The Experts below are selected from a list of 43212 Experts worldwide ranked by ideXlab platform
Michael Boeckh - One of the best experts on this subject based on the ideXlab platform.
-
influenza infections after hematopoietic stem cell transplantation risk factors mortality and the effect of Antiviral Therapy
Clinical Infectious Diseases, 2004Co-Authors: Garrett W Nichols, Katherine A Guthrie, Lawrence Corey, Michael BoeckhAbstract:Background. Community-acquired respiratory viruses, such as influenza virus, are thought to be major causes of morbidity and mortality in patients who had undergone hematopoietic stem cell transplantation (HSCT). Risk factors for acquisition, progression to pneumonia, and the effect of Antiviral Therapy are unknown. Methods. We reviewed records from patients with documented influenza over 12 consecutive respiratoryvirus infection seasons at a single transplantation center. Results. From 1 September 1989 through 31 March 2002, influenza virus was isolated from 62 of 4797 persons undergoing HSCT (1.3%); 44 patients had upper respiratory tract infections (URIs) alone, and 18 developed pneumonia. Among patients with influenza virus infection, pneumonia developed more commonly among those infected earlier after transplantation (median, 36 vs. 61 days, ) and those with concurrent lymphopenia. P p .04 Of the 51 cases that were initially diagnosed as URIs, 17 were treated with Antivirals, and 34 were not treated. Six untreated patients (18%) developed pneumonia, whereas 1 (13%) of 8 patients treated with rimantadine and 0 of 9 treated with oseltamivir developed pneumonia. The duration of influenza virus shedding was longer in patients treated with steroid doses of 11 mg/kg than among those treated with doses of !1 mg/kg (mean, 15 vs. 9 days); there was a trend towards decreased shedding with oseltamivir Therapy (but not rimantadine Therapy) after controlling for steroid use ( ). The 30-day mortality rate was highest among patients who had progression to P ! .08 pneumonia (5 [28%] of 18 patients); pulmonary copathogens (such as Aspergillus fumigatus) were commonly isolated. Conclusions. Influenza virus infection is an important cause of mortality early after HSCT. Our nonrandomized data suggest that early Antiviral Therapy with neuraminidase inhibitors may prevent progression to pneumonia and decrease viral shedding, which may prevent both influenza-related death in index patients and nosocomial transmission to others.
-
parainfluenza virus infections after hematopoietic stem cell transplantation risk factors response to Antiviral Therapy and effect on transplant outcome
Blood, 2001Co-Authors: Garrett W Nichols, Lawrence Corey, Ted Gooley, Chris Davis, Michael BoeckhAbstract:Parainfluenza virus (PIV) infections may be significant causes of morbidity and mortality in patients undergoing stem cell transplantation, but data regarding their impact on transplant-related mortality is limited. This study sought to determine the risk factors of PIV acquisition and progression to lower respiratory tract infection, their impact on transplant-related mortality, and the effectiveness of Antiviral Therapy. A total of 3577 recipients of hematopoietic stem cell transplantation (HSCT) between 1990 and 1999 were studied. PIV infections occurred in 253 patients (7.1%); 78% of these infections were community acquired. Multivariable analysis identified the receipt of an unrelated transplant as the only risk factor for PIV acquisition; the dose of corticosteroids at the time of PIV infection acquisition was the primary factor associated with the development of PIV-3 pneumonia, both among allogeneic and autologous HSCT recipients. Both PIV-3 upper respiratory infection and pneumonia were associated with overall mortality. Pulmonary copathogens were isolated from 29 patients (53%) with pneumonia. Mortality was highly influenced by the presence of copathogens and the need for mechanical ventilation. Aerosolized ribavirin with or without intravenous immunoglobulin did not appear to alter mortality from PIV-3 pneumonia, nor did such Therapy decrease the duration of viral shedding from the nasopharynx among patients with pneumonia. Corticosteroid administration thus drives the development of PIV pneumonia in a dose-dependent fashion, even among autologous HSCT recipients. Both upper and lower tract PIV infections are predictors of mortality after HSCT. Currently available Antiviral Therapy appears to be inadequate in reducing viral shedding or mortality once pneumonia is established.
Xavier Forns - One of the best experts on this subject based on the ideXlab platform.
-
evaluation of a portable hemoglobinometer hemocue to control anemia in hepatitis c liver transplant recipients undergoing Antiviral Therapy
European Journal of Gastroenterology & Hepatology, 2011Co-Authors: Zoe Marino, J A Carrion, Josep Lluis Bedini, Gonzalo Crespo, Stella M Martinez, J M Sancheztapias, Xavier Forns, Miquel NavasaAbstract:Background Monitoring of anemia, the most frequent side-effect of Antiviral Therapy in hepatitis C virus (HCV)-infected liver transplant recipients, requires frequent blood tests and medical visits. Aims The primary aim of this study was to assess the usefulness and the accuracy of a portable hemoglobinometer (HemoCue) in patients receiving Antiviral Therapy after liver transplantation due to severe hepatitis C recurrence in the graft. The secondary aim was to evaluate the usefulness of this device in terms of cost-saving and time-saving benefits. Methods Multiple simultaneous hemoglobin measurements were obtained in venous blood by the reference method (ADVIA 120) and in capillary blood using HemoCue in 16 patients receiving Antiviral Therapy after liver transplantation. In addition, paired HemoCue measurements were taken to assess the reproducibility of this method, and correlation coefficients (CC) were calculated between them. Time requirements and cost of both procedures were recorded and compared. Results HemoCue showed an excellent reproducibility (CC 0.92) and very high correlation with the standard method (CC 0.89). Its accuracy in detecting anemia (hemoglobin ≤10 mg/dl) was excellent as well (area under the receiver operator characteristic curve, 0.96). The application of HemoCue in this cohort of patients resulted in a significant reduction in the economical expense and labor (i.e., time) per patient during follow-up. Conclusion HemoCue is accurate and reproducible in measuring hemoglobin levels, and could be effectively used in this cohort of patients to control anemia during Antiviral Therapy. It could also help to reduce both overall costs and displacements, thereby improving the quality of life of these patients.
-
efficacy of Antiviral Therapy on hepatitis c recurrence after liver transplantation a randomized controlled study
Gastroenterology, 2007Co-Authors: J A Carrion, Gonzalo Crespo, Miquel Navasa, Montserrat Garcia Retortillo, Juan Carlos Garcia Pagan, M Bruguera, Jaime Bosch, Xavier FornsAbstract:Background & Aims: Recurrence of hepatitis C virus (HCV) infection is a relevant problem of liver transplantation programs. We evaluated the effect of Antiviral Therapy on disease progression in 81 HCV-infected liver transplantation recipients. Methods: Patients with mild hepatitis C recurrence (fibrosis stage F0 to F2, n=54) were randomized to no treatment (group A, n=27) or peginterferon alfa-2b/ribavirin for 48 weeks (group B, n=27). Patients with severe recurrence (F3 to F4, cholestatic hepatitis) were treated (group C, n=27). All patients (n = 81) underwent a liver biopsy at baseline and after follow-up; paired hepatic venous pressure gradient (HVPG) measurements were available in 51 patients. Results: Thirteen (48%) patients of group B and 5 (18.5%) of group C achieved sustained virological response. Liver fibrosis progressed ≥1 stage in 40 (49%) of 81 patients: 19 (70%) of group A versus 7 (26%) of group B ( P = .001) and in 14 (54%) of group C. HVPG increased (6.5 to 13 mm Hg, P P = .017) or remained unchanged in those with fibrosis improvement or stabilization, respectively. The only variable independently associated with fibrosis improvement/stabilization was treatment (odds ratio [OR] =3.7, 95% confidence interval [CI] 1.3 to 10, P = .009). Among treated patients, alanine aminotransferase (ALT) normalization and viral clearance were independently associated with histological or hemodynamic improvement/stabilization (OR 5.3, 95% CI 1.5 to 18, P P = .01; respectively). Conclusions: Our data demonstrate that in liver transplantation recipients, Antiviral Therapy slows disease progression (particularly in sustained virological responders), as shown by its effects on liver histology and on HVPG.
-
Antiviral Therapy of patients with decompensated cirrhosis to prevent recurrence of hepatitis c after liver transplantation
Journal of Hepatology, 2003Co-Authors: Xavier Forns, Miquel Navasa, M Garciaretortillo, Trinidad Serrano, Anna Feliu, Francisco Suarez, Manuel De La Mata, Juan Carlos Garciavaldecasas, Antoni Rimola, J RodesAbstract:Abstract Background/Aims : After liver transplantation (LT) infection of the graft with the hepatitis C virus (HCV) is almost universal and chronic hepatitis and cirrhosis develop in a significant proportion of patients. One of the possible strategies to prevent HCV infection recurrence is to eradicate HCV before LT. Methods : We evaluated the efficacy and safety of Antiviral Therapy to prevent HCV recurrence in 30 HCV-cirrhotic patients awaiting LT. At the time of inclusion 15 patients were Child–Pugh A and 15 Child–Pugh B/C. The infecting genotype was 1b in 25 patients. Treatment with interferon α-2b 3 MU/day and ribavirin 800 mg/day was initiated when the expected time for LT was less than 4 months and continued until LT. The median duration of treatment was 12 weeks. Results : Nine patients (30%) achieved a virological response and 21 did not respond to Therapy. In nine (43%) of the 21 non-responders viral load decreased \ ge 2 log 10 during treatment. A viral load decrease \ ge 2 log 10 at week 4 of treatment was the strongest predictor of virological response. All nine virological responders have already undergone LT; six patients remain free of infection after a median follow-up of 46 weeks and HCV infection recurred in three patients after LT. In one of these patients HCV-RNA was still detectable in the explanted liver. Side effects were frequent and dose reduction was necessary in 19 (63%) of the 30 patients; no patient died while on Therapy. Conclusions : Our data support the utilization of Antiviral Therapy in HCV-infected patients awaiting LT as one of the strategies to prevent hepatitis C recurrence after transplantation.
Christina J Flaxel - One of the best experts on this subject based on the ideXlab platform.
-
combination systemic and intravitreal Antiviral Therapy in the management of acute retinal necrosis syndrome an american ophthalmological society thesis
Transactions of the American Ophthalmological Society, 2013Co-Authors: Christina J Flaxel, Andreas K LauerAbstract:Purpose: To compare the outcomes of combination systemic and intravitreal Antiviral Therapy vs systemic Antiviral Therapy alone for treating acute retinal necrosis syndrome (ARN). We hypothesize that combination Therapy might result in superior visual acuity (VA) and retinal detachment (RD) outcomes vs traditional systemic Antiviral Therapy alone.
-
primary treatment of acute retinal necrosis with oral Antiviral Therapy
Ophthalmology, 2006Co-Authors: Geoffrey G Emerson, Justine R Smith, David J Wilson, James T Rosenbaum, Christina J FlaxelAbstract:Purpose To explore the possibility of oral Antiviral Therapy in lieu of intravenous acyclovir for treating acute retinal necrosis (ARN), a necrotizing retinopathy caused by herpes simplex virus type 1 or 2 or by varicella zoster virus. Design Retrospective, interventional, small case series. Participants Four patients (6 eyes). Methods Patients were treated with oral Antiviral Therapy. Medications included valacyclovir (1 g 3 times daily), oral famciclovir (500 mg 3 times daily), and topical and oral corticosteroids. Main Outcome Measures Improvement of symptoms, including photophobia, blurred vision, ocular discomfort, and floaters; increase in visual acuity; and resolution of vitreitis, retinitis, and retinal vasculitis, where present. Results Symptoms and visual acuity improved within 2 weeks to 1 month in 3 of 4 patients (75%) treated with oral Antiviral medication. One patient required surgical treatment for asymptomatic retinal detachment after 3 weeks of treatment; retinal detachment in the fellow eye was repaired 2 months later. Duration of Antiviral Therapy ranged from 5 weeks to 3 months. Conclusions For 4 patients with relatively indolent cases of ARN, oral Antiviral Therapy alone was effective in eliminating signs and symptoms of the disease. In particular, oral valacyclovir and famciclovir appeared to be effective, although further study is necessary to determine whether these drugs are as effective as intravenous acyclovir for initial treatment of ARN.
Garrett W Nichols - One of the best experts on this subject based on the ideXlab platform.
-
influenza infections after hematopoietic stem cell transplantation risk factors mortality and the effect of Antiviral Therapy
Clinical Infectious Diseases, 2004Co-Authors: Garrett W Nichols, Katherine A Guthrie, Lawrence Corey, Michael BoeckhAbstract:Background. Community-acquired respiratory viruses, such as influenza virus, are thought to be major causes of morbidity and mortality in patients who had undergone hematopoietic stem cell transplantation (HSCT). Risk factors for acquisition, progression to pneumonia, and the effect of Antiviral Therapy are unknown. Methods. We reviewed records from patients with documented influenza over 12 consecutive respiratoryvirus infection seasons at a single transplantation center. Results. From 1 September 1989 through 31 March 2002, influenza virus was isolated from 62 of 4797 persons undergoing HSCT (1.3%); 44 patients had upper respiratory tract infections (URIs) alone, and 18 developed pneumonia. Among patients with influenza virus infection, pneumonia developed more commonly among those infected earlier after transplantation (median, 36 vs. 61 days, ) and those with concurrent lymphopenia. P p .04 Of the 51 cases that were initially diagnosed as URIs, 17 were treated with Antivirals, and 34 were not treated. Six untreated patients (18%) developed pneumonia, whereas 1 (13%) of 8 patients treated with rimantadine and 0 of 9 treated with oseltamivir developed pneumonia. The duration of influenza virus shedding was longer in patients treated with steroid doses of 11 mg/kg than among those treated with doses of !1 mg/kg (mean, 15 vs. 9 days); there was a trend towards decreased shedding with oseltamivir Therapy (but not rimantadine Therapy) after controlling for steroid use ( ). The 30-day mortality rate was highest among patients who had progression to P ! .08 pneumonia (5 [28%] of 18 patients); pulmonary copathogens (such as Aspergillus fumigatus) were commonly isolated. Conclusions. Influenza virus infection is an important cause of mortality early after HSCT. Our nonrandomized data suggest that early Antiviral Therapy with neuraminidase inhibitors may prevent progression to pneumonia and decrease viral shedding, which may prevent both influenza-related death in index patients and nosocomial transmission to others.
-
parainfluenza virus infections after hematopoietic stem cell transplantation risk factors response to Antiviral Therapy and effect on transplant outcome
Blood, 2001Co-Authors: Garrett W Nichols, Lawrence Corey, Ted Gooley, Chris Davis, Michael BoeckhAbstract:Parainfluenza virus (PIV) infections may be significant causes of morbidity and mortality in patients undergoing stem cell transplantation, but data regarding their impact on transplant-related mortality is limited. This study sought to determine the risk factors of PIV acquisition and progression to lower respiratory tract infection, their impact on transplant-related mortality, and the effectiveness of Antiviral Therapy. A total of 3577 recipients of hematopoietic stem cell transplantation (HSCT) between 1990 and 1999 were studied. PIV infections occurred in 253 patients (7.1%); 78% of these infections were community acquired. Multivariable analysis identified the receipt of an unrelated transplant as the only risk factor for PIV acquisition; the dose of corticosteroids at the time of PIV infection acquisition was the primary factor associated with the development of PIV-3 pneumonia, both among allogeneic and autologous HSCT recipients. Both PIV-3 upper respiratory infection and pneumonia were associated with overall mortality. Pulmonary copathogens were isolated from 29 patients (53%) with pneumonia. Mortality was highly influenced by the presence of copathogens and the need for mechanical ventilation. Aerosolized ribavirin with or without intravenous immunoglobulin did not appear to alter mortality from PIV-3 pneumonia, nor did such Therapy decrease the duration of viral shedding from the nasopharynx among patients with pneumonia. Corticosteroid administration thus drives the development of PIV pneumonia in a dose-dependent fashion, even among autologous HSCT recipients. Both upper and lower tract PIV infections are predictors of mortality after HSCT. Currently available Antiviral Therapy appears to be inadequate in reducing viral shedding or mortality once pneumonia is established.
Miquel Navasa - One of the best experts on this subject based on the ideXlab platform.
-
evaluation of a portable hemoglobinometer hemocue to control anemia in hepatitis c liver transplant recipients undergoing Antiviral Therapy
European Journal of Gastroenterology & Hepatology, 2011Co-Authors: Zoe Marino, J A Carrion, Josep Lluis Bedini, Gonzalo Crespo, Stella M Martinez, J M Sancheztapias, Xavier Forns, Miquel NavasaAbstract:Background Monitoring of anemia, the most frequent side-effect of Antiviral Therapy in hepatitis C virus (HCV)-infected liver transplant recipients, requires frequent blood tests and medical visits. Aims The primary aim of this study was to assess the usefulness and the accuracy of a portable hemoglobinometer (HemoCue) in patients receiving Antiviral Therapy after liver transplantation due to severe hepatitis C recurrence in the graft. The secondary aim was to evaluate the usefulness of this device in terms of cost-saving and time-saving benefits. Methods Multiple simultaneous hemoglobin measurements were obtained in venous blood by the reference method (ADVIA 120) and in capillary blood using HemoCue in 16 patients receiving Antiviral Therapy after liver transplantation. In addition, paired HemoCue measurements were taken to assess the reproducibility of this method, and correlation coefficients (CC) were calculated between them. Time requirements and cost of both procedures were recorded and compared. Results HemoCue showed an excellent reproducibility (CC 0.92) and very high correlation with the standard method (CC 0.89). Its accuracy in detecting anemia (hemoglobin ≤10 mg/dl) was excellent as well (area under the receiver operator characteristic curve, 0.96). The application of HemoCue in this cohort of patients resulted in a significant reduction in the economical expense and labor (i.e., time) per patient during follow-up. Conclusion HemoCue is accurate and reproducible in measuring hemoglobin levels, and could be effectively used in this cohort of patients to control anemia during Antiviral Therapy. It could also help to reduce both overall costs and displacements, thereby improving the quality of life of these patients.
-
efficacy of Antiviral Therapy on hepatitis c recurrence after liver transplantation a randomized controlled study
Gastroenterology, 2007Co-Authors: J A Carrion, Gonzalo Crespo, Miquel Navasa, Montserrat Garcia Retortillo, Juan Carlos Garcia Pagan, M Bruguera, Jaime Bosch, Xavier FornsAbstract:Background & Aims: Recurrence of hepatitis C virus (HCV) infection is a relevant problem of liver transplantation programs. We evaluated the effect of Antiviral Therapy on disease progression in 81 HCV-infected liver transplantation recipients. Methods: Patients with mild hepatitis C recurrence (fibrosis stage F0 to F2, n=54) were randomized to no treatment (group A, n=27) or peginterferon alfa-2b/ribavirin for 48 weeks (group B, n=27). Patients with severe recurrence (F3 to F4, cholestatic hepatitis) were treated (group C, n=27). All patients (n = 81) underwent a liver biopsy at baseline and after follow-up; paired hepatic venous pressure gradient (HVPG) measurements were available in 51 patients. Results: Thirteen (48%) patients of group B and 5 (18.5%) of group C achieved sustained virological response. Liver fibrosis progressed ≥1 stage in 40 (49%) of 81 patients: 19 (70%) of group A versus 7 (26%) of group B ( P = .001) and in 14 (54%) of group C. HVPG increased (6.5 to 13 mm Hg, P P = .017) or remained unchanged in those with fibrosis improvement or stabilization, respectively. The only variable independently associated with fibrosis improvement/stabilization was treatment (odds ratio [OR] =3.7, 95% confidence interval [CI] 1.3 to 10, P = .009). Among treated patients, alanine aminotransferase (ALT) normalization and viral clearance were independently associated with histological or hemodynamic improvement/stabilization (OR 5.3, 95% CI 1.5 to 18, P P = .01; respectively). Conclusions: Our data demonstrate that in liver transplantation recipients, Antiviral Therapy slows disease progression (particularly in sustained virological responders), as shown by its effects on liver histology and on HVPG.
-
Antiviral Therapy of patients with decompensated cirrhosis to prevent recurrence of hepatitis c after liver transplantation
Journal of Hepatology, 2003Co-Authors: Xavier Forns, Miquel Navasa, M Garciaretortillo, Trinidad Serrano, Anna Feliu, Francisco Suarez, Manuel De La Mata, Juan Carlos Garciavaldecasas, Antoni Rimola, J RodesAbstract:Abstract Background/Aims : After liver transplantation (LT) infection of the graft with the hepatitis C virus (HCV) is almost universal and chronic hepatitis and cirrhosis develop in a significant proportion of patients. One of the possible strategies to prevent HCV infection recurrence is to eradicate HCV before LT. Methods : We evaluated the efficacy and safety of Antiviral Therapy to prevent HCV recurrence in 30 HCV-cirrhotic patients awaiting LT. At the time of inclusion 15 patients were Child–Pugh A and 15 Child–Pugh B/C. The infecting genotype was 1b in 25 patients. Treatment with interferon α-2b 3 MU/day and ribavirin 800 mg/day was initiated when the expected time for LT was less than 4 months and continued until LT. The median duration of treatment was 12 weeks. Results : Nine patients (30%) achieved a virological response and 21 did not respond to Therapy. In nine (43%) of the 21 non-responders viral load decreased \ ge 2 log 10 during treatment. A viral load decrease \ ge 2 log 10 at week 4 of treatment was the strongest predictor of virological response. All nine virological responders have already undergone LT; six patients remain free of infection after a median follow-up of 46 weeks and HCV infection recurred in three patients after LT. In one of these patients HCV-RNA was still detectable in the explanted liver. Side effects were frequent and dose reduction was necessary in 19 (63%) of the 30 patients; no patient died while on Therapy. Conclusions : Our data support the utilization of Antiviral Therapy in HCV-infected patients awaiting LT as one of the strategies to prevent hepatitis C recurrence after transplantation.