Nadia Campo

Chronic hepatitis induced by Jin Bu Huan

BACKGROUND/AIMS Jin Bu Huan and other Chinese herbal products are widely taken remedies. They have been developed as a natural alternative to traditional drugs in the treatment of various ailments. Their ability to induce several side effects such as acute hepatitis has already been described. We report a case of chronic hepatic damage following administration of Jin Bu Huan Anodyne tablets. METHODS The patient, a 49-year-old man, developed biochemical signs of liver damage 2 months after beginning Jin Bu Huan intake (3 tablets/daily) including biopsy-proven chronic hepatitis with moderate fibrosis. Virological, autoimmune, metabolic or other hepatotoxic causes were excluded. Liver function impairment was resolved by discontinuing Jin Bu Huan intake. CONCLUSIONS This case reinforces the already known hepatotoxicity of this product and should make us think more about the uncontrolled use of alternative products.

Antiviral Activity of Amantadine in Elderly Patients with Chronic Hepatitis C

Background: Hepatitis C virus (HCV) infection is a worldwide problem of public health. Epidemiological studies have shown a significant higher prevalence of infection in the elderly. Amantadine is an antiviral agent active against the influenza A virus that has been used in cases of chronic hepatitis C. Objectives: To evaluate the antiviral activity and the safety of amantadine (200 mg daily for 6 months) in elderly patients with chronic hepatitis C. Methods: The study group consisted of 23 consecutive patients over 65 years suffering from chronic hepatitis C. Aminotransferase (ALT) levels were tested at baseline, at 15 days and then monthly until the end of therapy. HCV genotype was determined at baseline. A quantitative HCV-RNA measurement was performed at baseline, at 15 days and at the 1st, 3rd and 6th month of treatment. Results: 13 males and 10 females were enrolled (mean age 70.1 ± 3.4 years; range: 65–75). The mean ALT levels did not change significantly during therapy except in 1 patient subsequently returned normal. The HCV-RNA remained detectable in all patients, but a significant difference in response was observed in patients infected by genotype 1b. Conclusions: Our results confirm the antiviral activity of amantadine against HCV, mainly for genotype 1b with initial high viral load. No consistent effects on aminotransferases were observed.

HCV-RNA levels play an important role independently of genotype in predicting response to interferon therapy

Objective: To evaluate the relationship between hepatitis C virus (HCV)‐RNA levels and genotypes in order to establish their potentially predictive role in interferon (IFN) response. Design: To detect HCV genotype at baseline and HCV viraemia levels before and during IFN treatment in three groups of patients with different IFN response. Methods: Our study included 85 patients with biopsy‐proven chronic hepatitis C who underwent IFN therapy at standard schedule (3MU thrice weekly for 6 months). On the basis of IFN response they were subdivided into three groups as follows: non responders (NR: 27 cases) when alanine aminotransferase (ALT) values (normal value: 0‐40 IU) at the end of treatment were abnormal (101.7±10.4); responders relapsing (RR: 29 cases) when normal ALT values at the end of therapy (28.14±1.7) increased during follow‐up; sustained (long‐term) responders (LTR: 29 cases) when ALT values remained normal for at least 12 months of follow‐up (ALT values at the end of therapy: 21.8± 1.4). ALT activity was monitored monthly during therapy and each month during 12 months of follow‐up. HCV genotype was evaluated before starting treatment whereas HCV‐RNA viraemia was checked at baseline and at the 1st and 6th months of therapy. Results: The baseline viral load was higher in the NR group than in the RR and LTR groups independently of genotype; HCV‐RNA levels progressively decreased during therapy independently of response but the levels remained significantly higher in the NR group. Genotype 1b was prevalent in the NR group. However, levels of viraemia in genotype 1b LTR patients are significantly lower than in genotype 1b NR patients. Conclusion: These results suggest that among viral‐related parameters viraemia alone seems to play an important role in predicting response to IFN independently of genotype.

Hepatitis G Virus Infection in Haemodialysis and in Peritoneal Dialysis Patients

The aim of this study was to detect hepatitis G virus RNA (HGV RNA) and antibodies against the virus envelope protein E2 (anti-E2) in 107 patients either on maintenance haemodialysis (n = 78) or peritoneal dialysis (n = 29) to evaluate the prevalence of HGV infection and to establish its role in liver disease. The total prevalence of HGV infection was of 15.4% among haemodialysis patients, whereas it was 10.3% among peritoneal dialysis patients. HGV RNA was detected in 2 haemodialysis patients (2.6%) and in 3 peritoneal dialysis patients (10.3%). Anti-E2 was found in 10 haemodialysis patients (7.8%), whilst all peritoneal dialysis patients resulted negative. In only 1 patient the alanine aminotransferase level was elevated. This patient underwent liver biopsy that did not reveal evidence of chronic hepatitis. The lower HGV prevalence in haemodialysis patients, when compared with data reported by other European authors, should be related to the lower rate of polytransfused patients in our series (29.5%). Multiple blood transfusions should be considered as the main factor to explain the different prevalence of HGV infection among various European dialysis centres. Detection of both antibody and viraemia is important to establish the real rate of the infection.

Soluble β2-μ-Associated and β2-μ-Free HLA class I heavy chain serum levels in interferon-α nonresponder chronic hepatitis C patients. Markers of immune activation, and response to antiviral retreatment

The serum levels of soluble β2-μ-associated and β2-μ-free HLA class I heavy chains were determined in 28 interferon-α nonresponder chronic hepatitis C patients retreated with interferon-α plus ribavirin and in 70 healthy subjects. The baseline levels of β2-μ-associated and β2-μ-free HLA class I heavy chains were significantly higher in patients than in healthy controls(P = 0.001). The levels of β2-μ-associated HLA class I heavy chains significantly increased in responder patients with respect to nonresponders at the third month of treatment(P = 0.03). At the sixth month of treatment and after 6 months of follow up the levels of β2-μ-associated HLA class I heavy chains decreased in responder patients and increased in nonresponders. The levels of β2-μ-free HLA class I heavy chains showed only minor changes during and after treatment. We suggest that the determination of hepatitis C virus RNA levels combined with soluble β2-μ-associated HLA class I heavy chains, as a marker of immune activation, could identify interferon-α non responder chronic hepatitis C patients most likely to respond to a retreatment with interferon-α plus ribavirin.

Hepatitis G virus and HCV related extrahepatic disease.

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