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Response to therapy among patients with acute exacerbation of chronic Hep C

The latest issue of Clinical Gastroenterology & Hepatology investigates clinical presentation, outcome, and response to therapy among patients with acute exacerbation of chronic Hepatitis C.

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The slow asymptomatic progression of chronic hepatitis C can be interrupted by an acute exacerbation, characterized by increased serum levels of alanine aminotransferase and bilirubin and other symptoms of acute hepatitis.

Dr Evangelista Sagnelli and colleagues provided more information about the clinical presentation of acute exacerbation of chronic hepatitis C.

The research team identified 82 consecutive patients, from 2 locations in Italy, who had an acute exacerbation of chronic hepatitis C from 2005 through 2010.

The team followed them up for a median period of 36 months.

Hepatitis C virus genotype 2 was detected in 46% of cases
Clinical Gastroenterology and Hepatology

These cases were hepatitis C virus RNA positive, hepatitis B surface antigen-negative, and had not received anti-hepatitis C virus therapy.

The cases were matched with 82 subjects with hepatitis C without reactivation for age, sex, and hepatitis C virus genotype.

The researchers followed 69 cases, and 73 controls were followed up for at least 2 years.

Liver biopsy specimens had been taken from 23 cases and 31 controls—once before enrollment in the study and once during the follow-up period.

The research team detected hepatitis C virus genotype 2 in 46% of cases, and hepatitis C virus genotype 1 was detected in 44%.

Among cases, the mean alanine aminotransferase level was 1063 IU/dL, and the mean total bilirubin level was 16 mg/dL.

The doctors analyzed a higher percentage of cases carried the interleukin-28B CC genotype than controls.

Among cases, 44% had a steady increase in alanine aminotransferase level for 56% of these patients, alanine aminotransferase levels returned to baseline values before the acute exacerbation of chronic hepatitis.

Based on comparisons of biopsy specimens, 18 cases and 11 controls had increasing fibrosis, with Ishak scores increasing by more than 2.

The team found that 14 cases and 3 controls had increases in necroinflammation of more than 2 points.

The researchers observed that 32 cases and 38 controls received treatment with pegylated interferon and ribavirin.

A sustained virologic response was achieved in 26 cases and 23 controls.

Dr Sagnelli's team commented, "Although an acute exacerbation of chronic hepatitis is a serious medical condition, most patients achieve a sustained virologic response after treatment with pegylated interferon and ribavirin."

Clin Gastroenterol and Hepatol 2013: 11(9): 1174-1180
19 September 2013

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