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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 detailCoinfection of hepatitis B and hepatitis Delta virus in Belgiumy: a multicenter BASL Study. Prospective epidemiolog and comparison with HBV mono-infection
Ho, E; Deltenre, P; Nkuize, M et al

in Journal of Medical Virology (2013), 85

Epidemiological data on hepatitis delta virus (HDV) infection in Belgium are lacking. A multicenter questionnaire-based registry on HDV infection was collated between March 1, 2008 and February 28, 2009 ... [more ▼]

Epidemiological data on hepatitis delta virus (HDV) infection in Belgium are lacking. A multicenter questionnaire-based registry on HDV infection was collated between March 1, 2008 and February 28, 2009. It consisted of patients coinfected with hepatitis B virus (HBV) and HDV. The data samples were compared to those of a concurrent registry on HBV infection. Prospective data of patients with HBV–HDV coinfection were collected. Active HBV replication is defined as HBeAg positivity or HBV DNA > 2,000 IU/ml. Forty-four patients from 15 centers were registered. A comparison of 29 patients infected with HDV (registered in the concurrent HBV registry) was made against 785 HBV mono-infected patients. The seroprevalence of patients coinfected with HBV and HDV in Belgium is reported to be 3.7% (29/785), consisting solely of the HBV–HDV coinfected patients in the HBV registry. This rises to 5.5% (44/800) if all patients infected with HDV from the two registries combined are included. The patients coinfected with HBV and HDV had higher (P < 0.05) ALT values and more advanced liver disease (Metavir score F2), but had less active HBV replication and lower HBV DNA titers when compared with the patients infected only with HBV. Additionally, the majority of HBV– HDV coinfected patient was male, and 13.6% (6/ 44) of the patients that were coinfected HBV and HDV were also infected with HCV. In conclusion, this study provided much needed epidemiological data on the current state of HDV infection in Belgium. [less ▲]

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See detailUpdate of the Belgian Association for the Study of the Liver Guidelines for the treatment of chronic hepatitis C genotype 1 with protease inhibitors.
Orlent, H; Deltenre, P; Francque, S et al

in Acta Gastro-Enterologica Belgica (2012), 75(2), 245-259

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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 detailUpper gastrointestinal tract bleeding management: Belgian guidelines for adults and children.
Colle, I.; Wilmer, A.; Le Moine, O. et al

in Acta Gastro-Enterologica Belgica (2011), 74

Upper gastrointestinal bleeding (UGIB) remains a common disease affecting 100 to 170 per 100 000 adults per year and causing thereby a significant burden to healthcare resources. Despite the improvements ... [more ▼]

Upper gastrointestinal bleeding (UGIB) remains a common disease affecting 100 to 170 per 100 000 adults per year and causing thereby a significant burden to healthcare resources. Despite the improvements in the management of this disorder, the associated mortality ranges from 5 to 14 %. Since the general management of UGIB is not uniform, the main objective of this work is to provide guidelines for the care of adults and children presenting with bleeding caused by gastro-duodenal ulcer or variceal rupture. Methods: In the absence of evidence-based recommendations, these guidelines were proposed after expert opinions reconciliation and graded accordingly. They are based on the published literature up to September 2010 and graded according to the class of evidence. Results: The current guidelines for the management of UGIB include recommendations for the diagnostic process, general supportive care, pharmacological therapy aiming at bleeding control, specific and endoscopic treatment of acute bleeding and follow-up for both gastro-duodenal ulcers and portal hypertension induced bleeding. [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 detailDelayed introduction of reduced-dose tacrolimus, and renal function in liver transplantation: the 'ReSpECT' study
Neuberger, J. M.; Mamelok, R. D.; Neuhaus, P. et al

in American Journal of Transplantation (2009), 9(2), 327-336

We report a multicenter, prospective, randomized, open-label trial investigating the effect of lower levels and delayed introduction of tacrolimus on renal function in liver transplant recipients. Adult ... [more ▼]

We report a multicenter, prospective, randomized, open-label trial investigating the effect of lower levels and delayed introduction of tacrolimus on renal function in liver transplant recipients. Adult patients with good renal function undergoing primary liver transplant were randomized to either: group A (standard-dose tacrolimus [target trough levels >10 ng/mL] and corticosteroids; n = 183); group B (mycophenolate mofetil [MMF] 2g/day, reduced-dose tacrolimus [target trough levels </=8 ng/mL], and corticosteroids; n = 170); group C (daclizumab induction, MMF, reduced-dose tacrolimus delayed until the fifth day posttransplant and corticosteroids, n = 172). The primary endpoint was change from baseline in estimated glomerular filtration rate (eGFR) at 52 weeks. The eGFR decreased by 23.61, 21.22 and 13.63 mL/min in groups A, B and C, respectively (A vs C, p = 0.012; A vs B, p = 0.199). Renal dialysis was required less frequently in group C versus group A (4.2% vs. 9.9%; p = 0.037). Biopsy-proven acute rejection rates were 27.6%, 29.2% and 19.0%, respectively. Patient and graft survival was similar. In conclusion, daclizumab induction, MMF, corticosteroids and delayed reduced-dose tacrolimus was associated with less nephrotoxicity than therapy with standard-dose tacrolimus and corticosteroids without compromising efficacy or tolerability. [less ▲]

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See detailEffects of delayed introduction of calcineurin inhibitor on GFR in liver transplant: 12 month data from a multi-centre randomised controlled study
Pirenne, J.; Boon, N.; Colle, I. et al

in Acta Gastro-Enterologica Belgica (2009, January), 72(1), 30

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See detailDiscussion on the risk of surgery in patients with cirrhosis
Colle, I.; Orlent, H.; Delwaide, Jean ULg

in Acta Gastro-Enterologica Belgica (2008), 71(1), 47

Several reasons result in the finding that patients with cirrhosis need surgery more often than other patients groups. Patients with cirrhosis frequently have comorbidities resulting in gastrointestinal ... [more ▼]

Several reasons result in the finding that patients with cirrhosis need surgery more often than other patients groups. Patients with cirrhosis frequently have comorbidities resulting in gastrointestinal, lung or cervical cancer, among others. Independent of cirrhosis, surgical resection may be the best alternative for a number of those malignancies. Comorbidities may also result in an increased incidence of vascular complications (such as lower extremity atherosclerosis and coronary stenosis) sorne of them being potential indications for surgery, Patients with alcohofic cirrhosis are more frequently subjected to trauma and bone fractures. Ascites leads to umbilical hernia which can be strangulated or ruptured. Emergency surgery may be needed in this context. Finally, a significant proportion of patients with cirrhosis develop hepatocellular carcinoma (HCC) during the course of the disease. Surgical resection remains a first line option for HCC. While reliable guidefines have been proposed for surgical resection of HCC and liver transplantation, no precise guidelines are available for other aspects of surgical management during cirrhosis. Specific surgical procedures such as hepatectomy and transplantation are concentrated in highly speciafised centres, where detailed evaluation is relatively easy to obtain. In contrast, more general surgical procedures, either abdominal or non abdominal, are performed in various centres, making it more difficult to obtain detailed evaluation and draw recommendations. General surveys are still needed to precisely assess the risk of non-specifie surgery in patients with cirrhosis, to identify risk factors and to propose reliable guidelines. [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 detailThe HepCar registry: report on a one-year registration program of hepatocellular carcinoma (HCC) in Belgium. What is daily practice in HCC?
Van Vlierberghe, H.; Colle, I.; Henrion, J. et al

in Acta Gastro-Enterologica Belgica (2005), 68(4), 403-411

INTRODUCTION: Due to a rise in HCV induced liver cirrhosis, hepatocellular carcinoma becomes more prevalent in Western European countries. The HepCar registry is an initiative in which patients with ... [more ▼]

INTRODUCTION: Due to a rise in HCV induced liver cirrhosis, hepatocellular carcinoma becomes more prevalent in Western European countries. The HepCar registry is an initiative in which patients with hepatocellular carcinoma, their treatment and follow up are registered. MATERIALS AND METHODS: Belgian physicians were asked to report all new cases of hepatocellular carcinoma which were seen between January 2003 and December 2003. Reporting was done on a voluntary basis. Data reported were: demographic figures, the nature of the underlying liver disease, presentation characteristics of the tumour, laboratory findings and choice of therapy. Every six months, a reminder was sent to determine survival. RESULTS: 131 patients (94 male/37 female) were reported. Mean age was 63 years +/- 13. Underlying liver disease was HCV (n = 54, 41%), HBV (n = 22, 17%), alcoholic liver disease (n = 39, 30%) and miscellaneous (n =16, 12%). Diagnosis of hepatocellular carcinoma was made by surveillance in 47 (36%) patients. After logistic regression, survival was 5 times better for patients inside the Milan criteria (one lesion less than 5 cm in diameter or less than 3 nodules each less than 3 cm in the absence of vascular invasion and metastasis). DISCUSSION: Tumours inside the Milan criteria have a better survival. The majority of the patients have an underlying cirrhosis as background for the development of a HCC. [less ▲]

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See detailGuidelines for the management of chronic hepatitis C in patients infected after substance use
Robaeys, G.; Buntinx, F.; Bottieau, E. et al

in Acta Gastro-Enterologica Belgica (2005), 68(1), 38-45

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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 detailRisk factors for hepatitis C: past, present and future
Delwaide, Jean ULg; Bourgeois, N.; Colle, I. et al

in Acta Gastro-Enterologica Belgica (2002), 65(2), 87-89

Patients at risk for hepatitis C (HCV) are those exposed to a major risk factor (i.e. blood transfusion prior 1990, and intravenous drug abuse), and those exposed to a minor risk factor (sexual, mother-to ... [more ▼]

Patients at risk for hepatitis C (HCV) are those exposed to a major risk factor (i.e. blood transfusion prior 1990, and intravenous drug abuse), and those exposed to a minor risk factor (sexual, mother-to-infant transmission, household contact, nosocomial contamination). The present paper aims to review the current and past modes of transmission of the virus C. [less ▲]

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See detailFactors inftuencing ribavirin-induced hemolysis
Van Vlierberghe, H.; Delanghe, J. R.; De Vos, M. et al

in Journal of Hepatology (2001), 34

BackgroundlAims: One of the major side eft'ects of the combination therapy for chronic hepatitis C is ribavirininduced hemolytic anemia. Little is known about variables inftuencing tbis anemia. Our study ... [more ▼]

BackgroundlAims: One of the major side eft'ects of the combination therapy for chronic hepatitis C is ribavirininduced hemolytic anemia. Little is known about variables inftuencing tbis anemia. Our study tried to search for these variables in a large group of patients with hepatitis C treated with the combination therapy. Methods: Two hundred and forty-four patients chronically infected with the hepatitis C virus were treated either with induction treatment (daily dose ofinterferon) or with a standard treatment (interferon thrice weekly). Both groups received 1000-1200 mg of ribavirin from week 4 until the end of the treatment. The drop in hemoglobin level was defined as the dift'erence between the pretreatment hemoglobin level and the hemoglobin level at week 8. Seventeen variables which could possibly influencê'this drop in hemoglobin level were examined. Results: After multivariate analysis, the drop in hemoglobin level was only significant influenced by pretreatment platelet level, treatment and haptoglobin phenotype. The ribavirin dose did not influence the drop in hemoglobin level or the early virological response. Conclusions: Ribavirin-induced hemolysis is inftuenced by the pretreatment platelet level, the administered amount of a-interferon and the haptoglobin phenotype. A careful search for the minimal dose of ribavirin needed in combination treatment is necessary. [less ▲]

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