ABSTRACT
A report is presented of a rare case of B-cell non-Hodgkin's lymphoma and severe exacerbation of cryoglobulinic vasculitis which developed in a female patient with chronic hepatitis C four years after achievement of a persistent virusological response to antivirus treatment. Causes of a specific course of the disease and development of the tumor in the absence of HCV in blood serum are discussed: latent HCV-infection in immune cells with persistent antigenic stimulation of B-lymphocytes, possibility of HCV-independent lymphoproliferation.
Subject(s)
Cryoglobulinemia/complications , Hepatitis C, Chronic/complications , Lymphoma, B-Cell/complications , Adult , B-Lymphocytes/pathology , Biopsy , Cryoglobulinemia/diagnosis , DNA, Viral/analysis , Diagnosis, Differential , Female , Follow-Up Studies , Hepacivirus/genetics , Hepatitis C, Chronic/diagnosis , Hepatitis C, Chronic/virology , Humans , Lymphoma, B-Cell/diagnosisABSTRACT
The aim of this prospective study was too asses the frequency and clinical significance of metabolic syndrome (MS), insulin resistance (IR) and hepatic steatosis in 114 patients with chronic hepatitis C (HCV) genotype 1. MS was found in 47% and IR in 50% of the cases. Diagnosis of IR in patients without MC and marked fibrosis supported the role of HCV in the development of metabolic abnormalities. Hepatic steatosis was found in 38% of the patients and the degree of steatosis significantly correlated with that of fibrosis. Obesity, IR, steatosis and liver cirrhosis were independent negative predictors of the response to the treatment with peginterferon alpha and ribavirin.
Subject(s)
Antiviral Agents/therapeutic use , Fatty Liver , Hepacivirus/genetics , Hepatitis C, Chronic , Hepatocytes , Liver Cirrhosis , Metabolic Syndrome , Adult , Fatty Liver/etiology , Fatty Liver/metabolism , Fatty Liver/pathology , Fatty Liver/physiopathology , Female , Genome, Viral , Hepacivirus/drug effects , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/drug therapy , Hepatitis C, Chronic/metabolism , Hepatitis C, Chronic/physiopathology , Hepatocytes/metabolism , Hepatocytes/pathology , Humans , Insulin Resistance , Interferon alpha-2 , Interferon-alpha/therapeutic use , Leptin/blood , Liver Cirrhosis/etiology , Liver Cirrhosis/metabolism , Liver Cirrhosis/pathology , Liver Cirrhosis/physiopathology , Male , Metabolic Syndrome/complications , Metabolic Syndrome/metabolism , Metabolic Syndrome/physiopathology , Middle Aged , Polyethylene Glycols/therapeutic use , Prospective Studies , Recombinant Proteins , Ribavirin/therapeutic use , Severity of Illness Index , Treatment OutcomeABSTRACT
A case of metabolic syndrome is reported in which its elimination before the onset of antiviral treatment of chronic hepatitis A and drug therapy of subsequent depression promoted successful outcome with a stable virological response. Modern approaches are discussed to enhancing efficiency of antiviral therapy by active correction of factors responsible for poor results of the treatment and its undesirable consequences.
Subject(s)
Antiviral Agents/therapeutic use , Depression/chemically induced , Exercise Therapy/methods , Hepatitis C, Chronic/drug therapy , Interferon-alpha/adverse effects , Metabolic Syndrome/complications , Polyethylene Glycols/adverse effects , Adult , Antidepressive Agents, Tricyclic/therapeutic use , Antiviral Agents/adverse effects , Depression/complications , Depression/drug therapy , Drug Therapy, Combination , Female , Follow-Up Studies , Hepatitis C, Chronic/complications , Humans , Interferon alpha-2 , Interferon-alpha/therapeutic use , Metabolic Syndrome/therapy , Polyethylene Glycols/therapeutic use , Recombinant Proteins , Thiazepines/therapeutic useABSTRACT
AIM: To estimate the incidence and clinical value of metabolic syndrome, insulin resistance, and steatosis in patients with chronic hepatitis C (CHC) caused by its virus genotype 1. SUBJECTS AND METHODS: One hundred and fourteen patients (67 men and 47 women; mean age 44.9 +/- 13.3 years) were examined. RESULTS: There were high incidence rates of metabolic syndrome (47.2%) and insulin resistance (50%), in the genesis of which the host-virus interaction is discussed. There was an independent correlation of the insulin resistance and elevated leptin levels with abdominal obesity and hepatic steatosis; however, these indicators did not correlate with the stage of fibrosis. At the same time hepatic steatosis (found in 38% of the patients) and its degree correlated with the stage of fibrosis. Thirty-four of 66 (54.5%) patients receiving antiviral therapy achieved a stable virological response. CONCLUSION: Obesity, hyperglycemia, and significant insulin resistance along with the stage of hepatic cirrhosis are independent cofactors that determine no treatment response.
