Diagnosis, Management, and Treatment of Hepatitis C: An Update

Department of Health and Human Services, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
Hepatology (Impact Factor: 11.06). 04/2009; 49(4):1335-74. DOI: 10.1002/hep.22759
Source: PubMed


At least five groups have evaluated treatment for patients with decompensated cirrhosis preliminary to liver transplantation.330–334 In the earliest reported study, 32 patients awaiting liver transplantation were considered for antiviral treatment, but over one-half were found ineligible because of cytopenias.330 Among those treated with standard or low doses of interferon alfa-2b or low doses of both interferon alfa-2b and ribavirin, 33% became HCV RNA negative. Almost all developed adverse effects, most of which was graded as severe. In a second study, 30 patients with HCV-related cirrhosis destined for liver transplantation (half graded as CTP class A) were treated with interferon alfa-2b, 3 mU daily and ribavirin, 800 mg/day if their presumed time to liver transplantion was less than 4 months.331 After a median treatment duration of 12 weeks, 30% responded to treatment and then underwent liver transplantation, 2/3 of whom remained HCV RNA negative over a median follow-up period of 46 weeks. Sixty percent developed neutropenia. Reported in the same year was a study of 20 patients, most with genotype 1 infection, who were treated before transplantation for a mean of 14 months with interferon alfa-2b in a dose of 5 mU daily.332 At transplantation, 60% were HCV RNA negative, but only 20% remained negative after transplantation. A fourth study involved 124 patients with advanced cirrhosis (CTP classes A, B and C) treated mainly with interferon alfa-2b plus ribavirin, and less frequently, with pegylated interferon plus ribavirin.333 Treatment began with half doses that were increased incrementally as tolerated at 2 week intervals (referred to as a low accelerating dose regimen), and growth factors were used as needed. An SVR developed in 13% of patients with genotype 1 and in 50% with non-genotype 1 infections. Adverse events were frequent, requiring dose reductions or treatment termination, but among those who did become HCV RNA negative before transplantation, 80% remained negative 6 or more months after transplantation. The most recent study is the only one to include non-treated controls but these consisted of patients unwilling to participate in the study.334 The treatment administered was peginterferon alfa-2b, 1.0 μg/kg body weight given weekly and ribavirin, 800 to 1000 mg daily for 24 weeks. An SVR developed in 44% of the patients with HCV genotypes 2 or 3, and in 7% of those with genotypes 1 or 4. Treatment had to be discontinued in 20%, was reduced in 39%, and was tolerated in 41%. Over a 30-month follow-up period, decompensated events occurred in 83% of the controls, 62% of the non-responders, and in 23% of the patients who had developed an SVR. The conclusion of this study was that antiviral therapy can be life-saving, improves hepatic function, and that treatment seems appropriate for persons with genotype 2 and 3 infections particularly in those with cirrhosis, CTP classes A and B.

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    • "To define the epidemiology of the HCV disease the identification of the HCV genotype is very important. Genotype 1a, 1b and 3a is particularly common in Europe and United State (Ghany et al., 2009). Genotypes 4 and 5 are distributed in Africa and genotype 6 is distributed in Asia and in Pakistan most common HCV genotype is 3a (Muzaffar et al., 2008). "
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    ABSTRACT: To find out the significant factors associated with HCV disease and evaluate the impact of these factors on the survival patternof HCV patients in district Multan. The study was conducted in Nishter Hospital of Multan district from 1 st January 2011 to 1 st October 2012. To see a significant difference between the survival rates of patients with associated factors, non-parametric Cox-proportional hazard model with their graphical results were used. All the patients above 11 years old of both sexes were included in the study. All those who were surviving with HCV diseasewere studied with their associated factors such as age, family history (FH) barber/parlor services, blood group (BG) types weight loss (WL), Gender and drug use were collected from Nishter Hospital Multan. Results indicated that age, blood group types and gender are the most significant factors in the patients who are surviving with HCV disease. It was also observed that survival rate of female patients is high as compare to male patients.
    Pakistan journal of pharmaceutical sciences 10/2015; 28(5):1807-1810. · 0.68 Impact Factor
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    • "several adverse effects that could result in the termination of therapy [8] [13] [35]. The adverse effects include flu like syndrome, hematological disorders, thyroiditis and depression [2] [41] [42] [43] [44] [45]. "
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    ABSTRACT: Chronic hepatitis C (CHC) is one of the most common causes of liver diseases worldwide, affecting 3% of the world population and 3 to 4 million people acquire new infection annually. Despite the recent introduction of novel antiviral drugs for the treatment of CHC, these drugs are expensive and the access to them is not an option for many patients. Hence, the traditional therapy by pegylated interferon-α (Peg-IFN-α) and ribavirin may still have a role in the clinical management of CHC especially in developing countries. However, this standard therapy is associated with several severe extra-hepatic side effects and the most common adverse events are hematological abnormalities and thyroid disorders and they could result in dose reduction and/or termination of therapy. Vitamin D has been shown to be a key regulatory element of the immune system, and its serum concentrations correlate with the severity of liver damage and the development of liver fibrosis/cirrhosis. Furthermore, supplementation with vitamin D with Peg-IFN-α based therapy for the treatment of CHC could be beneficial in increase the response rate to Peg-INF-α based therapy. Vitamin D has also been shown to regulate the thyroid functions and the process of erythropoiesis. This review appraises the data to date researching the role of vitamin D during the treatment of CHC and the potential role of vitamin D in preventing/treating Peg-IFN-α induced thyroiditis and anemia during the course of treatment.
    International Journal of Clinical and Experimental Medicine 09/2015; 8(7):10284-10303. · 1.28 Impact Factor
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    • "The hepatitis C virus (HCV) is a major public health problem and a leading cause of chronic liver disease [1]. Owing to shared routes of transmission, co-infection with human immunodeficiency virus (HIV) affected almost five million of person worldwide [2] with a more rapid progression to endstage hepatic damage in this population [3] [4], particularly in those subjects in which depletion of CD4+ cell counts is more pronounced [5] [6]. "
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    ABSTRACT: Rapid virological response (RVR) is a critical end-point in the era of the new direct-acting antiviral agents (DAA). The aim of this study was to evaluate the predictive value in achieving RVR of HCV-RNA load and IP10 after 48hours of standard anti HCV therapy. HCV mono-infected and HIV/HCV co-infected patients naives to interferon were included. Demographic data, immune-virological HIV-related condition and HCV disease status were recorded before starting treatment. HCV-RNA and IP10 concentrations were also measured 48hours after first interferon dose. Univariate model, logistic regression and ROC curve were performed for statistical analysis. Thirty-two patients were enrolled (mean age 49.2±5.6 years): all were treated with pegylated-interferon and ribavirin. Nineteen (59.3%) were HIV/HCV co-infected patients. RVR was reached in 10 patients (31.2%). A decline of more than two log of HCV-RNA after 48hours of therapy was associated with RVR (P=0.004). A trend was observed between increased IP10 levels at 48hours and RVR (P=0.08). In a multivariable model only HCV-RNA at 48hours was associated with RVR (P=0.011). ROC curve analysis for both HCV-RNA at 48hours and IP-10 at 48hours showed an area under the curve of 0.87 (95%CI: 0.74-1; P=0.001) with specificity of 72.2% and sensibility of 90%. In HCV treatment-naïve patients HCV-RNA and IP10 determination after 48hours of interferon and ribavirin may be a worthwhile endpoint to predict RVR and select patients that may not require DAA addition. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
    Gastroentérologie Clinique et Biologique 06/2015; DOI:10.1016/j.clinre.2015.04.001 · 1.64 Impact Factor
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