Active HCV Infection Research Articles

Outcomes of Plasma Cell Disorder Patients with Abnormal Hepatitis B and C Screening Tests Prior to Autologous Stem Cell Harvest and Transplantation

Abstract 4472 Background:High dose melphalan with autologous stem cell transplant (ASCT) is a standard treatment for patients with multiple myeloma (MM) and AL amyloidosis. A standard part of the pre stem cell harvest (SCH)/SCT evaluation at most medical centers is a battery of infection screening tests. While the reactivation of hepatitis B with rituximab is well described, there are limited data on the outcomes or significance of abnormal test results in non-endemic areas in the context of ASCT. Moreover, it is unclear whether patients with plasma cell disorders (PCDs), with their dysregulation of humoral immunity, may have differing rates of abnormal test results on antibody based testing than patients without PCDs. Indeed, one study found hepatitis B seroconversions more commonly with MM post ASCT (Uhm et al, ASBMT 2007). We therefore conducted this retrospective study to examine the outcomes of abnormal infection screening in patients with PCDs and non PCDs undergoing SCH/SCT in the New York Metropolitan area. Method:We reviewed 639 consecutive patients who had autologous hematopoietic stem cell harvests (SCH) done at Saint Vincent Hospital, NY from February, 2000 to March, 2010. Of these patients, 555 had PCDs including multiple myeloma and AL Amyloidosis. The 84 non PCDs included lymphoma and solid tumors patients were used as a comparator group. Result:We first reviewed the rate of positive infectious screening tests and found no difference between PCDs (55 out of 555, 9.9%) and non PCDs (9 out of 84, 10.7%). Of these patients with abnormal screening results, 40 and 7 patients respectively went on to ASCT. 11 patients had more than one infection screening test abnormality, making a total of 76 abnormal tests.As shown in Table 1, 67.1% (51/76) were positive for Hep B core Ab, 19.7% (15/76) for Hepatitis C Ab, 6.5 % (5/76) for syphilis, 5.2 % (4/76) for HTLV and 1.3% (1/76) for HIV.Amongst the 44 patients with PCDs and positive anti-HBc total, 39% (17) were positive antiHBc Ig G antibody but negative for IgM, representing chronic carriers. 9% (4) were negative by both antiHBc Ig M and IgG, which may represent false positive tests, and this pattern was not seen in any of the 7 patients with non PCDs. Of the PCD patients who had Hepatitis B PCR testing, 1 showed chronic active hepatitis and 9 had undetectable viral load. 68.5% of positive Hepatitis B screening patient went on to SCT (including the patient with PCR + but IgM was negative) regardless of the status of test results without any treatment for hepatitis B.Of the 13 PCD patients with positive anti-HCV Ab screening, 46% (6) had active viral replication by PCR and 30% (4) had with undetectable viral load by PCR. 2 patients had negative repeat HCV testing. Only one patient with chronic active HCV infection (146,1200,000 IU/ml) by PCR got treatment by IFN and Ribavirin pretransplant and did not get ASCT. 66.6% of positive Hepatitis C screening patient went on to SCT.Five patients had RBC transfusions during the year preceding infection screening (3 with positive antiHBc total antibody, 1 with HCV antibody and 1 with HTLV antibody). One patient had IVIG transfusion 7 days before screening. There appeared to be no relationship to abnormal screening tests and MM subtype or hypogammaglobulinemia.Of those patients who went on to SCT, transient grade 1 transaminitis during transplant or by day 100 was found in 4 patients (6%) with positive hepatitis B screening. One patient had transient asymptomatic hepatomegaly. We observed no serious hepatic complications in chronic hepatitis B and C carriers without active disease and ASCT appears to be feasible and safe without any anti-viral treatment. ConclusionWith the exception of a possible excess of false positive hepatitis B testing in patients with PCDs, there are no other differences in rates of abnormal infection screening tests between PCDs and nonPCDs. The use of more specific viral testing like PCR and Western blot or highly sensitive immunoassay should be considered to avoid false positive results in the analysis of antibody based tests to avoid both unnecessary delays of SCT and anti-viral treatment. In the absence of clinical hepatitis and active viral replication, treatment for chronic Hepatitis B and C carriers does not appear to be required preASCT. Disclosures:Jagannath:Celgene: Membership on an entity's Board of Directors or advisory committees; Merck: Membership on an entity's Board of Directors or advisory committees; Millennium: Membership on an entity's Board of Directors or advisory committees. [Display omitted]

New approaches to in vitro diagnosis of hepatitis C infection a reason for post transfusion hepatitis: Diagnostic value of determination of hepatitis C virus core antigen

In between the dates of February 2008–March 2009, by applying to Istanbul University CTF Microbiology and Clinical Microbiology Basic Sciences Branch and Duzen laboratories, 123 cases, where HCV RNA and anti-HCV positivity are identified with molecular (real-time PCR) and serologic (ELISA) methods as a positive control group, and 48 cases where HCV RNA and anti-HCV negativity are identified as a negative control group are established. The values of sensitivity, specificity, positive and negative approximation of recently developed HCV Core Ag (Abbott Diagnostics, Germany) kit are determined successively as 94.3%, 97.9%, 99.1%, 87%, 95.3% and 88%. Although the new HCV Ag assay is clearly not sensitive enough to replace HCV NAT it may serve as a valuable tool in the HCV diagnostic algorithm as it is able to pick up a great majority of anti-HCV and HCV RNA positive samples, thus allowing a timely and less expensive serological diagnosis of an active HCV infection. This may be an advantage for labs that do not have access to PCR easily.

Active hepatitis C infection and HCV genotypes prevalent among the IDUs of Khyber Pakhtunkhwa.

Injection drug users (IDUs) are considered as a high risk group to develop hepatitis C due to needle sharing. In this study we have examined 200 injection drug users from various regions of the Khyber Pakhtunkhwa province for the prevalence of active HCV infection and HCV genotypes by Immunochromatographic assays, RT-PCR and Type-specific PCR. Our results indicated that 24% of the IDUs were actively infected with HCV while anti HCV was detected among 31.5% cases. Prevalent HCV genotypes were HCV 2a, 3a, 4 and 1a. Majority of the IDUs were married and had attained primary or middle school education. 95% of the IDUs had a previous history of needle sharing. Our study indicates that the rate of active HCV infection among the IDUs is higher with comparatively more prevalence of the rarely found HCV types in KPK. The predominant mode of HCV transmission turned out to be needle sharing among the IDUs.

Prevalence of HCV among the high risk groups in Khyber Pakhtunkhwa.

Hepatitis C is an infectious disease, caused by blood borne pathogen; the Hepatitis C Virus. In this study we analyzed blood samples collected from various risk groups for the prevalence of anti-HCV and active HCV infection with the help of Immunochromtographic tests and nested PCR. The prevalence of active HCV infection among the high risk groups was 15.57% (26/167). The prevalence of HCV in individual risk groups was 15%, 28%, 8%, 14.28% and 14.28% in the case of thalassemics, dialysis, major surgery group, dental surgery group and injection drug users respectively. Our analysis reveals the fact that health care facilities in the Khyber Pakhtunkhwa province of Pakistan are contributing a great deal towards the spread of HCV infection.

Cylex ImmuKnow assay in Chinese stable liver transplant recipients

Objective To identify the level of functional immunity as measured by the ImmuKnow assay in Chinese stable liver transplant recipients and to correlate these values with the dose and the trough levels of immunosuppressant, and with other clinical parameters of these patients. Methods Functional immune response was assessed by the ImmuKnow assay in 46 blood samples taken from 46 stable liver transplant recipients from Beijing Youan Hospital, Capital Medical University Liver Transplantation Center. Results The average ATP value in these stable liver transplant recipients was 203±114 ng/ml (range: 38.47 ATP ng/ml to 524.06 ATP ng/ml) at 22± 15 month post liver transplantation. There was no correlation either between ImmuKnow ATP values and the tacrolimus trough levels, or between ImmuKnow ATP values and the liver function (P<0. 05). Stepwise multiple regression analysis identified WBC and CD3+, CD3+ CD4+ as independent predictors of ImmuKnow assay levels when age, gender and underlying diagnosis were taken into account (P<0. 05). Five patients who were detected to have active HCV infection had lower ImmuKnow ATP values (<61 ng/ml). Conclusions The Cylex ImmuKnow assay ATP values were lower in Chinese stable liver transplant recipients compared with American patients. Further investigation is required to determine the role of the ImmuKnow assay in tailoring immunosuppressant therapy in liver transplant recipients. Key words: Liver transplant; The ImmuKnow assay; Immunosuppression

Frequency distribution of HCV genotypes among chronic hepatitis C patients of Khyber Pakhtunkhwa

BackgroundHepatitis C Virus (HCV) genotypes frequency is important for the predication of response to therapy and duration of treatment. Despite variable response rates experienced in the case of Interferon (IFN) -based therapies, there was scarcity of data on HCV genotypes frequency in Khyber Pakhtunkhwa (KPK).Study DesignA total of 200 blood samples were collected from chronic HCV patients prior to the initiation of anti-viral therapy. The study population included patients from 6 districts of KPK. Active HCV infection was confirmed in case of all the patients by real time PCR. HCV genotypes were determined in each case by Type-specific PCR.ResultsThe analysis revealed that out of 200 PCR positive samples; 78 (39%) were 2a, 62 (31%) were 3a, 16 (8%) were 3b, 34 (17%) were untypable while 1a, 2b and 1b were 3 (1.5%), 2 (1%) and 5 (2.5%), respectively.ConclusionGenotype determination is not carried out prior to therapy in KPK. Although, the abundantly prevalent types (2a and 3a) of HCV in KPK are susceptible to combination therapy, yet resistance experienced in some of the chronic HCV patients may partly be attributed to the prevalence of less prevalent resistant genotypes (1a, 1b) of HCV among the population.

Presence of occult HBV, but near absence of active HBV and HCV infections in people infected with HIV in rural South Africa

Human immunodeficiency (HIV), hepatitis B (HBV), and hepatitis C (HCV) viruses are endemic in Sub-Saharan Africa, but data regarding the prevalence of hepatitis co-infections in HIV-positive individuals residing there are limited. The aim of the study was to determine the prevalence of HBV, HCV, and occult HBV (presence of HBV-DNA in the absence of HBsAg) in a rural, South African cohort. The results were compared to various ethnic groups in a Dutch cohort of people infected with HIV. Antiretroviral-naïve individuals with HIV from both a rural South African clinic (n = 258), and a Dutch University hospital (n = 782), were included. Both serological (HBV and HCV) and molecular (occult HBV) assays were performed. Logistic regression analysis was used to define independent predictors of a hepatitis co-infection. HBV and HCV prevalence rates in the South African cohort were exceptionally low (0.4%, 1/242 and 0.8%, 2/242, respectively), compared to those observed in Caucasians (HBV 4.4% and HCV 10.9%) and African immigrants (HBV 8.9% and HCV 4.8%). Conversely, occult HBV was observed in a considerable proportion (10%, 6/60) of South African patients who were anti-HBc-positive but HBsAg-negative. Occult infections were less frequent in Caucasians and Africans in the Dutch cohort (3.2% and 1.4%, respectively). Independent predictors for occult HBV were not identified, but a trend towards more occult HBV at lower CD4 counts was observed. Local HBV/HCV prevalence data are needed to optimize vaccination and antiretroviral treatment strategies. Occult HBV in patients with HIV may be missed regularly when molecular analyses are not available.

Can Hepatitis C virus treatment be used as a prevention strategy? Additional model projections for Australia and elsewhere

Zeiler et al. (2010) use a simple model to project the potential prevention utility of using pegylated interferon and ribavirin to treat active injecting drug users (IDUs) for HCV infection. Their analysis shows that increasing the level of HCV treatment in Australia could dramatically reduce the prevalence of HCV infection among IDUs. We argue that their projections are under-estimating the possible impact of HCV treatment because their assumed prevalence of active HCV infection in Australia is too high (assumed prevalence of acute plus chronic is 60%) and their model effectively assumes a treatment efficacy of 33%. We replicate their model and show that if these issues are corrected (assuming 45% prevalence of active HCV infection, i.e. ∼60% antibody prevalence and 50% treatment efficacy), then substantially greater impact can be achieved. In addition, we show that the effect of HCV treatment on the primary prevention of HCV increases in populations with lower background HCV prevalence. We also query their finding that HCV treatment should be preferentially targeted to IDUs not on methadone maintenance treatment.

Oral Chelator Deferiprone in Adult with Sickle Cell Disease.

Abstract 4615 INTRODUCTIONLong-term blood transfusion is essential for patients with sickle cell disease (SCD) in case of cerebral vasculopathy, organ dysfunction, leg ulcer, failure or intolerance of hydroxyurea treatment. Secondary iron overload is a factor of morbidity and mortality by organ damage.In practice, three chelators are available: deferoxamine (DFO) which is administrated by subcutaneous infusion and therefore source of poor compliance in SCD. Deferasirox (DFX), the new oral chelator is the first line therapy since 2007. Deferiprone (DFP) is an option when DFX or DFO are contraindicated or inadequate. However, DFP has no approval for SCD.The purpose of this study is to describe the characteristics of SCD patients treated by DFP. METHODOLOGYThe patients included in this study arise from the group of the patients with long-term blood transfusion by manual exchange in Henri Mondor's SCD center, and in whom iron overload is treated by DFP.The monitoring of iron overload is obtained by regular serum ferritin level, combined liver and heart MRI. Only one iron measure by MRI is available for each patient throughout the study. RESULTSNine patients (8 SS and 1 Sβ0thal) are included: 5 men and 4 women. The mean age is 44.2 years (22 to 64 years). The median duration of chronic transfusion is 10 years (4 to 27 years). The average dose of DFP is 68 mg / kg / day (50 to 93 mg / kg / day). The median follow-up under DFP is 30 months (7 to 60 months). The median level of serum ferritin before the initiation of DFP is 5830 μg / l (1800 to 9300 μg / l); and the median level of serum ferritin at the end point is 7940 μg / l (4540 to 11300 μg / l). MRI shows an important hepatic iron overload (up to 320 μmol) in all patients and one cardiac iron overload (T2* = 12 ms).Three patients stopped DFP and switch to deferasirox (DFX) as soon as DFX was available. For the other patients, the reason of prescribing DFP instead of DFX was renal failure in 5 patients and DFX related GI symptoms in one patient.No agranulocytosis is observed. The weekly then monthly monitoring of blood count is insured for all patients. No cytolysis by drug's toxicity is observed, except for one patient with liver transplant and who has an active HCV infection. DISCUSSIONSerum ferritin level is the easiest marker of iron overload follow-up, but is subject of important variations due to inflammation, hemolysis, and cytolysis. Indeed, MRI is the only one reliable measure.The evidence of cardiac iron overload is proved in one patient, and confirms the importance of this measure on SCD patients. This motivates the edition of guidelines concerning the prevention and monitoring of iron overload among these patients.The dosage of DFP remains reasonable compared to the mean dosage use in other pathologies. This dosage depends of the degree of iron overload and the individual tolerance.Data are not sufficient at these days to evaluate the efficacy of DFP to reduce or to stabilize the level of iron overload. However, we observe globally a good clinical and biological tolerance, even in patients who have organ transplant and therefore have several concomitant treatments. CONCLUSIONDFP in patients with SCD is globally well-tolerated, but its efficiency is not proved yet. Approval of DFP for SCD is needed. As life expectancy improves in SCD, more patients will require long-term transfusion and thus iron chelation therapy. Cardiac Iron overload is possible in patients with SCD. So, it would be systematically looked after. Disclosures:No relevant conflicts of interest to declare.

Management of patients co-infected with HBV and HCV

HBV and HCV are both hepatotrophic pathogens that share common routes of transmission, namely through exposure to infected blood and body fluids. Available natural history studies suggest dual infection with HBV and HCV increases the risk of progressive liver disease, and the risk of cirrhosis and liver cancer. Owing to the dynamic nature of these chronic infections, with fluctuations in viral level and disease activity, close monitoring is needed to determine the appropriate time to intervene with treatment. The clinical profile most commonly encountered is for active HCV infection (HCV RNA-positive) with or without active HBV infection (HBsAg-positive with variable HBV DNA levels). For these patients, treatment with pegylated interferon and ribavirin is the treatment of choice. For those with HBV-predominant disease (and HCV RNA-undetectable), the treatment is identical to that with HBV infection alone. For patients unresponsive to these initial treatments, there are no specific guidelines, and additional studies to define the treatment algorithms for nonresponders or relapsers are needed.

Multifocal central and peripheral demyelination associated with hepatitis C virus infection

Sirs: HCV infection is occasionally associated with neurological manifestations, mainly affecting the peripheral nervous system (PNS) in the form of a sensory axonal polyneuropathy [1]; demyelinating forms are rarely documented [2]. Most frequently, there is an association with essential mixed cryoglobulinaemia [3, 4]; however, some cases without cryoglobulinaemia have been described for isolated peripheral [5] and central presentations [6–9].We report the first reported association of CNS and PNS demyelinating lesions with a concomitant active HCV infection and absent cryoglobulinaemia.

'I just keep thinking I haven't got it because I'm not yellow': a qualitative study of the factors that influence the uptake of Hepatitis C testing by prisoners.

BackgroundHepatitis C viral (HCV) infection is a significant public health problem. In the UK, an estimated 200,000 individuals have active HCV infection, most of whom are injecting drug users (IDUs). Many IDUs spend time within the prison system therefore screening for HCV infection in this setting is important. However, uptake of testing within prisons is very low.MethodsQualitative interview study. 30 interviews with 25 male and 5 female prisoners with a history of injecting drug use.ResultsPersonal and institutional barriers to uptake of testing for HCV were identified. Personal barriers included: prisoners' fears and lack of knowledge about HCV, low motivation for testing, lack of awareness about the testing procedure, and concerns about confidentiality and stigma. Institutional barriers included: the prisons' applications procedure for testing, inadequate pre- and post-test discussion, lack of pro-active approaches to offering testing, and lack of continuity of care on discharge and transfer.ConclusionThis study highlights potential areas of development in the management of HCV in prisons. Further research is needed to evaluate care pathways for HCV in the prison setting and to develop and assess interventions to improve the uptake of testing for HCV by prisoners.

HCV core antigen detection in seropositive samples

Detection of antibodies to HCV is typically the primary test utilized to identify HCV-infected individuals. Seropositive individuals may then be tested for HCV RNA by nucleic acid testing (NAT) to determine if the individual is actively infected with HCV. In addition, NAT assays that are based on quantitation of HCV RNA copies/ml, are utilized to determine the effectiveness of antiviral therapy. Over the last several years, HCV core antigen tests have been developed that have shown utility both for the identifying active HCV infection and for monitoring antiviral therapy. Although these assays are relatively simple and rapid, the HCV core antigen tests have not been widely accepted mostly due to their lack of sensitivity. Recently developed assays have shown improved sensitivity, and may represent an alternative or adjunct to HCV NAT both for identifying active HCV infection and for monitoring antiviral therapy. J. Med. Virol. 79:S52–S53, 2007. © 2007 Wiley-Liss, Inc.

SIGNIFICANCE OF THE HEPATITIS C VIRUS (HCV) CORE ANTIGEN AS AN ALTERNATIVE PLASMA MARKER OF ACTIVE HCV INFECTION

Purpose: To evaluate the role of core antigen (Ortho trak-C assay) as a marker of active HCV infection in comparison to HCV RNA as detected by reverse transcription polymerase chain reaction (RT-PCR). Methods: This evaluation was carried out during January 2000 to December 2003 in HCV infected individuals who were treatment naïve or were on anti-viral therapy. Additionally, sequential plasma samples from patients on clinical follow-up were included in this study. A total of 167 samples from 61 patients were tested by trak-C and RT-PCR. HCV RNA detection was achieved by a RT PCR. Trak-C assay results were also compared in a limited proportion of these samples with known HCV viral load and genotype. Results: Of 167 samples tested, 56.9% were RNA positive and 43.1% were RNA negative while 50.3% were trak-C positive and 49.7% were trak-C negative, yielding a sensitivity of 85.3% and a specificity of 95.8% for the trak-C assay (Kappa co-efficient = 0.8). The concentration of HCVcAg and HCV RNA showed significant correlation (n=38, r=0.334, P =0.04). The trak-C assay detected the most prevalent HCV genotypes in India without significant difference (P =0.335). The difference between mean absorbance values of HCV RNA positive samples compared to HCV RNA negative samples in the trak-C assay was highly significant (P 0.000). Qualitative results of trak-C assay and RT-PCR were comparable in 93% of follow-up samples. Conclusions: Trak-C assay can be recommended for confirmation of HCV infection and follow-up in laboratories with resource-poor facilities.

Hepatitis C at the Israeli National Hemophilia Center

Haemophilia patients who received non-virucidally treated large pool clotting factors before 1987 have a high rate of chronic hepatitis C viral infection (HCV). Some patients are coinfected with HIV. Haemophilia patients and other coagulation disorders were treated at one centre since the beginning of the 1970, and the Israeli National Hemophilia Center (INHC) was officially founded in 1987. To characterize patients with HCV as well as patients with HCV/HIV coinfection at the INHC. Patients with haemophilia and other coagulation disorders positive for HCV antibodies were evaluated between 2001 and 2004. Demographic data, type and severity of coagulation disorder, frequency of coagulation factor usage and treatment with concentrated clotting factors prior to 1987 were recorded. Liver enzymes, viral load, genotype and data supporting advanced liver disease were evaluated. About 179 of 239 haemophilia patients (75%) tested positive for anti-HCV antibodies. Our cohort consisted of 165 patients in whom clinical, biochemical and virological data were available. About 117 patients had active HCV infection with HCV-RNA-positive, and 27 were HCV/HIV coinfected. Twenty-one patients (13%) persistently tested HCV-RNA-negative, hence were considered to clear their HCV infection. There was no former USSR immigrants among HCV/HIV coinfected compared with HCV-infected or HCV-RNA-negative groups (0 vs. 30% and 38%, respectively; P < 0.001). HCV-RNA-negative patients used concentrated coagulation factor less frequently than HCV or HCV/HIV-infected patients (48% vs. 73%; P = 0.023, and 48% vs. 74%; P = 0.043, respectively). The use of concentrated clotting factors before 1987 was significantly more frequent in HCV/HIV than in either HCV-infected or HCV-RNA-negative patients (96% vs. 49% and 48%, respectively; P < 0.001). Compared with HCV/HIV subjects, patients with HCV monoinfection were characterized by a higher proportion of infection with genotype 1 (80% vs. 61%; P = 0.027). The rate of persistently normal liver enzymes in these patients was higher (24% vs. 7%; P = 0.05) than in the HCV/HIV-coinfected patients. Advanced liver disease was significantly more common in patients with HCV/HIV-coinfection than in HCV-monoinfected patients (11% vs. 3%; P = 0.045). The majority of haemophilia patients are infected with HCV. Viral clearance occurred in a minority of these patients. HCV monoinfected and HCV/HIV coinfected differ clinically and prognostically.

Interferon-Alpha Therapy in Liver Transplant Recipients: Lack of Association with Increased Production of Anti-HLA Antibodies

Interferon-alpha (IFN) is a useful treatment for active HCV infection. In kidney transplantation, IFN has been shown to trigger acute rejection with de novo anti-HLA antibodies. Interferon-alpha has not been reported to enhance the risk of acute rejection in HCV-positive liver transplant recipients (LTRs). Sera were collected from 44 LTRs greater than 6 months post-transplant. Sera were tested with ELISA for the presence and the specificity of anti-HLA antibodies. The prevalence of anti-HLA antibodies was 11% and was not significantly different in 13 HCV-positive recipients who received IFN, compared with 10 who did not receive IFN (8% vs. 20%), or with 21 HCV-negative recipients (10%). None of the patients had an acute rejection after starting IFN. In this study, LTRs receiving IFN did not have an increased frequency of anti-HLA antibodies. This may partially explain the safety of IFN previously reported in LTRs requiring antiviral therapy.

Significant percentage of normal ALT values seen in chronic HCV infected patients at a VA Medical Center

Purpose: Some have proposed that a normal ALT indicates minimal or no liver injury. This study was undertaken to clarify the significance of normal ALT in veterans with active chronic HCV infection.

Regional thermoablation of local or metastatic renal cell carcinoma.

The objective of the study was to elucidate thermal based ablation techniques for local tumor control. Seven lesions of renal cell carcinoma (2 renal, 1 adrenal, 2 muscle, 1 hepatic, 1 bone) were treated under local (n=2) or general (n=6) anaesthesia with percutaneous cryoablation (CRA): CryoHit device or radiofrequency (RF) ablation (RFA): RF 3000). Treatment was palliative in 4 patients with progression after systemic therapies, and with curative intention in one organ confined tumor (patient with active HCV and HIV infection). Mean power for RFA was 165 watts. Duration of treatments was 10-91 min. No bleeding or urinary leakage was observed; no drainage or indwelling catheters necessary. Pain relief was sufficiently achieved by tramadol and novaminesulfon. Inpatient period on average was 4.25 days. CRA led to complete tumor destruction (CTD) of an adrenal mass (time to progression, 15+ months) and partial tumor destruction (PTD) of a lumbar lesion (19 months); RFA resulted in CTD of 3 lesions (liver, 9+ months; kidney, 1+, 13+ months) and PTD in 2 lesions (muscle and bone, 3 months). In conclusion, it was found that CRA and RFA are safe and effective methods to destroy metastatic RCC. Such minimal invasive techniques are favorable for palliative treatment (low performance status, surgical preconditions) and in conjunction with immunochemotherapy; A decreased risk of bleeding, the shorter duration of hospitalization and a faster recovery of the patient encourage minimal invasive percutaneous thermal based therapies due to life-quality and economic aspects. Treatment of primary renal cell carcinoma is currently under investigation.

Significant percentage of normal ALT values seen in chronic HCV infected patients at a VA Medical Center

Purpose: Some have proposed that a normal ALT indicates minimal or no liver injury. This study was undertaken to clarify the significance of normal ALT in veterans with active chronic HCV infection.

Oxidatives stress in patients with active HCV infection compared to healthy volunteers

Oxidatives stress in patients with active HCV infection compared to healthy volunteers