1,721,384 research outputs found
Hepatitis C and pregnancy
Full text linkAcute hepatitis C is a rare event in pregnancy. The most common scenario is chronic hepatitis C virus (HCV) infection in pregnancy. During pregnancy in women with chronic HCV infection a significant reduction in mean alanine aminotransferase levels has been reported, with a rebound during the postpartum period. In few cases exacerbation of chronic hepatitis C has been reported in pregnancy. A cofactor that might play a role in the reduction of liver damage is the release of endogenous interferon from the placenta. Observations regarding serum HCV-RNA concentration have been variable. In some women HCV-RNA levels rise toward the end of pregnancy. In general, pregnancy does not have a negative effect on HCV infection. Conversely, chronic hepatitis does not appear to have an adverse effect on the course of pregnancy, or the birth weight of the newborn infant. The role of spontaneous abortion is approximately the same as in the general population. The overall rate of mother-to-child transmission for HCV is 3%-5% if the mother is known to be anti-HCV positive. Co-infection with human immunodeficiency virus (HIV) increases the rate of mother-to-child transmission up to 19.4%. Numerous risk factors for vertical transmission have been studied. In general, high viral load defined as at least 2.5 × 10(6) viral RNA copies/mL, HIV co-infection, and invasive procedures are the most important factors. Both interferon and ribavirin are contraindicated during pregnancy. Viral clearance prior to pregnancy increases the likelihood that a woman remains non-viremic in pregnancy with a consequent reduced risk of vertical transmission
Liver diseases in the elderly: an update
No full textAlthough there are no liver diseases specific to advanced age, the clinical course and management of liver diseases in the elderly may differ in several aspects from those of younger adults. During the last decade an explosion of new knowledge in liver disease has provoked increasing enthusiasm among hepatologists. On the other hand, the development of new emerging conditions (e.g. non-alcoholic steatohepatitis) and novel therapeutic approaches has made it increasingly difficult to validate and assimilate information to be applied in clinical practice. Some liver diseases in the elderly need to be revisited, particularly non-alcoholic fatty liver disease, chronic hepatitis C, alcoholic liver disease, and hepatocellular carcinoma. Moreover, some therapeutic approaches, especially antiviral therapy and liver transplantation, should be discussed also in selected groups of elderly patients
Sleisinger & Fortrand's Trattato di Gastroenterologia ed Epatologia.Capitoli 74-75-76-77
No full textPerspective of fixed daily dose of sofosbuvir and ledipasvir for the treatment of chronic hepatitis C
Full text linkThe fixed dose combination of sofosbuvir and ledipasvir (SOF/LDV) has marked a new era for patients with chronic HCV because it is the first drug to be approved by the FDA that does not include peginterferon or ribavirin. The results of three clinical studies show that SOF/LDV has sustained virologic response of approximately 96% when given as once a day pill for 3 months to both treatment naive and treatment-experienced HCV-1 patients with the exception of prior null responder patients with cirrhosis. Moreover, emerging data in special populations (patients with decompensated cirrhosis, with post-transplant recurrence, with prior SOF-based therapy failure, and with HIV co-infection) show a good tolerance and high sustained virological profile. Many other emerging therapies are now available. Actually, the recommendations of the international guidelines are applicable only for selected patients followed-up by dedicated specialists, including hepatologists and infectologists, and are specifically individualized for patients with advanced fibrosis. We will expect that the landscape for management of HCV will include direct-acting antivirals for treatment of patients with different genotypes and low-grade fibrosis in order to interrupt the progression to late stage of disease and the complications of the infection, including renal disease, thyroid dysfunction, and some cancers
Preventative therapy in primary biliary cirrhosis
No full textBecause the etiology of PBC is still unknown, therapies remain empirical. Moreover, no contributions on preventative therapy supported by evidence-based medicine have been published to date. However, there are at least two groups of subjects who might benefit from preventative therapy: (1) subjects with normal liver enzymes who are found AMA-positive during autoantibody screening and (2) subjects transplanted for PBC with no histologic or biochemical signs of disease recurrence. The key questions are whether any therapy should be proposed to these subjects, since the natural history of the disease is very long, and what kind of treatment should be prescribed. UDCA is a well-tolerated, definitely "physiologic" treatment, but it is expensive and two recent meta-analyses question its benefit on survival. Current theory considers PBC an autoimmune disease, with a genetic predisposition, possibly triggered by an infectious agent or xenobiotic. If this is so, gene therapies might be the most promising future preventative therapies. For the time being, however, the only practical preventative management is in regards to the complications of PBC, namely osteopenia and portal hypertension
Liver disorders in the elderly
No full textAlthough there are no specific age-related liver diseases, it is increasingly recognized that the percentage and the actual number of elderly will increase substantially over the next twenty years. Moreover, the developments of new emerging conditions (e.g. non-alcoholic steatohepatitis) and novel therapeutic approaches have provoked increasing enthusiasm among hepatologists. Some liver diseases are particularly frequent in the elderly, e.g. chronic hepatitis C and hepatocellular carcinoma. The clinical course and management of liver disease in the elderly may differ in several aspects from those of younger adults. The problem of whether to offer antiviral treatment to a wide range of patients with chronic hepatitis C has arisen over the last eight to ten years, since the reduction in the risk of hepatocellular carcinoma was analyzed. Selected patients aged 65 and older have a chance of treatment with pegylated interferon plus ribavirin, despite a higher likelihood of side effects. The diagnosis of autoimmune hepatitis should be suspected in a patient over 65 years of age in case of 'acute' presentation with 10-fold increase in transaminases, jaundice and hyper-gammaglobulinemia, to avoid any delay in starting immunosuppressive therapy. The age of an end stage liver disease will increase over the next years, thus we will expects an increasing number of decompensated liver disease and hepatocellular carcinomas
Should antiviral therapy be offered to elderly patients?
No full textrelatively little information exists on the prognosis for elderly patients with chronic hepatitis C (CHC). Moreover, the majority of randomized, clinical trials of hepatitis C treatment exclude elderly patients. Findings from a 2009 clinical study address risk of hepatocellular carcinoma, life expectancy and the influence of antiviral therapy in elderly patients with CHC
Primary biliary cholangitis: Old and novel therapy
No full textPrimary biliary cholangitis (PBC), formerly called primary biliary cirrhosis, is a chronic cholestatic liver disease that
progresses slowly to end-stage liver disease. The first Food and Drug Administration (FDA)-approved treatment for
PBC was ursodeoxycholic acid (UDCA). This treatment slows the progress of the disease, but approximatively 30–
40% of patients fail to respond to UDCA. A number of options are under investigation as second line treatment.
Obeticholic acid (OCA), a Farnesoid X Receptor agonist, has been approved in May 2017 by FDA for patients non
responders or intolerant to UDCA. The results of a randomized, double blind, phase 3 study of OCA (mg or
10 mg) compared to placebo, showed that approximatively 50% of patients reached a significant reduction in
serum alkaline phosphatase, a marker predictive of disease progression, liver transplantation or death. Other
emerging therapies include: agents targeting fibrosis, inflammation, or immunological response. Indeed, after
30 years of UDCA therapy as unique choice for PBC patients, a number of targets, derived froma deeper knowledge
of the pathophysiology of the disease, has been discovered and they offer different and new therapeutic approaches
that are now under evaluation
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