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Early interferon (IFN) therapy prevents viral persistence in acute hepatitis C, but in view of the resulting costs and morbidity patients who really need therapy have to be identified. Twelve consecutive patients with acute hepatitis C (9 women, 3 men, mean age: 39.5 ؎ 18.8 y, genotype 1: 7, genotype 3a: 3, 2 could not be genotyped) were studied. The sources of infection were medical procedures in 6, sexual transmission in 3, and intravenous drug abuse in 3 patients. N atural history of acute hepatitis C virus (HCV) infection is variable. Progression to chronic hepatitis occurs in 50% to 84% of cases. [1][2][3][4][5][6][7][8][9] This variation can be partly explained by the mode of transmission of HCV, viral factors, and by the ability of the host to mount a strong T-cell response to eliminate the virus. Acute HCV infection generally has a mild course, most cases are asymptomatic, and fulminant hepatic failure is very rare. 10,11 The long-term sequelae of chronic hepatitis are the subject of ongoing discussions. Carefully conducted epidemiologic studies in well-documented cases of acute hepatitis C indicate that disease follows a very mild course and that occurrence of cirrhosis within the first 25 years after infection is rare. 2,3,7 Treatment of chronic hepatitis C, especially in patients infected with genotype 1 or 4, is still unsatisfactory. Despite improvements in response rates, current combination therapy with pegylated interferon (IFN) alfa-2a or -2b and ribavirin for chronic hepatitis C infection yields response rates from 54% to 56%. 12,13 Prevention of chronicity by early antiviral treatment thus may be important. Because of the infrequent nature of acute hepatitis C the impact of early antiviral therapy has not been well studied and is conflicting. 14 Only in 2 of 6 controlled trials using 3 MU IFN-2b 3 times a week for 6 to 24 weeks 15 eradication of HCV RNA was assessed. In general, transition to chronicity was not different from untreated controls. Only one study using 10 MU of IFN-2b until normalization of transaminase levels reported an 82% sustained virologic response. 16 A recent study 17 using 5 MU IFN alfa-2b for 6 months showed a 98% HCV eradication in Abbreviations: HCV, hepatitis C virus; IFN, interferon; ALT, alanine transaminase. From the

Although there have been significant advances in understanding the clinical and biochemical features of primary biliary cirrhosis (PBC), there is still a paucity of data on the usefulness of biomarkers as prognostic indicators. This is particularly important at the time of initial diagnosis. Indeed, the widespread use of antimitochondrial antibody testing has led to an earlier diagnosis of asymptomatic PBC and it is difficult to predict which patients will experience a benign versus a rapidly progressive course. To address this issue, we examined a unique population of 127 newly diagnosed patients with PBC during a 15-year period of observation that began in January 1990. Sera from these patients were analyzed for antimitochondrial, antinuclear, and anti-smooth muscle antibodies, and immunoblotting was performed for nuclear pore complex (NPC). The patients were then followed up longitudinally using biochemical liver function tests. No patient was under any medical therapy for PBC at the time of the initial sera collection. Data were analyzed based not only on the clinical features, but also the Mayo score and specific outcome measures, including time to death, need for liver transplantation, and complication free survival. Among patients with early disease, bilirubin increased to >2 mg/dL in the anti-NPC(؉) patients (26% vs. 5%, P ‫؍‬ .019). Anti-NPC antibodies remained stable or slightly increased over the period of observation. In conclusion, anti-NPC identifies patients likely to experience an unfavorable clinical course and more rapid disease progression. (HEPATOLOGY 2006;43:1135-1144

Aims:The characteristic histological feature of autoimmune hepatitis (AIH) is interface hepatitis with predominant portal lymphoplasmacytic necroinflammatory infiltration. Centrilobular necrosis (CN), reminiscent of toxic or circulatory liver injury, has been reported in AIH. The aim of this study was to assess the frequency of CN in patients with AIH and its correlation with laboratory and clinical data. Methods: Liver biopsies were obtained from 114 patients (90 women, 24 men, mean (SD) age 45.4 (19.4) years) with AIH and were evaluated under code by a single pathologist according to the modified Knodell score. Results: CN was found in 20 (17.5%) patients with virtually unaffected portal areas in four cases. Patients with AIH with CN had a higher total hepatic activity index (median (range) 11 (6 to 15) v 5 (2 to 10)) and presented less frequently with cirrhosis (10% v 38%). Patients with CN had a higher frequency of acute onset (87% v 32%), higher bilirubin (median (range) 12.0 (0.43 to 40.0) v 1.9 (0.36 to 46)) and higher ALT levels (median (range) 25.6 (2.7 to 63.9) v 7.2 (0.7 to 62.6)), than did patients with AIH without centrizonal injury. Conclusion: CN with sparing of the portal areas represents a rare histological pattern in AIH. CN is associated with an acute clinical presentation and might reflect an early lesion preceding portal involvement. Recognition of this particular histological appearance enables early diagnosis of AIH and a timely initiation of immunosuppressive therapy.A utoimmune hepatitis (AIH) is characterised by the presence of autoantibodies, hypergammaglobulinaemia, elevated serum transaminases, and the histological evidence of interface hepatitis with a predominantly portal lymphoplasmacytic necroinflammatory infiltrate.