Hepatic flares in chronic hepatitis C: Spontaneous exacerbation vs hepatotropic viruses superinfection

The hepatitis C virus(HCV)causes an acute infection that is frequently asymptomatic,but a spontaneous eradication of HCV infection occurs only in one-third of patients.The remaining two-thirds develop a chronic infection that,in most cases,shows an indolent course and a slow progression to the more...

Full description

Saved in:
Bibliographic Details
Published inWorld journal of gastroenterology : WJG Vol. 20; no. 22; pp. 6707 - 6715
Main Authors Sagnelli, Evangelista, Sagnelli, Caterina, Pisaturo, Mariantonietta, Coppola, Nicola
Format Journal Article
LanguageEnglish
Published United States Baishideng Publishing Group Inc 14.06.2014
Subjects
Antiviral Agents - therapeutic use
Chronic
Disease Progression
flares
Hepacivirus - drug effects
Hepacivirus - immunology
Hepacivirus - pathogenicity
Hepatic
hepatitis
Hepatitis C, Chronic - diagnosis
Hepatitis C, Chronic - drug therapy
Hepatitis C, Chronic - immunology
Hepatitis C, Chronic - virology
Humans
Immunocompromised Host
Immunosuppressive Agents - adverse effects
infection
Risk Factors
Superinfection
Topic Highlight
Treatment Outcome
virus
Hepatitis A virus superinfection
Hepatic flares
Chronic hepatitis C virus infection
Hepatic flares in immunocompromised patients
Immunocompromised patients
Online AccessGet full text

Cover

More Information
Summary:The hepatitis C virus(HCV)causes an acute infection that is frequently asymptomatic,but a spontaneous eradication of HCV infection occurs only in one-third of patients.The remaining two-thirds develop a chronic infection that,in most cases,shows an indolent course and a slow progression to the more advanced stagesof the illness.Nearly a quarter of cases with chronic hepatitis C(CHC)develop liver cirrhosis with or without hepatocellular carcinoma.The indolent course of the illness may be troubled by the occurrence of a hepatic flare,i.e.,a spontaneous acute exacerbation of CHC due to changes in the immune response,immunosuppression and subsequent restoration,and is characterized by an increase in serum aminotransferase values,a frequent deterioration in liver fibrosis and necroinflammation but also a high frequency of sustained viral response to pegylated interferon plus ribavirin treatment.A substantial increase in serum aminotransferase values during the clinical course of CHC may also be a consequence of a superinfection by other hepatotropic viruses,namely hepatitis B virus(HBV),HBV plus hepatitis D virus,hepatitis E virus,cytomegalovirus,particularly in geographical areas with high endemicity levels.The etiology of a hepatic flare in patients with CHC should always be defined to optimize follow-up procedures and clinical and therapeutic decisions.
Bibliography:Evangelista Sagnelli;Caterina Sagnelli;Mariantonietta Pisaturo;Nicola Coppola;Section of Infectious Diseases,Department of Mental Health and Public Medicine,Second University of Naples,80131 Naples,Italy;Mariantonietta Pisaturo,Division of Infectious Diseases,AORN Sant’Anna e San Sebastiano di Caserta,81100 Caserta,Italy;Department of Clinical and Experimental Medicine and Surgery "F Magrassi e A Lanzara",Second University of Naples,80131 Naples,Italy
Author contributions: Sagnelli E, Sagnelli C, Pisaturo M and Coppola N contributed to the substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content; and final approval of the version to be published.
Correspondence to: Evangelista Sagnelli, Professor, Section of Infectious Diseases, Department of Mental Health and Public Medicine, Second University of Naples, Vico Luigi de Crecchio, 16, 80131 Naples, Italy. evangelista.sagnelli@unina2.it
Telephone: +39-8-15666271 Fax: +39-8-23232296
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v20.i22.6707