Hepatitis: Robaeys G

Robaeys G, Buntinx F, Bottieau E, Bourgeois S, Brenard R, Colle I, De Bie J, Matheï C, Mulkay JP, Van Damme P, Van Ranst M, Verrando R, Michielsen P, Bourgeois N, Brenard R, de Galocsy Ch, Delwaide J, Henrion J, Horsmans Y, Michielsen P, Reynaert H, Robaeys G, Sprengers D, Anonymous00401. · Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Schiepse Bos, 6, B-3600 Genk, Belgium. · Acta Gastroenterol Belg. · Pubmed #15832586 No free full text.

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Robaeys G, Buntinx F, Bottieau E, Bourgeois S, Brenard R, Colle I, De Bie J, Matheï C, Mulkay JP, Van Damme P, Van Ranst M, Verrando R, Michielsen P, Bourgeois N, Brenard R, de Galocsy Ch, Delwaide J, Henrion J, Horsmans Y, Michielsen P, Reynaert H, Robaeys G, Sprengers D, Anonymous00401. · Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Schiepse Bos, 6, B-3600 Genk, Belgium. · Acta Gastroenterol Belg. · Pubmed #15832586 No free full text.

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Michielsen P, Brenard R, Bourgeois N, De Galocsy Ch, Delwaide J, Henrion J, Horsmans Y, Nevens F, Reynaert H, Robaeys G, Sprengers D, Van Vlierberghe H, Anonymous00046. · Department of Hepatogastroenterology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem. · Acta Gastroenterol Belg. · Pubmed #12812144 No free full text.

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Verrando R, Robaeys G, Matheï C, Buntinx F. · Medisch Social Opvang Centrum, Genk, Belgium. · Acta Gastroenterol Belg. · Pubmed #15832591 No free full text.

Abstract: Heroin addiction is a chronic relapsing disease that is difficult to cure, but stabilisation and harm reduction can importantly increase the life time expectancy and the quality of life of the patient, his immediate vicinity and society in general. Currently, no proven effective pharmacological interventions are available for cocaine addiction, and treatment has to rely on existing cognitive behaviour therapies combined with contingency management strategies. Substitution therapy, however, is effective in caring for heroin addicts. Methadone is a synthetic opioid that counteracts withdrawal symptoms of heroin. Buprenorphine is a derivative of the morphine alkaloid, thebaine, and is a partial opioid agonist at the micro opioid receptor in the nervous system. A substitution treatment program effectively reduces and often eliminates heroin injection behaviour, rendering patients more socially stabilised. Reduction in the number of viral co-infections can be observed. Methadone undergoes oxidative biotransformation in the liver, but is also stored in the liver and released into the blood in unchanged form. The usual dose can be continued in patients with stable chronic liver disease, including advanced cirrhosis. In acute liver disease or acute decompensation of chronic liver disease, close clinical observation for signs of narcotic overdose or withdrawal is necessary. A modest alteration in methadone dose may be appropriate for some patients. Buprenorphine can cause liver dysfunction after sublingual and even more after intravenous administration. It is advised to follow the liver function during buprenorphine treatment and to warn the clients for intravenous use of buprenorphine. Neither methadone nor buprenorphine do influence the effect of interferon and ribavirin during the treatment of chronic hepatitis C patients. It may be necessary to increase the dosage of methadone during interferon treatment.

De Bie J, Robaeys G, Buntinx F. · Department of Liaison Psychiatry, Ziekenhuis Oost Limburg, Campus Sint Jan, Schiepse Bos 6, 3600 Genk. · Acta Gastroenterol Belg. · Pubmed #15832590 No free full text.

Abstract: The evidence regarding the co-morbidity of chronic hepatitis C, psychiatric illness and intravenous drug abuse is reviewed from the literature. Also the occurrence and the treatment of psychiatric side effects during treatment with interferon in patients with a history of drug abuse are reviewed. There is insufficient evidence for a specific hepatitis C induced depression or fatigue, but a direct link between hepatitis C and cerebral dysfunction is not excluded. Immune system activation rather than drug use may explain cerebral symptoms. In HCV positive substance users anxiety and depression are more prevalent than in HCV negative substance users. During treatment with regular or pegylated (PEG) interferon depression is a frequent side effect (ca 30%) and occurs independently from pre-existing psychiatric disorders or drug abuse. A history of drug abuse per se does not increase the risk of depression as a side effect of interferon treatment. It is extremely important to monitor symptoms of depression in the early weeks of treatment and to start antidepressant treatment as early as possible. Antidepressants should be continued throughout the interferon treatment period. There are insufficient data to assess these situations in which preventive antidepressant treatment should be started before interferon treatment. Clinical judgement can, however, lead to preventive antidepressant treatment, even at subclinical levels of depression. A cut off score of > 10 on the Beck Depression Inventory before interferon treatment is associated with a higher risk of depression during treatment. Both selective serotonin reuptake inhibitors and other classes of antidepressants can be used.

Robaeys G, Buntinx F. · Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Schiepse Bos, 6, B-3600 Genk, Belgium. · Acta Gastroenterol Belg. · Pubmed #15832589 No free full text.

Abstract: AIMS: To examine the evidence for excluding chronic hepatitis C (CHC) patients with substance abuse from treatment with interferon (IFN) and ribavirin. METHODS: We reviewed clinical trials focussing on the treatment of chronic hepatitis C of patients with substance abuse between 2001 and 2004. Ten clinical trials concerning antiviral treatment in substance abusers were described of which six were controlled ones. There were no randomised trials. There was one controlled multi-centre trial. One trial used pegylated IFN. RESULTS: In the total group of substance abusers the sustained viral response (SVR) and the adherence was not different from control groups. In former drug users, active drug users and patients taking substitution therapy for opioid dependence the sustained viral response and adherence was not different from control populations. However, non-substituted active drug users seemed more likely to be lost to follow-up. Discontinuation of treatment occurred most frequently during the first 8 weeks of therapy. Neurobehavioural changes leading to depression started in the first 8 weeks of treatment. Although follow-up periods after SVR were short, the currently described re-infection rate occurring in active intravenous drug users remains low. CONCLUSIONS: There is no evidence to withhold antiviral treatment against HCV in active substance abusers. It seems important to advise to start substitution therapy in non-substituted active drug users, increase substitution therapy dose in substituted patients and treat depression as early as possible. More prospective controlled trials on HCV treatment in active and difficult-to-reach substance users are needed.

Matheï C, Robaeys G, Van Ranst M, Van Damme P, Buntinx F. · Department of General Practice, Katholieke Universiteit Leuven, Leuven, Belgium. · Acta Gastroenterol Belg. · Pubmed #15832588 No free full text.

Abstract: In industrialised countries, injecting drug use is currently the most important risk factor for infection with hepatitis C, resulting in high prevalence rates of hepatitis C among injecting drug users. To contain the hepatitis C epidemic major efforts should be done to prevent new infection among injecting drug users. Monitoring infection rates are crucial as it may provide feedback on the effectiveness of interventions. In this article the epidemiology of hepatitis C among injecting drug users in Belgium is briefly reviewed. More specifically the prevalence of anti-HCV antibodies, the prevalence of co-infections, the proportion of chronic HCV carriers, the distribution of genotypes and preventive measures among injecting drug users in Belgium are discussed and compared to the situation elsewhere in Western Europe.

Robaeys G, Matheï C, Buntinx F, Vanranst M. · Division of Gastro-enterology and Hepatology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, B-3600 Genk, Belgium. · Acta Gastroenterol Belg. · Pubmed #12148448 No free full text.

Abstract: Intravenous drug use is a major route of hepatitis C virus (HCV) transmission. In Belgium, more than 70% of the intravenous drug users (IVDUs) are HCV seropositive. In the past, medical treatment of HCV-positive IVDUs has been controversial. However, current studies support that the anti-HCV therapy of IVDUs should be the same as in other HCV-infected patients. In prison populations, HCV screening and therapy has to be performed. Patients should be counseled about the benefits of alcohol abstinence, should be educated about safer injection techniques to avoid reinfection, and should be vaccinated to avoid hepatitis A or B co-infections. Treatment of HCV infections should not be withheld from patient populations with complicated social problems. Physicians should rather develop individual treatment and follow-up plans in order to optimize compliance in IVDUs.

Delwaide J, Bourgeois N, Colle I, Robaeys G. · Dept. Gastroenterology, CHU Sart Tilman, B-4000 Liège. · Acta Gastroenterol Belg. · Pubmed #12148445 No free full text.

Abstract: Patients at risk for hepatitis C (HCV) are those exposed to a major risk factor (i.e. blood transfusion prior 1990, and intravenous drug abuse), and those exposed to a minor risk factor (sexual, mother-to-infant transmission, household contact, nosocomial contamination). The present paper aims to review the current and past modes of transmission of the virus C.

Wichers MC, Kenis G, Leue C, Koek G, Robaeys G, Maes M. · Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands. · Biol Psychiatry. · Pubmed #16487941 No free full text.

Abstract: BACKGROUND: Major depression has been associated cross-sectionally with increased cell-mediated immune activation but causality has been difficult to establish. This study prospectively investigated the hypothesis that baseline level of immune activation predicts the development of depression during interferon-alpha (IFN-alpha) treatment. METHODS: Sixteen hepatitis C patients without psychiatric disorder underwent IFN-alpha treatment. Proinflammatory and anti-inflammatory cytokines were determined before starting treatment. Presence of a major depressive disorder (MDD) was assessed at baseline and several times during treatment. RESULTS: Baseline soluble interleukin-2 receptor (sIL-2r), interleukin-6 (IL-6), and interleukin-10 (IL-10) concentrations were significantly increased in the five subjects that developed MDD during treatment compared with those that did not, with standardized effect sizes of 1.08, 1.16, and 1.25, respectively, controlling for marijuana use, cigarette smoking, and baseline level of depressive symptoms. CONCLUSIONS: Results suggest that increased immune activation, rather than an epiphenomenon, is a causal risk factor for the development of MDD.

Wichers MC, Koek GH, Robaeys G, Praamstra AJ, Maes M. · Department of Psychiatry and Neuropsychology, Maastricht University, The Netherlands. · Psychol Med. · Pubmed #15841878 No free full text.

Abstract: BACKGROUND: The vegetative symptoms of depression resemble the symptoms of malaise associated with activation of the inflammatory response system (IRS), and can be regarded as an expression of a central motivational state that resets the organism's priorities to promote recovery from infection. Early vegetative symptoms, however, may also contribute to the high rates of depression seen later in the course of immune activation. We hypothesized that the onset of vegetative-depressive symptoms early in the treatment with the pro-inflammatory cytokine IFN-alpha in chronic hepatitis C patients would increase the risk for subsequent depressive cognitions. METHOD: Sixteen patients eligible for IFN-alpha treatment and free of psychiatric disorders were recruited. The DSM-IV, the Multidimensional Fatigue Inventory, and the Montgomery-Asberg Depression Rating Scale (MADRS) were administered at baseline and 1, 2, 4, 8, 12 and 24 weeks after treatment was initiated. Cognitive-depressive and vegetative-depressive symptom clusters were constructed. RESULTS: Fatigue and depression scores increased significantly during IFN-alpha treatment. Depression scores were highest at week 8 of treatment. First week increase in vegetative-depressive symptom score predicted cognitive-depressive symptom score at week 8 and at week 24. CONCLUSIONS: During IFN-alpha treatment, vegetative symptoms of depression appear earlier than, and are predictive of, their cognitive counterparts. This finding suggests that low mood state may in part be driven by the increase in early vegetative-depressive symptoms in the course of IFN-alpha-induced immune activation.

Wichers MC, Koek GH, Robaeys G, Verkerk R, Scharpé S, Maes M. · Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands. · Mol Psychiatry. · Pubmed #15494706 No free full text.

Abstract: Studies show that administration of interferon (IFN)-alpha causes a significant increase in depressive symptoms. The enzyme indoleamine 2,3-dioxygenase (IDO), which converts tryptophan (TRP) into kynurenine (KYN) and which is stimulated by proinflammatory cytokines, may be implicated in the development of IFN-alpha-induced depressive symptoms, first by decreasing the TRP availability to the brain and second by the induction of the KYN pathway resulting in the production of neurotoxic metabolites. Sixteen patients with chronic hepatitis C, free of psychiatric disorders and eligible for IFN-alpha treatment, were recruited. Depressive symptoms were measured using the Montgomery Asberg Depression Rating Scale (MADRS). Measurements of TRP, amino acids competing with TRP for entrance through the blood-brain barrier, KYN and kynurenic acid (KA), a neuroprotective metabolite, were performed using high-performance liquid chromatography. All assessments were carried out at baseline and 1, 2, 4, 8, 12 and 24 weeks after treatment was initiated. The MADRS score significantly increased during IFN-alpha treatment as did the KYN/TRP ratio, reflecting IDO activity, and the KYN/KA ratio, reflecting the neurotoxic challenge. The TRP/CAA (competing amino acids) ratio, reflecting TRP availability to the brain, did not significantly change during treatment. Total MADRS score was significantly associated over time with the KYN/KA ratio, but not with the TRP/CAA ratio. Although no support was found that IDO decreases TRP availability to the brain, this study does support a role for IDO activity in the pathophysiology of IFN-alpha-induced depressive symptoms, through its induction of neurotoxic KYN metabolites.

Delwaide J, Bourgeois N, Gérard C, De Maeght S, Mokaddem F, Wain E, Bastens B, Fevery J, Géhénot M, Le Moine O, Martinet JP, Robaeys G, Servais B, Van Gossum M, Van Vlierberghe H, Anonymous00181. · Department of Gastroenterology, CHU, Sart Tilman, Liège, Belgium. · Aliment Pharmacol Ther. · Pubmed #15225166 links to  free full text

Abstract: AIM: To evaluate the efficacy of early interferon alpha-2b in non-post-transfusion acute hepatitis C virus: a prospective study with historical comparison. PATIENTS: Group A: 28 patients prospectively treated for acute hepatitis C virus with daily regimen of interferon 5 million units for 2 months. Group B: historical series of 16 patients with untreated acute hepatitis C virus. RESULTS: There was no significant difference between the two groups with regard to gender, age, icterus, alanine aminotransferase, or genotypes. In group B, hepatitis spontaneously resolved in three of 16 (19%) patients (follow-up 1-7 years). In group A, 21 of 25 patients became sustained viral responders (75%; P = 0.0003 vs. group B). Factors include not predictive of sustained viral response: age, gender, sources of infection, presence of icterus, alanine aminotransferase peak, bilirubin peak, incubation period, presence of hepatitis C virus antibodies at presentation, or genotypes. The time from presentation to the start of therapy was, however, significantly shorter in sustained viral responders (43 +/- 31 days) than in relapsers or non-responders (88 +/- 52 days) (P = 0.016). CONCLUSIONS: Early treatment of acute hepatitis C virus with interferon prevents chronicity. A short waiting time from presentation to treatment appears as the most relevant predictive factor for sustained response.

Van Vlierberghe H, Leroux-Roels G, Adler M, Bourgeois N, Nevens F, Horsmans Y, Brouwer J, Colle I, Delwaide J, Brenard R, Bastens B, Henrion J, de Vries RA, de Galocsy C, Michielsen P, Robaeys G, Bruckers L. · Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium. hans.vanvlierberghe@rug,ac.be · J Viral Hepat. · Pubmed #14633181 No free full text.

Abstract: The standard treatment for patients with chronic hepatitis C is a 6-12-month combination therapy with interferon alpha and ribavirin. Induction treatment could result in a faster early decline of the hepatitis C virus (HCV) load and a better response rate. Naive chronically infected HCV patients (n = 454) were randomized into two arms to receive either induction treatment with interferon alpha 2b 5 million units (MU) subcutaneously (s.c.) daily during a period of 8 weeks (arm A); or treatment with interferon alpha 2b 5 MU s.c. three times a week (TIW) for a period of 8 weeks (arm B). After week 8, interferon treatment in both arms was 3 MU s.c. TIW for a total period of 12 months. In both arms, ribavirin (1000-1200 mg orally per day) was added at week 4. Induction treatment resulted in a higher virological response at week 8 of treatment (66%vs 47%; P < 0.01). However, response at the end of treatment and at 6 months follow-up was not different (53%vs 50%, 41%vs 33%). The occurrence of adverse events and the drop-out rate were similar in both arms. Although an early virological response is observed more frequently in the induction treatment, end of treatment response and sustained responses did not differ.

Robaeys G, Nevens F, Stärkel P, Colle I, Van Eyken P, Bruckers L, Van Ranst M, Buntinx F. · ZOL Campus St.-Jan, Genk, Belgium. · Transplant Proc. · Pubmed #19328933 No free full text.

Abstract: BACKGROUND: End-stage liver disease due to hepatitis C viral (HCV) infection is the most common reason for liver transplantation. One of the major risk factors for infection with HCV is intravenous drug use (IVDU). The pretransplantation characteristics and outcome of liver transplantation in patients with chronic hepatitis C (CHC) infected after IVDU are poorly known. METHODS: We performed a retrospective cohort study in patients with CHC who underwent liver transplantation between 1998 and 2002 in Belgium. Seven patients with and 60 patients without a history of IVDU were compared. RESULTS: Patients with CHC infected after IVDU were primarily men, significantly younger, and affected more by genotype 2 or 3. There was no relapse in substance use. No patients required a second transplantation or developed surgical complications. Progression to fibrosis in the posttransplantation period seemed to be slower. Graft and patient survival, and compliance were similar in both groups. CONCLUSIONS: Compared with patients in the non-IVDU group, patients with CHC infected after IVDU in complete remission have the same compliance, and patient and graft survival after liver transplantation. Therefore, patients with IVDU should not be excluded for liver transplantation because of HCV-induced cirrhosis.

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.

Robaeys G, De Bie J, Wichers MC, Bruckers L, Nevens F, Michielsen P, Van Ranst M, Buntinx F. · Ziekenhuis Oost Limburg, Department of Gastroenterology and Hepatology, Schiepse Bos 6, B 3600 Genk, Belgium. · World J Gastroenterol. · Pubmed #17963300 links to  free full text

Abstract: AIM: To study the predictive value of the vegetative-depressive symptoms of the Zung Depression Rating Scale for the occurrence of depression during treatment with peg-interferon alpha-2b of chronic hepatitis C (CHC) patients. METHODS: The predictive value of vegetative-depressive symptoms at 4 wk of treatment for the occurrence of a subsequent diagnosis of major depressive disorder (MDD) was studied in CHC patients infected after substance use in a prospective, multi-center treatment trial in Belgium. The presence of vegetative-depressive symptoms was assessed using the Zung Scale before and 4 wk after the start of antiviral treatment. RESULTS: Out of 49 eligible patients, 19 (39%) developed MDD. The area under the ROC curve of the vegetative Zung subscale was 0.73, P = 0.004. The sensitivity at a cut-point of > 15/35 was 95% (95% CI: 74-100). The positive predictive value equalled 44% (95% CI: 29-60). CONCLUSION: In this group of Belgian CHC patients infected after substance use, antiviral treatment caused a considerable risk of depression. Seven vegetative-depressive symptoms of the Zung scale at wk 4 of treatment predicted 95% of all emerging depressions, at a price of 56% false positive test results.

Robaeys G, De Bie J, Van Ranst M, Buntinx F. · Ziekenhuis Oost Limburg, Department of Gastroenterology and Hepatology, Schiepse Bos 6, B 3600 Genk, Belgium. · World J Gastroenterol. · Pubmed #17511042 links to  free full text

Abstract: During treatment of chronic hepatitis C patients with interferon and ribavirin, a lot of side effects are described. Twenty-three percent to 44% of patients develop depression. A minority of patients evolve to psychosis. To the best of our knowledge, no cases of psychogenic parasitosis occurring during interferon therapy have been described in the literature. We present a 49-year-old woman who developed a delusional parasitosis during treatment with pegylated interferon alpha-2b weekly and ribavirin. She complained of seeing parasites and the larvae of fleas in her stools. This could not be confirmed by any technical examination. All the complaints disappeared after stopping pegylated interferon alpha-2b and reappeared after restarting it. She had a complete sustained viral response.

Wichers MC, Kenis G, Koek GH, Robaeys G, Nicolson NA, Maes M. · Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, The Netherlands. <> · J Psychosom Res. · Pubmed #17270579 No free full text.

Abstract: OBJECTIVE: Proinflammatory cytokines have the potential to activate the hypothalamo-pituitary-adrenocortical (HPA) axis, and HPA axis hyperactivity is also encountered in depression. Therefore, the induction of depressive symptoms by interferon-alpha (IFN-alpha) may be mediated by changes in the cytokine network and the HPA axis. METHODS: In 17 hepatitis C patients undergoing IFN-alpha treatment, depressive symptoms were measured using the Montgomery-Asberg Depression Rating Scale (MADRS). In addition, serum cytokine concentrations were measured. Saliva was collected five times over the course of a day in order to assess daily average cortisol (DAC) and awakening response. Assessments were carried out at baseline and six later time points after starting treatment. RESULTS: During treatment, the increases in the MADRS were significantly and positively correlated with soluble interleukin (IL)-2 receptor, tumor necrosis factor alpha (TNF-alpha), and IL-6. There were no significant associations between the DAC or cortisol awakening response with the MADRS score. CONCLUSION: Results suggest a clear connection between IFN-alpha-induced depressive symptoms and cytokine concentrations, but not cortisol.

Robaeys G, Van Vlierberghe H, Matheï C, Van Ranst M, Bruckers L, Buntinx F, Anonymous00138, Anonymous00139. · Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium. · Eur J Gastroenterol Hepatol. · Pubmed #16394797 No free full text.

Abstract: OBJECTIVES: There is some reluctance to treat intravenous drug users (IVDUs) with chronic hepatitis C (CHC) because of presumed lower compliance and response to antiviral therapy. We intended to evaluate the compliance and response to antiviral treatment for CHC in IVDUs compared with non-IVDUs. METHODS: A retrospective cohort study--secondary analysis of the results of a treatment trial--was performed in Belgium and The Netherlands. A total of 406 previously untreated CHC patients, including 98 (24%) IVDUs, were studied for compliance (presentation at the end of treatment), complete response (alanine aminotransferase within normal limits and serum hepatitis C virus polymerase chain reaction negative) at the end of therapy and sustained virological response (SVR). RESULTS: Non-compliance (8.2%) in IVDUs was not different from non-IVDUs (6.8%) (relative risk=1.20; 95% confidence interval=0.55-2.62). Complete response after controlling for hepatitis C virus was similar (relative risk=1.19; 95% confidence interval=0.89-1.60). Controlling for treatment arm, age, sex, presence of cirrhosis or hepatitis C virus viral load before treatment did not change these results. There was a marginally significant difference in the sustained virological response between IVDUs (46.6%) and non-IVDUs (34.6%) (relative risk=1.35; 95% confidence interval=1.00-1.81), also disappearing after adjusting for genotype. No difference in compliance or sustained virological response was found between active and non-active IVDUs or between IVDU patients in or without a methadone maintenance program. CONCLUSIONS: In this group of Benelux patients, IVDUs showed similar compliance and response to treatment with interferon and ribavirin compared with other patients with CHC infection. Therefore, it is no longer justifiable to withhold treatment to chronic hepatitis C patients who use intravenous drugs.

Matheï C, Wollants E, Verbeeck J, Van Ranst M, Robaeys G, Van Damme P, Buntinx F. · Department of General Practice, Katholieke Universiteit Leuven, Kapucijnenvoer 33 Blok J, 3000, Leuven, Belgium. · Eur J Clin Microbiol Infect Dis. · Pubmed #16133411 No free full text.

Abstract: The aim of this study was to determine the genotypic variation of hepatitis C among drug users in Flanders and to relate the distribution of genotypes to the characteristics of the population. Hepatitis C virus RNA (HCV-RNA) quantification and genotyping was performed on stored samples from 161 anti-HCV-positive injecting and non-injecting drug users. Information on sociodemographic status, drug-related risk behaviour and sexual risk behaviour was available for each drug user. HCV-RNA was present in 152 of 161 samples (94.4%). Genotype 1 was predominant (48.7%), followed by genotype 3 (41.2%), genotype 4 (8.8%) and genotype 2 (1.4%). In the multivariate analysis, lack of a history of injecting drug use was confirmed as a statistically significant predictor for infection with genotype 1. Predictors for infection with genotype 3 were the presence of anti-HBc antibodies and a history of injecting drug use. Being tattooed emerged as a statistically significant predictor for infection with genotype 4. The 94.4% prevalence of HCV-RNA among anti-HCV-positive drug users was considerably higher than the 54-86% chronicity rate found globally among HCV-infected patients. The results of this study suggest the existence of separate transmission networks for injecting drug users and non-injecting drug users. Finally, the results suggest that tattooing practices play a role in the spread of HCV among drug users.

Thoelen I, Verbeeck J, Wollants E, Maes P, Robaeys G, Matheï C, Buntinx F, Nevens F, Van Ranst M. · Laboratory of Clinical and Epidemiological Virology, Department of Microbiology and Immunology, Rega Institute for Medical Research, University of Leuven, Minderbroedersstraat 10, B-3000 Leuven, Belgium. · Viral Immunol. · Pubmed #15802968 No free full text.

Abstract: A 32-base pair deletion in the CC-chemokine receptor 5 gene (CCR5), associated with resistance to human immunodeficiency virus type 1 (HIV-1) infection, has recently been suggested to act as an adverse host factor in hepatitis C virus (HCV) infection. To examine this hypothesis, we determined the CCR5-Delta32 allele frequency by polymerase chain reaction in a Belgian cohort of 163 HCV-infected patients and 310 healthy control subjects. The resulting CCR5-Delta32 allele frequencies were 0.080 and 0.119 for the patient group and control group, respectively. In contrast with a previous study, we could not show a statistically significant difference between the CCR5-Delta32 allele frequencies in HCV patients and controls. Moreover, genotype distributions in both populations were in agreement with Hardy-Weinberg equilibrium. Our results do not support the hypothesis that the CCR5-Delta32 mutant allele is a risk factor for hepatitis C virus infection.

Matheï C, Robaeys G, van Damme P, Buntinx F, Verrando R. · Department of General Practice, Katholieke Universiteit Leuven, Leuven, Belgium. · Epidemiol Infect. · Pubmed #15724720 No free full text.

Abstract: The prevalence of hepatitis C and related risk factors in drug users were compared in two geographic regions in Belgium, the city of Antwerp and the mixed urban-rural area of Limburg. All 310 participants were surveyed and screened for hepatitis B, hepatitis C and HIV. Prevalence rates of anti-HCV, anti-HBc and anti-HIV were 71, 62 and 4% in Antwerp and 46, 21 and 0% in Limburg respectively. Injecting drug use, duration of injecting drug use, work as a commercial sex-worker, originating from Turkey or Northern Africa, marginalization and anti-HBc positivity were identified as independent predictors for hepatitis C infection. In this study an important difference in HCV seroprevalence among drug users in a methadone maintenance programme across two geographic regions in Belgium was demonstrated. This was explained not only by variations in drug-related risk behaviour, but also by differences in sexual risk behaviour and socio-economic status.

Robaeys G, Wichers MC, De Bie J, Koek GH, Buntinx F, Van Os J. · No affiliation provided · Gut. · Pubmed #19091833 No free full text.

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