Hepatitis C Virus Infection: Diagnosis, Natural Course and Therapy

Abstract

The hepatitis C virus is a 9.4-kb single-stranded positive RNA virus. After infection, more than 80% of patients develop a chronic carrier state. The diagnosis is based on the detection of hepatitis C virus antibodies and of HCV RNA. Recently, methods have been established to quantify HCV RNA levels and determine HCV genotypes. Interferon treatment gives long-term response in 10-20% of individuals. Low transaminase levels, low levels of viremia and low histological activity are positive predictive parameters for treatment response. In contrast, cirrhosis, high ferritin levels and associated markers of autoimmunity are negative predictors of treatment response. At present, the combination of interferon with the nucleoside analogue ribavirin is being evaluated. Endstages of hepatitis-C-induced cirrhosis are treated with liver transplantation. Reinfection of the graft occurs regularly, the clinical implications of which are not yet clear. Our knowledge of the spontaneous course and treatment response of hepatitis C infection in hemodialysis patients is limited.

Kinetics of hepatitis C viral RNA and HCV‐antigen during dialysis sessions: Evidence for differential viral load reduction on dialysis

“…Hepatitis C infection is a common problem in dialysis units. The prevalence of infection among dialysis patients ranges from 3% [Schneeberger et al, 1998] to more than 50% [Karkar et al, 2006] according to the length of dialysis treatment before the availability of the antibody test in 1990 and the number of blood transfusions given [Tillmann and Manns, 1996]. Some investigators have reported increased cirrhosis and HCC rate, which has been confirmed even in a metaanalysis of 2,341 patients [Fabrizi et al, 2004].…”

Therapie der Hepatitis-C-Infektion

“…Da der natürliche Verlauf der Erkrankung jedoch sehr langsam ist und nur 5 bis 20% der Patienten nach 20 bis 30 Jahren eine Leberzirrhose entwickeln [6], besteht in keinem Fall eine absolute Indikation zu einer sofortigen Therapie bei jedem Patienten. Zudem ist die derzeitige Standardtherapie teuer und mit signifikanten Nebenwirkungen verbunden.Auf der anderen Seite ist die Hepatitis-C-Infektion die häu-figste Ursache für chronische Lebererkrankungen und Lebertransplantationen in der westlichen Welt und stellt eine zunehmende Belastung des öffentlichen Gesundheitswesens dar.…”

“…Für die Entscheidung zu einem erneuten Therapieversuch ist für uns letztlich das Ausmaß der Fibrose in der Leberbiopsie maßgebend (Abb. 6 …”