Neuropsychiatric Manifestations

A diverse constellation of neuropsychiatric symptoms are associated with the IFN component of therapy (43). The major psychiatric disorders include insomnia (39 ), irritability (32 ), depression (37 ), emotional lability (11 ), concentration impairment (14 ), nervousness (4 ), dizziness (23 ), and taste perversion (4 ). These disorders are not dose-dependent, and can occur at any time during therapy, and even after therapy has been completed. Insomnia is often related to ribavirin therapy, and...

Risk Of Decompensation In Childs A Cirrhosis

Patients who progress to cirrhosis may remain compensation without deterioration in liver function or clinical status, for many years. Fattovich et al. (112) reported outcomes in 384 European patients with compensated cirrhosis (Childs-Turcotte-Pugh score CTP < 7) caused by CHC. The mean length of follow-up was 5 yr, but some patients were only followed for 6 mo and others for over 12 yr. By actuarial analysis, the risk of decompensation (ascites, variceal bleed, or encephalopathy) was 18 and...

References

McHutchison JG, Gordon SC, Schiff ER, et al. Interferon alfa-2b alone or in combination with ribavirin as initial treatment for chronic hepatitis C. N Engl J Med 1998 339 1485-1492. 2. Poynard T, Marcellin P, Lee SS, et al. Randomised trial of interferon alfa-2b plus ribavirin for 48 weeks or for 24 weeks versus interferon alfa-2b plus placebo for 48 weeks for treatment of chronic infection with hepatitis C virus. Lancet 1998 352 1426-1432. 3. Afdhal NH, Keaveny AP, Nunes DP. Hepatitis C...

Hepatitis Caused by Injecting Illicit Drugs and Intranasal Cocaine

The sharing of needles, syringes, and other equipment for the injection of illicit drugs is responsible for a substantial proportion of both HBV and HCV infections. Prevention efforts may be instituted by primary care physicians through routine inquiry about the use of injection illicit drugs by their patients. Advice to discontinue drug use, discussion of substance abuse treatment, and, where available, participation in needle-exchange programs may be effective. If the latter are not...

Effects of Current Therapy of Chronic Viral Hepatitis on Drug Metabolism

IFN-a and other type-1 IFNs have been shown to affect phase I drug metabolism, potentially increasing the risk of adverse drug interactions. Not unexpectedly, these effects depend on the particular isoenzyme of cytochrome P-450 that is under consideration. Horsmans et al. (21) investigated the effect of IFN-a on the cytochrome P-450-mediated metabolism of 14C-aminopyrine, in patients with CHC. They found a Fig. 4. Interplay of factors that influence allergic or idiosyncratic responses to drugs...

David G Forcione MD Raymond T Chung MD and Jules L Dienstag MD

Impact of Immunopathogenetic Mechanisms of Hepatitis Injury on Outcome of Hepatitis B Extrahepatic Manifestations in Chronic Hepatitis B Virus Infection Prognosis and Survival in Chronic Hepatitis B HCC and Chronic Hepatitis B Virus Infection Infection with HBV Mutants Vaccination in HBV Infection Antiviral Therapy for Chronic Hepatitis B Virus Infection Role of Liver Transplant in Hepatitis B Hepatitis B virus (HBV) infects over 350 million persons, and represents one of the world's leading...

Alcohol and Chronic Viral Hepatitis

The most common form of nonalcohol-induced liver disease seen in patients with alcoholism is CHC (7). In patients with CHC, chronic alcoholism has been shown to cause more severe and rapidly progressive liver disease. This can lead more frequently to cirrhosis of the liver and hepatocellular carcinoma. Alcohol intake in excess of 10 g d has been associated with increased serum hepatitis C viral RNA and amino-transferase levels (7). The mechanisms of these increases are poorly understood, but,...

Patients Not Suitable for Treatment Developing the Therapeutic Plan

Alcohol Abuse Treatment Algorithms

There are many patients infected with HBV or HCV, who, at the time of initial evaluation, are not considered suitable for treatment. These patients include the alcoholic who is actively drinking, the active drug user,the patient with a significant psychiatric history, and those patients with significant psychosocial issues. These patients should have a well-formulated plan centered on those factors. The HCV-infected alcoholic patient is at increased risk for the development of cirrhosis (28)....

Chronic Infection With Normal Alt Carrier

Patients with hepatitis C, who have a persistently normal ALT, represent a unique subgroup of patients. One early study indicated that 26 of patients with positive hepatitis C virus antibody had normal ALT (36). But, as noted previously, this is likely an underestimate of the true proportion of patients with positive hepatitis C virus antibody who are ALT-normal. In the two studies of women who acquired hepatitis C after administration of anti-D immunoglobulin, nearly two-thirds of those who...

Outcome After Decompensation Of Cirrhosis

The natural history and the prognostic factors in hepatic cirrhosis have been extensively studied, but several aspects remain unclear, and prognostic factors have not been validated fully (47,112-134). Certain clinical problems, such as development or complications of ascites, predict a poor prognosis (Fig. 7). Patients with compensated cirrhosis who develop ascites have a 2-yr survival of 50 and 5-yr Fig. 7. Development of ascites carries an ominous prognosis. Complications of ascites, such as...

Patient Selection

The initial selection of patients for therapy is an important determinant of the outcome of treatment. In a typical cohort of patients diagnosed with hepatitis C, approx one-third of patients are not candidates of therapy. Typically, in this third of patients are included those who are still actively using intravenous iv drugs, patients who are abusing alcohol, patients with concomitant serious medical illnesses, patients with advanced liver disease, and patients who decline therapy. In this...

Introduction

Hepatitis C virus HCV infection often causes insidious and progressive liver injury in infected individuals. Acute infection is typically mild and subclinical, yet there is a high rate of chronicity after infection. As many as 55-85 of individuals who contract HCV infection will develop chronic infection and hepatitis. Of these, at least 20 will progress to cirrhosis after a 10-30 yr period, and are at risk to develop hepatocellu-plar carcinoma 1 . The estimated worldwide prevalence of chronic...

Eye Problems

IFN has been associated with multiple neurovisual complications. The most common ocular complication associated with IFN use has been the development of a mild-to-moderate ischemic retinopathy 22-27 . On fundoscopy, this manifests as cotton-wool spots or hemorrhage, which is similar to diabetic retinopathy. The reported incidence of this retinopathy has varied greatly in different series 2-86 , but most cases are not associated with significant visual loss. Several cases of glaucoma have also...

HBV and HCV Latency

The mutual suppression of viral replication in HBV and HCV co-infection may lead to the development of both HBV and HCV latency. In one study, co-infected patients with active HCV infection lost their HBsAg, and had undetectable serum HBV DNA. However, histologic evaluation of tumorous and nontumorous liver tissues from these patients revealed the presence of HBV DNA HBV latency . Likewise, some patients with dual infection who had active HBV replication had undetectable serum HCV RNA, and yet...