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Management of hepatitis C virus infection in HIV/HCV co-infected patients: Clinical review

World Journal of Gastroenterology 2009年第30期15卷 3713-3724页

作者： ashwani k singal Bhupinderjit S Anand Divsion of Gastroenterology Department of Internal Medicine University of Texas Medical Branch Galveston TX 77555-0764 United States Department of Gastroenterology and Hepatology Michael E. DeBakey Veterans Affairs Medical Center Baylor College of Medicine Houston TX 77555-0764 United States

Nearly one fourth of individuals with human immunodeficiency virus (HIV) infection have hepatitis C virus (HCV) infection in the US and Western Europe. With the availability of highly active antiretroviral therapy and the consequent reduction in opportunistic infections, resulting in the prolongation of the life span of HIV-infected patients, HCV co-infection has emerged as a signif icant factor influencing the survival of HIV patients. Patients with HIV/HCV co-infection have a faster rate of fibrosis progression resulting in more frequent occurrences of cirrhosis, end-stage liver disease, and hepatocellular carcinoma. However, the mechanism of interaction between the two viruses is not completely understood. The treatment for HCV in co-infected patients is similar to that of HCV monoinfection; i.e., a combination of pegylated interferon and ribavirin. The presence of any barriers to antiHCV therapy should be identified and eliminated in order to recruit all eligible patients. The response to treatment in co-infected patients is inferior compared to the response in patients with HCV mono-infection. The sustained virologic response rate is only 38% for genotype-1 and 75% for genotype-2 and -3 infections. Liver transplantation is no longer considered a contraindication for end-stage liver disease in coinfected patients. However, the 5 year survival rate is lower in co-infected patients compared to patients with HCV mono-infection (33% vs 72%, P = 0.07). A better understanding of liver disease in co-infected patients is needed to derive new strategies for improving outcome and survival.

关键词： Hepatitis C virus Human immunodeficiencyvirus Coinfection Pegylated interferon Ribavirin

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Management of Hepatorenal Syndrome:A Review

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Journal of Clinical and Translational Hepatology 2020年第2期8卷 192-199页

作者： Raseen Tariq ashwani k.singal Department of Medicine Rochester General HospitalRochesterNYUSA Division of Gastroenterology and Hepatology University of South DakotaSanford School of MedicineSioux FallsSDUSA

Acute kidney injury (AkI) occurs frequently in patients with cirrhosis, and hepatorenal syndrome (HRS) is second most common etiology of AkI after volume responsible pre-renal etiology. AkI in these patients negatively impacts pre- and post-transplant patient survival and healthcare burden. Re-duced effective blood volume with consequent reduced renal blood flow, along with systemic inflammation in patients with decompensated cirrhosis, result in susceptibility to HRS. In this article, we will review updates over the last 5 years on the changing definition with diagnostic criteria and nomenclature of AkI and HRS, data on medical treatment with vasocon-strictors, and urinary biomarkers in diagnosis of etiology of AkI. We will also discuss the significance of liver trans-plantation evaluation once the diagnosis of HRS is established and the post-transplant immunosuppression management. We will also review one of the challenging issues that remains among transplant-eligible patients, that of allocation of si-multaneous liver kidney transplant. Finally, we will review the new implemented policy from the Organ Procurement Trans-plant Network on simultaneous liver kidney allocation.

关键词： HRS Management Liver transplant for HRS

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Mitochondrial dysfunction and alcohol-associated liver disease:a novel pathway and therapeutic target

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Signal Transduction and Targeted Therapy 2020年第1期5卷 2292-2293页

作者： Mohamed A.Abdallah ashwani k.singal Department of Medicine University of South DakotaSanford School of MedicineSioux fallsSDUSA Division of Gastroenterology and Hepatology University of South DakotaSanford School of MedicineSioux fallsSDUSA Avera University Hospital Transplant Institute&Chief Clinical Research Affairs Transplant HepatologyInstitute of Human Genetics ResearchSioux FallsSD 57105USA

In a recent study in signal transduction and targeted therapy,Zhou et *** novel experimental data on the role of DNAdependent protein kinase catalytic subunit(DNA-Pkcs)in causing abnormalities in the structure and fun... 详细信息

关键词： al liver alcohol

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Alcoholic hepatitis and concomitant hepatitis C virus infection

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World Journal of Gastroenterology 2014年第34期20卷 11929-11934页

作者： Mohamed Shoreibah Bhupinderjit S Anand ashwani k singal Division of Gastroenterology and Hepatology University of Alabama BirminghamBirminghamAL 35294-0012United States Department of Gastroenterology and Hepatology Michael DeBakey VA CenterBaylor College of MedicineHoustonTX 77030United States

Hepatitis C virus(HCV)infection and alcohol abuse are two most important causes of chronic liver disease in the United *** hepatitis is a unique clinical syndrome among patients with chronic and active alcohol abuse with a potential for high short-term *** 20%of patients presenting with alcoholic hepatitis have concomitant HCV *** from alcoholic hepatitis is increased in the presence of concomitant hepatitis C due to synergistic interaction between HCV and alcohol in causing hepatocellular *** prospective randomized studies are needed to develop guidelines on the use of corticosteroids among patients with alcoholic hepatitis and concomitant HCV *** impact of antiviral therapy on mortality and outcome in the setting of alcoholic hepatitis remains a novel area for future research.

关键词： Alcoholic liver disease Alcoholic hepatitis Hepatitis C virus infection Corticosteroids Transplantation

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Outcomes after liver transplantation for combined alcohol and hepatitis C virus infection

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World Journal of Gastroenterology 2014年第34期20卷 11935-11938页

作者： Rashid khan ashwani k singal Bhupinderjit S Anand Division of Gastroenterology and Hepatology University of Texas Medical BranchGalvestonTX 77555United States Division of Gastroenterology and Hepatology University of Alabama BirminghamBirminghamAL 35294-0012United States Department of Gastroenterology and Hepatology Michael DeBakey VA CenterBaylor College of MedicineHoustonTX 77030United States

Alcohol abuse and chronic hepatitis C virus(HCV)infection are two major causes of chronic liver disease in the United *** 10%-15%of liver transplants performed in the United States are for patients with cirrhosis due to combined alcohol and HCV *** on outcomes on graft and patient survival,HCV recurrence,and relapse of alcohol use comparing transplants in hepatitis C positive drinkers compared to alcohol abuse or hepatitis C alone are conflicting in the *** studies report a slightly better overall outcome in patients who were transplanted for alcoholic cirrhosis vs those transplanted for HCV alone or for combined HCV and alcohol related ***,some other studies do not support these ***,most studies are limited to a retrospective design or small sample *** prospective multicenter studies are needed to better define the outcomes in hepatitis C drinkers.

关键词： Alcoholic liver disease Hepatitis C virus Liver transplantation Graft survival Mortality

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Integrated Multidisciplinary Management of Alcoholassociated Liver Disease

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Journal of Clinical and Translational Hepatology 2023年第6期11卷 1404-1412页

作者： Malia Holbeck Hannah Statz DeVries ashwani k.singal Addiction Medicine Avera McKennan University HospitalUniversity of South DakotaSioux FallsSDUSA Psychiatry Avera McKennan University HospitalUniversity of South DakotaSioux FallsSDUSA Transplant Hepatology Avera McKennan University HospitalUniversity of South DakotaSioux FallsSDUSA

Alcohol-associated liver disease(ALD)is one of the most common liver diseases and indications for liver transplantation(LT).Alcohol use disorder(AUD),a frequent accompaniment in ALD patients,may also be associated with psychiatric comorbidities such as depression and *** of ALD at an earlier stage,and treatment of AUD may help prevent progression to advanced stage of ALD such as cirrhosis and alcoholic *** for alcohol use and AUD treatment in ALD patients is often not performed due to several barriers at the level of patients,clinicians,and administrative *** review details the integrated multidisciplinary care model especially on the specific role of the hepatologist,psychiatrist,addiction counselor,and social worker in providing complete management for the dual pathology of liver disease and of *** assessment,pharmacological and behavioral therapies,and recommended assessments for follow-up care by the respective specialists is *** provide perspective along with the literature support,with the goal of providing team based comprehensive care of patients with ALD.

关键词： Alcohol Cirrhosis Liver transplant Depression Anxiety Multidisciplinary

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Changing Population of Liver Transplant Recipients in the Era of Direct-acting Antiviral Therapy

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Journal of Clinical and Translational Hepatology 2020年第3期8卷 262-266页

作者： Chencheng Xie Yong-Fang kuo ashwani k.singal Division of Gastroenterology and Hepatology Thomas Jefferson UniversityPhiladelphiaPAUSA Department of Medicine University of South Dakota Sanford School of MedicineSioux FallsSDUSA Division of Biostatistics University of Texas Medical BranchGalvestonTXUSA Division of Transplant Hepatology Avera Transplant InstituteSioux FallsSDUS

Background and Aims:With the availability of direct-acting antiviral(DAA)therapy for hepatitis C virus(HCV)infection and changing liver disease etiology for liver transplantation(LT),data on the changes in LT recipient population in the DAA era are ***:The United Network for Organ Sharing(UNOS)registry(01/2007 to 06/2018)was used to develop a retrospective cohort of LT recipients for HCV,alcohol-associated liver disease(ALD),and non-alcoholic steatohepatitis(NASH).LT recipients in the DAA era(2013-2018)were compared with those in the pre-DAA era(2007-2012)era for recipient ***-square and analysis of variance were the statistical tests used for categorical and continuous variables,***:Of 40,309 LT recipients(21,110 HCV,7586 NASH,and 11,713 ALD),the 21,790 in the DAA era(9432 HCV,7240 ALD,and 5118 NASH)were more likely to be older,female,obese,diabetic,have acute-on-chronic liver failure with a higher model for end-stage liver disease score,receive grafts with a lower donor risk index,and have waited on the LT list for a shorter period compared with their pre-DAA era *** to ALD,LT recipients with alcohol hepatitis were more likely to be younger at the time of *** 9895 LT recipients with hepatocellular carcinoma,recipients in the DAA era were observed to have a higher proportion of HCV(43%vs.32%,p<0.001),a lower proportion of ALD(9%vs.12%,p<0.001),and no change for NASH(13%vs.13%,p=0.9)compared with the pre-DAA *** the hepatocellular carcinoma population,LT recipients in the DAA era were older,diabetic,and waited on the LT list longer compared with their pre-DAA ***:Along with changing liver disease etiology in the DAA era,the LT recipient population demographics,comorbidities,liver disease severity,and graft quality are *** changes are relevant for future studies,immunosuppression,and post-transplant follow-up.

关键词： DAA Cirrhosis OLT

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Potent suppression of hepatitis B virus and hepatocellular carcinoma: how long is good enough?

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Hepatobiliary Surgery and Nutrition 2018年第3期7卷 212-213页

作者： Sudha kodali ashwani k. singal Division of gastroenterology and hepatology University of Alabama at BirminghamBirminghamALUSA

Approximately one third of the world's population has serological evidence of past or present infection with hepatitis B virus (HBV). The natural history of chronic HBV infection, ranges from an inactive carrier state to progressive chronic hepatitis B (CHB), which may evolve to cirrhosis and hepatocellular carcinoma (HCC) (1,2). HBV-related end stage liver disease is responsible for over 0.5–1 million deaths per year and currently represent 5–10% of cases of liver transplantation (1). Many factors can potentially induce development of HCC in HBV infected patients. These are (I) chronic necroinflammatory activity induced by immune response to the virus, (II) apoptosis of cells with cellular damage resulting in dysplasia of the hepatocytes, and (III) direct oncogenic potential of HBV with integration of its DNA with the host DNA.

关键词： hepatocellular hepatitis infection

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Liver transplantation in alcoholic liver disease current status and controversies

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World Journal of Gastroenterology 2013年第36期19卷 5953-5963页

作者： ashwani k singal khushdeep S Chaha khalid Rasheed Bhupinderjit S Anand Division of Gastroenterology and Hepatology Department of Medicine University of Alabama at Birmingham Department of Medicine UAB Huntsville Program Huntsville Department of Medicine UAB Montgomery Program Montgomery Department of Gastroenterology and Hepatology Michael DeBakey VA Center Baylor College of Medicine Houston

Alcoholic cirrhosis remains the second most common indication for liver transplantation.A comprehensive medical and psychosocial evaluation is needed when making a decision to place such patients on the transplant *** transplant centers worldwide need a minimum of 6 mo of alcohol abstinence for listing these *** with alcohol dependence are at high risk for relapse to alcohol use after transplantation(recidivism).These patients need to be identified and require alcohol rehabilitation treatment before *** to the level of harmful drinking is reported in about 15%-20%***,recurrent cirrhosis and graft loss from recidivism is rare,occurring in less than 5%of all alcoholic cirrhosis-related transplants,harmful drinking in the post-transplant pe-riod does impact the long-term *** development of metabolic syndrome with cardiovascular events and de novo malignancy are important contributors to non liver-related mortality amongst transplants for alcoholic liver *** protocols for earlier detection of de novo malignancy are needed to improve the long-term *** need for a minimum of 6 mo of abstinence before listing makes transplant a nonviable option for patients with severe alcoholic hepatitis who do not respond to *** data from retrospective and prospective studies has challenged the 6 mo rule,and beneficial effects of liver transplantation have been reported in select patients with a first episode of severe alcoholic hepatitis who are unresponsive to steroids.

关键词： Alcoholic liver disease Liver transplantation Transplant evaluation Recidivism Six months rule Alcoholic hepatitis

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Corticosteroids and pentoxifylline for the treatment of alcoholic hepatitis:Current status

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World Journal of Hepatology 2011年第8期3卷 205-210页

作者： ashwani k singal Ishmeet Walia Anjna singal Roger D Soloway Department of Internal Medicine University of Texas Medical Branch Division of Gastroenterology and Hepatology Mayo ClinicRochesterMN 55905-0001United States

The treatment of choice for patients with severe alcoholic hepatitis (AH) is use of *** randomized well designed studies have been reported from all over the world on the use of corticosteroids in the treatment of ***,the data on the efficacy of corticosteroids in these patients have been *** meta-analyses also failed to show beneficial effects of *** on individual data meta-analysis showing clear benefit of corticosteroids amongst patients with severe AH (modified discriminant function of 32 or more),led American College of Gastroenterology to recommend use of corticosteroids as the first line treatment option amongst patients with severe ***,corticosteroids are relatively contraindicated amongst patients with severe AH and coexistent sepsis,gastrointestinal bleeding,and acute *** patients may be candidates for second line treatment with ***,specific treatment of AH with corticosteroids far from satisfactory with as many as 40%-50% of patients failing to respond to steroids,thus classified as nonresponsive to *** management of these patients is a continuing challenge for *** treatment modalities need to be developed for this group of patients in order to improve the outcome of patients with severe *** article describes at length the available trials on use of corticosteroids and pentoxifylline with their current *** of administration,dosage,adverse effects,and mechanisms of action of these two drugs are also ***,an algorithm with clinical approach to management of patients who present with clinical syndrome of AH is described.

关键词： Corticosteroids Pentoxifylline Alcoholic hepatitis

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