Öz
Aim: The diagnosis of acute hepatitis C virus (HCV) infection can be made during follow-up in patients with a generally known risk contact, as it is mostly asymptomatic. The earliest indicator of acute HCV infection is increased HCV-RNA. Anti-HCV seroconversion is also the strongest evidence of acute infection. The risk of chronicity is at least 80%. Treatment of acute HCV infection is recommended because of the high rate of chronicity. Spontaneous recovery can be seen after 8-12 weeks in acute viral hepatitis C. Therefore, 8-12 weeks should be waited to start specific treatment. The aim of this study is to evaluate the data of the patients we follow up with the diagnosis of acute HCV in our clinic, to determine the most appropriate time to start treatment in acute viral hepatitis C and to evaluate the effectiveness of Peg-interferon alfa 2a treatment.
Materials and Methods: The data of patients diagnosed with acute viral hepatitis C in our clinic between 2005 and 2015 were evaluated.
Results: Twelve patients with acute viral hepatitis C were followed in our clinic. Twelve of the cases were male, and the mean age was 38.83 ± 6.75 (range, 25-50) years. Spontaneous clearance was observed in three patients at the third month. Three months after the acute diagnosis of HCV, pegylated-interferon alpha 2a 180 mcg (1x1 / week sc) was started in nine patients without spontaneous improvement and treatment was performed for six months. Treatment response was 100% at 6-month and 2-year follow-ups.
Conclusion: Acute viral hepatitis C is a disease that should not be overlooked.
After diagnosis, 8-12 weeks should be waited for spontaneous viral clearance. Patients who do not develop spontaneous viral clearance after 8-12 weeks can be largely treated with interferon alfa 2a therapy.
Spontaneous recovery was observed in three of our patients after 8-12 weeks of follow-up (HCV-RNA was negative by PCR, AST-ALT values were normal).
Anahtar Kelimeler
Acute viral hepatitis C pegylated interferon alpha 2a spontaneous viral clearance
Kaynakça
- Mıstık R, Balık İ. Türkiye’de viral hepatitlerin epidemiyolojik analizi. Viral hepatit. 2003;1:10-55.
- Jaeckel E, Cornberg M, Wedemeyer H et al. Treatment of acute hepatitis C with interferon alfa-2b. New England Journal of Medicine. 2001;345(20):1452-7.
- Akhan S. Hepatit C virusu. Topçu AW, Söyletir G, Doğanay M (eds), Enfeksiyon Hastalıkları ve Mikrobiyolojisi, 3.baskı, İstanbul: Nobel Tıp Kitabevleri, 2008: 1911-29.
- Corey KE, Mendez-Navarro J, Gorospe EC, Zheng H, Chung RT. Early treatment improves outcomes in acute hepatitis C virus infection: a meta-analysis. Journal of viral hepatitis. 2010;17(3):201-7.
- Basu PP, Shah NJ, Aloysius MM, Brown Jr R. Sofosbuvir and ledipasvir vs. sofosbuvir and simeprevir for acute hepatitis C: a RCT (SLAM C study). Hepatol Int 2016;10: S14– S15.
- Rockstroh JK, Bhagani S, Hyland RH et al. Ledipasvir/sofosbuvir for 6 weeks in HIV-infected patients with acute HCV infection. Conference on Retroviruses and Opportunistic Infections (CROI), February 22–25, Boston, Massachusetts.
- Deterding K, Spinner C, Schott E et al. Six weeks of sofosbuvir/ledipasvir (SOF/LDV) are sufficient to treat acute hepatitis C virus genotype 1 monoinfection: The HEPNET Acute HCV IV Study. J Hepatol 2016;64: S211.
- Wiegand J, Jäckel E, Cornberg M et al. Long-term follow-up after successful interferon therapy of acute hepatitis C. Hepatology. 2004;40(1):98-107.
- Kamal SM, Fouly AE, Kamel RR et al. Peginterferon alfa-2b therapy in acute hepatitis C: impact of onset of therapy on sustained virologic response. Gastroenterology. 2006;130(3):632-8.
- Cãruntu FA, Benea L Acute hepatitis C virus infection: Diagnosis, pathogenesis, treatment. Journal of Gastrointestinal and Liver Diseases: JGLD. 2006;15(3):249-56.
- Orland JR, Wright TL, Cooper S Acute hepatitis C. Hepatology (Baltimore, Md). 2001;33(2):321-7.
- Seeff LB, Hoofnagle JH The National Institutes of Health Consensus Development Conference: Management of Hepatitis C 2002. Clinics in Liver Disease. Feb 2003;7(1):261-87.
- Kamal SM, Moustafa KN, Chen JC et al. Duration of peginterferon therapy in acute hepatitis C: a randomized trial. Hepatology. 2006;43(5):923-31.
- Strader DB, Wright T, Thomas DL, Seeff LB American Association for the Study of Liver Diseases, Diagnosis, management, and treatment of hepatitis C. Hepatology. Apr 2004;39(4):1147-71.
- Gerlach JT, Diepolder HM, Zachoval R et al. Acute hepatitis C: high rate of both spontaneous and treatment induced viral clearance. Gastroenterology. 2003;125(1):80-8.
- Hofer H, Watkins-Riedel T, Janata O et al. Spontaneous viral clearance in patients with acute hepatitis C can be predicted by repeated measurements of serum viral load. Hepatology, 2003;37(1):60-4.
- Licata A, Di Bona D, Schepis F, Shahied L, Craxı A, Cammà C When and how to treat acute hepatitis C? Journal of hepatology. 2003;39(6):1056-62. Wiegand J, Buggisch P, Boecher W et al. Early monotherapy with pegylated interferon alpha-2b for acute hepatitis C infection: the HEP-NET acute-HCV-II study. Hepatology. 2006;43(2):250-6.
- Kamal SM, Fouly AE, Kamel RR et al. Peginterferon alfa-2b therapy in acute hepatitis C: impact of onset of therapy on sustained virologic response. Gastroenterology. 2006;130(3):632-8.
- Ghany MG, Strader DB, Thomas DL, Seeff LB Diagnosis, management, and treatment of hepatitis C: an update. Hepatology (Baltimore, Md). 2009;49(4):1335.
- Kamal SM, Ismail A, Graham CS et al. Pegylated interferon α therapy in acute hepatitis C: Relation to hepatitis C virus–specific T cell response kinetics. Hepatology. 2004;39(6):1721-31.
Öz
Amaç: Akut hepatit C virüs (HCV) enfeksiyonu tanısı, çoğunlukla asemptomatik seyrettiği için genel olarak bilinen bir risk teması olan hastalarda takip sırasında konulabilmektedir. Akut HCV enfeksiyonunun en erken göstergesi artmış HCV-RNA'dır. Anti-HCV serokonversiyonu da akut enfeksiyonun en güçlü kanıtıdır. Kronikleşme riski en az %80'dir. Akut HCV enfeksiyonunun tedavisi, yüksek kronikleşme oranı nedeniyle önerilmektedir. Akut viral hepatit C'de 8-12 hafta sonra spontan iyileşme görülebilmektdir. Bu nedenle spesifik tedaviye başlamak için 8-12 hafta beklenmesi önerilmektedir. Bu çalışmada kendi kliniğimizde akut HCV tanısı ile takip ettiğimiz hastaların verilerini değerlendirerek akut viral hepatit C’de en uygun tedavi başlama zamanını saptamak ve Peg-interferon alfa 2a’nın akut viral hepatit C vakaları üzerindeki etkisini değerlendirmek amacıyla yapılmıştır.
Gereç ve Yöntem: 2005 ile 2015 yılları arasında kliniğimizde akut viral hepatit C tanısı almış olan hastaların verileri değerlendirildi.
Bulgular: Akut viral hepatit C'li 12 hasta kliniğimizde takip edildi. Olguların 12'si de erkek olup, yaş ortalaması 38,83 ±6,75 (aralık, 25-50) yıl idi. Üçüncü ayda üç hastada spontan klirens gözlendi.
Akut HCV tanısından üç ay sonra, spontan düzelme olmayan dokuz hastaya pegile interferon alfa 2a 180 mcg (1x1/hafta sc) başlandı ve altı ay tedavi uygulandı. 6 aylık ve 2 yıllık takiplerinde tedavi yanıtı %100’dü.
Sonuç: Akut viral hepatit C, tanısı atlanmaması gereken bir hastalıktır.
Tanı konulduktan sonra spontan viral klerens için 8-12 hafta beklenmelidir. 8-12 hafta sonra spontan viral klerens gelişmeyen hastalar, interferon alfa 2a tedavisi ile büyük ölçüde tedavi edilebilmektedirler.
8-12 haftalık takip sonrasında üç hastamızda spontan düzelme gözlendi (HCV-RNA PCR ile negatif, AST-ALT değerleri normaldi).
Anahtar Kelimeler
Akut viral hepatit C pegile interferon alfa 2a spontan viral klerens
Kaynakça
- Mıstık R, Balık İ. Türkiye’de viral hepatitlerin epidemiyolojik analizi. Viral hepatit. 2003;1:10-55.
- Jaeckel E, Cornberg M, Wedemeyer H et al. Treatment of acute hepatitis C with interferon alfa-2b. New England Journal of Medicine. 2001;345(20):1452-7.
- Akhan S. Hepatit C virusu. Topçu AW, Söyletir G, Doğanay M (eds), Enfeksiyon Hastalıkları ve Mikrobiyolojisi, 3.baskı, İstanbul: Nobel Tıp Kitabevleri, 2008: 1911-29.
- Corey KE, Mendez-Navarro J, Gorospe EC, Zheng H, Chung RT. Early treatment improves outcomes in acute hepatitis C virus infection: a meta-analysis. Journal of viral hepatitis. 2010;17(3):201-7.
- Basu PP, Shah NJ, Aloysius MM, Brown Jr R. Sofosbuvir and ledipasvir vs. sofosbuvir and simeprevir for acute hepatitis C: a RCT (SLAM C study). Hepatol Int 2016;10: S14– S15.
- Rockstroh JK, Bhagani S, Hyland RH et al. Ledipasvir/sofosbuvir for 6 weeks in HIV-infected patients with acute HCV infection. Conference on Retroviruses and Opportunistic Infections (CROI), February 22–25, Boston, Massachusetts.
- Deterding K, Spinner C, Schott E et al. Six weeks of sofosbuvir/ledipasvir (SOF/LDV) are sufficient to treat acute hepatitis C virus genotype 1 monoinfection: The HEPNET Acute HCV IV Study. J Hepatol 2016;64: S211.
- Wiegand J, Jäckel E, Cornberg M et al. Long-term follow-up after successful interferon therapy of acute hepatitis C. Hepatology. 2004;40(1):98-107.
- Kamal SM, Fouly AE, Kamel RR et al. Peginterferon alfa-2b therapy in acute hepatitis C: impact of onset of therapy on sustained virologic response. Gastroenterology. 2006;130(3):632-8.
- Cãruntu FA, Benea L Acute hepatitis C virus infection: Diagnosis, pathogenesis, treatment. Journal of Gastrointestinal and Liver Diseases: JGLD. 2006;15(3):249-56.
- Orland JR, Wright TL, Cooper S Acute hepatitis C. Hepatology (Baltimore, Md). 2001;33(2):321-7.
- Seeff LB, Hoofnagle JH The National Institutes of Health Consensus Development Conference: Management of Hepatitis C 2002. Clinics in Liver Disease. Feb 2003;7(1):261-87.
- Kamal SM, Moustafa KN, Chen JC et al. Duration of peginterferon therapy in acute hepatitis C: a randomized trial. Hepatology. 2006;43(5):923-31.
- Strader DB, Wright T, Thomas DL, Seeff LB American Association for the Study of Liver Diseases, Diagnosis, management, and treatment of hepatitis C. Hepatology. Apr 2004;39(4):1147-71.
- Gerlach JT, Diepolder HM, Zachoval R et al. Acute hepatitis C: high rate of both spontaneous and treatment induced viral clearance. Gastroenterology. 2003;125(1):80-8.
- Hofer H, Watkins-Riedel T, Janata O et al. Spontaneous viral clearance in patients with acute hepatitis C can be predicted by repeated measurements of serum viral load. Hepatology, 2003;37(1):60-4.
- Licata A, Di Bona D, Schepis F, Shahied L, Craxı A, Cammà C When and how to treat acute hepatitis C? Journal of hepatology. 2003;39(6):1056-62. Wiegand J, Buggisch P, Boecher W et al. Early monotherapy with pegylated interferon alpha-2b for acute hepatitis C infection: the HEP-NET acute-HCV-II study. Hepatology. 2006;43(2):250-6.
- Kamal SM, Fouly AE, Kamel RR et al. Peginterferon alfa-2b therapy in acute hepatitis C: impact of onset of therapy on sustained virologic response. Gastroenterology. 2006;130(3):632-8.
- Ghany MG, Strader DB, Thomas DL, Seeff LB Diagnosis, management, and treatment of hepatitis C: an update. Hepatology (Baltimore, Md). 2009;49(4):1335.
- Kamal SM, Ismail A, Graham CS et al. Pegylated interferon α therapy in acute hepatitis C: Relation to hepatitis C virus–specific T cell response kinetics. Hepatology. 2004;39(6):1721-31.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 19 Mart 2024 |
| Gönderilme Tarihi | 30 Mayıs 2023 |
| Yayımlandığı Sayı | Yıl 2024 |