[Myalgia cruris, again current in Stockholm].
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Adult↗
Biomedical subjects
O Weiland
Publications and source records attributed to O Weiland.
The application of a numerical scoring system for evaluating the histological outcome in patients with chronic hepatitis B followed in long-term.
A numerical scoring system was applied and compared with conventional histological classification to assess the histological outcome in 42 patients with chronic hepatitis B followed for 16 to 162 months (mean = 75 months). Four histological categories in the biopsies were assessed and scored: (i) piecemeal necrosis; (ii) lobular necrosis; (iii) portal inflammation, and (iv) fibrosis and cirrhosis. The sum of all four categories was defined as the "Histological Activity Index." Altogether, 102 liver specimens, including 2 to 4 repeats from each patient, were investigated. A good correlation was noted between a high value of the Histological Activity Index score and several liver histology as monitored by conventional terminology for chronic hepatitis. Among patients with HBeAg persistence, 8 of 14 (57%) deteriorated during follow-up as judged by an increase in the Histological Activity Index score compared to 3 of 13 (23%) of the patients with HBeAg seroconversion (0.5 less than p less than 0.1). Piecemeal necrosis has been postulated to be a predictive marker for the eventual development of cirrhosis. Here, we found that a low score for piecemeal necrosis in the initial liver biopsy was significantly less predictive of a high fibrosis score in the follow-up biopsy than was a high score for initial piecemeal necrosis (p less than 0.001). It is concluded that the scoring system used can be applied to monitor the histological long-term follow-up, especially when separated into its four constituent categories. It also offers a means of predicting a chronic hepatitis outcome.
Adult↗
Delta infection among patients with chronic hepatitis B in the Stockholm region.
The prevalence, epidemiology and consequences of delta infection were analysed in 60 patients attending the Roslagstull Hospital for Infectious Diseases, Stockholm, Sweden, between 1972 and 1982. All of the patients had biopsy-documented chronic hepatitis B. Using radioimmunoassay techniques, sera from all patients were tested for antibodies to hepatitis A virus, for hepatitis B surface antigen and the corresponding antibody, for antibodies to hepatitis B core antigen, for hepatitis B e antigen and the corresponding antibody and for antibodies to delta antigen. All 60 patients underwent a liver biopsy which was repeated in 28 patients. 32% of the patients (19/60) were found to be anti-delta positive. The majority of the anti-delta positive patients were either immigrants from non-European countries or addicts (both 9/19 or 47%). Infections with delta agent were found to have already occurred in the Stockholm region in the early 1970s. During the study period, four of the patients developed clinical and laboratory signs of acute hepatitis in association with a delta infection. Among the anti-delta positive patients, 63% (12/19) were classified as having chronic active hepatitis, with or without cirrhosis, as against 39% (16/41) of the anti-delta negative patients. Histological progression to cirrhosis was observed in two of the four anti-delta positive patients with initial chronic active or chronic persistent hepatitis.
Adolescent↗
Seroconversion to hepatitis C virus antibodies in patients with acute posttransfusion non-A, non-B hepatitis in Sweden.
Seventy-four patients in 1978 and 316 in 1986, all transfused during open-heart surgery in Stockholm, Sweden, were studied prospectively for the development of posttransfusion non-A, non-B (NANB) hepatitis, seroconversion to hepatitis C virus antibodies (anti-HCV) (C-100), time lag to seroconversion to anti-HCV and outcome of posttransfusion NANB/C hepatitis. Anti-HCV was tested up to six months after transfusions in patients from 1978 and up to one year after transfusions in patients from 1986. Fifty-four percent of the patients who developed posttransfusion NANB hepatitis seroconverted to anti-HCV, 7/15 (47%) in 1978 and 8/13 (62%) in 1986. Four (27%) of the 15 patients who seroconverted to anti-HCV were anti-HCV reactive within one week, 12 (80%) within eight weeks and all within 18 weeks after the onset of hepatitis. The ELISA optical density/cut-off (OD/CO) ratio was above 4.0 in all patients with hepatitis C who seroconverted. One transfused patient with normal serum aminotransferase levels throughout follow-up seroconverted after six months. He had a temporary positive anti-HCV reactivity with a maximal ELISA OD/CO ratio for anti-HCV of only 1.2, which became negative three years later. Development of chronic hepatitis was noticed in 9/15 (60%) patients who seroconverted to anti-HCV and in 5/13 (38%) patients with posttransfusion NANB hepatitis who did not seroconvert.
Acute Disease↗
Acute hepatitis B and hepatitis D co-infection in the Stockholm region in the 1970s and 1980s--a comparison.
The frequency and clinical features of acute hepatitis B virus (HBV) infection with and without a hepatitis D virus (HDV) co-infection was investigated retrospectively in the Stockholm region during two different time periods, September 1977-October 1978 and November 1984-October 1986. Totally, 31/229 (14%) patients with acute HBV infection had a HDV co-infection. No change in the frequency of co-infections, 12% and 15%, respectively, was observed between the 1970s and 1980s. Among the 31 HDV co-infected patients 74% were intravenous drug addicts. Totally 23/66 (35%) intravenous drug addicts with acute HBV infection had HDV co-infection. Clinically a biphasic rise of the serum levels of alanine aminotransferase and bilirubin was noted among 63% of the HDV co-infected patients but only among 8% of the solely HBV infected patients (p less than 0.001). A clinically more severe hepatitis was seen significantly more often among the HDV co-infected patients than among the solely HBV infected.
Acute Disease↗
Response to a booster dose 18 months after a low anti-HBs response (10-99 IU/l) to three doses of intradermally or intramuscularly administered recombinant hepatitis B vaccine.
The response to a booster dose, given by the same route 18 months after the completion of the primary vaccination scheme, was studied in hospital staff members who responded with anti-HBs levels in the range of 10-99 IU/l after three intradermal (i.d., n = 51) or intramuscular (i.m., n = 11) doses of recombinant hepatitis B virus (HBV) vaccine administered at 0, 1 and 6 months. At the time of boostering the anti-HBs levels had declined to < 10 IU/l in 44/51 (86%) of the i.d. and 10/11 of the i.m. vaccines. All i.m. and 90% of i.d. vaccinees responded to the booster dose with anti-HBs level > or = 10 IU/l, and with geonmetric mean titres 1,074 IU/l and 121 IU/l, respectively. It was concluded that all i.m. and 90% of i.d. vaccinees with an initial anti-HBs response of 10-99 IU/l after three doses of HBV vaccine (among whom the anti-HBs levels in the majority had declined < 10 IU/l) mounted an anti-HBs level > or = 10 IU/l after a booster dose. The anti-HBs concentrations were generally higher after i.m. than i.d. booster doses in accordance with the response to primary vaccination.
Adult↗
Treatment of chronic replicative hepatitis B virus infection with short-term continuous infusion of foscarnet.
Three patients with chronic replicative hepatitis B virus infection were treated for 7 days with a continuous intravenous infusion of foscarnet (trisodium phosphonoformate) after an initial bolus dose of 20 mg/kg body weight. Although the dose was calculated from a nomogram, approximately only half the intended plasma concentration (500 microM/l = 150 micrograms/l) was achieved. The levels of s-ALAT, HBV-DNA and DNA-polymerase changed only marginally during the treatment and 24-week follow-up period. All three patients remained HBsAg and HBeAg positive during treatment and follow-up. There were no severe side-effects. We conclude that foscarnet treatment with the dose regimen given in this study had no or only a minor antiviral effect in patients with chronic replicative HBV infection. It remains to be explored if higher doses, longer treatment periods or the use of foscarnet in combination regimen are more effective.
Adult↗
HCV genotypes in Swedish blood donors as correlated to epidemiology, liver disease and hepatitis C virus antibody profile.
Sixty-two anti-HCV and HCV-RNA positive Swedish blood donors (44 men, 18 women; median age 34 years) were studied. HCV genotypes were correlated to parenteral risk factors, liver morphology, serum alanine aminotransferase (ALAT) levels and HCV antibody profile. Forty percent of the donors were infected with HCV genotype 1a, 10% with 1b, 21% with 2b, and 29% with 3a. Intravenous drug use (IVDU) was more common in donors with genotype 3a than in those with genotype 1a (p = 0.024), and prior blood transfusion more common in genotype 2b than in 3a (p = 0.012). Chronic active hepatitis with and without cirrhosis was found in 38% of donors infected with genotype 2b as compared to 8% of donors infected with 1a (p = 0.034). Forty percent of donors with genotype 1a had normal ALAT at the time of liver biopsy versus 11% with genotype 3a (p = 0.046). Antibodies to C33c and C22-3 were present in nearly all donors whereas reactivity to C100-3 and 5-1-1 was detected more often in donors with genotypes 1a and 1b as compared to donors with genotypes 2b and 3a. In conclusion, genotype 3a was correlated to IVDU or tattooing as parenteral risk factors for the acquisition of HCV infection, and genotype 2b to prior blood transfusion. Donors with genotypes 1a seemed to have less severe liver disease than those infected with genotypes 2b and 3a.
Adult↗
Genotyping of hepatitis C virus performed by type-specific PCR in comparison to nucleotide sequencing of NS5 and core regions.
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Genotype↗
Interferon and ribavirin combination therapy: indications and schedules.
Treatment outcome for patients with chronic hepatitis C virus infection has greatly improved during the last years with the development of interferon (IFN) and ribavirin combination therapy. The final decision to treat or not, however, is complex and should be based on several factors such as the age of the patient, the general health, the risk of developing cirrhosis and the probability of a cure with treatment. Combination therapy with standard doses (IFN-a 3 x 106 IU three times per week plus ribavirin 1000-1200 mg daily in two divided doses) for six (up to 12) months significantly improves the sustained biochemical and virological response rates 2-3 times as compared to IFN alone given during 12 months. Combination therapy has thus become standard therapy for na ve patients and relapse patients after a prior IFN treatment course. For patients with favourable baseline viral characteristics (genotype 2 and 3 irrespective of viral load) six months combination therapy is sufficient whereas patients with unfavourable viral baseline characteristics (genotype 1 with high baseline viral load) will need 48 weeks combination treatment. In addition, for patients with compensated cirrhosis, combination therapy is superior and better tolerated than IFN monotherapy. For the future better optimised treatment schedules and dosing regimens for IFN in combination with ribavirin need to be worked out and individualised according to genotype to further improve treatment results. Utilisation of new IFN formulas such as pegylated IFN and consensus IFN in combination regimens will probably improve treatment further.
Age Factors↗
Changes of serum neopterin, beta 2-microglobulin and interferon-gamma in patients with chronic hepatitis C treated with interferon-alpha 2b.
OBJECTIVES: Treatment with interferon (IFN) reduces viral replication and normalizes aminotransferase levels in a significant percentage of patients with non-A, non-B hepatitis or hepatitis C. Soluble immune activation markers were evaluated in patients with hepatitis. PATIENTS AND METHODS: Serum concentrations of soluble immune activation markers neopterin and beta 2-microglobulin (B2M) were compared to endogenous IFN-gamma levels in 17 patients with chronic hepatitis C before, during and after 9-months of treatment with IFN-alpha 2b. RESULTS: Before therapy some patients had increased concentrations of the studied variables. During therapy neopterin and B2M concentrations further increased whereas IFN-gamma decreased. IFN-gamma and neopterin levels were correlated before but not during therapy. The correlations between neopterin and B2M were significant throughout the study. CONCLUSION: The data indicate that IFN-gamma decreases during treatment and IFN-alpha 2b appears to enhance formation of neopterin and B2M.
Adult↗