Liver disease compensated

Interferon and ribavirin are indicated for the treatment of chronic hepatitis C with compensated liver disease. Compensated liver disease typically is defined as no history of hepatic encephalopathy, variceal hemorrhage, ascites, or other signs of decompensation. In addition, laboratory values should be near normal (bilirubin < 2 mg/dU stable [near normal] albumin, PT < 3 second prolongation, WBC > BOOO/imm, platelets > 70,000/mm3,... 

Today, ISOpg of peginterferon-a2a once weekly for 48 weeks is recommended in patients with compensated liver disease. However, treatment schedules mat were chosen in clinical trials vary between 24 weeks to 2 years and optimal treatment durations and dose remain to be defined. 

Treatment for HCV infection is necessary because a high percentage of acutely infected patients develop chronic infections. Treatment is indicated in patients previously untreated who have chronic HCV, circulating HCV RNA, increased alanine transaminases levels, evidence on biopsy of moderate to severe hepatic grade and stage, and compensated liver disease. 

Chronic hepatitis C with compensated liver disease after a-IFN Jan. 1998... 

Chronic HCV- In combination with peginterferon alfa-2a for the treatment of adults with chronic HCV infection who have compensated liver disease and have not been previously treated with interferon alpha. Patients in whom efficacy was demonstrated included patients with compensated liver disease and histological evidence of cirrhosis (Child-Pugh class A). 

Chronic HCV- In combination with interferon alfa-2b injection for the treatment of chronic HCV in patients 3 years of age (oral solution) or 5 years of age (capsules) and older with compensated liver disease previously untreated with alpha interferon or in patients who have relapsed following alpha interferon therapy. Note Ribaspheres is only indicated in combination with interferon alfa-2b in patients 18 years of age and older. 

Chronic hepatitis C For use alone or in combination with ribavirin capsules for the treatment of chronic hepatitis C in patients with compensated liver disease who have not been previously treated with interferon alpha and are at least 18 years of age. When used in combination with ribavirin, refer to ribavirin monograph for additional prescribing information. 

Indications Treatment of chronic hepatitis C virus (HCV) infection in patients 18 years of age or older with compensated liver disease who have anti-HCV serum antibodies and/or the presence of HCV RNA... 

B. Indications and nse Infergen is indicated for treating chronic hepatitis C virus (HCV) infection in adults with compensated liver disease who have anti-HCV serum antibodies and/or the presence of HCV RNA. It is also effective in the subsequent treatment of patients who did not respond or relapsed after initial interferon therapy. In some patients with chronic HCV infection, Infergen normalizes serum alanine aminotransferase (ALT) concentrations, reduces serum HCV RNA concentrations to undetectable quantities (<100 copies/ml), and improves liver histology. 

Treatment of chronic hepatitis C in patients not previously treated with interferon alfa who have compensated liver disease and are at least 18 years of age... 

Glucocorticoid treatment of known diabetics normally leads to deregulation, but this can be compensated for by adjusting the dose of insulin. The increased gluconeogenesis induced by glucocorticoids mainly takes place in the liver, but glucocorticoid treatment is especially likely to disturb carbohydrate metabolism in liver disease. 

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. 

Table 4.3 summarises the potential extent of change in each individual LFT for an example patient with compensated chronic liver disease, decompensated chronic liver disease, hepatitis, hyperacute liver failure and cholestasis. This is a snapshot of the changes that may occur in these conditions however, if each patient s results were observed over time a range of results would be seen. 

Understanding liver function Compensated chronic liver disease... 

Malnutrition is found in 80-100% of patients with decompensated liver disease, and in up to 40% of those with compensated disease. As the disease progresses patients become malnourished. Dry weight decreases, as they often reduce their food intake due to anorexia, malabsorption. 

Based on their pharmacokinetic profile alone, the safest statins in chronic compensated liver disease and a history of decompensation are prohahly pravastatin and rosnvastatin. However, clinical experience with rosnvastatin in liver disease is lacking, and so it cannot be recommended. In addition, the true rate of post-marketing adverse drug reactions is not yet clear. Pravastatin is therefore the drug of choice in these patients, where treatment is deemed necessary. It should, however, be avoided in acute episodes until liver function or transaminases stabilise/return to normal. 

In 2006 the National Lipid Association s Statin Safety Assessment Task Force concluded that chronic liver disease and compensated liver disease are not contraindications to the use of statins, but that they are contraindicated in decompensated disease or liver failure [2, 3] see Hepatic Adverse Effects. 

A 2006 review by the National Lipid Association s Statin Safety Assessment Task Force concluded that hepatic function does not appear to be compromised by statin use and that there was no apparent link between elevations in LFTs and the development of liver toxicity. They noted that TFT monitoring may itself be of little value in the absence of other symptoms of liver toxicity, but should be performed for medicolegal reasons, as it is recommended in the product SPCs. The expert group concluded that the use of statins is not contraindicated in chronic and compensated liver disease, but that it is contraindicated in decompensated disease or liver failure [2, 3]. 

The Tagy study discussed earlier [22] showed DMPA to be safe in compensated bilharzial liver fibrosis, although this could be difficult to extrapolate to other liver diseases. 

If liver disease is stable and well compensated, prescribing of most drugs is safe. Particular care should attend evidence of ... 

Dietrich, R., Bachmann, C., Lauterburg, B.H. Exercise-induced hyperammonemia inpatients with compensated chronic liver disease. Scand. X Gastroenterol. 1990 25 329-334... 

Latent and compensated forms of consumptive coagulopathy frequently occur in the course of severe acute or chronic liver disease. In 80-85% of cirrhosis patients, the values of at least one basic test (thrombocytes. Quick s value, fibrinogen, AT III, bleeding time) are pathological. In 15-30% of cases, clinically relevant haemorrhagic diathesis evolves. 

Depending on the time period involved in the course of the disease, acute liver failure without pre-existing liver disease can initially be differentiated by massive liver cell disintegration due to a variety of causes. In contrast, chronic liver insufficiency with pre-existing liver disease is mostly found in advanced liver cirrhosis with a progressive loss of function. A sudden necrotising episode is also able to precipitate the change from chronic and still compensated liver insufficiency into acute liver failure ( acute on chronic ) in the same way that acute liver failure which has been overcome can develop into chronic liver insufficiency. 

This condition describes acute liver failure in cases of hitherto well-compensated liver disease. The result is a sudden deterioration in clinical status accompanied by... 

The above statements can only serve as general criteria for the physician s evaluation of patients suffering from liver disease. More detailed information is usually available from the insurance provider. Thus it is desirable that medical practitioners cooperate closely with sociomedical specialists, so that it is possible to deal directly with any application for compensation, disability pension, etc. 

Interferon alfa, in combination with ribavirin, is currently first-line therapy for patients with chronic hepatitis C and compensated liver disease, and its use has been extensively reviewed (6). A meta-analysis of trials in patients who were... 

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