Viral hepatitis and the estimations of the effects of antiviral treatment


Viral hepatitis and the estimations of the effects of antiviral treatment

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Article_Title: Viral hepatitis and the estimations of the effects of antiviral treatment
Authors: Veronica Grec, Eftimie Miuțescu
Affiliation: Faculty of Medicine, Pharmacy and Dental Medicine, ″Vasile Goldis″ Western University of Arad, Romania
Abstract: For a long time, fibrosis was assessed only through hepatic biopsy puncture (PBH). The disadvantage of invasiveness and limitations of this method are the source of research for identification of alternative tests, noninvasive for fibrosis assessment, already grouped in serological scores or imaging methods (transient elastography). Diagnosis, eligibility, selection and monitoring regimen during antiviral therapy of patients with chronic hepatitis and HCV hepatic cirrhosis were established according to the therapeutic protocol in chronic hepatitis and compensated cirrhosis with HCV virus. This protocole is included in order MS / CNAS no. 1.301/500 from 11 July 2008 (* updated *) for approval of therapeutic protocols regarding medicine prescription, correspondent to international common names common names provided in the list including the relevant international medicines that insured persons, with or without personal contribution benefit of, on prescription, in health insurance system, approved by Government Decision no. 720/2008. Of the total patients who had received antiviral treatment two thirds were female. Numerical ratio between men and women varies by age, being almost equal before 40 years and over with increasing age. Initial viremia does not correlate with the amount of cytolysis or histological damage, but a higher value may influence response to treatment. Vast submitted is correlated with a higher viral load and a higher score of inflammation and fibrosis. Early viral response, accepted as a predictor for sustained response was present in 91 % of patients treated. The study showed a significant reduction of hepatic cytolysis after treatment and if at first the majority of patients have values 2-3 times upper limit of normal, after 6 months 77, 27 % had normal transaminases. Lack of a significant percentage of patients who do not respond early was an impediment in determining predictive factors for lack of response to therapy. However we found a better response in those with lower viremia and females.
Keywords: viral C hepatitis; antiviral treatment; hepatic fibrosis
References: Shaw-Stffel T. Reference to Hepatitis C infection. London: Science Press 2004
Kim WR. Global epidemiology and burden of hepatitis C. Microbes and infection 2002; 4: 1119-1125
Lauer GM, Walker BD. Hepatitis C virus infection. N Engl J Med 2001; 345: 41-52
Wasley A, Alter MJ. Epidemiology of hepatitis C: geographic differences and temporal trends. Semin liver dis 2000; 20:1-16
Armstrong GL,Alter MJ, McQuillianGM et al. The past incidence of hepatitis C virus infection. Hepatology 2000;31:777-782
Hoofnagle JH. Hepatitis C. The Clinical Spectrum of Desease. Hepatology 1997; 26:15-20
Feitelson MA. Hepatitis C Virus: From Laboratory to Clinic. Cambridge University Press, 2002
Alter JH, Conry- Catilena C, Melpolder J et al. Hepatitis C in asymptomatic blood donors. Hepatology 1997; 26:29-33
Schvarcz R, Johansson B, Nystrom B. Nosocomial transmission of hepatitis C virus. Infection 1997; 25: 74-77
Fauci AS, Braunwald E, Isselbacher KJ et al. Harrison. Principii de medicina interna-editia 14.Bucuresti: Teora, 2003: 1869-1878
Mondelli MU, Silini E. Clinical significance of hepatitis C genotypes. Hepatology 1999; 31: 65-70
Pawlotsky JM. Hepatitis C virus genetic variability: pathogenic and clinical implications. Clin Liver Dis 2003; 7:45-66
Westin J, Nordlinger H, Lagging M et al. Steatosis accelerates fibrosis development over time in hepatitis C virus genotype 3 infected patients. J Hepatol 2002; 36: 1266-1272
Palmer M.Guide to Hepatitis and Liver Disease. New York: Avery, 2004; 85-104
Seeff LB. Natural history of hepatitis C. IN: Biomedical research Reaports: Hepatitis C. London: Academic Press, 2002; 85-105
Villano SA, Vlahov D, Nelson KE et al. Persistence of viremia and importance of long-term follow-up after acute hepatitis C infection. Hepatology 1999; 29: 908-914
Read_full_article: pdf/23-2013/23-3-2013/SU23-3-2013-GrecV1.pdf
Correspondence: Grec Veronica, Faculty of Medicine, Pharmacy and Dental Medicine, Arad Romania, email:medicina@uvvg.ro

Read full article
Article Title: Viral hepatitis and the estimations of the effects of antiviral treatment
Authors: Veronica Grec, Eftimie Miuțescu
Affiliation: Faculty of Medicine, Pharmacy and Dental Medicine, ″Vasile Goldis″ Western University of Arad, Romania
Abstract: For a long time, fibrosis was assessed only through hepatic biopsy puncture (PBH). The disadvantage of invasiveness and limitations of this method are the source of research for identification of alternative tests, noninvasive for fibrosis assessment, already grouped in serological scores or imaging methods (transient elastography). Diagnosis, eligibility, selection and monitoring regimen during antiviral therapy of patients with chronic hepatitis and HCV hepatic cirrhosis were established according to the therapeutic protocol in chronic hepatitis and compensated cirrhosis with HCV virus. This protocole is included in order MS / CNAS no. 1.301/500 from 11 July 2008 (* updated *) for approval of therapeutic protocols regarding medicine prescription, correspondent to international common names common names provided in the list including the relevant international medicines that insured persons, with or without personal contribution benefit of, on prescription, in health insurance system, approved by Government Decision no. 720/2008. Of the total patients who had received antiviral treatment two thirds were female. Numerical ratio between men and women varies by age, being almost equal before 40 years and over with increasing age. Initial viremia does not correlate with the amount of cytolysis or histological damage, but a higher value may influence response to treatment. Vast submitted is correlated with a higher viral load and a higher score of inflammation and fibrosis. Early viral response, accepted as a predictor for sustained response was present in 91 % of patients treated. The study showed a significant reduction of hepatic cytolysis after treatment and if at first the majority of patients have values 2-3 times upper limit of normal, after 6 months 77, 27 % had normal transaminases. Lack of a significant percentage of patients who do not respond early was an impediment in determining predictive factors for lack of response to therapy. However we found a better response in those with lower viremia and females.
Keywords: viral C hepatitis; antiviral treatment; hepatic fibrosis
References: Shaw-Stffel T. Reference to Hepatitis C infection. London: Science Press 2004
Kim WR. Global epidemiology and burden of hepatitis C. Microbes and infection 2002; 4: 1119-1125
Lauer GM, Walker BD. Hepatitis C virus infection. N Engl J Med 2001; 345: 41-52
Wasley A, Alter MJ. Epidemiology of hepatitis C: geographic differences and temporal trends. Semin liver dis 2000; 20:1-16
Armstrong GL,Alter MJ, McQuillianGM et al. The past incidence of hepatitis C virus infection. Hepatology 2000;31:777-782
Hoofnagle JH. Hepatitis C. The Clinical Spectrum of Desease. Hepatology 1997; 26:15-20
Feitelson MA. Hepatitis C Virus: From Laboratory to Clinic. Cambridge University Press, 2002
Alter JH, Conry- Catilena C, Melpolder J et al. Hepatitis C in asymptomatic blood donors. Hepatology 1997; 26:29-33
Schvarcz R, Johansson B, Nystrom B. Nosocomial transmission of hepatitis C virus. Infection 1997; 25: 74-77
Fauci AS, Braunwald E, Isselbacher KJ et al. Harrison. Principii de medicina interna-editia 14.Bucuresti: Teora, 2003: 1869-1878
Mondelli MU, Silini E. Clinical significance of hepatitis C genotypes. Hepatology 1999; 31: 65-70
Pawlotsky JM. Hepatitis C virus genetic variability: pathogenic and clinical implications. Clin Liver Dis 2003; 7:45-66
Westin J, Nordlinger H, Lagging M et al. Steatosis accelerates fibrosis development over time in hepatitis C virus genotype 3 infected patients. J Hepatol 2002; 36: 1266-1272
Palmer M.Guide to Hepatitis and Liver Disease. New York: Avery, 2004; 85-104
Seeff LB. Natural history of hepatitis C. IN: Biomedical research Reaports: Hepatitis C. London: Academic Press, 2002; 85-105
Villano SA, Vlahov D, Nelson KE et al. Persistence of viremia and importance of long-term follow-up after acute hepatitis C infection. Hepatology 1999; 29: 908-914
*Correspondence: Grec Veronica, Faculty of Medicine, Pharmacy and Dental Medicine, Arad Romania, email:medicina@uvvg.ro