Khat-induced liver injuries: a report of two cases

Khat is consumed for recreational purposes in many countries, including Yemen, where >50% of adults chew khat leaves regularly. A wide spectrum of khat-induced liver injuries has been reported in the literature. Herein, we report two patients with khat-induced liver injury. Both patients clinically presented with acute hepatitis, one of whom showed radiological evidence of hepatic outflow obstruction. Based on the histological tests, both patients had acute hepatitis, which indicated drug-induced liver injury [DILI] on a background of chronic hepatitis and portal fibrosis; of the two, one presented with symptoms of immune-mediated liver injury

Management of obesity and outcomes of hepatitis C treatment

Obesity is a modifiable risk factor for nonresponse to chronic hepatitis C [CHC] treatment. We examined whether weight loss during pegylated interferon [IFN] plus Ribavirin therapy is associated with improved response. Rapid virological response, early virological response, end of treatment response, and sustained virological response [SVR] were compared among patients with or without weight loss [>/= 0.5 body mass index [BMI]] during therapy for hepatitis C virus. Among 324, who provided consent, 280 were treatment-naive patients and 200 started pegylated-IFN/Ribavirin therapy and were included in the study. Median pretreatment BMI was 28.8 +/- 5.7 [19.9-48.9] with 42.6% overweight and 31.6% obese [BMI 25-30 and >/= 30, respectively]. Hepatitis C virus genotype 1 was the prevalent genotype among the candidates of this study, affecting 99 cases of 136 [72.7%], whereas genotypes 2/3 affected 37 cases [27.3%]. For genotype 1, weight loss at 1 and 3 months was associated with higher SVR rates [59.5 vs. 36.8% at 1 month and 55.2 vs. 34.1% at 3 months, respectively, P values=0.02 and 0.03, respectively]. Hepatic fibrosis, elevation of high-density lipoprotein, and decline of homeostasis model of assessment-insulin resistance at 6-months follow-up were proven to be independent predictors for SVR. Weight loss during the first 6 months of IFN therapy was associated with improved SVR in patients with CHC genotype 1 rather than genotypes 2/3. Molecular changes associated with weight loss during CHC and its relation with treatment response need to be prospectively examined