HEPATOLOGY WATCH®
FEBRUARY 2003
HEPATITIS C VIRUS (HCV) INFECTION
Prevalence of liver disease in asymptomatic persons. Alfredo Alberti and colleagues
tested for serum anti-HCV by ELISA and HCV RNA by PCR in 4,820 adults in
northeastern
Extrahepatic manifestations. Hashem El-Serag and coworkers utilized the computerized
databases of the Department of Veterans Affairs to identify all cases of
HCV-infected patients hospitalized from 1992 to 1999 (n=34,204). Compared to randomly chosen control subjects
(N=136,816), a significantly greater proportion of HCV-infected patients had
porphyria cutanea tarda, vitiligo, lichen planus, cryoglobulinemia, and
membranoproliferative glomerulonephritis.
After age adjustment, the prevalence of non-Hodgkin's lymphoma was also
higher in HCV patients. Surprisingly,
diabetes was more prevalent in controls.
Thus, patients with the above systemic disorders should be tested for
HCV infection. (El-Serag H, et al. Hepatology
2002;36:1439-1445)
HEPATITIS B VIRUS (HBV) INFECTION
Influence of virus genotype. Hajime Sumi et al. from
Results with entecavir therapy. Entecavir (Bristol-Myers Squibb) is
a novel potent nucleoside analogue with specific activity against HBV. Ching-Lung Lai and colleagues performed a
randomized, multicenter, double blind study of 24 weeks of therapy with
different doses of entecavir (0.01, 0.1, and 0.5 mg/d orally) or lamivudine
(100 mg/d orally). A dose-response
relationship was observed for entecavir viral suppression. Branched DNA assays demonstrated that a
greater percentage of patients treated with entecavir 0.5 mg/day became
HBV-DNA-negative compared to those treated with lamivudine (83.7% vs. 57.5%;
p=0.008). Entecavir was well
tolerated. These encouraging results
show entecavir to be superior to lamivudine in the treatment of chronic HBV
infection. Research and development
continues to be active in chronic hepatitis B, and more novel compounds are
expected in the near future. (Lai C-L, et al. Gastroenterology 2002; 123:1831-1838)
AUTOIMMUNE HEPATITIS (AIH)
Evolution to primary sclerosing cholangitis (PSC). Ayman Abdo and associates report 6
cases in which PSC was diagnosed several years after established AIH. At the initial diagnosis of AIH no evidence
of biliary disease had been noted by liver biopsy or endoscopic retrograde
cholangiography (ERCP). The AIH had
responded well to immunosuppressive therapy in all cases; however after an
average duration of 4.6 years, resistance had developed and features of PSC
became evident. Three patients also had
ulcerative colitis. No predictive
baseline factors for the evolution of AIH to PSC were identified. These findings indicate that ERCP should be
performed in patients with AIH who become resistant to immunosuppression
treatments or develop cholestasis and that PSC may sequentially follow AIH as
well as overlap with AIH in some patients (Abdo AA, et al. Hepatology 2002;36:1393-1399)
ACUTE LIVER FAILURE
Multicenter, prospective study.
George Ostapowicz and colleagues conducted a prospective cohort study in
which the cases of 308 consecutive patients with acute liver failure identified
over a 41-month period (1998-2001) were analyzed. The median age of these patients was 38 years
and 73% of the patients were women. The
most common cause of acute liver failure was acetaminophen overdose (39%). Other etiologies included idiosyncratic drug
reactions (13%), hepatitis A and B (12%), and indeterminate causes (17%). The overall survival rate at 3 weeks was 67%,
and coma grade at admission was associated with outcome. Only 29% of patients were treated with liver
transplantation. These observations
demonstrate that acetaminophen overdose and idiosyncratic drug reaction are
more frequent causes of acute liver failure than hepatitis and that most
patients were not treated with liver transplantation. (Ostapowicz G, et al. Ann Intern Med 2002; 137:947-954)
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