Viral hepatitis case study

Milk thistle has been used to treat acute and chronic viral hepatitis, alcoholic liver disease, and toxin-induced liver injury in human patients. Milk thistle has most often been studied in the treatment of alcoholic hepatitis and cirrhosis. In both of these disorders, outcomes have been mixed and reports include significant reductions in markers of liver dysfunction and in mortality, as well as no effect. In acute viral hepatitis, studies have generally involved small sample sizes and have shown mixed outcomes of improved liver function (eg, aminotransferase values, bilirubin, prothrombin time) or no effect. Studies in chronic viral hepatitis and toxin-induced injury have also been of small size but have reported mostly favorable results. Parenteral silybin is marketed and used in Europe as an antidote in Amanitaphalloides mushroom poisoning, based on favorable outcomes reported in case-control studies. 

Interferon The occurrence of AIH during the treatment of chronic hepatitis B with interferon has already been described (13), as have manifestations and new episodes of inflammation caused by interferon in patients with AIH and chronic hepatitis C. (32, 66, 78) The indication for interferon therapy has to be considered with caution in cases of chronic viral hepatitis with concurrent AIH or autoimmune cholangitis it should also be monitored with great care. In replicative chronic hepatitis B, B/D or C, the chronic viral hepatitis constitutes the major factor - whereas AIH is seen as a concomitant phenomenon. Immunosuppressive therapy is not indicated. In addition, as recent studies show, there are also differences within the HCV infection itself for example, 90% of HCV carriers in Japan and 20% of those in the USA and Germany are at the same time HGV carriers (GB-C). The GB-C and HGV hepatitis viruses are designated defective because they require completion by the helper virus HCV. (s. p. 450)... 

Transmission of viral hepatitis continues to be a serious problem related to the transfusion of whole blood, cellular blood components, and to a lesser degree plasma-derived prodncts (8,155). It is difficult and probably impossible to obtain complete data on the true incidence of hepatitis transmitted by blood or blood products the incubation time is long, mild anicteric cases are not recognized, and systematic follow-up studies of transfused patients are difficnlt and expensive (156). In addition, the epidemiology of viral hepatitis is different in different regions. 

In a prospective study of the incidence of severe hepato-toxicity among 312 patients taking efavirenz, hepatitis C and hepatitis B viruses were detected in 7.7% of the patients (14). There was severe hepatotoxicity in 8.0%, but only 50% of the episodes were detected during the first 12 weeks of therapy. The risk was significantly greater among those with chronic viral hepatitis (69% of cases) and those taking concurrent protease inhibitors (82% of cases). However, 84% of patients with chronic hepatitis C or hepatitis B did not have severe hepatotoxicity. 

In a nested case-control study conducted by the Swiss HIV Cohort there was a strong association between prolonged exposure to didanosine and non-cirrhotic portal hypertension [107 ]. In 15 patients with non-cirrhotic portal hypertension and 75 controls matched for duration of HIV infection, absence of viral hepatitis, and duration of follow-up, cumulative exposure to antiretroviral drug therapy (OR per year = 1.3 95% Cl = 1.0,1.6), nucleoside reverse transcriptase inhibitors (OR = 1.3 95% Cl = 1.1, 1.7), didanosine (OR = 3.4 95% Cl = 1.5, 8.1), ritonavir (OR = 1.4 95% Cl = 1.0, 1.9), and nelfinavir (OR = 1.4 95% Cl = 1.0,1.9) were longer in the patients with portal hypertension. Exposure to non-nucleoside reverse transcriptase inhibitors and other protease inhibitors were not different. 

Except for one case/° recent clinically oriented MRS studies of human liver have been at 1.5T. Several studies applied in vivo MRS to diffuse liver disease. ° °" The PDE intensity was lower in cirrhosis than in controls ° and served to distinguish the alcoholic, viral, and cholestatic etiologies of diffuse liver disease. ° However, there was no difference between patients with non-alcoholic fatty liver disease (NAFLD) and controls. Sharma et al., using the relative PME intensity as a measure of altered gluconeogenesis (this peak can contain glucose-6-P and 3-phos-phoglycerate in addition to PC and PE), found that hepatic gluconeogenesis was altered in both obese and non-obese Asian Indians with NAFLD, relative to non-obese subjects without NAFLD. 

Hepatitis C can be considered the most serious viral infection among types of hepatitis due to its high capacity of chronicity. Only 15 of those with acute infection recover, while 85 of affected individuals feature a chronic infection with the possibility of developing cirrhosis, hepatocellular carcinoma in a third of cases, and even liver failure (Gillcrist, 1999). So far there is no complete study as regards an effective vaccine being developed for the treatment of this disease (Cardo, 2003). 

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