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"Chronic hepatitis C virus : lessons from the past, promise for the future documents the monumental advances that have been made in our understanding of chronic HCV during the past decade. The first section reviews the natural history of chronic HCV, how this virus can affect other organs in addition to the liver, and whether treating chronic HCV alters the natural history of this disease. Section 2 reviews the advances that have been made in the treatment of chronic HCV during the past decade with interferon based therapy. Separate chapters on response guided therapy and how to manage the adverse events associated with these medications provide the physician with the concepts required to more effectively treat chronic HCV now and in the future. As the genetics of virologic response have recently been elucidated, a chapter is devoted to helping the clinician understand how genes that modulate disease processes and their treatment are identified and utilized in clinical care. Section 3 deals with the future of HCV treatment and specific inhibitors of HCV. Specific chapters explain how targets for drugs are identified and how drugs are then developed and tested; how mutations of HCV develop and how anti-viral agents will affect this process; the most up to date data regarding the treatment of chronic HCV with peginterferon, ribavirin and anti-viral agents; and the potential to treat chronic HCV with just oral anti-viral agents and without peginterferon and ribavirin in the future. The final section of this book covers issues related to liver transplantation in patients with chronic HCV. Separate chapters review the natural history of chronic HCV in liver transplant recipients and the impact of utilizing HCV positive donors. The volume concludes with chapters that cover the treatment of chronic HCV both prior to and after liver transplantation with potent anti-viral agents. Chronic hepatitis C virus : lessons from the past, promise for the future is a valuable resource for all physicians caring for patients with chronic HCV."

"Chronic hepatitis B is still a major health problem in Indonesia. Unfortunately, to date, treatment of chronic HBV (Hepatitis B virus) infection had not shown satisfactory result. Monotherapy with alpha interferon or lamivudine have been widely used as treatment of chronic HBV. However, treatment response to Alpha interferon in Asian people was not satisfactory (15% - 20%), while monotherapy with lamivudine was not sufficient to eradicate HBV in chronically infected patients and commonly induce drug resistance. The occurrence of chronic hepatitis B resistant to lamivudine had encouraged development of newer agents such as adefovir, entecavir, emtricitabine and nucleoside analog. New therapeutic strategy using combination therapy should be considered if there is no sufficient response to monotherapy"

"Hepatitis C merupakan penyebab penyakit hati kronik yang penting di seluruh dunia termasuk lndonesia. Diperkirakan terdapat 300 juta pembawa virus hepatitis C di seluruh dunia. Pada penelitian yang dilakukan di Indonesia didapatkan prevalensi anti Hepatitis C Virus (anti HCV) berkisar antara 2,1-2,5%.s Penelitian di Jakarta pada tahun 1990 memperlihatkan prevalensi anti HCV pada hepatitis kronik non B sebesar 80,4%. Hepatitis C merupakan jenis hepatitis dengan gejala k1inis yang ringan tapi dengan tingkat kronisitas dan progresifitas yang tinggi ke arah sirosis. Sekitar 70-80% hepatitis C akut akan menjadi kronik dan 20% akan berkembang menjadi sirosis bati.

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Hepatitis C is an important cause of chronic liver disease around the world, including Indonesia. It is estimated that there are 300 million carriers of the hepatitis C virus worldwide. In a study conducted in Indonesia, the prevalence of anti-Hepatitis C Virus (anti-HCV) ranged from 2.1-2.5%.s A study in Jakarta in 1990 showed an anti-HCV prevalence in chronic non-B hepatitis of 80.4%. Hepatitis C is a type of hepatitis with mild k1inis symptoms but with a high degree of chronicity and progression to arabic cirrhosis. About 70-80%. Acute hepatitis C will become chronic and 20% will develop into batic cirrhosis."

"Chronic hepatitis due to hepatitis B virus (HBV) or hepatitis C virus (HCP) is still a major problem in terms of progressive liver damage, prevention and therapy in most parts ofthe world. Unfortunately, to date, there is still no specific and effective therapy for HBV. No therapy can be given to carrier; non-replicative and asymptomatic patients of chronic HBV infection. Lamivudine or alpha-interferon can be used for treatment of compensated chronic hepatitis B infection with significant increase of aminotransferase. Approximately 40 % of patients can have seroconversion with this form of therapy. Chronic hepatitis D virus injection can be treat with alpha-interferon and in the final stage, may undergo liver transplantation. For chronic hepatitis C virus infection, alpha-interferon with ribavirin have been shown to have a better efficacy than afpha-interferon alone where the efficacy can reach 39-49 %."

"Nowadays studies have shown that liver fibrosis is a reversible process. Theraupetic target on Hepatic Stellate Cell (HSC) through inhibition of fibrotic signaling transduction is one of the way to treat liver fibrosis (e.g. pentoxifylline)..."

"Background: Hepatitis B is endemic in Indonesia and treatment response need to be monitored during and after antiviral therapy. Liver stiffness measurement and alanine aminotransferase to platelet ratio index (APRI) are noninvasive method to detect liver fibrosis available in Indonesia. However, little is known about their ability to evaluate treatment response in chronic hepatitis B (CHB) patients in Indonesia. This study aimed to investigate liver stiffness changes by transient elastography (TE) and APRI before and after one year oral antiviral treatment in CHB patients and the correlation between TE and APRI.Methods: this study was retrospective cohort on CHB patients in CiptoMangunkusumo Hospital, Jakarta who uderwent treatment between January 2012 and December 2014. Patients received oral antiviral treatment with newer nucleoside analogues (entecavir or telbivudine) for at least one year. TE and APRI were obtained before and after treatment. TE and APRI reductions were analyzed statistically with Spearmans test.Results: a total of 41 patients were enrolled in this study. Median liver stiffness value was significantly reduced from 10.8 to 5.9 kPa after oral antiviral treatment (p<0.001, Wilcoxons test). Median APRI was also significantly reduced from 1.13 to 0.43 after treatment (p<0.001, Wilcoxons test). The correlation between liver stiffness and APRI before treatment was weak (r=0.40), but it was strong after treatment (r=0.73).Conclusion: the liver stiffness measured with transient elastography and APRI significantly decreased after one year of antiviral treatment in chronic HBV patients. There was a significant correlation between TE and APRI after one year of treatment.

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Latar belakang: prevalensi Hepatitis B di Indonesia masih tinggi dan pengobatan dengan obat antivirus memerlukan pamantauan untuk menilai respons terapi. Salah satu metode pemantauan respons terapi yang non-infasif dan mudah dilakukan di Indonesia adalah dengan pengukuran derajat kekerasan hati atau transient elatography (TE)dan alanine aminotransferase-to-platelet ratio index (APRI) yang merupakan metode alternatif untuk mendeteksi fibrosis hati. Meskipun demikian, akurasinya dalam mengevaluasi respon terapi pada pasien hepatitis B kronik di Indonesia masih belum diketahui. Penelitian ini bertujuan untuk mengetahui perubahan derajat kekerasan hati dengan menggunakan transient elastography (TE) dan APRI sebelum dan setelah terapi antiviral per oral selama satu tahun pada pasien hepatitis B kronik dan korelasi antara TE dan APRI.

Metode: desain penelitian yang digunakan adalah studi kohort retrospektif pada pasien hepatitis B kronik di Rumah Sakit Cipto Mangunkusumo Jakarta yang diberikan terapi selama bulan Januari 2012 hingga Desember 2014. Pasien diberikan antiviral dengan analog nukleosida terbaru (entecavir atau telbivudine) selama minimal satu tahun. TE dan APRI diperiksakan sebelum dan setelah terapi. Reduksi TE dan APRI diuji secara statistik menggunakan korelasi Spearman.

Hasil: penelitian ini mengikutsertakan 41 pasien dan mendapatkan nilai median kekerasan hati berkurang secara signifikan dari 10,8 menjadi 5,9 kPa setelah terapi antiviral per oral (p<0,001, Uji Wilcoxon). Nilai median APRI juga berkurang secara signifikan dari 1,13 menjadi 0,43 setelah terapi (p<0,001, Uji Wilcoxon). Sebelum terapi dimulai nilai korelasi antara derajat kekerasan hati dan APRI menunjukkan hasil 0.40 dan nilai korelasi setelah terapi antiviral menjadi 0,73.

Kesimpulan: derajat kekerasan hati yang diukur menggunakan TE dan APRI berkurang secara signifikan setelah terapi antiviral selama satu tahun pada pasien hepatitis B kronik.Terdapat korelasi yang signifikan antara TE dan APRI."

"Aim: To investigate the expression CD4+ T cell and CD8+ T cell as well as TNF-a and INF-7 level on Citron ic hepatitis C. Methods: This is a cross-sectional study. Forty patients with chronic hepatitis C based on laboratory examination, who were collected from blood transition centers at Dn M. Djamil Hospital. The control group used forty healthy samples. Results: There were 40 chronic hepatitis C cases satisfying the inclusion criteria. We found that CD4+ T cells count 50.35 + 3.1 8%; CD8+ T cells count 59.37 + 3.52%; TNF-a level 22.03 :t 3.?2 pg/ml and INF-7 level 4.47 + 1.47 pg/ml. Conclusion: The chronic infection hepatitis C virus have given the effects on the immunocompetent cells which increased of CD4+, CD8+, TNF-a level and INF-y level."