Chronic hepatitis C infection

Zeuzem S, Buti M, Ferenci P, Sped J, Horsmans Y, Cianciara J, Ibranyi E, Weiland O, NovieUo S, Brass C, Albrecht J (2006) Efficacy of 24 weeks treatment with peginterferon alfa-2b plus ribavirin in patients with chronic hepatitis C infected with genotype 1 and low pretreatment viremia. J Hepatol 44(1) 97-103... 

Yee LJ, Tang J, Gibson AW, Kimberly R, Van Leeuwen DJ, Kaslow RA. Interleukin 10 polymorphisms as predictors of sustained response in antiviral therapy for chronic hepatitis C infection. Hepatology 2001 33[3] 708—712. 

Rebetron Combination Therapy (kit containing interferon alfa-2b inj plus ribavirin capsules) more effective than interferon alfa-2b monotherapyfor chronic hepatitis C infection... 

Drug interactions It is not known if PEG-Intron causes clinically significant drug-drug interactions with drugs metabolized by the liver in patients with chronic hepatitis C infection. 

Pharmacokinetics, safety, and antiviral effects of hypericin were studied in patients with chronic hepatitis C infection (Fig. 4) (71). The patients received an eight-weeks course of 0.05 and 0.10 mg/kg hypericin orally once a day. The pharmacokinetic data revealed a long elimination half-life (mean values of 36.1 and 33.8 hours, respectively, for the doses of 0.05 and 0.10 mg/ kg) and mean AUC determinations of 1.5 and 3.1 pg/mL/hr, respectively. Because relatively high doses of 0.05 and O.lOmg/kg/day were given, which will probably be not reached after oral intake of recommended doses of SJW extract preparations, it is not surprising that hypericin caused a considerable phototoxicity in this study. 

Tasi TN, Hsieh CH. Development of reversible diabetes mellitus after cessation of interferon-alpha therapy for chronic hepatitis C infection. NZ Med J 2004 117 U1230. 

Antiviral Efficacy and Clinical Use. Ribavirin (Vira-zole) is active against several RNA and DNA viruses, including respiratory syncytial virus (RSV).106 Clinically, this drug is used to treat severe RSV pneumonia in infants and young children,106 and RSV in certain adult populations, including the elderly, people with cardiopulmonary problems, and people with a compromised immune system.29 Ribavirin may also be useful as a secondary agent in the treatment of influenza A and B in young adults. The combination of ribavirin and interferons (see section on Interferons, later) is often the treatment of choice in chronic hepatitis C infection.30 72... 

Ribavirin capsules in combination with subcutaneous interferon alfa-2b are effective for the treatment of chronic hepatitis C infection in patients with compensated liver disease (see Anti-Hepatitis Agents, above). Monotherapy with ribavirin alone is not effective. 

Epidemiological studies have identified a number of factors that contribute to the risk of developing cirrhosis. Regular (moderate) alcohol consumption, age older than 50 years, and male gender are examples that increase cirrhosis risk in chronic hepatitis C infection, and older age, obesity, insulin resistance or type 2 diabetes, hypertension and hyperlipidaemia in non-alcoholic steatohepatitis. 

Ribavirin (Tribavirin) is a synthetic nucleoside which may be administered by inhalation via a special ventilator for RSV bronchiolitis in infants and children. Efficacy for this indication is controversial, and it is usually reserved for the most severe cases, and those with co-existing illnesses, such as immunosuppression. Systemic absorption by the inhalational route is negligible. It is effective by mouth 45 h) in treating Lassa fever and, when combined with interferon alfa-2b, for chronic hepatitis C infection (see below). Systemic ribavirin is an important teratogen, and it may cause cardiac, haematological, gastrointestinal and neurological side effects. 

Dietrich, C.R, Stryjek-Kaminska, D., Teuber, G., Lee, J.H., Caspary, W.R, Zeuzem, S. Perihepatic lymph nodes as a marker of antiviral response in patients with chronic hepatitis C infection. Amer. J. Roentgenol. 2000 174 699-704... 

R., Jnca, N., Mizokami, M., McFarlane, I.G. Chronic hepatitis C infection influence of the viral load, genotypes, and GBV-C/HGV coinfection on the severity of the disease in a Brazilian population. X Med. Virol. 2002 67 27-32... 

Forton, D.M., Taylor-Robinson, S.D., Thomas, H.C. Cerebral dysfunction in chronic hepatitis C infection (review). J. Viral Hepat. 2003 10 81-86... 

Kramer, L., Bauer, E., Funk, G., Hofer, H., Jessner, W., Steindl-Mnnda, P, Wrba, F., MadI, C., Gai, A., Ferenci, P Subclinical impairment of brain function in chronic hepatitis C infection. J. Hepatol. 2002 37 349-354... 

Planko, S., Patella, S., Slevert, W. Alcohol consumption induces hepa-tocyte apoptosis in patients with chronic hepatitis C infection. J. 

Sherman, K.E., Sjogren, M., Creager, R.L., Damiano, M.A., Freeman, St., Lewey, S., Davis, D., Root, S., Weber, F.L., Ishak, K.G., Goodman, ZJ>. Combination therapy with thymosin al and interferon for the treatment of chronic hepatitis C infection a randomized, placebo-controlled double-blind trial. Hepatology 1998 27 1128—1135... 

Ellenrieder, V., Beckh, K., Muller, D., Klatt, S., Adler, G. Intrahepatic high-grade malignant non-Hodgkin lymphoma in a patient with chronic hepatitis C infection. Z. Gastroenterol. 1996 34 283 - 285... 

Ibuprofen has been rarely thought responsible for liver damage. A recent report has described three patients, 33-44 years old, with chronic hepatitis C infection who developed more than five-fold increases in serum liver transaminases after taking ibuprofen for musculoskeletal pain. In all three there were no associated symptoms of hepatitis, and serum transaminases normalized after ibuprofen was withdrawn (18). 

Ogundipe O, Smith M. Bell s palsy during interferon therapy for chronic hepatitis C infection in patients with haemorrhagic disorders. Haemophilia 2000 6(2) 110-12. 

Willson RA. Interferon alfa-induced pernicious anemia in chronic hepatitis C infection. J Clin Gastroenterol 2001 33(5) 426-7. 

Ryan BM, McDonald GS, Phkington R, Kelleher D. The development of hepatic granulomas foUowing interferon-alpha2b therapy for chronic hepatitis C infection. Eur J Gastroenterol Hepatol 1998 10(4) 349-51. 

Tursen U, Kay a TI, Ikizoglu G. Interferon-alpha 2b induced facial erythema in a woman with chronic hepatitis C infection. J Eur Acad Dermatol Venereol 2002 16(3) 285-6. 

Dufour D R. Alanine aminotransferase variation in chronic hepatitis C infection An analysis of 357 cases. Chn Chem 2001 47 A26-A7. 

Park G, Lin B, Ngu M, Jones D, Katelaris R Aspartate ammotransferase alanine aminotransferase ratio in chronic hepatitis C infection Is it a useful predictor of cirrhosis J Gastroenterol Hepatol 2000 15 386-90. 

Hepatitis A infection usually results in an acute, self-limited disease that rarely leads to fulminant hepatic failure. The clinical features of acute hepatitis A are summarized in Table 40-1. After an average incubation period of 28 days, with a range of 15 to 50 days, symptomatic individuals will experience an abrupt onset of anorexia, nausea, vomiting, malaise, fever, headache, and right upper quadrant abdominal pain. Patients with underlying liver disease such as chronic hepatitis C infection are more likely to develop fulminant hepatic failure. Clinical symptoms also vary with age. Children younger than 6 years old are usually asymptomatic or have a mild influenzalike illness without clinical jaundice. In conhast, more than 70% of infected adults and older children display the characteristic clinical syndrome of acute hepatitis with elevated hepatic transaminase levels and jaundice. ... 

Salomon JA, Weinstein MC, Hammitt JK, Goldie SJ. Cost-effectiveness of treatment for chronic hepatitis C infection in an evolving patient population. JAMA 2003 290 228-237. 

With the success of HSCT, the number of long-term survivors has grown. Many survivors experience delayed complications of transplantation, especially those receiving alloHSCT, and primary care physicians will care for them. Major late complications include restrictive and obstructive pulmonary disease bone and joint disease cataract formation endocrine dysfunction, including sterility impaired growth and development infections cardiovascular disease and cirrhosis as a result of chronic hepatitis C infection and secondary malignancies. " ... 

Interferons are cytokines that are produced naturally by virally infected cells. They act to prevent infection of other cells by increasing the synthesis of enzymes that can destroy viral RNA. This interferes with the synthesis of viral proteins and reduces the production of virus particles. Interferon is used to treat chronic hepatitis C infection. 

A comprehensive discussion on the antiviral activity of hypericin 1 is included in three recent reviews on the chemical and biological properties of this compound [134, 145, 146]. The effective virucidal activity of hypericin 1 has now triggered its evaluation in human clinical trials for the treatment of HIV and chronic hepatitis C infection [147]. 

The efficacy of boceprevir as a treatment for chronic hepatitis C infection (genotype 1) was evaluated in phase III studies of -1500 adult patients. The SPRINT-2 trial was designed to assess boceprevir in treatment-naive patients, whereas the RESPOND-2 trial was designed for patients who had failed previons standaid-of-care PEG-INF/RBV (PR) therapy. 

Autoantibodies to P450 2E1 have also been detected in cases of chronic hepatitis C infection [1099, 1100]. 

In a systematic review of case reports of pneumonitis in patients receiving peginter-feron and ribavirin for chronic hepatitis C infection, 58 cases were traced [37 ]. Pneumonitis presented with any of the combination of fever, dyspnea, and cough and was fatal in 7% of cases, exclusively with pegin-terferon alfa-2b. 

A 30-year-old man with chronic hepatitis C infection developed activated protein C resistance, increased factor VIII activity, a raised fibrinogen concentration, and hyper-homocysteinemia after taking peginterferon alfa-I-ribavirin for 6 months, when he had a pulmonary embolism The hemato-... 

---