RESUMO
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.
Assuntos
Antivirais/uso terapêutico , Hepatite B , Hepatite C , Hepatopatias/prevenção & controle , Idoso , Gerenciamento Clínico , Transição Epidemiológica , Hepatite B/complicações , Hepatite B/diagnóstico , Hepatite B/epidemiologia , Hepatite B/imunologia , Hepatite B/fisiopatologia , Hepatite C/complicações , Hepatite C/diagnóstico , Hepatite C/epidemiologia , Hepatite C/imunologia , Hepatite C/fisiopatologia , Humanos , Hepatopatias/diagnóstico , Hepatopatias/etiologia , Programas de Rastreamento/métodos , Programas de Rastreamento/organização & administração , Monitorização Imunológica/métodos , Prevalência , Fatores de Risco , Resultado do TratamentoRESUMO
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.
Assuntos
Hepatopatias Alcoólicas/imunologia , Imunidade Adaptativa , Animais , Ativação do Complemento , Progressão da Doença , Endotoxinas/farmacocinética , Células Estreladas do Fígado/imunologia , Células Estreladas do Fígado/patologia , Humanos , Imunidade Inata , Mediadores da Inflamação/imunologia , Interleucinas/imunologia , Células de Kupffer/imunologia , Fígado/metabolismo , Fígado/patologia , Hepatopatias Alcoólicas/etiologia , Hepatopatias Alcoólicas/metabolismo , Hepatopatias Alcoólicas/patologia , Metagenoma , Neutrófilos/imunologia , Neutrófilos/patologia , Espécies Reativas de Oxigênio/metabolismo , Transdução de Sinais , Receptor 4 Toll-Like/imunologiaRESUMO
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.
