Boontar Valinluck

Short-term prednisone therapy affects aminotransferase activity and hepatitis C virus RNA levels in chronic hepatitis C

BACKGROUND/AIMS The effects of corticosteroids on chronic hepatitis B have provided insight into the mechanism of liver cell injury caused by hepatitis B. In this study, this model was applied to investigate the effects of prednisone on alanine aminotransferase (ALT) and hepatitis C virus (HCV) RNA levels in chronic hepatitis C. METHODS Ten patients with chronic hepatitis C who had increased levels of ALT and HCV RNA detectable in serum were given a 7-week course of a tapering dose of prednisone. Quantitation of serum HCV RNA was determined by polymerase chain reaction (PCR) and by branched-chain DNA amplification. RESULTS ALT levels decreased in 8 of 10 patients during therapy. Mean ALT levels of all 10 patients decreased from 184 to 84 U/L (P = 0.002) and then rebounded in 7 of the 8 patients after discontinuation of prednisone. HCV RNA was detectable by the branched DNA technique in 9 of 10 patients. These values increased in all 9 patients during prednisone therapy. The mean serum HCV RNA levels increased from 40.9 before treatment to 414.3 Eq/mL x 10(5) during treatment (P = 0.043). Using PCR, HCV RNA titers increased one log-fold in 8 of 10 patients (geometric mean of 1:4420 to 1:23410). HCV RNA levels decreased to pretreatment values within a mean of 2.8 weeks (range, 1-5) after discontinuation of prednisone. CONCLUSIONS These responses in ALT and HCV RNA suggest the participation of an immune-mediated mechanism in the liver cell injury in chronic hepatitis C.

Lack of association between hepatitis C infection and development of AIDS-related lymphoma.

Hepatitis C virus (HCV) has been associated with various lymphoproliferative disorders, and a high prevalence (9%-32%) of chronic HCV infection has been demonstrated among patients with lymphoma. Dual coinfection by HIV and HCV has been demonstrated in approximately 40% of certain populations of HIV-infected individuals. Because of this high prevalence of coinfection by HIV and HCV, the known relations between HCV and lymphoproliferative disorders, and the association of HIV and B cell lymphoma, the potential association between chronic HCV and the development of AIDS-related lymphoma was examined. The prevalence of HCV infection in HIV-infected patients with lymphoma was compared with that in patients with AIDS, diagnosed on the basis of an illness other than lymphoma. Risk factors for HCV infection, overall, were also evaluated. Evidence of HCV infection was ascertained by assessing anti-HCV antibodies, and HCV RNA in serum. The study consisted of 99 homosexual/bisexual men with AIDS-related lymphoma, and 43 other AIDS patients. HCV infection was detected in 11 of 99 (11.1 %) men with lymphoma, and in 5 of 43 (11.6%) other AIDS patients. Further, in patients with AIDS-related lymphoma, no relation was found between HCV infection and lymphoma histology or site. History of use of injected illicit drugs was associated with a significantly elevated risk of HCV infection in the combined group of lymphoma and other AIDS patients. The current study demonstrates no relation between dual infection by HIV and HCV and subsequent increased risk of lymphoma.

Study of reactivation of chronic hepatitis delta infection

Five patients with chronic hepatitis delta virus (HDV) infection suffered spontaneous episodes of liver enzyme elevation on a background of otherwise biochemically stable liver disease. In all five patients these episodes were accompanied by a rise in serum levels of anti-HDV IgM, HDV antigen and HDV RNA. These episodes of increased HDV replication accompanied by biochemical evidence of liver injury are reminiscent of reactivation in chronic hepatitis B. Surges of increased HDV replication may be important in the progression of liver disease in chronic HDV infection.

Hepatitis B Virus DNA in Fulminant Hepatitis B

Excerpt Patients with fulminant hepatitis B have hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) detected for shorter periods than do patients with nonfulminant infections, an...

Clinical significance of hepatitis C viral RNA status and its correlation to antibodies to structural HCV antigens in anti-HCV reactive patients with normal liver tests.

Extensive serological testing and HCV RNA determination by RT‐PCR was performed in serum, PBMCs, and liver tissue in thirteen anti‐HCV reactive patients with persistently normal liver tests. Absolute concordance in the status of HCV RNA between serum, PBMCs, and liver was noted. Five patients were HCV RNA positive but only three had mild histological changes. Eight patients were HCV RNA negative in all three sites and had virtually normal liver histology. Patterns of reactivity in RIBA™ 2.0 strip immunoblot assay did not differentiate viremic from nonviremic patients. ELISA testing using multiple individual HCV recombinant antigens from the structural and non‐structural regions of HCV demonstrated mean antibody titers to the structural antigens, in particular HCV E2 antibodies, to be significantly lower in HCV RNA negative patients. The status of HCV RNA in the serum appears to infer the status of HCV RNA in the liver and PBMCs in patients with persistently normal liver tests. Patients with persistently normal liver tests and undetectable HCV RNA have probably spontaneously cleared HCV infection.

Prevalence of Hepatitis G Virus RNA in the Sera of Patients With HIV Infection

OBJECTIVE The routes of transmission of the hepatitis G virus (HGV) are similar to those responsible for infection with HIV. We sought to evaluate the prevalence of HGV RNA in the sera of HIV-infected patients. METHODS The sera of 157 HIV-infected patients were assayed by reverse transcriptase-polymerase chain reaction (RT-PCR) using established primers for HGV. Patients were divided into group 1 (positive circulating hepatitis B surface antigen [HBsAg]), group 2 (positive anti-hepatitis C virus [HCV] antibody) and group 3 (without markers for HBV or HCV). RESULTS The overall prevalence of HGV RNA was 22%; prevalence was higher in group 1 (49%) than in groups 2 (16%) or 3 (7%). Patients with positive HGV RNA had laboratory values similar to HGV RNA-negative patients except for higher CD4 counts. Patients with an estimated risk duration of < or = 14 years were more likely to be HGV RNA-positive than patients at risk for >15 years. HGV RNA was found as frequently in patients with a homosexual lifestyle as in injection drug users (IDU). Multivariable analysis showed that the presence of HBsAg was the strongest factor associated with the presence of HGV RNA in serum. CONCLUSIONS Patients with HIV and HBV coinfection are significantly more likely to be HGV RNA-positive. Patients with a risk factor duration for >15 years were less likely to be HGV RNA-positive, pointing to a decrease in HGV RNA prevalence over time. This study supports the notion that homosexual lifestyle, in addition to injection drug usage and blood product transfusion, is a risk factor for HGV infection.

Serum Hepatitis B Viral DNA in Acute Viral Hepatitis B

Excerpt There is no way to identify which patients with acute hepatitis B infection will recover and which will become chronic carriers. Several studies (1-3) noted absence of serum hepatitis B vir...