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See detailResponse of Black African patients with hepatitis C virus genotype 4 to treatment with peg-interferon and ribavirin
Nkuize, M; Mulkay, JP; Adler, M et al

in Acta Gastro-Enterologica Belgica (2013), 76

Aim : To compare responses to therapy of Black African (BA) and non-Black African (non- BA) patients with hepatitis C virus genotype 4 (HCV-4) residing in Belgium. Methods : In this retrospective ... [more ▼]

Aim : To compare responses to therapy of Black African (BA) and non-Black African (non- BA) patients with hepatitis C virus genotype 4 (HCV-4) residing in Belgium. Methods : In this retrospective multicenter study, 473 patients with HCV-4 were selected from databases at 7 Belgian centers ; 209 treatment-naïve patients (154 BA) had received treatment with peg-interferon (peg-IFN) plus ribavirin (RBV) and were included in the study. Results : There was a greater percentage of female patients in the BA group than in the non- BA group ; BA patients were also older, had a greater body mass index, and more frequently had abnormal glucose metabolism. The route of contamination was more frequently unknown in BA than in non-BA patients and BA patients had more HCV-4 subtypes. There were no differences in other demographic factors between the groups. Sustained viral response (SVR) and complete early viral response rates were significantly lower and relapse rates significantly higher in BA than in non-BA patients. There were no differences between groups in rates of dose modification or in drug tolerance. Conclusion : In our cohort, treatment-naïve BA patients with HCV-4 who were treated with peg-IFN and ribavirin had a much lower SVR rate than treatment-naïve non-BA patients with HCV- 4 who were treated with peg-IFN and ribavirin, and a higher relapse rate, possibly related to a weaker response to interferonbased therapy. Treatment may need to be adapted in this population. [less ▲]

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See detailHepatitis B virus and hepatitis C virus infection in Belgium: similarities and differences in epidemic and initial management
De Vroey, B; Moreno, C; Laleman, W et al

in European Journal of Gastroenterology & Hepatology (2013), 25(5), 613-619

Introduction Nationwide studies comparing patients with hepatitis B and C virus (HBV and HCV) infections are mandatory for assessing changes in epidemiology. Aim The aim of this study was to compare ... [more ▼]

Introduction Nationwide studies comparing patients with hepatitis B and C virus (HBV and HCV) infections are mandatory for assessing changes in epidemiology. Aim The aim of this study was to compare epidemiological data and initial management of newly diagnosed patients with persistent HBV (HBsAg positive) or HCV (detectable HCV RNA) infection in Belgium. Patients and methods Data were extracted from two Belgian observational databases. Results A total of 655 patients (387 HBV and 268 HCV) were included. Compared with HCV patients, HBV patients were younger, more frequently men, more often of Asian or African origin (43 vs. 10%, P < 0.0001), and less frequently contaminated by transfusion or intravenous drug use (9 and 6% vs. 34 and 44%, P< 0.0001). Viral replication was assessed in 89% of HBV patients. Compared with HCV patients, HBV patients more frequently had normal alanine aminotransferase (ALT) levels (65 vs. 29%, P < 0.0001), less frequently underwent liver biopsy (29 vs. 67%, P < 0.0001), and were less often considered for antiviral therapy (25 vs. 54%, P < 0.0001). When taking only HBV patients with detectable viral replication into consideration, results remained unchanged. During the multivariate analysis, ALT was a major factor for performing liver biopsy or considering antiviral therapy in both groups. Conclusion HBV and HCV screening policies should be targeted toward immigrants and intravenous drug users, respectively. Guidelines recommending systematic search for viral replication should be reinforced in HBV patients. HBV patients less frequently underwent liver biopsy and were less often considered for antiviral therapy compared with HCV patients. Despite the lack of sensitivity and specificity, ALT remains a pivotal decision-making tool for liver biopsy and antiviral therapy in both infections. [less ▲]

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See detailThe influence of laboratory-induced Meld score differences on liver allocation: more reality than myth.
Schouten, J. N.; Francque, S.; Van Vlierberghe, H. et al

in Clinical Transplantation (2012), 26(1), 62-70

Background: Liver allocation in Eurotransplant (ET) is based on the MELD score. Interlaboratory MELD score differences in INR and creatinine determination have been reported. The clinical implication of ... [more ▼]

Background: Liver allocation in Eurotransplant (ET) is based on the MELD score. Interlaboratory MELD score differences in INR and creatinine determination have been reported. The clinical implication of this observation has not been demonstrated. Methods: MELD scores were calculated in 66 patients with liver cirrhosis using bilirubin, creatinine, and INR analyzed in six liver transplant centers. Based on allocation results of ET, patients transplanted from December 2006 to June 2007 were divided according to MELD score in four groups. For each group, the influence of the match MELD on the probability of receiving a transplant was studied (Cox proportional hazards model). Results: Laboratory-dependent significant differences in MELD score were demonstrated. Cox proportional hazards model showed a significant association between MELD score and the probability of organ allocation. The unadjusted hazard ratio for receiving a liver transplant was significantly different between group 2 and group 4 (group 2: MELD 19–24; group 4: MELD > 30). Conclusion: Laboratory-dependent significant differences in MELD score were observed between the six transplant centers. We demonstrated a significant association between the MELD score and the probability of organ allocation. The observed interlaboratory variation might yield a significant difference in organ allocation in patients with high MELD scores. [less ▲]

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See detailHBV infection in Belgium: results of the BASL observatory of 1456 HBsAg carriers.
Deltenre, P.; Laleman, W.; Van Gossum, M. et al

in Acta Gastro-Enterologica Belgica (2012), 75(1), 35-41

Introduction : Nationwide studies are mandatory to assess changes in the epidemiology of HBV infection in Europe. Aim : To describe epidemiological characteristics of HBsAgpositive patients, especially ... [more ▼]

Introduction : Nationwide studies are mandatory to assess changes in the epidemiology of HBV infection in Europe. Aim : To describe epidemiological characteristics of HBsAgpositive patients, especially inactive carriers, and to evaluate how practitioners manage HBV patients in real life. Methods : Belgian physicians were asked to report all chronically infected HBV patients during a one-year period. Results : Among 1,456 patients included, 1,035 (71%) were classified into one of four phases of chronic infection : immune tolerance (n = 10), HBeAg-positive hepatitis (n = 248), HBeAgnegative hepatitis (n = 420) and inactive carrier state (n = 357 HBeAg-negative patients with ALT < upper limit of normal (ULN) and HBV DNA < 2,000 IU/mL). Using less restrictive criteria for ALT (1-2 ULN) or HBV DNA (2,000-20,000 IU/mL), 93 unclassified patients were added to the group of inactive carriers. These 93 additional inactive carriers were younger, more frequently males, with similar risk factors for HBV infection and histological features compared to inactive carriers according to recent guidelines. Recent guidelines on management of HBV patients were generally followed, but systematic HBV DNA measurements and HDV coinfection screening should be reinforced. Conclusion : In Belgium, an inactive carrier state was a common form of chronic HBV infection. Using less restrictive criteria for classification of inactive carriers did not modify their main characteristics and seemed better adapted to clinical practice. Recent guidelines on management of HBV patients should be reinforced. [less ▲]

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See detailEfficacy of interferon-based antiviral therapy in patients with chonic hepatitis C infected HCV genotype 5: a meta-analysis of two large prospective clinical trials
D'Heygere, F.; George, C.; Van Vlierberghe, H. et al

in Journal of Medical Virology (2011), 83(5), 815-819

The characteristics and response rate to pegylated interferon and ribavirin (PEG-INF + RBV) of patients with chronic hepatitis C infected with genotype 5 are poorly documented. A meta-analysis of two ... [more ▼]

The characteristics and response rate to pegylated interferon and ribavirin (PEG-INF + RBV) of patients with chronic hepatitis C infected with genotype 5 are poorly documented. A meta-analysis of two large phase III/IV prospective randomized clinical trials conducted in Belgium in patients with chronic hepatitis C (n = 1,073 patients) was performed in order to compare the response to antiviral therapy of hepatitis C virus (HCV) genotype 5 with that of other HCV genotypes. A subset of HCV-1 infected patients selected from within the study database were selected to match the HCV-5 sample for known prognostic factors. In Belgium HCV-5 is responsible for a significant minority of cases of chronic hepatitis C CHC (4.5%) and is characterized by a more advanced age (58.4 years), a high frequency of cirrhosis (27.7%), a specific mode of HCV acquisition, and a particular geographic origin (66.7% of patients from West Flanders). The primary comparative analysis showed that response to treatment with PEG-INF + RBV of HCV-5 is similar to HCV-1 and lower compared to HCV-2/3. The analysis of the matched patient subgroup demonstrates that the HCV-5 "intrinsic sensitivity" to PEG-IFN + RBV therapy is identical to HCV-1, with a sustained virological response of 55% in both groups. In contrast to previous publications, this meta-analysis suggests that HCV-5 response to treatment is closer to HCV-1 than to HCV-2/3 and suggests that in Belgium HCV-5 infection should be treated with the same antiviral regimen as HCV-1. [less ▲]

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See detailAre patients with HBV and HCV infection different? Comparison between 2 cohorts of newly diagnosed cases included in prospective registries of the Belgian Association for the Study of the Liver
De Vroey, B.; Moreno, C.; Laleman, W. et al

in Acta Gastro-Enterologica Belgica (2011, March), 74(1), 21

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See detailEffectiveness and tolerability of pegylated interferon alfa2b in combination with ribavirin for treatment of chronic hepatitis C: the PegIntrust study
Van Vlierberghe, H.; Adler, M.; Bastens, B. et al

in Acta Gastro-Enterologica Belgica (2010), 73

Background and study aims : Large international clinical trials conducted in the past 5 years rapidly improved the treatment of chronic hepatitis C; however, it is unclear whether the advances seen in ... [more ▼]

Background and study aims : Large international clinical trials conducted in the past 5 years rapidly improved the treatment of chronic hepatitis C; however, it is unclear whether the advances seen in clinical trials are being paralleled by similar improvements in routine clinical practice. PegIntrust is a Belgian community based trial evaluating the sustained virological response. Patients and Methods : Observational study of 219 patients receiving pegylated interferon alfa-2b (1.5 μg/kg/wk) and weight-based ribavirin (800-1200 mg/day) for 48 weeks. Primary study end point was sustained virological response (SVR), defined as undetectable HCV RNA 6 months after the completion of treatment. Results : In total, 108 patients (49.3 %) had undetectable HCV RNA at the end of therapy, 91 (41.6%) attaining SVR. Of the 111 patients without an end-of-treatment response, 28 were non-responders, and 21 had virological breakthrough. In total, 134 patients attained early virological response (EVR); 88 (65.7%) of those patients attained SVR. In contrast, 82 (96.5 %) of the 85 patients who did not attain EVR also did not attain SVR. Age, fibrosis score and baseline viral load were identified as important predictors of treatment outcome. The most frequently reported serious adverse events resulting in treatment discontinuation were anemia (n = 10), fatigue/asthenia/malaise (n = 6) and fever (n = 3). Conclusion : Our data indicate that treatment of chronic hepatitis C with PEG-IFN alfa-2b plus weight-based ribavirin results in favourable treatment outcomes in a Belgian cohort of patients treated in community- based clinical practice. [less ▲]

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See detailA randomized, open-label, multicenter study evaluating the efficacy of peginterferon alfa-2a versus interferon alfa-2a, in combination with ribavirin, in naïve and relapsed chronic hepatitis C patients.
Nevens, F.; Van Vlierberghe, H.; D'Heygere, F. et al

in Acta Gastro-Enterologica Belgica (2010), 73

Background/Aims : A large multicenter trial to compare the efficacy of peginterferon alfa-2a with interferon alfa-2a, in combination with ribavirin, in chronic hepatitis C patients. Efficacy data for ... [more ▼]

Background/Aims : A large multicenter trial to compare the efficacy of peginterferon alfa-2a with interferon alfa-2a, in combination with ribavirin, in chronic hepatitis C patients. Efficacy data for prior relapsers are reported because treatment recommendations for this patient population are not well defined. Patients and methods : This study was a multicenter, prospective, randomized clinical trial. The primary efficacy endpoint was sustained virologic response in naïve patients (n = 348) and relapsers (n = 95). Results : Sustained virologic response rates were similar in naïve patients and relapsers, both for non-pegylated and pegylated interferon (respectively 27 and 26% and 54 and 43%). Pegylated interferon given for 48 weeks did not improved the relapse rate : 15.9 and 27.3% for non-pegylated and 16.7 and 30.4% for pegylated interferon, naïve vs relapsers respectively. Stepwise logistic regression analysis revealed a significant association between slow response (detectable HCV RNA at week 12 and undetectable at week 24) and relapse in patients with an end-of-treatment response (55% versus 13% respectively ; p = 0.02 ; odds ratio = 6.07). Conclusions : This trial confirms the value of using peginter - feron alfa-2a in both naïve and relapsed patients and provides support for a more tailored approach to treatment for relapsers and particulary for patients with a slow viral response. (Acta gastro enterol. belg., 2010, 73, 223-228). [less ▲]

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See detailA randomized trial of pegylated-interferon alpha 2a plus ribavirin with or without amantadine in treatment-naïve or relapsing chronic hepatitis C patients
Langlet, P.; D'Heygere, F.; Henrion, J. et al

in Alimentary Pharmacology & Therapeutics (2009), 30

Background The combination therapy of pegylated-interferon-a2a plus ribavirin is considered as the standard of care for patients with chronic hepatitis C. A sustained viral response is obtained in 40–50 ... [more ▼]

Background The combination therapy of pegylated-interferon-a2a plus ribavirin is considered as the standard of care for patients with chronic hepatitis C. A sustained viral response is obtained in 40–50% of naı¨ve patients with genotype 1 and in around 80% of naı¨ve patients with genotype 2 or 3. Aim To assess whether amantadine, added to the conventional combination therapy, could improve the treatment efficacy. Methods In all, 630 patients (intent-to-treat population) with chronic hepatitis C were randomized into two groups: 316 patients (treatment group) received pegylated-interferon-a2a (180 lg once weekly) plus ribavirin (1000–1200 mg⁄ daily) with amantadine (200 mg⁄ daily); 314 patients (control group) received pegylated-interferon-a2a (180 lg once weekly) plus ribavirin (1000–1200 mg⁄ daily) without amantadine. The duration of the treatment was 48 weeks for genotypes 1, 4, 5 and 6, and 24 weeks for genotypes 2 and 3. Results There was no statistically significant difference between treatments groups for any of the variables tested for. Subgroups of patients likely to take advantage of the addition of amantadine were not identified. Conclusions This large study definitely excludes the role of amantadine in addition of conventional combination therapy in the treatment of chronic hepatitis C patients. [less ▲]

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See detailManagement and treatment of chronic hepatitis B virus: Belgian Association for the Study of the Liver (BASL) 2007 guidelines
Colle, I.; Adler, M.; Brenard, R. et al

in Acta Gastro-Enterologica Belgica (2007), 70(4), 389-420

1. Introduction Chronic hepatitis B virus (HBV) infection currently affects about 400 million people and is responsible for 500,000 to 1,000,000 deaths annually worldwide from cirrhosis and hepatocellular ... [more ▼]

1. Introduction Chronic hepatitis B virus (HBV) infection currently affects about 400 million people and is responsible for 500,000 to 1,000,000 deaths annually worldwide from cirrhosis and hepatocellular carcinoma (HCC) (1). For this reason, screening high risk populations to identify HBV infected persons is important so that guidelines for treatment and prevention of transmission can be given in this specific group. Recently, new drugs became available for HBV and new insights in resistance and definitions came up. So, the purpose of this paper is providing an update of the recent literature and guidelines concerning 1. screening for chronic hepatitis B (CHB) 2. management of patients with CHB 3. treatment of CHB in mono-infected patients and in special patient populations (co-infected, transplanted and immunosuppressed patients). The recommendations are based onpublished information and the level of evidence is reported with each recommendation. The level of evidence is graded as :grade 1 : randomized controlled trials ; grade II-1 : controlled trials without randomization ; grade 11-2 : cohort or case-control analytic study ; grade 11-3 : multiple time series, dramatic uncontrolled experiments ; grade III : descriptive epidemiology, expert opinions. [less ▲]

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See detailOutcome of patients with hepatocellular carcinoma listed for liver transplantation within the eurotransplant allocation system
Adler, M.; Lerut, J.; Starkel, P. et al

in Journal of Hepatology (2006), 44(Suppl. 2), 14

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See detailThe management of patients with mild hepatitis C
Verslype, C.; Michielsen, P.; Adler, M. et al

in Acta Gastro-Enterologica Belgica (2005), 68(3), 314-318

Infection with the hepatitis C virus (HCV) represents an important public health problem and is a leading cause of chronic hepatitis, cirrhosis and hepatocellular carcinoma. Chronic hepatitis C is a ... [more ▼]

Infection with the hepatitis C virus (HCV) represents an important public health problem and is a leading cause of chronic hepatitis, cirrhosis and hepatocellular carcinoma. Chronic hepatitis C is a heterogeneous disease. Many patients have mild disease at presentation but not all of them will develop advanced liver disease. However, the identification of these patients with mild hepatitis C who will show progressive disease is difficult and is based on histological criteria and the assessment of co-factors (age, alcohol intake, steatosis). In addition, serum transaminases that are persistently normal on several occasions during 18 months may point to a more benign course. Patients with mild hepatitis C should not be excluded "a priori" from the possibility of being treated, as treatment with pegylated interferon and ribavirin is safe and effective in this group. Overall, the decision to initiate therapy should be individualized and based on the severity of the disease by liver biopsy, the potential of serious side effects, the probability of response and the motivation of the patient. [less ▲]

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See detailDaily induction combination treatment with alpha 2b interferon and ribavirin or standard combination treatment in naive chronic hepatitis C patients. A multicentre randomized controlled trial
Van Vlierberghe, H.; Leroux-Roels, G.; Adler, M. et al

in Journal of Viral Hepatitis (2003), 10(6), 460-466

The standard treatment for patients with chronic hepatitis C is a 6-12-month combination therapy with interferon alpha and ribavirin. Induction treatment could result in a faster early decline of the ... [more ▼]

The standard treatment for patients with chronic hepatitis C is a 6-12-month combination therapy with interferon alpha and ribavirin. Induction treatment could result in a faster early decline of the hepatitis C virus (HCV) load and a better response rate. Naive chronically infected HCV patients (n = 454) were randomized into two arms to receive either induction treatment with interferon alpha 2b 5 million units (MU) subcutaneously (s.c.) daily during a period of 8 weeks (arm A); or treatment with interferon alpha 2b 5 MU s.c. three times a week (TIW) for a period of 8 weeks (arm B). After week 8, interferon treatment in both arms was 3 MU s.c. TIW for a total period of 12 months. In both arms, ribavirin (1000-1200 mg orally per day) was added at week 4. Induction treatment resulted in a higher virological response at week 8 of treatment (66%vs 47%; P < 0.01). However, response at the end of treatment and at 6 months follow-up was not different (53%vs 50%, 41%vs 33%). The occurrence of adverse events and the drop-out rate were similar in both arms. Although an early virological response is observed more frequently in the induction treatment, end of treatment response and sustained responses did not differ. [less ▲]

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See detailOne year experience of the Belgian Liver Intestine Comittee (BLIC) intranet database
Lerut, Jan; Roggen, F.; De Hemptinne, Bernard et al

in Acta Gastro-Enterologica Belgica (2001, January), 64(1), 7

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See detailHas disinfection of endoscopes by automatic machines become obligatory?
Delwaide, Jean ULg; Pelckmans, P.; Defrance, P. et al

in Revue Médicale de Bruxelles (1999), 20(1), 49-50

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See detailLa desinfection des endoscopes par machines automatiques est-elle devenue obligatoire?
Delwaide, Jean ULg; Pelckmans, P.; Defrance, P. et al

in Revue Médicale de Bruxelles (1999), 20(1), 49-50

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See detailIs automatic disinfection between each endoscopy mandatory? Jury opinion
Delwaide, Jean ULg; Pelckmans, P.; Defrance, P. et al

in Acta Gastro-Enterologica Belgica (1998), 61(4), 429-430

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