ABSTRACT
Hepatitis B and hepatitis C are common predisposing factors leading to cirrhosis and liver cancer. Therapies for hepatitis B suppress viral replication and improve morbidity and mortality. Treatment and evaluation of hepatitis B should be similar in all age groups. This article discusses special topics related to hepatitis B and the elderly. Hepatitis C is a treatable disease whose treatment can lead to viral eradication. This article discusses key points regarding hepatitis C diagnosis and treatment in the context of new advances in disease staging and treatment, with special attention on hepatitis C infection in the elderly.
Subject(s)
Antiviral Agents/therapeutic use , Hepatitis B , Hepatitis C , Liver Diseases/prevention & control , Aged , Disease Management , Health Transition , Hepatitis B/complications , Hepatitis B/diagnosis , Hepatitis B/epidemiology , Hepatitis B/immunology , Hepatitis B/physiopathology , Hepatitis C/complications , Hepatitis C/diagnosis , Hepatitis C/epidemiology , Hepatitis C/immunology , Hepatitis C/physiopathology , Humans , Liver Diseases/diagnosis , Liver Diseases/etiology , Mass Screening/methods , Mass Screening/organization & administration , Monitoring, Immunologic/methods , Prevalence , Risk Factors , Treatment OutcomeABSTRACT
Hepatic fibrosis is a known consequence of long-term use of alcohol and is regarded as a turning point in alcohol-induced liver disease because it can lead to cirrhosis. The mechanisms of injury are not well understood, but recent studies have helped advance the understanding of the earliest events in the process that eventually leads to hepatic injury and, in some cases, fibrosis. It is hoped that increasing understanding of the role played by the immune system in the process will lead to the development of new therapies for these patients.
Subject(s)
Liver Diseases, Alcoholic/immunology , Adaptive Immunity , Animals , Complement Activation , Disease Progression , Endotoxins/pharmacokinetics , Hepatic Stellate Cells/immunology , Hepatic Stellate Cells/pathology , Humans , Immunity, Innate , Inflammation Mediators/immunology , Interleukins/immunology , Kupffer Cells/immunology , Liver/metabolism , Liver/pathology , Liver Diseases, Alcoholic/etiology , Liver Diseases, Alcoholic/metabolism , Liver Diseases, Alcoholic/pathology , Metagenome , Neutrophils/immunology , Neutrophils/pathology , Reactive Oxygen Species/metabolism , Signal Transduction , Toll-Like Receptor 4/immunologyABSTRACT
Disseminated herpes simplex virus (HSV) infection may lead to acute liver failure (ALF) and the need for emergency liver transplantation (LT). The primary aim of this study was to determine the utility of HSV serological testing and HSV DNA testing by polymerase chain reaction (PCR) in the diagnosis and management of indeterminate, pregnancy-related, and known HSV-related ALF. Stored sera obtained on study day 1 or 2 from patients enrolled in the United States ALF Study Group with indeterminate (n = 51), pregnancy-related (n = 12), and HSV-related (n = 4) ALF were screened for HSV DNA by PCR and serology. While 7 of the indeterminate and pregnant patients had positive anti-HSV immunoglobulin M, none had detectable HSV DNA. The 4 known HSV cases all had high-titer HSV DNA on presentation (range: 3.5 to 36 x 10(8) copies/mL). Two HSV patients underwent LT but developed posttransplant extrahepatic HSV infection despite suppression of HSV DNA with acyclovir treatment, and one of them eventually died. The 2 other fulminant HSV patients died within 48 hours of presentation. In conclusion, serum HSV DNA indicative of occult HSV infection was not detected in 51 indeterminate and 12 pregnancy-related ALF patients. The 4 patients with known HSV-related ALF all had high HSV DNA levels at presentation, and despite the rapid use of antiviral therapy and emergency LT, substantial morbidity and mortality were encountered, highlighting the poor prognosis with severe disseminated HSV infection.
