Chronic hepatitis in polymyalgia rheumatica

A review of the literature relating hepatic abnormalities with the giant cell arteritis, polymyalgia rheumatica syndrome is presented. A case of polymyalgia rheumatica with biochemical and histological abnormalities of the liver is described. It is suggested that a more detailed investigation of liver function should be made in patients with this syndrome where reasonably indicated.     

Chronic hepatitis B in hepatocarcinogenesis

Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world, and has a wide geographical variation. Eighty per cent of HCC is attributed to hepatitis B virus (HBV). The predominant carcinogenic mechanism of HBV associated HCC is through the process of liver cirrhosis, but direct oncogenic effects of HBV may also contribute. Prevention of HBV infections as well as effective treatment of chronic hepatitis B is still needed for the global control of HBV associated HCC. Continued investigation of the mechanisms of hepatocarcinogenesis will refine our current understanding of the molecular and cellular basis for neoplastic transformation in the liver.     

慢性肝病与乙、丙型肝炎病毒感染关系的探讨

目的　探讨慢性肝病与乙、丙型肝炎病毒感染的关系。方法　EIA法检测HBV感染指标 (两对半系统 )及抗HCV ;PCR法检测HBVDNA ,反转PCR法检测HCVRNA。结果　 32 8例慢性肝病患者中 ,HBV感染率明显高于HCV感染率 (P <0 .0 5 ) ,肝癌患者中HBV、HCV重叠感染率明显高于慢性肝炎组 (P <0 .0 5 )。结论　本地区慢性肝病仍以HBV感染为主 ;HBV、HCV重叠感染对肝癌的发生似有相加作用。     

Chronic viral hepatitis C: management update

The management of chronic viral hepatitis C is evolving rapidly. Monotherapy with interferon, the accepted standard of treatment until recently, achieves only a modest sustained virological response rate of 15%. Combination treatment with alpha-2b interferon and ribavirin has been shown to increase sustained response rates to 40% in patients who have never been treated with interferon and to 50% in those who have relapsed following monotherapy with interferon. However, side effects, which have led to the discontinuation of combination treatment in a significant proportion of patients, must be carefully monitored. Treatment with interferon alpha-2b and ribavirin has now been approved in Canada, but the selection and monitoring of patients suitable for combination treatment requires special expertise. Although improvements in current therapeutic options may be possible with more frequent, higher doses or long-acting forms of interferon together with ribavirin, low sustained response rates (i.e., below 30%) for patients with hepatitis C virus genotype 1 emphasize the need for novel antiviral medications that will target the functional sites of the HCV genome.     

Chronic hepatitis B infection in Singapore.

Four hundred and four patients (273 men, 131 women) aged 3 to 85 years with chronic Hepatitis B virus (HBV) infection seen during a five year period were analysed. At presentation, 177 patients (44%) were Hepatitis B e Antigen (HBeAg) positive (mean age 32 years) and 217 patients (54%) were anti-HBe-positive (mean age 40 years). Ten patients (2%) were negative for HBeAg and anti-HBe. Serum HBV-DNA was detected in 169 patients (42%). 85% of the HBeAg-positive patients had detectable serum HBV-DNA and 9% of the HBeAg-negative patients were positive for serum HBV-DNA. The mean serum Alanine amino-transferase (ALT) and Aspartate amino-transferase (AST) levels were higher in HBeAg-positive patients (75 and 52 iu/l) than in HBeAg negative patients (46 and 37 iu/l) (P less than 0.001). Liver biopsies were performed in 135 patients. Fifty-three (39%) had minimal changes, 61 (45%) chronic hepatitis (CPH, CLH & CAH) and 21 (16%) cirrhosis. There was no significant difference in the histologic distribution between HBeAg-positive and HBeAg-negative groups. Two hundred and fifty eight patients were followed up for a mean duration of 2 years (range 3 to 108 months). The cumulative probability of clearing HBeAg at the end of the first, second and third year were 14%, 16% and 18% respectively. Of these, the cumulative probability of developing anti-HBe over one, two and three years were 8%, 9% and 11% respectively. Reversion to HBeAg occurred in 1.5% of patients who were HBeAg-negative at presentation and 11% of HBeAg-positive patients who cleared HBeAg.(ABSTRACT TRUNCATED AT 250 WORDS)     

Chronic hepatitis C treatment. Side effects and their management

The current standard of treatment of chronic hepatitis C infection is the combination therapy of pegylated interferon plus ribavirin for 48 weeks for genotype 1 and 4 and 24 weeks for genotype 2 and 3. Side effects such as influenza-like syndrome, gastrointestinal, neuropsychiatric, dermatological and endocrinological symptoms are not uncommon. Laboratory abnormalities such as hematological and biochemical may be frequent. These side effects are compatible with treatment continuation if symptoms are managed carefully. The adverse effects are dose dependent and often reversible. Premature withdrawal rates can be reduced if side effects are identified early. It is, however, pertinent to target treatment to early responders and avoid side effects in patients who have low predictive response to treatment.