Hepatitis: Telegdy L

Anonymous00086, Anonymous00087, Gervain J, Horváth G, Hunyady B, Makara M, Pár A, Szalay F, Tornai I, Telegdy L. · No affiliation provided · Orv Hetil. · Pubmed #19087916 No free full text.

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Dalmi L, Gervain J, Horváth G, Hunyady B, Ibrányi E, Makara M, Pár A, Szalay F, Tornai I, Telegdy L, Anonymous00498, Anonymous00499. · No affiliation provided · Orv Hetil. · Pubmed #18194921 No free full text.

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Dalmi L, Gervain J, Hunyady B, Ibrányi E, Makara M, Pár A, Szalay F, Tornai I, Telegdy L. · No affiliation provided · Orv Hetil. · Pubmed #17378168 No free full text.

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Telegdy L. · Fovárosi Onkormányzat, Szent László Kórháza, Hepatológiai Ambulancia, Budapest. · Orv Hetil. · Pubmed #15573894 No free full text.

Abstract: Treatment of hepatitis B. Treatment of acute icteric hepatitis B is similar to the principles of treatment of acute hepatitis syndrome. Special care must be given to the possibility of fulminant outcome and to the trend to chronicity. Diagnosis and treatment of chronic hepatitis B serves prevention of liver cirrhosis and hepatocellular carcinoma as well as elimination of the sources of further infections. Interferon-alpha treatment results in sustained clinical and virological response in about half of the patients. Nucleoside analogues as lamivudine, entecavir, adenovir dipivoxil are the alternatives. They are effective also in endstage liver cirrhosis caused by hepatitis B virus and able to prevent reinfection and graft loss after liver transplantation. Evaluation of the benefits and disadvantages of the antiviral agents help to determine the individual, patient-tailored treatment.

Pár A, Telegdy L, Gógl A, Müller E. · Pécsi Orvostudományi Egyetem I. Belgyógyászati Klinika. · Orv Hetil. · Pubmed #10377733 No free full text.

Abstract: In Hungary over the past 5 years more than thousand patients with chronic viral hepatitis have been examined and included in a treatment program with interferon (IFN) at 16 major hepatology centers, using unified diagnostic and therapeutical criteria. Authors give an account of their experiences on the clinical features of patients with chronic viral hepatitis and report the results of the treatment with IFN. According to the rules and availability of IFN for patients with chronic viral hepatitis in the country, virtually the entire Hungarian population with this diseases who required IFN therapy have been included. A total of 94 patients suffered from hepatitis B virus (HBV) infection, in addition 11 HBV + hepatitis Delta virus (HDV), 24 HBV + Hepatitis C virus (HCV) related liver disease, and 993 had chronic hepatitis C. IFN therapy for chronic HBV hepatitis consisted of IFN 5 MU thrice weekly for 6 months, and resulted in 33% seroconversion and sustained remission with 14% HBsAg clearance. For chronic hepatitis C treatment protocols (dose of IFN and duration of therapy) have changed with the time (from a weekly dose of 3 x 3 MU IFN for 6 months, to 3 x 3 MU for 12 months), and even a combination with ribavirin has been introduced. Although the therapeutic results showed a gradual improvement form a 13% sustained response over 22% in the first and second periods, respectively, differences were most significant with the advent of the combination therapy, that resulted in 36% remission rate. Only fibrosis in histology and baseline pretreatment HCV-RNA level appeared as predictors of response in chronic hepatitis C. Neither age nor gender did influence the outcome, but longer duration of treatment and higher total dose of IFN resulted moderately higher sustained remission rates. The experiences are in accordance with findings of suboptimal efficacy of IFN monotherapy reported worldwide and emphasize the need of seeking for newer and combination therapeutic modalities for these chronic viral diseases.

Telegdy L, Szabó Z. · Szent László Kórház, Budapest. · Orv Hetil. · Pubmed #10323072 No free full text.

Abstract: Loss of cellular immunity accompanying the progressive HIV/AIDS disease, results in altered clinical picture and outcome of traditional infections as well as severe and often lethal illness caused by facultative pathogens. Unusual infections may call the attention to the underlining HIV disease. Liver disease appears in the great majority of HIV/AIDS patients. The authors review the viral, bacterial, fungal and protozoal infections involving the liver in AIDS. Liver biopsy has a diagnostic value beside the serology and bacteriology and may give therapeutic consequences.

Nemes B, Sárváry E, Gerlei Z, Fazakas J, Doros A, Németh A, Görög D, Fehérvári I, Máthé Z, Gálffy Z, Pár A, Schuller J, Telegdy L, Fehér J, Lotz G, Schaff Z, Nagy P, Járay J, Lengyel G. · Semmelweis Egyetem, Altalános Orvostudományi Kar, Transzplantációs és Sebészeti Klinika, Budapest, Baross u. 23-25., 1082. · Orv Hetil. · Pubmed #17932003 No free full text.

Abstract: The main indication of the Hungarian Liver Transplant Program is liver cirrhosis caused by hepatitis C. AIM: Authors present the results of liver transplantations performed due to HCV infection. METHOD: The data (donor-, recipient-, perioperative characteristics, survival, serum titer of C RNA, histology) of 111 HCV positive recipients were evaluated, that are 37.6% of the 295 patients, who were transplanted since 1995 till the closure of this report. RESULTS: Twenty-two (22) of them (20%) died in the early postoperative period, for other reasons, before the recurrence of the HCV was detectable. Among the 89 HCV-positive patients the recurrence of the HCV is still not detected in 16 cases (18%), and there is a histology-proven recurrence in 73 cases (82%). In 40 cases (56%) the viral recurrence was proven within 1 year after OLT, while in 32 cases (44%) over 1 year. The cumulative 1, 3, 5, and 10 years patient survival is 73%, 67%, 56% and 49%, among HCV-positive patients and 80%, 74%, 70% and 70% among HCV-negatives. The difference is significant. The cumulative graft survival at the same time points is 72%, 66%, 56% and 49% among HCV-positives and 76%, 72%, 68% and 68% among HCV-negatives, which is a non-significant difference. The serum titer of HCV-RNA was significantly higher among those HCV-patients who had an early viral recurrence within 1 year, compared to those who had a late one. In case of an early HCV-recurrence the Knodell-score was significantly higher in the 6 months posttransplant biopsy than that of in case of late viral recurrence, however, less fibrosis was observed in early recurrence. CONCLUSIONS: An early HCV recurrence can be expected in case of an older donor, with a marginal or fatty liver graft transplanted with a higher transfusion need and having an acute rejection treated with steroid bolus in the postoperative period. The protocol of the postoperative antiviral treatment differs from the average: the so-called "stop-rule" cannot be applied, since less then 10% of the recipients are expected to turn to HCV-PCR-negative due to the immunosuppression. The combined interferon + ribavirin treatment is maintained in spite of RNA-positive state, further, a second or third course of treatment might also be applied. The prolonged and--in case if necessary--repeated antiviral treatment prevents fibrosis, and therefore rate of retransplantation need. The better is the general state of the patient the results of a secondary liver transplantation are better as well. MELD-score can help to set the exact timing for a re-OLT.

Nemes B, Sárváry E, Kóbori L, Gerlei Z, Fehérvári I, Görög D, Perner F, Ther G, Varga M, Szonyi L, Telegdy L, Schuller J, Weszelits V, Járay J. · Semmelweis Egyetem, Altalános Orvostudományi Kar, Transzplantációs es Sebészeti Klinika, Budapest. · Orv Hetil. · Pubmed #16089102 No free full text.

Abstract: INTRODUCTIONS: The authors summarize the demographic, morbidity and mortality characteristics of the Hungarian Liver Transplant Program. AIMS: They evaluate the changes and development, that has taken place with regard to indications, recipient population and characteristics, operation technique, and peroperative patient management. METHOD: In order to present the development, data are compared between two time periods (before and after 1999). The results are summarized on Tables and statistical Figures. Categorical variables are evaluated by chi2-test, continuous ones are with Levene Test (for homogeneity of means), Student T test and Mann-Whitney U-test. Cumulative survivals are computed with Kaplan-Meier log rank analysis. RESULTS: 194 primary liver transplantation have been performed. The hepatitis C was the leading indication from the beginning. Ten (10) liver transplantation have been performed in 1995, while 44 in 2004. The mortality within the first 2 months decreased from 24% to 5%. The 1, 3 and 5 year cumulative patient survival increased from 55%, 45% es 39% (1995-1997), to 72%, 64% es 61% (1998-2000). Recently this is 78%, 77% es 77%. CONCLUSIONS: Between 1995-1997 conventional liver transplantation became standard, while piggy back turned to be popular from 1998. From 1999 the HCV-PCR monitoring, the combined antiviral treatment, the UW perfusion of the donors took place. From 2003 we introduced the tailored immunosuppression, the steroid-free protocol for viral diseases. Total infused volume was decreased together with the amount of transfusion. The retrograde graft reperfusion (from the caval side) was introduced in 2004 together with the split technique in the liver transplantation and the rebirth of the pediatric program. The overall outcome of the retrospective analysis is, that the program has been developed to European standards with respect to its volume, technical capabilities and results.

Kalabay L, Nemesánszky E, Csepregi A, Pusztay M, Dávid K, Horváth G, Ibrányi E, Telegdy L, Pár A, Bíró A, Fekete B, Gervain J, Horányi M, Ribiczey P, Csöndes M, Kleiber M, Walentin S, Prohászka Z, Füst G. · Third Department of Internal Medicine, Faculty of Medicine, Semmelweis University, Kútvölgyi út 4, 1125 Budapest, Hungary. · Int Immunol. · Pubmed #14688060 links to  free full text

Abstract: Previously we observed elevation of the serum concentration of two acute-phase protein (AFP) complement components (C9 and C1-inhibitor) in patients with chronic hepatitis C who responded (R) to IFN-alpha therapy, but not in non-responders (NR). In the present study we investigated the effect of high-dose IFN-alpha therapy on serum concentrations of two positive [orosomucoid (OROSO) and C-reactive protein (CRP)] and two negative [transferrin (TF) and fetuin/alpha2HS-glycoprotein (AHSG)] AFP in an outpatient setting. We investigated blood samples of 40 patients with chronic hepatitis C at the onset and at the end of a 3-month treatment with high-dose IFN-alpha2b (5 MIU/day for 6 weeks, followed by 5 MIU t.i.w.) and of 52 healthy individuals. Serum concentrations of OROSO, TF and AHSG were measured by radial immunodiffusion; CRP levels were determined by immunotubridimetry. Compared to controls, patients with chronic hepatitis C had significantly lower OROSO and CRP, and higher AHSG levels. By the end of treatment, OROSO concentration increased in R (P = 0.0054), but not in NR patients. In contrast, TF levels decreased in R (P = 0.0040), but did not change in NR patients. Similarly, in R patients, AHSG levels tended to decrease (P = 0.0942) following IFN-alpha treatment. We conclude that the acute-phase reaction is suppressed in patients with chronic hepatitis C that may be potentially related to the responsiveness to IFN-alpha therapy.

Gervain J, Papp I, Csöndes M, Nemesánszky E, Rácz I, Ribiczey P, Telegdy L, Tornai I, Weisz G. · Fejér Megyei Szent György Kórház, I. Belgyógyászat, Hepato-Pancreatologiai Részleg és Vírusszerológiai Laboratórium, Székesfehérvár. · Orv Hetil. · Pubmed #12901182 No free full text.

Abstract: INTRODUCTION: In addition to interferon, lamivudine is the other widely used antiviral agent in the therapy of chronic hepatitis B. This nucleoside analogue inhibits the RNA-dependent DNA polimerase and the reverse transcription by integrating in the viral DNA, which results in the secondary suppression of viral protein synthesis and replication of HBV. It has numerous advantages such as effective viral inhibition, mild side effects and the possibility of oral administration; on the other hand it poses the problem of time-correlated appearance of lamivudine resistant mutants during therapy. AIMS: In the Virusserology Laboratory of the Department I. Internal Medicine, Szent György Hospital, Székesfehérvár, detection and type determination of the therapy resistant mutants in the C and B domains of HBV DNA polimerase gene has been carried out the for one year. In this paper, the authors review the molecular biological background of lamivudine resistance and summarise the applied test methodologies and the early results. PATIENTS: Six-month and/or 12-, 18-month samples of 18 chronic hepatitis B patients (4 women/14 men) treated in seven Hepatology Centres in Hungary were analysed. METHODOLOGY: Mutants of codons 528, 552, and 555 in the HBV polimerase gene were determined by nested polimerase chain reaction and reverse hybridisation. RESULTS: M528, V552, I552 and I555 mutants in different variations could be detected in ten out of 18 patients. CONCLUSIONS: Nowadays, drug therapy is the only treatment option used for the therapy of early and progressed chronic hepatitis B in Hungary. This new diagnostic technique was introduced to clarify the background of ineffective lamivudine therapy. Therapy resistance can occur due to the lack of reaction or the appearance of the special, therapy resistant mutants of the virus. Detection of these YMDD mutants together with the clinical picture and the biochemical and virological parameters can help in forming a decision about cessation of lamivudine therapy or application of a new drug.

Biró A, Horváth A, Varga L, Nemesánszky E, Csepregi A, Dávid K, Tolvaj G, Ibrányi E, Telegdy L, Pár A, Romics L, Karádi I, Horányi M, Gervain J, Ribiczey P, Csöndes M, Füst G. · 3rd Department of Medicine, Semmelweis University, Budapest, Hungary. · Immunobiology. · Pubmed #12777057 No free full text.

Abstract: Previously we detected more than 3 times higher anti-cholesterol antibody (ACHA) levels in HIV positive patients compared to healthy individuals, however, this level significantly decreased during highly active anti-retroviral therapy (HAART). In our present study we examined whether these findings could also be detected in patients with chronic hepatitis C (CHC). We calculated the correlation between the ACHA levels and the C5b-9 complement activation product. 39 patients with CHC were treated with IFN-alpha-2b (Schering-Plough) 5 MU daily for 6 weeks, followed by 5 MU TIW. Serum levels of ACHA and complement activation products were measured with ELISA. Serum HCV RNA was measured by a highly sensitive branched DNA technique before and 3, 6 and 12 months after the beginning of IFN-alpha-2b therapy. 52 healthy persons served as controls. At the onset of treatment ACHA level was significantly (p = 0.0062) higher in patients (40 (24-69) AU/ml) (median (interquartile range)) than in control sera (26 (20-35) AU/ml). In the 26 responder patients ACHA levels decreased to the normal level during the therapy, but no change was observed in the 13 non-responders. In patients with a sustained response ACHA levels remained low till the end of the 12 months IFN treatment. ACHA levels were significantly (p = 0.0422) higher in the patients with low (< 4.0 mmol/l) than in those with normal (> or = 4.0 mmol/l) cholesterol concentrations. The ACHA level before the therapy strongly correlated (r = 0.5499, p = 0.0014) with C5b-9 serum levels. ACHA levels are elevated in CHC, but this elevation is not as high as in HIV. Decrease of viral load by IFN-alpha-2b treatment in the responders results in normalization of ACHA concentration. High ACHA levels in patients with low serum cholesterol concentration suggest that high ACHA levels may contribute to the decrease in cholesterol levels. The correlation between the ACHA and C5b-9 levels indicate, that the ACHA may play a role in the complement activation in CHC.

Lotz G, Szalay F, Firneisz G, Abonyi M, Lengyel G, Telegdy L, Ibrányi E, Nemes B, Kury F, Schaff Z, Simon S. · 2nd Dept of Pathology, Semmelweis University, Budapest, Hungary. · Scand J Gastroenterol. · Pubmed #12059061 No free full text.

Abstract: BACKGROUND: Our previous results showed that hepatitis C virus (HCV) is detectable on erythrocytes by RT in situ PCR. The aims of the present study were to compare the sensitivity of this erythrocyte in situ PCR to routine serum solution phase HCV PCR as well as to obtain more data about the binding and cellular localization of HCV in the erythrocyte. METHODS: 105 previously HCV-infected patients and 20 control individuals were studied using RT in situ PCR on erythrocytes and solution phase RT-PCR from serum samples. Binding of HCV to erythrocytes was studied by in vitro inoculation. RT in situ PCR results were evaluated by fluorescence and confocal laser scanning microscopy. RESULTS: From 105 HCV cases, 78 gave positive, while 5-and all control cases-gave negative results by both PCR techniques. In 21 cases, only the in situ technique provided positive results, while in only I case did the solution phase method provide positive results. During in vitro inoculation, an early HCV-erythrocyte binding was detected followed by virus internalization. CONCLUSIONS: Erythrocyte-in situ PCR was found to show higher sensitivity for the detection of HCV compared to the generally applied serum PCR method. In vitro studies suggested a specific binding of HCV to erythrocyte and showed the virus to be capable of internalization.

Kalabay L, Jakab L, Prohászka Z, Füst G, Benkö Z, Telegdy L, Lörincz Z, Závodszky P, Arnaud P, Fekete B. · 3rd Department of Internal Medicine, Faculty of Medicine, Semmelweis University, Kútvölgyi út 4, Budapest, Hungary. · Eur J Gastroenterol Hepatol. · Pubmed #11943951 No free full text.

Abstract: OBJECTIVE: Human fetuin/alpha2HS-glycoprotein (AHSG) is synthesized by hepatocytes. We intended to determine whether liver dysfunction or acute phase reaction is dominant in the regulation of its serum concentrations and to see if decreased AHGS levels are associated with short-term mortality. DESIGN: We determined the serum AHSG levels in patients with acute alcoholic, acute A, B, and Epstein-Barr virus hepatitis, alcoholic cirrhosis, and hepatocellular cancer and correlated them to conventional laboratory parameters of inflammation and liver function. Patients were followed for 1 month. METHODS: Serum AHSG was determined by radial immunodiffusion. RESULTS: Compared to controls, significantly lower AHSG levels were found in patients with liver cirrhosis and hepatocellular cancer but not the acute viral hepatitides. Strong positive correlation with serum transferrin, albumin and prothrombin was found. Febrile episodes were not associated with significantly decreased AHSG levels. Concentrations below 300 microg/ml were associated with high mortality rate (52.0%; relative risk, 5.497; 95% confidence interval, 2.472-12.23; P < 0.0001). Of all laboratory parameters studied serum AHSG levels showed the greatest difference between deceased and survived patients with cirrhosis and cancer. Moreover, other acute phase reactants did not differ significantly. The multiple logistic regression analysis indicated that the decrease of serum AHSG is independent of all other variables that were found decreased in deceased patients. CONCLUSIONS: Decreased serum AHSG concentration is due rather to hepatocellular dysfunction than the acute phase reaction and is an outstanding predictor of short-term mortality in patients with liver cirrhosis and liver cancer.

Mihály I, Telegdy L, Ibrányi E, Lukács A, Rókusz L, Bánkuti E E, Dóczy J. · Laboratory for Diagnostic Virology, Central Hospital for Infectious Diseases "St. László", Budapest, Hungary. · J Hosp Infect. · Pubmed #11740870 No free full text.

Abstract: Blood samples from 477 hospital workers (HWs) at the Central Hospital for Infectious Diseases, Budapest, Hungary were tested for hepatitis C virus (HCV) antibodies by enzyme immunoassay (EIA), and 13 (2.7%) of these were found to be HCV antibody positive. Ten (2.7%) were from nursing/housekeeping staff and three (2.9%) from medical staff. HCV antibody positive HWs were detected in 10 of 17 work places, and the prevalence rates in these departments or units varied between 1.2% and 6.5%. The prevalence increased gradually with increasing age, being 0% in these under 21 years of age and 9.5% in those above 50 years of age. Eleven (85%) of 13 HCV antibody positive HWs had HCV RNA in their sera, four of them intermittently during the follow-up period. HCV genotype 1 was present in two HWs, 1b in six HWs, 3a in one HW and 4 in two HWs. Chronic hepatitis C has developed in six (46%) HCV antibody positive HWs. Although the source of infection through needlestick could only be traced directly in one case, circumstantial evidence indicated that the majority of infections were occupationally acquired, originating from percutaneous or mucocutaneous exposure.

Pár A, Telegdy L, Dalmi L, Müller E, Anonymous00220. · First Department of Medicine, Faculty of Medicine, University of Pécs, Ifjuság u.13, H-7643, Pécs, Hungary · J Physiol Paris. · Pubmed #11595466 No free full text.

Abstract: BACKGROUND/AIMS: in Hungary, over the past 5 years more than 900 patients with chronic hepatitis C have been examined for treatment with interferon at 16 major hepatology centres, using unified diagnostic and therapeutical criteria. Authors give an account of their experiences on the clinical features of patients with chronic hepatitis C and report the results of the interferon therapy. METHODS: a total of 993 patients--virtually the entire Hungarian hepatitis C patient population who had been referred for interferon treatment--were included in the program. Actually, the sustained efficacy of the therapy was evaluated in 724 cases. Treatment protocols (dose of interferon and duration of therapy) have changed with time from a weekly dose of 3x3 MU IFN for 6 months in the first period, to 3x3-5 MU for 12 months in the second period, and finally in the third period a combination therapy with ribavirin has also been introduced. RESULTS: in the first period, the end-of-treatment response (ETR) was 35%, sustained response (SR) 13%, the second phase schedule resulted in 42% ETR and 22% SR, while in the third period, ETR was 49% and SR 36%, respectively. Fibrosis in histology and baseline pretreatment HCV-RNA level appeared as predictors of response. The duration of treatment and the total dose of interferon exerted a moderate effect on therapeutic efficacy. Neither age nor gender influenced the outcome. CONCLUSIONS: our results-obtained in a Central East European country-are in accordance with findings of suboptimal efficacy of traditional interferon monotherapy for chronic hepatitis C reported in the West, and suggest the benefit of the combination treatment of interferon with ribavirin.

Werling K, Szentirmay Z, Szepesi A, Schaff Z, Szalay F, Szabó Z, Telegdy L, Dávid K, Stotz G, Tulassay Z. · Second Department of Medicine, Joint Research University of the Hungarian Academy of Sciences, Budapest. · Eur J Gastroenterol Hepatol. · Pubmed #11396526 No free full text.

Abstract: OBJECTIVE: Chronic hepatitis is characterized by necrosis of liver cells, accompanied by an inflammatory reaction and compensatory cell proliferation. The interaction of the core and non-structural proteins of hepatitis C virus (HCV) with several cellular factors suggests that cell proliferation may be influenced by HCV. The aim of this study was to investigate hepatocyte proliferation and DNA ploidy patterns in patients with chronic viral hepatitis C (CH-C) compared with chronic non-viral hepatitis (CH-N), using a TV image analysis method. METHODS: The DNA index (DI) and cell phase fractions (G1, S, G2) were measured by means of digital picture analysis method on nuclear suspensions of Feulgen stained hepatocytes. Cells were taken from the liver biopsy specimens of 71 patients with CH-C and 24 patients with CH-N. Twenty-six normal liver samples were used as controls. RESULTS: Significantly higher G1 (94 +/- 4) and lower S (3.56 +/- 3.16) phase fractions were measured in CH-C compared with CH-N (G1, 90 +/- 6; S, 6.4 +/- 5.99). The DI of moderate (1.12 +/- 0.05) and severe (1.12 +/- 0.05) CH-C showed near-aneuploid DNA content, while diploidy (DI < 1.10) was detected in cases of CH-N. CONCLUSION: The higher G1 and lower S cell cycle phase fractions in CH-C reflect decreased hepatocyte proliferation compared with CH-N. The near-aneuploid DNA content of the HCV-infected liver samples may be a sign of increased genetic instability, which may contribute to the carcinogenic potential of HCV.

Bíró L, Varga L, Pár A, Nemesánszky E, Telegdy L, Ibrányi E, Dávid K, Horváth G, Szentgyörgyi L, Nagy I, Dalmi L, Abonyi M, Füst G, Horányi M, Csepregi A. · National Institute of Hematology and Immunology, Budapest, Hungary. · Scand J Gastroenterol. · Pubmed #11099064 No free full text.

Abstract: BACKGROUND: Available data and our observations suggest that elevated levels of interleukin (IL)-6 and -10 and some complement parameters may be associated with a poor response to IFN alpha. We evaluated how baseline levels of C5b-9, IL-6, and IL-10 influence the outcome of IFN alpha treatment. METHODS: Fifty-one patients with established chronic hepatitis C were enrolled and treated with IFN alpha-2b. Before and after a 12-week-IFN-treatment (3 MU or 5 MU tiw) serum levels of IL-6, IL-10, C5b-9 and RNA of hepatitis C virus (HCV) were assessed. Sera of 46 sex- and age-matched, healthy blood donors served as control. RESULTS: While two-thirds of patients was considered 'responder', 14 patients had no significant decrease either in HCV RNA or in ALT levels. In the responder's group lower baseline levels of IL-6 and C5b-9 were found than those in the 'non-responder' group. As a result of IFN therapy HCV RNA and C5b-9 levels significantly decreased. While the serum concentration of IL-6 increased during the follow-up period, regarding IL-10, no change was observed. In patients with 'low' baseline levels of C5b-9 (<2053 ng/ml) IFN alpha resulted in a significantly (P = 0.0005) higher decrease in HCV RNA level. Regarding 'low' IL-6 values (< 1.47 pg/ml) similar but somewhat less significant (P = 0.0039) difference was found if the change of HCV RNA was investigated. The odds ratio of patients with low IL-6 and/or C5b-9 to responding to IFN alpha treatment was almost 10 times (CI: 9.1 (1.8-50.9)) higher as compared with patients without 'low' levels of these parameters. CONCLUSION: Our data suggest that serum level(s) of IL-6 and/or C5b-9 taken prior to the initiation of IFN treatment may serve as surrogate marker(s) in evaluating patients with chronic hepatitis C whether to get IFN alpha in monotherapy or to consider having combination therapy in the form of IFN alpha-ribavirin.

Bíró L, Varga L, Pár A, Nemesánszky E, Csepregi A, Telegdy L, Ibrányi E, Dávid K, Horváth G, Szentgyörgyi L, Nagy I, Dalmi L, Abonyi M, Füst G, Horányi M. · National Institute of Haematology and Immunology, Budapest, Hungary. · Immunol Lett. · Pubmed #10841940 No free full text.

Abstract: In order to study the effect of interferon alpha on the levels of acute phase complement proteins in vivo, serum concentrations of C9 and C1-inhibitor (C1-INH) were measured in patients with chronic hepatitis C before and 3 months after the beginning of interferon alpha2b therapy. Serum levels of the activation product of terminal complement pathway, C5b-9, HCV RNA and IL-6 were also determined. IFN alpha treatment significantly (P<0.0001) increased the serum concentrations of both complement proteins. C5b-9 levels were found to significantly decrease during the same period of time. When the patients were divided into responders or non-responders (more or less than 50% decrease in plasma HCV RNA concentrations) C9 and C1-INH levels were elevated only in the responder patients. There was no correlation between the changes of IL-6 levels or the amounts of IFN alpha administrated on one hand, and the changes in the complement protein levels on the other. These findings suggest that the marked increase in the serum concentrations of the acute phase complement proteins is a secondary phenomenon due to the IFN alpha-caused diminution of the viral load and the resulting immune complex-induced complement activation.

Telegdy L, Görög D, Horányi M, Schaff Z. · Szent László Kórház, Budapest. · Orv Hetil. · Pubmed #10502972 No free full text.

Abstract: A 38-year-old, male patient, with end-stage HCV cirrhosis, underwent liver transplantation (OLT). After a sufficient recovery a rapid elevation of ALT and profound jaundice developed 3 months after OLT, together with a 15-fold rise of pre-transplant HCV RNS level. Liver biopsy was carried out, histology excluded rejection and signs of acute hepatitis were observed. Interferon alpha 2b 3 MU TIW and ribavirin 800 mg/day resulted in normalization of ALT, se. bilirubin and decrease of viral load by 90 per cent at the 3rd month of treatment. Improvement of hepatitis and no rejection was shown by control histology. A 6-month combination therapy followed by continuous ribavirin monotherapy maintains a permanent good condition with normal ALT, no icterus, a continuously low HCV RNA level and a mild chronic hepatitis with fibrosis in the liver histology 18 months after OLT. Danger of HCV reactivation after OLT, difficulties of diagnosis, interactions of immunostimulant and immunosuppressive drugs, advantages of combination therapy are discussed.