Biomedical subjects

Brian L Pearlman

Publications and source records attributed to Brian L Pearlman.

6 recordsLinked to original sources

PubMed2006

Congestive heart failure-related anemia and a role for erythropoietin.

Congestive heart failure (CHF) is a common clinical problem, especially affecting the elderly. Current strategies of neurohormonal blockade with medications like angiotensin converting enzyme inhibitors have improved morbidity and mortality, but further improvement in outcomes requires new strategies. Both anemia and chronic renal disease commonly accompany congestive heart failure; their close relationship, in which one disease exacerbates the other, has been termed the cardio-renal-anemia syndrome. Correction of anemia in CHF patients using recombinant erythropoietin is feasible; small studies suggest that anemic congestive heart failure patients may have improved morbidity with this therapy. Recent animal and human studies of erythropoietin have shown that its benefit may be derived from both hematological and newly discovered non-hematological properties. Anemia might soon be considered a modifiable risk factor for optimal CHF management.

Anemia↗

PubMed2006

Chronic hepatitis C therapy: changing the rules of duration.

Traditional durations of therapy for patients with chronic hepatitis C can potentially be modified in hopes of cost savings, diminished exposure to medication side effects, and even improved rates of sustained virologic response. Clinical and viral kinetic studies suggest that shortened treatment durations for certain patients with genotype 2 and 3 infections might be equally effective as regimens of 24 weeks; for patients achieving undetectable viremia at 4 weeks of therapy, treatment durations of 12-16 weeks are sufficient. Nevertheless, abbreviated treatment courses might be inappropriate for those patients with advanced fibrosis or for genotype 3-infected patients with high viral loads. Similarly, if a rapid virologic response is obtained in those patients with genotype 1 infection and a low viral load, a truncated treatment course of merely 24 weeks is feasible. Conversely, slow virologic responders typically seen in genotype 1-infected individuals with high viral loads might benefit from an extended course of therapy; however, this approach needs to be validated prospectively. This review focuses on the evidence supporting such treatment individualization and discusses potential treatment algorithm modifications.

Antiviral Agents↗

PubMed2005

Hepatitis C virus infection in African Americans.

Hepatitis C is more prevalent among African Americans than among persons of any other racial group in the United States. However, comparatively little data are available on the natural history and treatment of hepatitis C in this population. Compared with white persons, African American persons have a lower rate of viral clearance and, consequently, a higher rate of chronic hepatitis C. Nonetheless, African American persons may have a lower rate of fibrosis progression than do white persons. African American persons with hepatitis C-related cirrhosis have higher rates of both hepatocellular carcinoma and liver cancer-related mortality than do white persons with hepatitis C-related cirrhosis. In nearly all treatment trials that enrolled a significant proportion of African American subjects, such patients had inferior treatment responses, compared with those of white subjects. The prevalence of infection with hepatitis C virus genotype 1 is higher among African American patients than white patients, although this difference does not account for a greatly dissimilar response to therapy. Some of the postulated mechanisms for these disparate treatment responses and natural histories of infection are also reviewed.

Black or African American↗

PubMed2004

Hepatitis C treatment update.

Hepatitis C is a leading cause of chronic liver disease in the United States, and the prevalence of hepatitis C-associated complications is increasing. Therapy with pegylated interferon and ribavirin has become the standard of care for chronic hepatitis C; the sustained response rate for treatment-naïve patients is about 55%. If certain patients fail to achieve a 12-week treatment milestone, an early virologic response, they may be taken off treatment early, potentially sparing them from unnecessary medication. Adherence is critical for treatment success. Although side effects continue to be a hindrance to the success of therapy, agents such as growth factors and antidepressants may help patients to maintain medication dosing and complete treatment. Therapy is generally recommended for those in whom the infection is most likely to progress to cirrhosis; however, there is continued debate about the suitability of certain patients for treatment, including those with persistently normal aminotransferase levels or acute hepatitis C and nonresponders to conventional treatment. Four broad groups of investigational therapeutic agents appear promising for future therapy: modified interferons and ribavirins, immunomodulators, viral life-cycle targets, and antifibrotic agents.

Acute Disease↗

PubMed2004

Hepatitis C infection: a clinical review.

Nearly three million persons in the United States are viremic with hepatitis C (HCV). Despite a decreasing incidence of HCV in this country, the prevalence of HCV-related chronic liver disease is increasing. Most infections in the United States are acquired by intravenous drug use. The chronicity rate of HCV is high, reaching 85% in some populations, and the risk of progression to advanced liver disease is as high as 20% within twenty years of infection. Host factors like alcohol use accelerate the rate of progression. The enzyme immunoassay is the preferred initial test for diagnosis; the third generation assay has greater than a 99% specificity in immunocompetent patients. Barring contraindications, the standard of care for treatment of chronic HCV has become pegylated interferon and ribavirin. With this therapy, the cure rate for treatment-naïve patients is about 55%, but rates are higher in certain groups. Common side effects of therapy include neuropsychiatric symptoms, influenza-like symptoms and hematological abnormalities.

Hepacivirus↗

PubMed2002

The new cholesterol guidelines. Applying them in clinical practice.

In 2001, the National Institutes of Health released the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Compared with previous cholesterol guidelines, the new guidelines contain several significant changes in treatment recommendations for patients with hyperlipidemia. In this article, Dr Pearlman reviews the latest guidelines and offers case examples that demonstrate how to incorporate the recommendations routinely into clinical practice.

Adult↗