RESUMO
Hepatitis B virus (HBV) infection is a leading cause of liver damage and hepatic inflammation. Upon infection, effective antiviral responses by CD8+ T cells, CD4+ T cells, Natural killer (NK) cells, and monocytes can lead to partial or complete eradication of the viral infection. To date, many studies have shown that the production of inhibitory cytokines such as Interleukin 10 (IL-10), Transforming growth factor beta (TGF-ß), along with dysfunction of the dendritic cells (DCs), and the absence of efficient innate immune responses could lead to T cell exhaustion, development of persistent infection, and inability to eradicate the viral infection from liver. Understanding the immunopathogenesis of the virus could be useful in providing further insights toward novel strategies in the eradication of HBV infection.
Assuntos
Anergia Clonal/efeitos dos fármacos , Vacinas contra Hepatite B/administração & dosagem , Vírus da Hepatite B/imunologia , Hepatite B Crônica/imunologia , Imunidade Inata/efeitos dos fármacos , Antivirais/uso terapêutico , Células Dendríticas/imunologia , Células Dendríticas/virologia , Regulação da Expressão Gênica , Vacinas contra Hepatite B/biossíntese , Vacinas contra Hepatite B/síntese química , Vírus da Hepatite B/efeitos dos fármacos , Vírus da Hepatite B/patogenicidade , Hepatite B Crônica/tratamento farmacológico , Hepatite B Crônica/patologia , Hepatite B Crônica/prevenção & controle , Humanos , Interleucina-10/agonistas , Interleucina-10/genética , Interleucina-10/imunologia , Células Matadoras Naturais/imunologia , Células Matadoras Naturais/virologia , Fígado/imunologia , Fígado/virologia , Vacinação em Massa/métodos , Monócitos/imunologia , Monócitos/virologia , Linfócitos T/imunologia , Linfócitos T/virologia , Fator de Crescimento Transformador beta/agonistas , Fator de Crescimento Transformador beta/genética , Fator de Crescimento Transformador beta/imunologia , Carga Viral/efeitos dos fármacos , Carga Viral/imunologiaRESUMO
Tuberculosis (TB) is a major global health problem. Awareness of liver injury due to anti-TB therapy is vital because fulminant hepatic failure is a devastating and often fatal condition without liver transplantation. Here, we report for the first time, two patients of fatal liver injury due to anti-TB drugs in the presence of alpha-1 antitrypsin deficiency. Based on the triad of rapid loss in hepatocyte function, the onset of hepatic encephalopathy, and absence of a prior history of liver disease, the diagnosis of acute liver failure was established. Both patients had low levels of serum alpha-1 antitrypsin, consistent with alpha-1 antitrypsin deficiency. Despite aggressive medical therapy and supportive care, patients developed multi-organ failure and died. It seems measuring the serum levels of alpha 1-antitrypsin before beginning anti-TB therapies is necessary, especially when there is emphysema or bronchiectasis.
