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A Comparison of the Clinical and Molecular Diagnosis of Herpes Simplex Keratitis

Open Journal of Ophthalmology 2014年第3期4卷 65-74页

作者： Victoria E. McGilligan Jonathan E. Moore Mohammad Tallouzi Sarah D. Atkinson Hugh O’Neill Susan Feeney Elena S. Novitskaya Anant Sharma Sunil Shah Jonathan A. Jackson David G. Frazer Tara C. B. Moore Birmingham and Midland Eye Centre City Hospital Birmingham UK Centre for Molecular Biosciences University of Ulster Coleraine N. Ireland Department of Ophthalmology Belfast Health and Social Care Trust The Royal Victoria Hospital Belfast N. Ireland Department of Ophthalmology Moorfields at Bedford Hospital Bedford UK Regional Virology Laboratory Belfast Health and Social Care Trust The Royal Victoria Hospital Belfast N. Ireland

Purpose: To compare the clinical and molecular diagnoses of Herpes Simplex Keratitis (HSK). Materials and Methods: Conjunctival swabs (after fluorescein and anaesthetic wash out) and detailed questionnaire data were obtained from 146 participants. Corneal rims and conjunctival epithelial cells were infected with Herpes Simplex Virus (HSV) type 1 or HSV2 and supernatant collected. HSV1;HSV2;Varicella Zoster Virus (VZV) and Adenovirus (ADV) DNA was assessed using two real time Polymerase Chain Reaction (PCR) methods. Results: Of the 146 participants recruited, 54 were clinically diagnosed with typical epithelial lesions and 38 with atypical epithelial lesions, 17 with old inactive HSK and 37 healthy volunteers. HSV1 DNA was detected in 28 (30%) of the 92 participants with clinically suspect HSK. Patients who presented with typical epithelial lesions had a higher positive rate (46%) than those who presented with atypical type lesions (8%), when using primers against the Glycoprotein (Gp) G region of the virus. When the same samples were retested with primers against the GpB region, the positive rate for the typical and atypical cases increased to 52% and 11% respectively. Antiviral use at the time of sampling reduced the rate of PCR positivity by 20% (p < 0.05). ADV DNA was detected in 6% of the typical cases and 8% of the atypical cases. All control participants with no history of HSK were negative for HSV1 DNA. Sample quantity was confirmed by testing for housekeeping control genes, beta-actin and beta-2 macroglobulin. PCR results from in vitro control investigations of HSV1 and 2 infected corneal rims and conjunctival epithelial cells were 100% positive for infected and 100% negative for uninfected samples when assessed using both PCR methods. Conclusions: Clinical diagnosis of typical HSK is not always confirmed by PCR. Concomitant use of an antiviral reduces levels of PCR positivity. Given this and the findings that other ocular surface pathogens may mimic HSK pathology, and that choice of gene amplification re

关键词： Herpes Simplex Keratitis PCR antivirals Viralgenotype

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HCV clearance by direct antiviral therapy and occurrence/recurrence of hepatocellular carcinoma:still an issue?

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Hepatoma Research 2018年第6期4卷 90-103页

作者： Francesco Paolo Russo Martina Tessari Angela Imondi Erica Nicola Lynch Fabio Farinati Department of Surgery Oncology and GastroenterologySection of GastroenterologyPadua University HospitalPadua 35128Italy

New regimens with direct-acting antivirals (DAAs) agents have changed both efficacy and safety of hepatitis C virus (HCV)-treatment, as almost all patients can be treated and cured at any stage of liver disease. The rates of sustained virological response to currently available combinations exceed 95% in real-life practice. However, conflicting results have been produced on the occurrence/recurrence of hepatocellular carcinoma (HCC) in patients with HCV-associated cirrhosis treated with DAAs. In this review we analyse the data available in the literature in order to elucidate the impact of DAAs on the risk of HCC occurrence in patients without previous history of tumor, and of recurrence after successful treatment of the tumor. Data on 'de novo' HCC incidence were quite homogeneous, suggesting that the treatment with DAAs does not modify the risk of HCC developing during the first 6-12 months after HCV eradication. On the contrary, HCC recurrence rates after DAAs were extremely variable across different studies, reflecting a large heterogeneity in this clinical setting. The possibility that treatment with DAAs may favour tumour growth and spread in individual patients with active HCC foci is supported by some observations but remains unproven.

关键词： Hepatitis C virus direct-acting antivirals eradication hepatocellular carcinoma occurrence recurrence

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Validity of Upper Gastro-Intestinal Endoscopic Screening in HCV Cirrhotic Patients Awaiting Antiviral Therapy

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Open Journal of Gastroenterology 2015年第12期5卷 191-199页

作者： Salem Y. Mohamed Bassim A. Gaballah Mohamed H. Emara Internal Medicine Department Faculty of Medicine Zagazig University Zagazig Egypt Tropical Medicine Department Faculty of Medicine Zagazig University Zagazig Egypt

Background and Aim: The Egyptian Ministry of Health initiated a nationwide HCV treatment program with the newly developed oral antiviral therapies and formulated national guidelines for treatment allocation which gave favor for patients with advanced fibrosis and early cirrhosis. One of the recommendations for treatment was upper Gastro-intestinal (GIT) endoscopy. This study aimed at estimating the prevalence of varices among those patients and judging the validity of this national recommendation. Methods: This study was carried out at gastrointestinal endoscopy units, Zagazig University Hospitals through the year 2014. The epidemiologic, clinical features and endoscopic findings of patients undergoing preparation for HCV therapy were analyzed. Endoscopic classifications of esophageal and gastric varices were carried out after the Italian liver cirrhosis project and Sarin’s classification respectively. Results: Totally 1143 patients performed upper GIT endoscopy as preparation for HCV treatment. This comprised 22% of all patients undergoing upper GIT endoscopy over that year. There was a fourfold rise in percentage of patients undergoing endoscopy for sofosbuvir-based therapy in this year (22%) when compared to assessment for Interferon/Ribavirin combination therapy (5%) in the previous year. A total of 361 patients had no esophageal or gastric varices. Small sized (grade I), medium sized (grade II) and large sized (grade III) varices were reported in 301, 188 and 293 patients respectively. Thirty patients (2.6%) had gastric varices. The prevalence of varices was higher in Child B in comparison to Child A (statistically not significant, p = 0.243). Conclusion: Screening endoscopy for early cirrhotic patients awaiting oral anti-HCV therapy is valid.

关键词： Upper Gastro-Intestinal Endoscopy HCV Cirrhosis Sofosbuvir Esophageal Varices Gastric Varices Direct Acting antivirals

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Rapid Development of Hepatocellular Carcinoma after Eradication of Hepatitis C Virus with Directly Acting Antiviral Treatment

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Open Journal of Gastroenterology 2018年第9期8卷 295-305页

作者： Fakhar Ali Qazi Arisar Saeed Hamid Section of Gastroenterology Department of Medicine The Aga Khan University Karachi Pakistan

Hepatitis C is a major risk factor for the development of hepatocellular carcinoma (HCC), arising typically on a background of liver cirrhosis. Treatment of hepatitis C has been revolutionized by the addition of oral direct-acting antivirals (DAAs) with sustained virological response (SVR) rates above 90%. There is a recent concern under debate about the increased risk of early HCC recurrence in patients with chronic hepatitis C who were treated with direct-acting antivirals. Nonetheless, these reports mostly focused on patients who were cirrhotic and were already treated for HCC. We report 4 cases of treatment naive, chronic hepatitis C patients who were treated with DAAs and rapidly developed infiltrative HCC despite achieving SVR. Moreover, in our scenario, one of the patients appeared clinically non-cirrhotic until he developed HCC.

关键词： Direct Acting antivirals Hepatitis C Hepatocellular Carcinoma Hepatoma

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New treatment strategies for hepatitis c infection

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World Journal of Hepatology 2015年第17期7卷 2100-2109页

作者： Fatih Ermis Elif Senocak Department of Gastroenterology Duzce University Faculty of Medicine Department of Internal Medicine Duzce University Faculty of Medicine

Hepatitis C infection can lead to cirrhosis and hepatocellular carcinoma and it is an important cause of mortality and morbidity. Achieving a sustained virological response has been the major aim for decades. Interferon treatment was the primarily developed therapy against the infection. Addition of the guanosine analog ribavirin to stop viral RNA synthesis increased the response rates as well as the adverse effects of the treatment. The increasing demands for alternative regimens led to the development of direct-acting antivirals(DAAs). The approval of sofosbuvir and simeprevir signaled a new era of antiviral treatment for hepatitis C infection. Although the majority of studies have been performed with DAAs in combination with interferon and resulted in a decrease in treatment duration and increase in response rates, the response rates achieved with interferon-free regimens provided hope for patients ineligible for therapy with interferon. Most DAA studies are in phase Ⅱ leading to phase Ⅲ. In the near future more DAAs are expected to be approved. The main disadvantage of the therapy remains the cost of the drugs. Here, we focus on new treatment strategies for hepatitis C infection as well as agents targeting hepatitis C virus replication that are in clinical development.

关键词： Direct-acting antivirals Eradication Genotype Hepatitis C virus infection Interferon-free Treatment

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