Showing papers by "Nassim Kamar published in 2003"

Evidence that Clearance of Hepatitis C Virus RNA after α-Interferon Therapy in Dialysis Patients Is Sustained after Renal Transplantation

Abstract: To date, there is no available treatment of hepatitis C virus (HCV) infection after renal transplantation (RT). Among 55 anti-HCV-positive/HCV RNA-positive hemodialysis patients who were treated with IFN-alpha (9 MU/wk during 6 or 12 mo), 21 of them (38%) had a sustained virologic response. Of these, 16 (76%) underwent RT 38 mo (range, 2 to 57 mo) after alpha-IFN therapy. There were 13 men and 3 women aged 46 yr (range, 27 to 68 yr). At RT, HCV serology was still positive in 15 patients, and HCV viremia was negative in all patients. Immunosuppression relied on anticalcineurin agents with or without steroids and/or antimetabolites; in addition, 12 of them received induction therapy with antithymocyte globulins. At the last follow-up after RT, at 22.5 mo (range, 2 to 88 mo), HCV viremia remained negative in all patients. Moreover, HCV RNA was not present in peripheral blood mononuclear cells when assessed in eight patients. HCV serology was found to be still positive in 13 patients. Three patients presented with acute rejection, one presented with a suppurative lymphocele, one died from a sepsis, and four presented with a cytomegalovirus infection. None of them developed posttransplant diabetes mellitus. In conclusion, hemodialysis patients waiting for a RT need to be treated with alpha-IFN because when HCV RNA clearance occurred, they experienced no relapse after transplantation despite chronic immunosuppressive treatment.

Evolution of hepatitis C virus quasispecies in renal transplant patients with de novo glomerulonephritis.

Abstract: Long-term renal allograft survival in kidney transplant recipients infected by hepatitis C virus (HCV) may be influenced by the occurrence of de novo glomerulopathy associated with this virus. Therefore, we studied the evolution of HCV quasispecies in kidney transplant recipients infected by HCV with or without de novo glomerulopathy. The hypervariable region 1 (HVR-1) of the virus envelope was analyzed by cloning and sequencing 20 clones per sample to assess complexity and diversity from six kidney transplant patients who developed de novo glomerulopathy (group I) matched to six kidney transplant recipients without glomerular disease (group II), according to age, time since renal transplantation, and HCV genotype. Two sera were analyzed for each patient: one at the time of renal transplantation and the other at the time of appearance of de novo glomerulopathy, or after a similar duration since transplantation in group II. Overall, there was a significant increase of HCV viremia after the transplantation. This increase did not differ significantly between group I (+0.5 log copies/ml) and group II patients (+1 log copies/ml). The intersample diversity of HCV was similar in the two groups. Complexity and viral diversity were also similar at the time of transplantation. By contrast, complexity, diversity, and the proportion of nonsynonymous substitutions per nonsynonymous site were significantly higher after transplantation in group I patients. Our findings suggest a higher immune response and/or a particular cytokine production in patients developing de novo glomerulopathy rather than a direct effect of HCV on renal cells. J. Med. Virol. 69:482–488, 2003. © 2003 Wiley-Liss, Inc.

Hepatitis C infection among patients receiving hemodialysis

Abstract: In France, the prevalence of hepatitis C virus (HCV) infection in chronic hemodialysis patients is high, about 15 to 42%. Although the incidence and the prevalence of HCV infection decreased during the last decade, de novo cases of HCV infection still occur in hemodialysis units. To date the nosocomial transmission is the principal cause of contamination. The strict application of universal precautions and the separation of chronic hemodialysis patients according to their virological status may decrease the incidence of HCV infection in hemodialysis units. The transaminase level and HCV viremia are lower in chronic hemodialysis patients than that in the general population. Liver disease seems also to be less aggressive. Chronic hemodialysis patients presenting acute hepatitis C infection and those waiting for renal transplantation have to be treated by interferon-alpha (IFN-alpha), since the virological response is elevated and sustained. In case of cirrhosis or severe liver disease, a combined liver-kidney transplantation can be proposed after IFN-alpha therapy. Finally, in chronic hemodialysis who are not candidate for renal transplantation IFN-alpha therapy can be discussed according the patients' age and general health status.

Is there a place for ribavirin in the treatment for renal transplant patients infected by hepatitis C virus

Abstract: Le traitement par interferon-a des transplantes renaux infectes par le virus de l'hepatite C (VHC (+)), a ete associe a un nombre eleve de rejets aigus. Nous avons evalue l'efficacite et la tolerance d'un traitement d'un an par ribavirine seule chez seize transplantes renaux VHC (+), apparies a trente-deux transplantes renaux VHC (+) n'ayant recu aucun traitement anti-viral. La dose initiale de 1000 mg/jour a secondairement ete adaptee, au besoin, en fonction du taux d'hemoglobine. En fin d'etude, une monotherapie par ribavirine a ete associee a une basse significative des taux d'ASAT, d'ALAT et de γ-GT. La creatininemie a baisse sans atteindre le seuil de significativite statistique. Lorsqu'une proteinurie etait presente (n = 5), celle-ci a regresse ou disparu. La viremie du VHC est restee stable. L'analyse histologique des biopsies hepatiques a montre une progression de la fibrose hepatique, sans amelioration du score d'inflammation. Il existait une baisse significative du taux d'hemoglobine, malgre un soutien par de fortes doses d'erythropoitine recombinante. La ribavirine a ete arretee chez trois patients. Dans le groupe controle, il existait une augmentation significative des taux d'ALAT et de creatininemie apres un an de suivi. La proteinurie a regresse uniquement chez deux patients sur douze. En conclusion, douze mois de traitement par ribavirine seule chez les transplantes renaux VHC (+) n'entraine pas d'amelioration de l'histologie hepatique bien qu'il y ait une baisse significative des enzymes hepatiques. Son effet sur la fonction renale reste indetermine en dehors d'une diminution patente de la proteinurie quand elle est presente.