Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, Naples, Italy; Division of Infectious and Tropical Diseases, AORN Sant'Anna e San Sebastiano di Caserta, Caserta, Italy. Electronic address: firstname.lastname@example.org.
BACKGROUND & AIMS:
The slow asymptomatic progression of chronic Hepatitis C can be interrupted by an acute exacerbation, characterized by increased serum levels of alanine aminotransferase (ALT) and bilirubin and other symptoms of acute hepatitis. We aimed to provide more information about the clinical presentation of acute exacerbation of chronic hepatitis C.
We identified 82 consecutive patients, from 2 locations in Italy, who had an acute exacerbation of chronic hepatitis C from January 2005 through June 2010; we followed them for a median period of 36 months. These cases were HCV RNA positive, hepatitis B antigen-negative, and had not received anti-HCV therapy. They were matched with 82 subjects with hepatitis C without reactivation for age, sex, and HCV genotype (controls). Sixty-nine cases and 73 controls were followed for at least 2 years. Liver biopsies had been taken from 23 cases and 31 controls-once before enrollment in the study and once during the follow-up period.
HCV genotype 2 was detected in 46.4% of cases genotype 1 in 43.9%. Among cases, the mean level of ALT was 1063±1038 IU/dL and of total bilirubin was 15.87±7.15 mg/dL. A higher percentage of cases carried the IL-28B CC genotype than controls (40.2% vs 24.4%; P <.05). Among cases, 43.5% had a steady increase in ALT (>2-fold baseline value); for 56.5% of these patients, ALT levels returned to baseline values before the acute exacerbation of chronic hepatitis. Based on comparisons of biopsies, 18 cases (78.3%) and 11 controls (35.5%) had increasing fibrosis, with Ishak scores increasing by >2 (P <.005); 14 cases (60.9%) and 3 controls (9.6%) had increases in necro-inflammation >2 points (P <.005). Thirty-two cases (46.4%) and 38 controls (52%) received treatment with pegylated interferon and ribavirin; a sustained viral response (SVR) was achieved by 26 cases (81.2%) and 23 controls (60.5%).
Although an acute exacerbation of chronic hepatitis is a serious medical condition, most patients achieve a SVR following treatment with pegylated interferon and ribavirin