@article { author = {G., Shiha and M., El-Basiouny and R., Soliman and NNH., Mikhail}, title = {Sofosbuvir plus Ribavirin for Treatment-Naïve Chronic HCV Genotype 4 Patients: Real-life Experience}, journal = {Medical Journal of Viral Hepatitis}, volume = {2.1}, number = {1}, pages = {1-8}, year = {2016}, publisher = {Egyptian Liver Research Institute and Hospital (ELRISH)}, issn = {2314-8748}, eissn = {2314-8756}, doi = {10.21608/mjvh.2016.4569}, abstract = {New regimens involving direct-acting antiviral agents have recently been approved for the treatment of genotype 4 HCV. Our aim was to assess the efficacy and safety of 12 or 24 weeks of Sofosbuvir plus ribavirin in treating patients with chronic genotype 4 hepatitis C virus infection. This is an open-label observational study that describes the effect of 12 week or 24 weeks of daily oral Sofosbuvir 400 mg and ribavirin 1000-12000 mg with dose adjustment if indicated. It includes the first 813 patients that fulfil the inclusion and exclusion criteria and treated in Egyptian Liver ResearchInstitute and Hospital (ELRIAH), Mansoura, Egypt. By week 4 of therapy 100% of patients had undetectable HCV RNA and all maintained virological suppression during therapy. SVR12 was achieved by 113 (77.4%) of the patients receiving 12 weeks of treatment, and by 622 (93.3%) of the patients receiving 24 weeks of treatment. SVR12 rates were significantly higher in patients with no cirrhosis, (86.3% for 12 weeks and 95.5% for 24 weeks) than in patients with cirrhosis (56.8% for 12 weeks and 87.0% for 24 weeks). The most common adverse events in both groups were anemia, headache, epigastric pain, insomnia, and heart burn. No serious adverse events were reported in the studied groups. No adverse events resulted in interruption of RBV. No patients had adverse events leading to dose modification or discontinuation of sofosbuvir. Treatment with Sofosbuvir and ribavirin for 12 or 24 weeks was effective and well tolerated in patients with genotype 4 HCV. }, keywords = {Genotype 4,Hepatitis C virus,Treatment-naïve,Sofosbuvir plus,Ribavirin}, url = {https://mjvh.journals.ekb.eg/article_4569.html}, eprint = {https://mjvh.journals.ekb.eg/article_4569_863da91957393e8afc9cd257ed6a5498.pdf} } @article { author = {R., Soliman and G., Shiha and M., El-Basiouny and H., Mikhail}, title = {The 13C-Aminopyrine Breath Test Predicts Advanced Fibrosis in Patients with Chronic Hepatitis C: A Pilot Study}, journal = {Medical Journal of Viral Hepatitis}, volume = {2.1}, number = {1}, pages = {1-8}, year = {2016}, publisher = {Egyptian Liver Research Institute and Hospital (ELRISH)}, issn = {2314-8748}, eissn = {2314-8756}, doi = {10.21608/mjvh.2016.4570}, abstract = {13C Aminopyrine breath test (13C-ABT) is a dynamic function test based on the use of a labelled substrate that selectively metabolized by the liver which is useful in the evaluation of hepatocyte function providing a quantitative information on liver function activity. A significant inverse correlation between C13-ABT results and liver fibrosis was found. In this study we investigate the accuracy of 13C-ABT as non-invasive method for identification of liver fibrosis compared to other non-invasive methods. Thirty-six chronic hepatitis C patients were recruited from the outpatient clinic of the EgyptianLiver Research Institute and Hospital (ELRIAH). Percutaneous liver biopsy and routine blood sampling were performed at the same day. FibroScan and 13C-ABT were done. Liver fibrosis showed strong correlation with FibroScan (r=0.717, p<0.001) and significant inverse correlation with 13C-ABT results, especially at 30 min. (r= -0.371, p=0.026). Significant correlation was found with FIB-4 (r=0.350, p=0.039) and not significant correlation was found with APRI (r=0.261, p=0.240). The cut-off value of 3.15% (dose/hr at 30 min) was associated with high prediction (positive predictive value, 60%; negative predictive value, 92.3%) yielding an overall sensitivity of 75% and specificity of 85.7%. As regards the 13C-ABT % cum. dose at 120 min, a cut-off value of 4.35 was also associated with high accuracy (PPV=47.1%, NPV=100%, Sensitivity=100% and Specificity=67.9%. These results of high accuracy is comparable to FibroScan and FIB-4, and is better than the results of APRI. 13C-aminopyrine breath test is a potential biomarker for advanced fibrosisthat warrants further validation. }, keywords = {13C-Aminopyrine Breath,test,Chronic hepatitis C,FibroScan,FIB-4,APRI}, url = {https://mjvh.journals.ekb.eg/article_4570.html}, eprint = {https://mjvh.journals.ekb.eg/article_4570_ead6210774d405d7c9d3c78ee366e719.pdf} } @article { author = {G., Shiha and S., El-Etreby and M., Bahgat and M., Hamed and M, El Sherbini and EA., Ghoneem and K., Zalata and R., Soliman and M., El-Basiouny and NNH., Mikhail}, title = {Comparison between Transient Elastography (FibroScan) and Liver Biopsy for the Diagnosis of Hepatic Fibrosis in Chronic Hepatitis C Patients}, journal = {Medical Journal of Viral Hepatitis}, volume = {2.1}, number = {1}, pages = {1-9}, year = {2016}, publisher = {Egyptian Liver Research Institute and Hospital (ELRISH)}, issn = {2314-8748}, eissn = {2314-8756}, doi = {10.21608/mjvh.2016.4571}, abstract = {Transient elastography (TE) is gaining popularity as a non-invasive method for predicting liver fibrosis. The practical utility of the method is based on establishing cutoff values for each stage of fibrosis. A diagnosis of stage is based on measurements of liver stiffness that vary in different studies. The present study aimed to establish cutoff values for each stage of fibrosis to assess the performance of TE in fibrosis staging in Egyptian chronic HCV patients. This cross-sectional study was conducted at Specialized Medical Hospital and the Egyptian Liver Foundation, Mansoura, Egypt. The inclusioncriteria were: age older than 18 years and chronic infection by hepatitis C. The exclusion criteria were the presence of ascites, pacemaker or pregnancy. Three hundred and fifty six consecutive patients with chronic hepatitis C participated in the study. Liver fibrosis was staged according to the METAVIR system. The AUROCs for F2 or greater, F3 or greater and cirrhosis (F4) were 0.91 (95% CI 0.87 to 0.94), 0.95 (95% CI 0.91 to 0.99) and 0.97 (95% CI 0.96 to 0.99), respectively. ROC curve analysis identified optimal cutoff value of liver stiffness measurements as high as 9.8 kPa for F ≥ 2, 10.4 kPa for F ≥ 3, and 17.2 kPa for F = 4. The overall relation between fibrosis stages when comparing both FibroScan and biopsy was significant agreement between both (the kappa measure was 0.430 and p<0.001). TE is a good non-invasivetool for diagnosis and monitoring of liver fibrosis among patients with Chronic HCV infection.}, keywords = {Transient elastography,FibroScan,Liver Biopsy,Chronic hepatitis C}, url = {https://mjvh.journals.ekb.eg/article_4571.html}, eprint = {https://mjvh.journals.ekb.eg/article_4571_fbbfe329453684086884b8b02784a4cb.pdf} } @article { author = {E., Toson and G., Shiha and A., Abdelgaleel}, title = {Fibrogenic/Angiogenic Linker for Non-invasive assessment of hepatic fibrosis staging in chronic hepatitis C genotype 4 patients}, journal = {Medical Journal of Viral Hepatitis}, volume = {2.1}, number = {1}, pages = {1-14}, year = {2016}, publisher = {Egyptian Liver Research Institute and Hospital (ELRISH)}, issn = {2314-8748}, eissn = {2314-8756}, doi = {10.21608/mjvh.2016.4572}, abstract = {Liver biopsy is the golden standard but has its complications. Our aim is to establish a method to assess hepatic fibrosis both directly and indirectly, correctly and non-invasively in chronic hepatitis C genotype 4 patients. Also, the diagnostic power of this method will be compared with those of APRI, AAR, FCI, FI, LOK, FIB4, GUCI and KING scores. Samples were collected from 220 patients (F0-F4) of whom 100 were used in the validation study. Hyaluronic acid (HA) and vascularendothelial growth factor (VEGF) levels, HCV RNA, liver function tests, platelet counts, and liver biopsy were done. HA and VEGF levels were correlated with the severity of the disease and acting as fibrogenic/angiogenic cross linker. The areas under receiver operating characteristic curve (AUCs) of the developed method were 0.979 and 0.994 for significant (F2–F4) and advanced fibrosis (F3–F4) (cut off= 0.583 and 6.27, respectively). These AUCs were directly based on HAand VEGF and indirectly on AAR and is termed HA vascular (HAV) method = -35.1+ 0.14 (HA) (ng/L) + 0.03 (VEGF) (pg/ml) + (-6.7) (AAR). Surprisingly, the validation study of this cross linker gave numerical values of AUCs near unity i.e. 0.990, 0.996 and 0.995 for significant, advanced and liver cirrhosis. Also, the indirect published scores gave lower AUCs compared with those of the developed one. Our developed method can not only help to assess liver fibrosis stagingeffectively but also avoid the invasiveness and the limitations of liver biopsy in such patients.}, keywords = {Hyaluronic acid,Hyaluronic acid vascular,Score,Vascular endothelial growth,factor,Liver fibrosis,Hepatitis C Virus Genotype 4}, url = {https://mjvh.journals.ekb.eg/article_4572.html}, eprint = {https://mjvh.journals.ekb.eg/article_4572_9023295936eaba01ab22cc6a3afb9859.pdf} } @article { author = {M., Elbasiony and G., Shiha and AA., El-Desoky and SM., Seif and NF., Abbas}, title = {Hepatitis B Surface Antigen Quantitation as a Predictor of Treatment Response in Chronic Hepatitis B}, journal = {Medical Journal of Viral Hepatitis}, volume = {2.1}, number = {1}, pages = {1-11}, year = {2016}, publisher = {Egyptian Liver Research Institute and Hospital (ELRISH)}, issn = {2314-8748}, eissn = {2314-8756}, doi = {10.21608/mjvh.2016.4573}, abstract = {Hepatitis B surface antigen loss (HBsAg) is a primary therapeutic aim in the management of chronic hepatitis B (CHB), HBsAg levels may be a surrogate marker of infected cells in the liver, and is considered as the only possiblequantitative assay for intrahepatic viral load in treated patients with undetected viremia. A rapid HBsAg decline during nucleoside/nucleotide (NA) therapy may identify patients who will show clearance of HBsAg. Currently, there is no consensus on the clinical utility of serum HBsAg monitoring for evaluating patient responses to NA therapy. We aimed to evaluate the possible value of HBsAg quantitation for prediction of treatment response to oral antiviral therapy. This prospective study was carried out on 130 CHB patients treated with oral antiviral therapy in outpatient clinic of Internal Medicine Department, Mansoura University Hospital and Egyptian Liver Research Institute and Hospital during the period from March 2011 to March 2015. Eighty five patients were on Lamivudine, 27 patients were on Entecavir, 11 patients were on Tenofovir and 7 patients were on Adifovir. Patients were checked every 6 months after starting treatment for 3 years. Twelve out of 130 patients partially responded to the therapy, 9 cases were break through, 103 cases responded and 6 cases achieved HBsAg loss, the baseline HBsAg level has a high predictive value for HBsAg loss vs other patients (AUROC= 0.870, P < 0.01) at cutoff value ≤1927.50 IU/mL with a sensitivity of 83.3%, a specificity of 73.4%, a PPV of 83.15%, and an NPV of 98.9%. While cut off value of ≤128.50 after 6 months of treatment has a sensitivity of 83.3%, aspecificity of 98.4%, a PPV of 71.4%, and an NPV of 99.2%. Significant HBsAg decline to 128.5 IU/ml after starting treatment is useful predictor for patients that can achieve HBsAg loss. }, keywords = {Hepatitis B Surface,Antigen Quantitation,Treatment response,Chronic hepatitis B,Cellular carcinoma}, url = {https://mjvh.journals.ekb.eg/article_4573.html}, eprint = {https://mjvh.journals.ekb.eg/article_4573_8bf10605b91e7b2a41d0874260fdec26.pdf} }