A severe hepatitis flare in an HBV-HCV coinfected patient during combination therapy with ?-interferon and ribavirin
Autor: | Kendal Yalcin, Nihal Kilinç, Halil Degertekin, Fetin Yildiz |
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Rok vydání: | 2003 |
Předmět: |
Male
medicine.medical_specialty HBsAg Cirrhosis medicine.disease_cause Antiviral Agents chemistry.chemical_compound Hepatitis B Chronic Recurrence Internal medicine Ribavirin medicine Humans Hepatitis B virus business.industry Gastroenterology Interferon-alpha virus diseases Lamivudine Hepatitis C Hepatitis C Chronic Middle Aged Hepatitis B Hepatology medicine.disease digestive system diseases chemistry Immunology Drug Therapy Combination Virus Activation business medicine.drug |
Zdroj: | Journal of Gastroenterology. 38:796-800 |
ISSN: | 1435-5922 0944-1174 |
Popis: | We report a reactivation of hepatitis B virus infection and a severe hepatitis flare in a patient with chronic hepatitis due to dual infection with hepatitis B and C viruses during combination therapy with alpha-interferon and ribavirin. Pretreatment, HCV was the dominant virus, with detectable serum HCV-RNA but undetectable HBV-DNA. The patient responded to therapy, with the disappearance of HCV-RNA and normalization of serum alanine aminotransferase (ALT) at months 1 and 6. In the seventh month of therapy, an ALT flare was observed, and serum HBV-DNA became detectable. The patient had a severe hepatitis flare leading to impending hepatic failure. Treatment was discontinued and the patient had marked clinical and biochemical improvement and recovered with normalization of liver function test results within 1 month. Two months later, serum HBV-DNA was again undetectable, both by hybridization and polymerase chain reaction (PCR) assays. The patient had a rapid progression to cirrhosis in a year. At month 24, 17 months after the end of therapy, serum HCV-RNA reappeared, with a level of 2.4 x 10(5) copies/ml. In conclusion, severe HBV reactivation may occur during interferon plus ribavirin therapy in patients with chronic hepatitis C who are also hepatitis B surface antigen (HBsAg)-positive, and thus more careful monitoring than usual should be considered. Longterm follow-up is recommended, because very late HCV relapses may occur in coinfected patients. These data exemplify the complexity of viral dominance in patients infected with multiple hepatitis viruses, and this has significant importance for treatment decisions. Lamivudine may be administered early in HCV-RNA/HBsAg-positive patients who are at high risk of liver failure once reactivation of HBV occurs during interferon therapy. |
Databáze: | OpenAIRE |
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