Does low-dose prolonged steroid therapy affect the natural history of chronic hepatitis C?

Chronic hepatitis C patients may require steroids due to other comorbidities. However, there is not enough information to consider steroids as beneficial or harmful drugs on natural history of chronic hepatitis C. The aim of the present study was to examine the effect of low-dose prolonged therapy with corticosteroids with or without azathioprine on these study patients. A retrospective-prospective observational study was established. Twenty-eight patients with chronic hepatitis C and treated with corticosteroids at low-dose (≤30 mg/day) with or without azathioprine for more than 6 months were included. AST, ALT, HCV RNA, and liver fibrosis were determined, and results were compared with a control group of non-treated chronic hepatitis C patients. The mean age was 47 ± 10 years. The male proportion was 43%. The mean dose of prednisone was 9 ± 5 mg/day (range: 2.5-30 mg/day). The mean treatment time was 76 ± 80 months (range: 7-349 months). Thirty six percent received concomitant azathioprine. Transaminases decreased significantly only within the first 3 months of treatment, with non-significant changes thereafter. Corticosteroids led to a non-significant increase in HCV RNA. Knodell Histology Activity Index decreased (from 8.5 ± 3.7 to 4.7 ± 1.7; P = 0.1). Fibrosis progression per year (final fibrosis stage-initial fibrosis stage/time between explorations, in years), was lower in treated cases than in control group (0.054 ± 0.25 units vs. 0.196 ± 0.6 units, P = 0.26). In conclusion, corticosteroid treatment caused a significant initial decrease in transaminases, non-significant changes in HCV RNA, and a trend to a slower fibrosis progression in comparison to a control group. Therefore, corticosteroids did not accelerate progression of chronic hepatitis C.

DNA-guided hepatitis B treatment, viral load is essential, but not sufficient.

Hepatitis B virus (HBV) infection is a global public health problem that concerns 350 million people worldwide. Individuals with chronic hepatitis B (CHB) are at increased risk of developing liver cirrhosis, hepatic de-compensation and hepatocellular carcinoma. To maintain undetectable viral load reduces chronic infection complications. There is no treatment that eradicates HBV infection. Current drugs are expensive, are associated with adverse events, and are of limited efficacy. Current guidelines try to standardize the clinical practice. Nevertheless, controversy remains about management of asymptomatic patients with CHB who are hepatitis B e antigen (HBeAg)-positive with normal alanine aminotransferase, and what is the cut-off value of viral load to distinguish HBeAg-negative CHB patients and inactive carriers. We discuss in detail why DNA level alone is not sufficient to begin treatment of CHB.

Riesgo de transmisión del virus de la hepatitis B de donantes de hígado anti-hbc positivos / Risk of hepatitis B virus transmission from hepatitis B core antibody-positive liver donors

FUNDAMENTO: Estudiar el riesgo de transmitir el virus de la hepatitis B (VHB) a los receptores de hígados de donantes AgHBs negativos y anti-HBc positivos. PACIENTES Y MÉTODO: Se han analizado retrospectivamente los marcadores séricos del VHB (MHB) (AgHBs, anti-HBc y anti-HBs) de 43 donantes, junto con los 41 receptores de estos órganos.La determinación de MHB se realizó por ELISA, y el ADN del VHB por técnica de hibridación molecular. RESULTADOS: Trece sueros de donantes (30,2 por ciento) presentaron algún MHB: 6 anti-HBc y anti-HBs (13,9 por ciento), 4 anti-HBc (9 por ciento) y tres anti-HBs (6,9 por ciento). De los receptores que recibieron un injerto sin MHB, ninguno desarrolló infección después del trasplante de hígado. De los 13 receptores de órganos con MHB, 9 han sido controlados durante 39 (DE 17) meses. Los 5 receptores de un injerto anti-HBc positivo, con anti-HBs o sin él, y que no presentaban MHB desarrollaron hepatitis B (100 por ciento). Los dos receptores de órganos anti-HBs positivos únicamente y sin MHB no desarrollaron infección (0 por ciento). Entre los receptores 15 tenían algún MHB antes del trasplante de hígado (31,7 por ciento); 5 de ellos tenían anti-HBs positivo antes del trasplante. Los dos receptores de este grupo que recibieron un injerto anti-HBc positivo no desarrollaron infección (0 por ciento). CONCLUSIONES: En este estudio la prevalencia de MHB entre los donantes y receptores es del 30,2 y del 31,7 por ciento, respectivamente. Los injertos anti-HBc positivos con anti-HBs o sin él transmitieron la enfermedad en el 100 por ciento de los receptores. La presencia de anti-HBs en el receptor protegió de la infección. Los injertos únicamente positivos para anti-HBs no transmitieron la enfermedad (AU)