Chronic Hepatitis В DISCUSSION

It is estimated that there are 2 billion HBV sufferers and >350 million HBV carriers throughout the world. Despite the strong polyclonal and multispe-cific CTL and TH1 response in patients who totally recovered from acute hepatitis B, the same responses were either nonexistent, limited or very weak in chronic HBV carriers. Also, it was reported that cytokine production occurring as a result of antigen stimulation was very inadequate in CHB patients.

Interferon-alpha treatment, which has antiviral and immunostimulant properties, maintains a stable response only in one-third of the hepatitis-B patients. A nucleoside analog—lamivudine—prevents HBV replication. However, since it was ineffective over circular covalently closed HBV-DNA, relapse was inevitable in short-term treatments. In long-term treatment, due to resistant viral variant development, breakthroughs were commonly observed. For this purpose, alternative treatment solutions were constantly investigated in CHB. Make your pharmacy dollar go further cialis super active

The target of therapeutic vaccination and levamisole treatments in CHB patients is to stimulate or maintain immune response. We investigated the effects of levamisole and HBsAg vaccine on viral indicators in CHB and inactive HBsAg carrier patients. After a three-month-long treatment period, we observed a HBV-DNA loss in six (10%) of the 63 patients who showed high levels of HBV-DNA before therapy. We also found a loss of HBeAg in 17 (34%) of 50 HBeAg-positive patients. Ten (20%) of them had HBeAg sero-conversion, and in two patients there was HBsAg sero-conversion. We found normal values in 15 (30%) of the 50 patients that showed high levels of transaminase before therapy, and nine patients were found to have higher ALT levels than in the pretreatment results.

Pol et al. applied three doses of Gen Hevac В treatment to 46 chronic hepatitis HBsAg carriers, and according to the tests performed after six months, eight patients (17%) were shown to have a decreased viral load. Twelve patients (26%) recorded a HBV-DNA loss. Again, Pol et al., in one of their subsequent studies, administered Pre S2/S (Gen Hevac B) or Pre S (Recombivax) vaccines to 81/118 chronic hepatitis-naive patients and used 37 patients as a control. After three months of standard treatment, the HBV-DNA value of the vaccinated group was found to be lower than that of the control group (16.3% vs. 2.7%). Moreover, the HBeAg sero-conversion rate was higher in the vaccinated group (13.6% vs. 3.6%). Furthermore, interferon alpha was reported to be effective in combined application with vaccine. Helvaci et al. compared interferon-alpha monotherapy with vaccine interfer-on-alpha combined therapy in 50 naive infant patients suffering from chronic active hepatitis В and reported HBV-DNA and ALT values to be lower after combined therapy. Senturk et al. determined HBV-DNA loss in six patients (24%), after a course of vaccine therapy in 25 chronic active naive patients. They reported a 50% continuous response in patients that they applied interferon-plus-vaccine combined group therapy. The response rate of the vaccinated group was stated to be 46%. However, there are also studies indicating the ineffectiveness of vaccine therapy. Dikici et al. reported that there appeared to be no differences based on the results of examinations performed in the sixth and 12th months, in terms of HBV-DNA loss, HBeAg and HBsAg sero-conversion between 43 vaccinated patients and 31 untreated patients from among 71 CHB cases in the immunotolerance phase with a normal aminotransferase level and a high viral load. In the vaccinated group, only one patient was reported to manifest HBsAg sero-conversion and only one HBeAg negativity was recorded in another patient. No HBeAg sero-conversion was reported. Yalgin et al. applied three doses of Gen Hevac В therapy to 31 healthy HBsAg carriers and at the end of the treatment three cases (10%) of HBsAg sero-conversion were observed. However, no sero-conversion was found among the untreated patients. It was also reported that vaccine therapy did not cause more virus elimination than interferon alpha and lamivu-dine. It was pointed out that the vaccine decreased the infection activity more quickly and it had other advantages, such as cost-effectiveness and an easily applicable pattern. Going without your pills? Buy cheap levitra professional online

Levamisole produces an immunostimulant effect by proliferating the natural killer cells, which kill T lymphocytes, virus-infected cells and tumor cells. It is reported to increase the antibody response in hemodialysis patients whose response to hepatitis-B vaccination is inadequate. There are reports in previous publications indicating the effectiveness of levamisole on CHB therapy. Fattovich et al. reported a 60% HBeAg negativity and 90% HBV-DNA loss at the end of their study of a 12-month treatment applied with a placebo control group to chronic active hepatitis patients. In the placebo control group, HBeAg negativity was 40% and HBV-DNA loss was 37.5%. At the end of the therapy, liver biopsies of the group receiving levamisole revealed greater histological healing. In another study, per­formed on eight children by administering levamisole for 6-18 months, the normalization of transaminase levels, HBeAg and HBV-DNA loss, and disappearance of HBeAg from the liver were reported. It is recorded that if interferon has no effect on CHB, levamisole treatment may be considered since it is inexpensive and yet effective. Krastev et al. reported three HBeAg sero-conversions, 10 HBV-DNA losses and 16 HBeAg negativities as a result of levamisole therapy for 12 months after interferon therapy had produced negative results in 25 viral hepatitis-B patients. It was reported that levamisole plus interferon-alpha therapy in CHB patients had no advantages; on the contrary, the side effects from this treatment were intensified. Make your pharmacy dollar go further and buy cialis professional online

In our study, we found less HBV-DNA loss than in the vaccination and levamisole therapies previously administered, and the results were positive. In certain cases, an increase in viral loads and ALT levels were observed. We think that this condition is the result of the hepatocellular caused by the immune response inflicted by levamisole and vaccine in our patients. The significant elevation of the HBV-DNA may occur in patients treated with immunostimulant drugs. The HBV-DNA and ALT elevation is presumed to be the destruction of infected hepatocytes and then the release of virus particles into the blood stream in early periods of the treatment. We also think the underlying cause of our results is because we started our testing early (in the third month). In some other studies performed with levamisole and interferon alpha, an increase in the viral load and ALT in the early period was also mentioned. Previous studies mostly indicated the values shown after 6-12 months. This could also be considered in the case of our own research. Although our study seems to have negative results according to previous ones, it is significant to find HBeAg loss, anti-HBeAg response and HBV-DNA loss in our patients. We can expect better results after longer periods.
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In summary, levamisole and vaccine therapy is a cost-effective, easily applied therapy choice with fewer side effects. Although the effectiveness of these therapies is less than that of interferon alpha and lamivudine, in patients to whom interferon and lamivudine treatments cannot be applied or who do not react positively to them, treatment with these drugs should be considered.

Category: Diseases / Tags: hepatitis В, levamisole therapy, vaccine therapy

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