The natural history of acute hepatitis C: clinical presentation, laboratory findings and treatment outcomes
01 Mar 2011-Alimentary Pharmacology & Therapeutics (Aliment Pharmacol Ther)-Vol. 33, Iss: 5, pp 559-565
TL;DR: Aliment Pharmacol Ther 2011; 33: 559–565.
Abstract: Aliment Pharmacol Ther 2011; 33: 559–565
Summary
Background Acute hepatitis C has variable modes of presentation and frequently results in chronic infection. Its optimal management has yet to be defined.
Aim To establish natural history and complications of treatment of acute hepatitis C.
Methods Data from all patients presenting with acute hepatitis C to the National Institutes of Health between 1994 and 2007 were reviewed.
Results Twenty-five patients were identified. Symptoms were reported by 80% and jaundice by 40%. Aminotransferase levels and hepatitis C virus (HCV) RNA levels fluctuated greatly; 18% of patients were intermittently negative for HCV RNA. Five patients recovered spontaneously whereas 20 developed chronicity or received interferon-based therapy during the acute phase. Among 15 patients treated during the acute phase with peginterferon with or without ribavirin for 24 weeks, all became HCV RNA negative within 4–8 weeks, and all except two (HIV-positive) achieved a sustained virological response. Side effects (particularly psychiatric) were common and limited treatment in 30%.
Conclusions Among 25 patients with acute HCV infection, fluctuating illness was common and spontaneous recovery occurred in only 20%. Anti-viral treatment with a 24-week course of peginterferon and ribavirin was highly effective, but marked by frequent and severe side effects.
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Cites background from "The natural history of acute hepati..."
..., fatigue, anorexia, mild or moderate abdominal pain, low-grade fever, nausea, and/or vomiting) with mild to moderate elevations in hepatic aminotransferases.(296) Jaundice occurs in a minority of patients (< 25%), and acute liver failure is extremely rare....
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Cites background from "The natural history of acute hepati..."
...Contrariwise, several studies have been published investigating patients recruited in the acute symptomatic phase of HCV infection with up to 81% of the patients presenting with diverse symptoms [13,15,16]....
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...50–84% of the clinical overt patients with acute HCV infection develop jaundice as the most specific liver related symptom [13,15,17]....
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TL;DR: Step by step the efficacy of the therapy for hepatitis C is rapidly increasing and nowadays with the very new medications, the so called Direct Antiviral Agents-DAAs of new generation, is around 80%-90%.
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TL;DR: This review assesses recent advances in the understanding of viral hepatitis, contrasts mechanisms of virus–host interaction in acute hepatitis B and hepatitis C, and outlines areas for future studies.
Abstract: More than 500 million people worldwide are persistently infected with the hepatitis B virus (HBV) and/or hepatitis C virus (HCV) and are at risk of developing chronic liver disease, cirrhosis and hepatocellular carcinoma. Despite many common features in the pathogenesis of HBV- and HCV-related liver disease, these viruses markedly differ in their virological properties and in their immune escape and survival strategies. This review assesses recent advances in our understanding of viral hepatitis, contrasts mechanisms of virus-host interaction in acute hepatitis B and hepatitis C, and outlines areas for future studies. NECROINFLAMMATORY A state in which there is morphological evidence of infiltration of inflammatory cells and necrosis of parenchymal
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TL;DR: The identification of hepatitis C virus (HCV) as the cause of non-A, non-B hepatitis represents a technical tour de force of modern molecular medicine and has led to a better understanding of the viral life cycle and the pathogenesis of HCV-associated disease.
Abstract: Approximately 4 million persons in the United States and probably more than 100 million persons worldwide are infected with hepatitis C virus. The virus has the unique ability to cause persistent infection in susceptible hosts after parenteral or percutaneous transmission, and its underlying mechanisms are not well understood. The immunologic correlates of protection and viral clearance and the pathogenesis of liver injury are yet to be defined, but recent studies suggest the importance of cell-mediated immune responses. Although 70% to 80% of infected persons become chronic carriers, most have relatively mild disease with slow progression. However, chronic and progressive hepatitis C carries significant morbidity and mortality and is a major cause of cirrhosis, end-stage liver disease, and liver cancer. Development of an effective hepatitis C virus vaccine is not imminent, but recent advances in technology and basic knowledge of molecular virology and immunology have engendered novel approaches to the fundamental problems encountered in vaccine development. Current therapy for hepatitis C, although effective in some patients, is problematic and still evolving. Advances in modern biology and immunology promise new therapies for this important disease.
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TL;DR: Treatment of acute hepatitis C with interferon alfa-2b with treatment during the acute phase could prevent the development of chronic infection.
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"The natural history of acute hepati..." refers background in this paper
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