Clinical significance of intrahepatic hepatitis C virus levels in patients with chronic HCV infection

Haydon, Geoffrey; Jarvis, L M; Blair, C S; Simmonds, Peter; Harrison, David J.; Simpson, Kenneth J.; Hayes, Peter

doi:10.1136/gut.42.4.570

Cited by 84 publications

(75 citation statements)

References 43 publications

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“…This goes well with the previous studies [23,25]. While patients with NAFLD/NASH have been noted to have more necroinflammation and fibrosis yet not significant in this study, investigators correlate that to different steps in the Pathophysiology such as predominance of steatosis that is mainly macrovesicular and injury in acinar zone 3; due to zonal localization of DNA damage, products of oxidative damage and expression of CYP 2E142 in zone 3 [29][30][31].…”

Section: Histopathological Featuressupporting

confidence: 76%

“…This was also supported by previous study [23] that compared clinical and pathological characteristics of occult HCV infection patients and untreated chronic HCV patients, but on contrast nearly 50% of NAFLD patients have fatigue and hepatomegaly in agreement with others [24]. The most common laboratory abnormalities often found in NAFLD patients are elevated alanine transaminase (ALT) and aspartate transaminase (AST) which are significantly higher (p value = 0.045 & 0.015 respectively) than that of occult HCV patients confirming the less inflammatory process present in occult HCV provided by the histopsthological examination later and come in context with other reports [23,25,26].…”

Section: Histopathological Featuressupporting

confidence: 70%

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Prevalence of occult hepatitis C in egyptian patients with non alcoholic fatty liver disease

Saad¹,

Zakaria²,

Ramzy³

et al. 2011

OJIM

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This study aim is to assess the prevalence of occult HCV infection among Egyptian patients with non alcoholic fatty liver disease (NAFLD) with elevated AST and ALT, and to correlate presence of occult HCV with severity of liver disease. Patients and Methods: After informed consent 27 patients with elevateed liver enzymes diagnosed as NAFLD were examined for demographic, clinical, laboratory data and Ultrasonography. Liver biopsy was done and tested for HCV RNA in tissue. Genotyping using RFLP analysis of PCR products in the 5'NCR was done for positive cases. Results: HCV RNA in tissue was positive in 11/27 patients (40.7%); genotype was 4a in all positive cases. AST and ALT values showed significantly lower values in occult HCV than the non HCV NAFLD group. Liver biopsy of studied patients showed no significant difference as regard inflammation and fibrosis according to METAVIR score. Conclusions: Occult HCV is highly prevalent among Egyptian NAFLD patients. It seems to induce a mild liver disease. Patients with elevated ALT and negative HCV RNA in sera might be investigated for tissue HCV RNA. Follow up is recommended for the occult HCV patients to monitor progression to overt disease.

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Section: Histopathological Featuressupporting

confidence: 76%

Section: Histopathological Featuressupporting

confidence: 70%

Prevalence of occult hepatitis C in egyptian patients with non alcoholic fatty liver disease

Saad¹,

Zakaria²,

Ramzy³

et al. 2011

OJIM

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“…Indeed our results confirm the findings of other smaller studies 3,4 but are in contrast to those of Haydon et al, 5 and Dries et al 6 We cannot explain the reason for the latter, particularly since the sensitivity of our assay was comparable to that of Haydon et al Neither, as Dries et al, correctly point out, can we predict which HCV RNA-negative end-of-treatment responders will relapse after treatment, as this issue was not dealt with in our study.…”

Section: To the Editorcontrasting

confidence: 56%

Serum versus intrahepatic HCV RNA and liver histology in anti-HCV-positive serum PCR-negative individuals

2003

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We thank Dries et al. for their comments 1 on our report, investigating serum versus intrahepatic HCV RNA and the role of liver biopsy in anti-HCV-positive serum PCR-negative individuals. 2 While acknowledging that our study "confirms that complete and lasting elimination of HCV is possible" they had objections to our conclusions viz "negative serum PCR status appears to reflect cleared past exposure in liver" and "neither liver histology nor PCR testing of liver tissue is necessary to diagnose active HCV infection" 223 in serum PCR-negative individuals. We would like to address these issues.Few studies have examined HCV viral clearance; possibly because of the difficulty in identifying individuals who have recovered from HCV infection. Furthermore as liver biopsies are invasive, costly, and potentially risky, they are neither routinely performed nor recommended in PCR-negative individuals. The availability of a large, wellcharacterized, homogenous cohort of serum PCR-negative individuals with proven exposure to HCV (via contaminated anti-D immunoglobulin), in our opinion, provided a rare opportunity to address the important issue of viral clearance. We investigated 96 serum PCRnegative women. None of these women received antiviral treatment, 42 (43.8%) were still RIBA positive, and 6 (6.2%) had elevated ALT levels at the time of presentation. Thirty-three (34%) underwent liver biopsy. Indications for biopsy included elevated ALT levels, strongly positive RIBA-3 tests, and/or symptoms dating from the time of inoculation or a specific patient request for liver biopsy. Our failure to detect HCV RNA in liver tissue using a sensitive nested PCR (Յ100 genomic equivalents/HCV per mL) favors the hypothesis that these individuals have resolved past infection rather than having active chronic HCV. This implies that HCV RNA status in serum reflects the status in liver and indicates that liver biopsy is not justified in anti-HCV-positive serum PCR-negative individuals.Although our cohort was unique, we believe the results of our study can be generalized to other clinical situations. Indeed our results confirm the findings of other smaller studies 3,4 but are in contrast to those of Haydon et al., 5 and Dries et al. 6 We cannot explain the reason for the latter, particularly since the sensitivity of our assay was comparable to that of Haydon et al. Neither, as Dries et al., correctly point out, can we predict which HCV RNA-negative end-of-treatment responders will relapse after treatment, as this issue was not dealt with in our study.McHutchison and the International Hepatitis Intervention Therapy Group 7 have comprehensively addressed this issue in a recent study. Their large study demonstrated that hepatic HCV RNA levels reflected levels of serum HCV RNA and concluded that "little, if any, clinical use is gained by measuring hepatic HCV RNA before or after therapy."In conclusion, we reiterate that our study shows that HCV RNA status in serum reflects the status in liver, that negative serum PCR status appears to reflect c...

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“…32 Immune Status. Immune status probably has a major affect on the natural history of hepatitis C and the development of cirrhosis.…”

Section: Factors Associated With Fibrosis Progressionmentioning

confidence: 99%

Fibrosis and disease progression in hepatitis C

2002

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The progression of fibrosis in chronic hepatitis C determines the ultimate prognosis and thus the need and urgency of therapy. Fibrogenesis is a complex dynamic process, which is mediated by necroinflammation and activation of stellate cells. The liver biopsy remains the gold standard to assess fibrosis. Scoring systems allow a semiquantitative assessment and are useful for cross-sectional and cohort studies and in treatment trials. The rate at which fibrosis progresses varies markedly between patients. The major factors known to be associated with fibrosis progression are older age at infection, male gender, and excessive alcohol consumption. Viral load and genotype do not seem to influence significantly the progression rate. Progression of fibrosis is more rapid in immunocompromised patients. Hepatic steatosis, obesity, and diabetes may also contribute to more rapid progression of fibrosis. There are no tests that reliably predict the rate of progression of fibrosis in an individual patient. High serum alanine aminotransferase (ALT) levels are associated with a higher risk of fibrosis progression, and worsening of fibrosis is uncommon in patients with persistently normal serum aminotransferase levels. Serum markers for fibrosis are not reliable and need to be improved and validated. Liver biopsy provides the most accurate information on the stage of fibrosis and grade of necroinflammation, both of which have prognostic significance. Repeating the liver biopsy, 3 to 5 years after an initial biopsy is the most accurate means of assessing the progression of fibrosis. (HEPATOLOGY 2002;36:S47-S56.)

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Clinical significance of intrahepatic hepatitis C virus levels in patients with chronic HCV infection

Abstract: (Gut 1998;42:570-575)

Cited by 84 publications

References 43 publications

Prevalence of occult hepatitis C in egyptian patients with non alcoholic fatty liver disease

Prevalence of occult hepatitis C in egyptian patients with non alcoholic fatty liver disease

Serum versus intrahepatic HCV RNA and liver histology in anti-HCV-positive serum PCR-negative individuals

Fibrosis and disease progression in hepatitis C

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