enzymes. In risk groups with a high prevalence of hepatitis C, the infection should be looked for even when liver enzymes are normal.

Niederau C, Bemba G, Kautz A. · Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Oberhausen. · Z Gastroenterol. · Pubmed #16625459 No free full text.

Abstract: BACKGROUND: Little is known as yet about the socio-economic consequences for patients with hepatitis C in Germany. AIMS AND METHODS: The study of the Deutsche Leberhilfe e. V., supported by the federal hepatitis competence net, prospectively analyzed questionnaires about quality-of-life, education and work situation, insurance, and various other socio-economical aspects of patients with chronic hepatitis C. The questionnaire included questions about the information status of patients concerning hepatitis C in general and their individual disease. Overall, 1500 questionnaires were distributed by clinics, general practitioners, patient-support groups and via the internet; 714 were sent back and analyzed. RESULTS: Most of the 714 patients were born in Germany; 56 % were women and 44 % men, with a mean age of 52 years and a hepatitis duration of 18 years. More than 60 % of subjects younger than 65 years of age did not have a regular job, and 27 % were already retired. Only 47 % had a sufficient retirement insurance, whereas almost all had a health insurance. Only 12 % had an insurance covering work invalidity, and of those who had applied for the latter insurance, it was denied in 29 %. About 80 % of subjects reported that the hepatitis disturbed various aspects of their life. Only 4 % considered the public knowledge about hepatitis C as good or very good, but 80 % as bad or very bad. Of the subjects 40 % did not know how they had been infected; 37 % considered blood products as their infection mode, but only 10 % drug abuse. Almost all subjects knew that HCV cannot be transmitted via shaking hands, use of bathrooms, kisses or food (< 1 %, respectively). Surgery (17 %) and the dentist (15 %), however, were mentioned relatively often as a major risk for infection. About 80 % of subjects knew recent quantitative data on ALT and HCV-RNA, their genotype and the results of liver biopsy. Both mental and physical scores in the SF12 questionnaire were markedly reduced by about one standard deviation in subjects with HCV infection when compared with the general German population. Mental and physical scores deteriorated with increases in inflammatory and fibrosis scores. Subjects with negative HCV-RNA and normal ALT had the best quality of life, whereas subjects with high levels of HCV-RNA and ALT had the worst. CONCLUSIONS: The data show that the public opinion is wrong when pretending that hepatitis C today is just a disease of drug addicts. Our analysis demonstrates for the first time that many HCV-infected subjects in Germany have problems with their insurance and jobs. German subjects are well informed about their infection including genotype, liver histology, ALT and HCV-RNA; on the other hand, there are information deficits and fears concerning the mode of infection. The recent analysis clearly shows that HCV-infected subjects consider the public information about the HCV infection as catastrophically bad. The recent data in addition show that elimination of HCV decisively ameliorates quality of life, whereas mental and physical health get increasingly worse with progressive liver disease and unsuccessful antiviral therapies.

Niederau C. · Klinik für Innere Medizin, St. Josef Hospital Oberhausen. · MMW Fortschr Med. · Pubmed #15757231 No free full text.

This publication has no abstract.

Niederau C. · Klinik für Innere Medizin, St. Josef Hospital, Oberhausen. · MMW Fortschr Med. · Pubmed #12638435 No free full text.

Abstract: Antiviral therapy can now eliminate the hepatitis C virus in some 60% of all hepatitis patients. The results of recent studies have led to new recommendations for treatment: patients with HCV genotype I should be treated with pegylated interferons and 1000 or 1200 (patients weighing > 75 kg) mg ribavirin for 48 weeks, while patients with genotypes 2/3 should receive only 800 mg ribvavirin (irrespective of body weight) for 24 weeks. Data provided by two large drug-approval studies with PEG interferons alpha 2a and 2b show that the initial decrease in HCV-RNA determines the sustained viral response. Patients with genotype 1 have only a minimal chance (0-3%) of a sustained viral response if HCV-RNA is not reduced by at least a factor of 100 by the 12th week of treatment, and in these patients, treatment should then be discontinued. Pre-treatment determination of HCV genotype and HCV-RNA is mandatory to establish the chances of attaining a sustained viral response. Liver biopsy is necessary to determine the stage of disease and the urgency of treatment. In young persons with biochemical and histological inflammatory activity treatment is usually indicated. In asymptomatic older patients with no liver fibrosis, however, in particular those with a limited chance of a sustained viral response or concomitant disease, the indication for antiviral therapy is doubtful.

Erhardt A, Maschner-Olberg A, Mellenthin C, Kappert G, Adams O, Donner A, Willers R, Niederau C, Häussinger D. · Klinik für Gastroenterologie, Hepatologie und Infektiologie, Heinrich-Heine-Universität Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany. · J Hepatol. · Pubmed #12586300 No free full text.

Abstract: BACKGROUND/AIMS: The impact of heterozygous HFE mutations on the course of chronic hepatitis C and iron indices was studied. METHODS: Ferritin, transferrin saturation (TS), serum iron, C282Y and H63D mutations were determined in 401 patients with chronic hepatitis C virus (HCV) infection and 295 healthy controls. Liver histologies were available in 217 and HCV genotypes in 339 patients. RESULTS: Allele frequencies of the C282Y and H63D mutation did not differ between HCV patients and healthy controls (6.95 vs. 6.2%; 14.75 vs. 16.4%; n.s.). HFE heterozygous HCV patients had higher ferritin (349+/-37 vs. 193+/-15 microg/l; P<0.0005), TS (38+/-2 vs. 32+/-1%; P<0.0005), serum iron (144+/-6 vs. 121+/-3 microg/dl; P<0.0005), semiquantitative liver iron staining (0.26+/-0.07 vs. 0.09+/-0.03; P<0.006) and fibrosis scores (1.9+/-0.2 vs. 1.4+/-0.1; P<0.003) compared to HFE wildtypes. By multivariate regression analysis odds ratios for liver cirrhosis were 5.9 (confidence interval (CI) 1.6-22.6; P<0.009) for C282Y heterozygotes and 2.9 (CI 1.0-8.4; P<0.05) for H63D heterozygotes compared to HFE wildtypes. Considering all HFE heterozygous HCV patients, odds ratios of 3.6 (CI 1.4-9.3; P<0.009) for cirrhosis and 3.1 (CI 1.3-7.3; P<0.009) for fibrosis were calculated. CONCLUSIONS: C282Y or H63D heterozygosity is an independent risk factor for liver fibrosis and cirrhosis in HCV infected individuals. Screening for HFE mutations should be considered in HCV infection.

Heintges T, Petry W, Kaldewey M, Erhardt A, Wend UC, Gerlich WH, Niederau C, Häussinger D. · Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine-University Düsseldolf, Germany. · Dig Dis Sci. · Pubmed #11330431 No free full text.

Abstract: Treatment with interferon-alpha leads to cessation of viral replication in 30-40% of patients with chronic hepatitis B. Preliminary data suggest that therapeutic vaccination in patients with chronic HBV infection may be beneficial. The present trial was conducted to assess the efficacy of combination therapy of interferon-alpha with HBsAg vaccination in patients who previously failed to respond to interferon-alpha alone. Eighteen patients positive for HBsAg and HBeAg were included. Mean ALT was 81+/-23 units/liter and 7 (39%) patients had HBV-DNA levels >2000 pg/ml. Patients received 5 million IU interferon-alpha 2b (Intron A) thrice weekly for six months and recombinant HBsAg (Gen H-B-Vax) at the beginning and 4 and 12 weeks after initiation of interferon therapy. No serious side effects were seen during the trial period. Loss of HBeAg was seen in 39% (7/18), HBV DNA was undetectable in 50% (9/18), and ALT was normal in 56% 10/18) of patients six months after completion of therapy. Simultaneous administration of interferon-a and HBsAg vaccination in patients previously not responding to interferon alone appears to be safe, well-tolerated, and it achieved response rates similar to or even higher than interferon in treatment naive patients. This combination therapy seems to offer a new and promising approach for patients with chronic hepatitis B virus infection.