Alpha-fetoprotein useful marker in HCC

Alpha-fetoprotein useful marker in HCC

By: DENISE NAPOLI, IMNG Medical News

Changes in serum alpha-fetoprotein levels over time correlated with the development of hepatocellular carcinoma in hepatitis C patients, wrote Dr. Elliot Lee and his colleagues in the April 1 issue of Clinical Gastroenterology and Hepatology.*

"If confirmed in future studies, these findings could be used to develop individualized risk assessments for clinical use, which could then influence the frequency and type of further testing" in this population, added the researchers (doi:10.1016/j.cgh.2012.11.029).

In what he called "the first large study to demonstrate that patterns of AFP [alpha-fetoprotein] over time are independently associated with HCC [hepatocellular carcinoma] development," Dr. Lee of the University of Michigan, Ann Arbor, looked at patients enrolled in the HALT-C (Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis) trial, in which hepatitis C patients who were nonresponders to prior antiviral therapy were randomized to receive maintenance pegylated interferon or placebo.

According to the trial protocol, patients were screened every 3 months for the first 3.5 years, then every 6 months thereafter on a voluntary basis, with levels of serum alpha-fetoprotein measured at each visit.

Patients who developed hepatocellular carcinoma were matched to controls without HCC in a 1:3 ratio according to the length of follow-up "in order to exclude bias caused by subjects with longer follow-up time having higher cumulative probability of HCC development, as well as more AFP values available," wrote the authors.

Overall, among 967 subjects with hepatitis C, 82 developed HCC during the study period, with a median of 18 (range, 5-22) AFP tests performed.

Dr. Lee then analyzed the association between the development of HCC and three AFP patterns.

First, the researchers assessed the rate of rise, defined as the patient’s final alpha-fetoprotein level (before study conclusion or HCC development, whichever came first) minus the AFP baseline value (on study entry), all over the follow-up duration divided by 90 days.

He found that this metric was associated with an odds ratio for developing HCC of 1.178 (P less than .001) in a simple logistic regression analysis that accounted for baseline risk factors only, with an area under the receiver-operating characteristic (AUROC) of 0.69.

Next, Dr. Lee calculated the standard deviation of AFP, defined as the standard deviation of all AFP values recorded within each patient.

In the same simple logistic regression, the standard deviation calculation was associated with an odds ratio of 1.026 for HCC per unit increase in standard deviation (P less than .001) and an AUROC of 0.76.

Third, Dr. Lee looked at the most recent AFP value on record. In this case, the odds ratio for developing HCC was 1.012 (also with P less than .001) and an AUROC of 0.76.

Finally, the researchers incorporated both standard deviation and rate of rise of AFP along with baseline age, platelet count, and smoking history to create a "history" model, which had an AUROC of 0.81 – an even better predictor than the models that looked only at one of those factors.

In an attempt to explain their findings, the researchers wrote, "it is intuitively evident why the rate of rise of AFP might be associated with risk of HCC development, but what might explain the association with standard deviation?"

They added, "The biologic basis is unknown, but we theorize that fluctuations in AFP may reflect cycles of damage and regeneration within the liver, and that growth factors involved in regeneration could stimulate hepatocarcinogenesis."

The authors acknowledged that the study had several limitations. "From a practical perspective, these metrics will only be useful once a patient has been followed for at least 2 years in order for the patterns to emerge," they wrote.

Additionally, "this study included only patients with hepatitis C; it is unknown whether these associations would be present among patients with other chronic liver diseases."

The authors said they had no relevant financial disclosures. They disclosed grant support from the National Science Foundation Graduate Research Fellowship.

*Correction, 3/25/2013: An earlier version of this story misstated the name of Clinical Gastroenterology and Hepatology.

http://www.gihepnews.com/single-view/alpha-fetoprotein-useful-marker-in-hcc/a339f62c7c64763148ef8c710980a48e.html

HIV, hepatitis B or C virus- 'Sharps' Injuries Have Major Health and Cost Impact for Surgeons

'Sharps' Injuries Have Major Health and Cost Impact for Surgeons
Released:4/2/2013 9:05 AM EDT
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Need for Increased Awareness, Reporting and Prevention, Says Review in Plastic and Reconstructive Surgery

Newswise — Philadelphia, Pa. (April 2, 2013) – Injuries caused by needles and other sharp instruments are a major occupational hazard for surgeons—with high costs related to the risk of contracting serious infectious diseases, according to a special article in the April issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

ASPS Member Surgeon Dr. Kevin C. Chung and colleagues at The University of Michigan Health System, Ann Arbor, review the risks, health impact and costs of "sharps" injuries for surgeons and other operating room personnel. They write, "Increased attention to the health, economic, personal and social implications of these injuries is essential for appropriate management and future prevention."

High Rate of Sharps Injuries in OR—Surgeons at Highest Risk
Nearly 400,000 sharps injuries occur each year in the United States. About 25 percent of injured workers are surgeons—for whom the risk is highest in the operating room. "Despite healthcare policies designed to protect healthcare workers, injuries remain common," Dr. Chung and colleagues write. Nearly all surgeons will sustain a sharps injury sometime during their career. Medical students and residents are also at high risk; fatigue and inexperience are important risk factors.

The main health concern of sharps injuries is the risk of acquiring a communicable disease from a patient. While HIV is the most-feared result, the risk of infection with hepatitis B virus is actually much higher. Sharps injuries can also have a major psychological impact on the injured person and his or her family—particularly during the time needed to confirm that the injured worker is free of infection, which may take several weeks or months.

Once an injury occurs, there are standardized guidelines for post-exposure prevention, depending on whether the patient has any known transmissible infections. Recommendations include antiviral medications for healthcare workers exposed to HIV and hepatitis B or C virus—ideally starting within hours after the injury.

As a result of the need for testing and treatment, sharps injuries have a major economic impact. Average costs for testing, follow-up and preventive treatment range from $375 for needlestick exposure from a patient with no known blood-borne illness, up to nearly $2,500 for injuries from a patient with known HIV.

Need for Increased Emphasis on Reporting and Prevention
Post-exposure prevention can only be executed if the injury is reported. One study found that 70 percent of surgeons "never or rarely" report sharps injuries. They may feel they "don't have time" to report, or may misunderstand the risks involved.

"Fortunately, the majority of sharps injuries are preventable," Dr. Chung and colleagues write. Engineered safety devices can prevent many injuries—especially if surgeons and other workers are involved in choosing to use them. Other options include the use of "non-sharp" alternatives, creating safe procedures for passing sharp instruments and wearing double gloves to reduce the risk of infection.

Over the years, regulations have been introduced to ensure that proper prevention and reporting strategies are in place. Introduction of the Needlestick Safety and Prevention Act of 2000 led to an overall 38 percent reduction in injuries in all care settings. However, one study reported that the rate of sharps injuries in the operating room actually increased. "Although preventive strategies exist, their success ultimately relies on clinician compliance," Dr. Chung and coauthors write.

The authors hope their review will help to increase awareness of the risks and potential harms of sharps injuries among surgeons and operating room personnel, and to increase awareness of efforts to reduce the risk. They conclude, "Targeting educational initiatives during medical school and training may improve knowledge among surgeons of the safest ways to practice in the operating room, and ensuring compliance among all surgeons in practice can reduce the economic and psychosocial burden of these highly prevalent injuries."

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

# # #
About Plastic and Reconstructive Surgery
For more than 60 years, Plastic and Reconstructive Surgery® (http://journals.lww.com/plasreconsurg/) has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, and cosmetic surgery, as well as news on medico-legal issues.

About ASPS
The American Society of Plastic Surgeons (ASPS) is the world's largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery. You can learn more and visit the American Society of Plastic Surgeons at www.plasticsurgery.org or www.facebook.com/PlasticSurgeryASPS and www.twitter.com/ASPS_news.

About Lippincott Williams & Wilkins
Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2012 annual revenues of €3.6 billion ($4.6 billion).

Researchers are first to use common virus to 'fortify' adult stem cells

Researchers are first to use common virus to 'fortify' adult stem cells
Potential uses of engineered cells include organ transplant and brain injury

WINSTON-SALEM, N.C. – April 1, 2013 – Using the same strategy that a common virus employs to evade the human immune system, researchers at Wake Forest Baptist Medical Center's Institute for Regenerative Medicine have modified adult stem cells to increase their survival – with the goal of giving the cells time to exert their natural healing abilities.

"Basically, we've helped the cells be 'invisible' to the body's natural killer cells, T cells and other aspects of the immune system, so they can survive to promote healing," said Graca Almeida-Porada, M.D., Ph.D., senior author and professor of regenerative medicine at Wake Forest Baptist.

The research, reported in the current issue of PLOS One, a peer-reviewed, open access journal, involves mesenchymal stem cells (MSCs), found in bone marrow, peripheral and cord blood and fetal liver and lung tissue. These cells are known for their ability to migrate to damaged tissues and contribute to healing. However, like all cells, they are susceptible to being killed by the body's complement system, a part of the immune system involved in inflammation and organ rejection.

"These cells have a natural ability to help modulate the immune response, so if we can increase their survival, they theoretically could be a therapy to decrease inflammation and help transplant patients avoid organ rejection," said Almeida-Porada.

In the study, the researchers evaluated the potential of human cytomegalovirus (HCMV), a member of the herpes virus family, to help increase the survival of MSCs. While the HCMN virus infects between 50 percent and 80 percent of people in the U.S., it normally produces no symptoms and remains latent in the body over long periods.

"We wanted to take advantage of the virus' ability to evade the immune system," said Almeida-Porada. "Our strategy was to modify the cells to produce the same proteins as the HCMV virus so they could escape death and help modulate inflammation and promote healing."

MSCs were purified from human fetal liver tissue. They were then engineered to produce specific proteins expressed by the HMCV virus. Through this process, the scientists identified the protein that was most effective at increasing cell survival. Specifically, the team is the first to show that overexpression of the US2 protein made the cells less recognizable to the immune system and increased cell survival by 59 percent (+/- 13 percent).

"The research showed that modifying the cells indeed improves their survival," said Almeida-Porada. "Next, we hope to evaluate the healing potential of these cells in conditions such as bowel disease, traumatic brain injury and human organ transplant."

###

The research was supported by National Institutes of Health grants HL73737 and HL97623.

Almeida-Porada's co-researchers were Melisa A. Soland, Ph.D., and Christopher Porada, Ph.D., Wake Forest Baptist; Mariana Bego, Ph.D., Institut de Recherches Cliniques de Montreal, Canada; and Evan Colletti, Ph.D, Esmail Zanjani, Ph.D., and Stephen S. Jeor, Ph.D., University of Nevada.

Media contacts:

Karen Richardson
Media Relations Office
336-716-4587.

Wake Forest Baptist Medical Center is a fully integrated academic medical center located in Winston-Salem, North Carolina. The institution comprises the medical education and research components of Wake Forest School of Medicine, the integrated clinical structure and consumer brand Wake Forest Baptist Health, which includes North Carolina Baptist Hospital and Brenner Children's Hospital, the creation and commercialization of research discoveries into products that benefit patients and improve health and wellness, through Wake Forest Innovations, Wake Forest Innovation Quarter, a leading center of technological discovery, development and commercialization, as well as a network of affiliated community-based hospitals, physician practices, outpatient services and other medical facilities. Wake Forest School of Medicine is ranked among the nation's best medical schools and is a leading national research center in fields such as regenerative medicine, cancer, neuroscience, aging, addiction and public health sciences. Wake Forest Baptist's clinical programs have consistently ranked as among the best in the country by U.S. News & World Report for the past 20 years.

Specialty drug costs account for more than 50 percent of the total cost of care for rheumatoid arthritis and hepatitis C patients

April 2, 2013, 9:00 a.m. EDT
Specialty drug costs account for more than 50 percent of the total cost of care for rheumatoid arthritis and hepatitis C patients

Studies suggest need for development of specialty medication management programs to manage the increasing burden of specialty drug costs

SAN DIEGO, April 2, 2013 /PRNewswire via COMTEX/ -- According to two new studies by Prime Therapeutics (Prime), a leading pharmacy benefit manager, rheumatoid arthritis (RA) and hepatitis C (Hep C) specialty drug costs now make up more than half of the total cost of care for patients with these conditions. Prime will present these studies at the Academy of Managed Care Pharmacy (AMCP)'s 25th Annual Meeting & Expo in San Diego.

"As the pipeline of expensive specialty drugs continues to grow, we need to stay alert to cost of care trends to make sure patients and plan sponsors receive the best value and can manage the increasing cost burden these treatments bring," said Patrick Gleason, PharmD, FCCP, BCPS, director of health outcomes at Prime.

The two studies from Prime, in conjunction with Blue Cross and Blue Shield of Minnesota, evaluated RA and Hep C cost of care trends.

In the first study, researchers found that despite the overall decrease in Hep C specialty drug use from 2008 to 2011 (17.2 percent vs. 14.1 percent), the Hep C specialty pharmacy total cost of care compound annual growth rate (CAGR) was 15 percent from 2008 to 2011. Specialty drug costs accounted for 35 percent ($13,332 of $38,055) of the total cost of Hep C care in 2008 and was substantially higher at 52.6 percent in 2011 ($30,415 of $57,799), with a CAGR of 31.8 percent.

In the second study, researchers found that although RA drug use remained steady from 2008 to 2010 (34.6 percent vs. 35.4 percent), the total cost of care CAGR was 7.3 percent from 2008 to 2010. All other medical costs were $11,252 in 2008 and increased to $13,710 in 2010, with a CAGR of 10.4 percent. Combined RA medical and specialty drug costs accounted for $16,218 (54.7 percent) of $29,652 total cost of care in 2008. In 2010, total cost of care was slightly lower at 53.0 percent ($18,098 of $34,163), with a CAGR of 5.6 percent.

"These studies show the RA and Hep C pharmacy costs now go beyond all medical costs, therefore the expected medical savings cannot offset the specialty drug investment," said Gleason. "As pharmacy benefit managers and health plans strive work to improve the quality of care for individuals with specialty drug needs, the expected increases in cost of care can be lessened through specialty pharmacy management programs. These programs include care management, a limited specialty network, utilization management, and rebate contractual relationships that provide price inflation protection."

Both studies analyzed integrated pharmacy and medical claims from 1.2 million commercially insured, continuously enrolled members receiving a Hep C or RA specialty drug. Among members using these drugs, the average per patient, per year total cost of care was calculated and total cost of care was separated by the following categories: medical specialty drug, medical all other, pharmacy specialty drug and pharmacy all other.

About Blue Cross and Blue Shield of Minnesota Blue Cross and Blue Shield of Minnesota, with headquarters in the St. Paul suburb of Eagan, was chartered in 1933 as Minnesota's first health plan and continues to carry out its charter mission today as a health company: to promote a wider, more economical and timely availability of health services for the people of Minnesota. Blue Cross is a not-for-profit, taxable organization. Blue Cross and Blue Shield of Minnesota is an independent licensee of the Blue Cross and Blue Shield Association, headquartered in Chicago. Go to bluecrossmn.com to learn more about Blue Cross and Blue Shield of Minnesota.

The Blue Cross and Blue Shield Association is a national federation of 38 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for 100 million members - one-in-three Americans. For more information on the Blue Cross and Blue Shield Association and its member companies, please visit www.BCBS.com. We encourage you to connect with us on Facebook, check out our videos on YouTube, follow us on Twitter and check out The BCBS Blog, for up-to-date information about BCBSA

About Prime TherapeuticsPrime Therapeutics LLC (Prime) helps people get the medicine they need to feel better and live well. Prime manages pharmacy benefits for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and delivers medicine to members, offering clinical services for people with complex medical conditions. Headquartered in St. Paul, Minn., Prime serves nearly 20 million people. It is collectively owned by 13 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans. Prime has been recognized as one of the fastest-growing private companies in the nation.

SOURCE Prime Therapeutics

Copyright (C) 2013 PR Newswire. All rights reserved

HIV sufferers need hepatitis safeguards

Zahid Butt, who now directs the epidemiology division of a public health institute in Pakistan, led a study on HIV and hepatitis as part of his doctoral dissertation in MSU's Department of Epidemiology and Biostatistics.
Courtesy photo.

HIV sufferers need hepatitis safeguards

Stronger protections are needed to prevent people with HIV from also becoming infected with hepatitis, researchers argue in a new study led by Michigan State University.

Behaviors that put people at higher risk of contracting HIV – sharing needles, having unprotected sex or getting blood transfusions, for instance – also raise their risk of getting hepatitis B or C, diseases that attack the liver and, if untreated, can be deadly.

The study, which included all registered cases of HIV in Michigan, found about four percent of HIV-positive people also had hepatitis. That’s less than some previous studies have found elsewhere, but it still represents a significant public health concern, said Zahid Butt, who led the research as a doctoral student in MSU’s Department of Epidemiology and Biostatistics.

“Ultimately, because of the fact that they’re suffering from two diseases, they’re more likely to die than if they only have one,” said Butt, who now runs the epidemiology division of a public health institute in Islamabad, Pakistan.

For example, having HIV more than triples the risk of liver disease, liver failure and liver-related death among individuals who also have hepatitis C, according to the Centers for Disease Control and Prevention.

The researchers found the highest rate of co-infection among males, particularly those who marked their race as “other,” which included anything other than white, black or Hispanic. Butt said that was surprising, since previous studies have found African American men were at highest risk for co-infection.

“It could be that we’re getting a cohort of people who were not vaccinated in childhood because they’re coming from countries that don’t require vaccination,” he said. “It also may be that some marginalized groups might not get vaccinated because they don’t trust the health care system.”

Butt said all states should require children to be vaccinated against hepatitis B when they go to school, as most states already do (there is no hepatitis C vaccine). He also said HIV-positive people should protect themselves from hepatitis B by getting vaccinated.

Published in the journal Epidemiology and Infection, the study also found that people who had received transfusions or other blood products were at the highest risk for co-infection. Butt said that raises concerns about whether current safeguards are sufficient to protect people who need transfusions.

“There’s a real need for proper screening of blood products,” he said. “Even with the screening process we have in place, there was a high risk of infection through blood products. We still have a four percent co-infection prevalence, which shouldn’t be the case.”

http://msutoday.msu.edu/news/2013/hiv-sufferers-need-hepatitis-safeguards/

Brain Scans Give Clues to Antidepressant’s Effects

Brain Scans Give Clues to Antidepressant’s Effects

Brain scans during memory tests might help predict which depressed patients will be helped by a fast-acting drug, a new study reports.

Major depression is marked by feelings of sadness, loss, anger or frustration that can interfere with daily life for many weeks. Symptoms can also include memory loss and trouble focusing.

Most depression-fighting drugs must be taken for several weeks before working, which can cause an agonizing wait for patients. Because different people respond to different medications, patients may need to try several drugs over a month or more before getting symptom relief.

Several years ago, NIH researchers discovered that a drug used to treat motion sickness could also rapidly reduce symptoms of depression. But the drug, called scopolamine, didn’t work in all patients.

To try to predict the drug’s effects, the researchers used MRI to track brain activity in adults with and without major depression. People with major depression are known to have unique patterns of brain activity when asked to pay attention to the emotional content of images. They also tend to remember negative information (such as sadness) better than positive or neutral information.

The researchers found that scopolamine relieved symptoms in 11 of the 15 participants who had major depression. Scopolamine’s effectiveness was linked to activity in a specific brain region when patients were asked to remember the emotions on faces that flashed by. Activity in this same brain region was also altered by infusions of scopolamine.

The findings suggest that activity in this brain region might provide early clues about how well scopolamine will work in different patients. Ongoing studies are exploring how the brain’s response to emotional images might help guide treatment strategies for major depression.

http://newsinhealth.nih.gov/issue/apr2013/capsule1

Dental Treatment as a Risk Factor for Hepatitis B and C Viral Infection. A Review of the Recent Literature

Dental Treatment as a Risk Factor for Hepatitis B and C Viral Infection. A Review of the Recent Literature
 

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Nima Mahboobi¹, Stephen R Porter², Peter Karayiannis³, Seyed-Moayed Alavian⁴

1) Department of Oral and Maxillofacial Surgery, Tehran University of Medical Sciences, Tehran, Iran
2) Department of Oral Medicine, Eastman Dental Institute for Oral Health Care Sciences, University College London, University of London, England
3) Department of Medicine, Imperial College, Variety Wing Floor D, St Mary's Campus, Norfolk Place, London, England
4) Baqiyatallah University of Medical Sciences, Research Center for Gastroenterology and Liver Disease, Tehran, Iran

Abstract

Background & Aim: Patients chronically infected either with hepatitis B (HBV) or hepatitis C virus (HCV) are at increased risk of developing cirrhosis, end stage liver disease and hepatocellular carcinoma. Different risk factors were found to be associated with the transmission of these viruses in various settings. HBV and HCV transmission seems to be also acquired by non-parenteral and non-sexual routes. A large number of patients infected with HCV might have non identifiable routes of viral acquisition. Hence, viral hepatitis transmission risk factors identification is the main way to reduce infection. Dental treatment may be one of such risk factors, and this aspect is addressed in the present literature review, drawing information from existing literature.

Methods: An online database search was conducted, limited to publications from January 1999 to February 2012 on specific aspects of HBV and HCV infection, including articles on risk factors, markers of infection, dentistry, epidemiology and transmission. Relevant material was evaluated and reviewed.

Results: Overall, 53 studies which met the selection criteria were evaluated. Although these studies were
from different geographical regions of varied socioeconomic status and study populations and assessed
different dental procedures, using different types of statistical analysis, we found that, although weak, there
is an all-time risk of HBV and HCV infection during dental treatment. This is more important in developing
countries where the rate of hepatitis infected individuals is higher. There is a need for more studies on this
subject, properly planned, controlled and analyzed.

Conclusion: Dental treatment can be included among the risk factors of HBV and HCV infection. This risk can easily be eliminated using standard precautionary measures.

Key words: hepatitis B virus (HBV) - hepatitis C virus (HCV) - dental treatment - risk factor - dentist
- review.

Type 1 Diabetes Mellitus with Dual Autoimmune Mechanism Related to Pegylated Interferon and Ribavirin Treatment for Chronic HCV Hepatitis

Type 1 Diabetes Mellitus with Dual Autoimmune Mechanism Related to Pegylated Interferon and Ribavirin Treatment for Chronic HCV Hepatitis
 

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Cristina Popescu^{1, 2}, Gabriel-Adrian Popescu^{1, 2}, Victoria Arama^{1, 2}

1) "Prof. dr. Matei Bals" National Institute of Infectious Diseases
2) "Carol Davila" University of Medicine and Pharmacy Bucharest Romania

Abstract

We report a case of type 1 diabetes mellitus during pegylated interferon and ribavirin treatment for chronic
hepatitis C, in a young man previously diagnosed with Hashimoto's thyroiditis and vitiligo. The diabetes
mellitus occurred during the 12th month of therapy and the cessation of interferon was necessary. Besides
anti-islet autoantibodies our patient had also anti-insulin receptor autoantibodies, which explains the type
B insulin resistance. One year after interferon discontinuation the patient continues insulin treatment and
all the pancreatic autoantibodies are still positive. Patients with autoimmune disorders should be closely
monitored and periodically tested for pancreatic autoantibodies during interferon treatment, even in the
absence of hyperglycemia.

Key words: type 1 diabetes mellitus - interferon-alpha side effects - insulin resistance - hepatitis.

Abbreviations: AIRA - anti-insulin receptor autoantibodies; APS - autoimmune polyglandular syndrome; cANCA - classical antineutrophil cytoplasmic antibodies; DM - diabetes mellitus; DNA - deoxyribonucleic acid ; FT4 - free thyroxin; GAD Ab - glutamic acid decarboxylase antibodies; HbA1c - glycated haemoglobin; HCV - hepatitis C virus; HLA - human leukocyte antigen; IA-2 Ab- insulinoma associated antigen 2 antibodies; IAA - insulin autoantibodies; ICA - islet cell autoantibodies; NK - natural killer; PAA - pancreatic associated autoantibodies; pANCA- protoplasmic-staining antineutrophil cytoplasmic antibodies; T1DM - type 1 diabetes mellitus; TNF - tumor necrosis factor; TSH - thyroid-stimulating hormone; VL - viral load; ZnT8 Ab - zinc transporter-8 autoantibodies; IL2 - interleukin 2; IL10 - interleukin 10.