Current Infectious Disease Reports

, Volume 2, Issue 1, pp 55–60 | Cite as

Current views on hepatitis C virus infection

  • Mark P. Epstein
  • Tamsin Knox


Hepatitis C virus infection affects more than 4 million people in the United States and is a leading cause of liver failure necessitating transplantation. Effective combination therapies are now available for subgroups of patients at risk for progression to cirrhosis. The benefits of therapy in immunosuppressed hosts, such as HIV-infected patients and liver transplant recipients, are less well established.


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References and Recommended Reading

  1. 1.
    Choo QL, Kuo G, Weiner AJ, et al.: Isolation of a cDNA clone derived from a blood-borne non-A, non-B viral hepatitis genome. Science 1989, 244:359–362.PubMedCrossRefGoogle Scholar
  2. 2.
    National Institutes of Health Consensus Development Conference Panel statement: management of hepatitis C. Hepatology 1997, 26(3 suppl 1):2S–10S.Google Scholar
  3. 3.
    Kelen GD, Green GB, Purcell RH, et al.: Hepatitis B and hepatitis C in emergency department patients. N Engl J Med 1992, 326:1399–1404.PubMedCrossRefGoogle Scholar
  4. 4.
    Centers for Disease Control and Prevention: Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR Morb Mortal Wkly Rep 1998, 47(RR-19):1–39. Approximately 40% of cases of chronic liver disease are HCV related, and the highest prevalence of infection is in persons 20 to 39 years of age.Google Scholar
  5. 5.
    Schiff ER: New perspectives in the diagnosis of hepatitis C. Semin Liver Dis 1999, 19(suppl 1):3–15.PubMedGoogle Scholar
  6. 6.
    Polyak SJ, McArdle S, Liu SL, et al.: Evolution of hepatitis C virus quasispecies in hypervariable region 1 and the putative interferon sensitivity-determining region during interferon therapy and natural infection. J Virol 1998, 72:4288–4296. Quasispecies may play a role in drug resistance and the inability to clear infection. Determination of quasispecies may be used to predict therapeutic response in the future.PubMedGoogle Scholar
  7. 7.
    Hoofnagle JH: Hepatitis C: the clinical spectrum of disease. Hepatology 1997, 26(3 suppl 1):15S-20S.PubMedCrossRefGoogle Scholar
  8. 8.
    Farci P, Alter HJ, Shimoda A, et al.: Hepatitis C virus-associated fulminant hepatic failure. N Engl J Med 1996, 335:631–634.PubMedCrossRefGoogle Scholar
  9. 9.
    Vento S, Garofano T, Renzini C, et al.: Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C. N Engl J Med 1998, 338:286–290.PubMedCrossRefGoogle Scholar
  10. 10.
    Alter MJ, Margolis HS, Krawczynski K, et al.: The natural history of community-acquired hepatitis C in the United States. The Sentinel Counties Chronic non-A, non-B Hepatitis Study Team. N Engl J Med 1992, 327:1899–1905.PubMedCrossRefGoogle Scholar
  11. 11.
    Di Bisceglie AM, Goodman ZD, Ishak KG, et al.: Long-term clinical and histopathological follow-up of chronic posttransfusion hepatitis. Hepatology 1991, 14:969–974.PubMedCrossRefGoogle Scholar
  12. 12.
    Saab S, Soliman G, Han S-H, et al.: Female patients over 50 years of age are at increased risk of developing hepatocellular carcinoma with cirrhosis due to HCV. In DDW-AASLD Poster Session L393. Orlando, 1999.Google Scholar
  13. 13.
    Willson RA: Extrahepatic manifestations of chronic viral hepatitis. Am J Gastroenterol 1997, 92:3–17.PubMedGoogle Scholar
  14. 14.
    Krawczynski K, Alter MJ, Tankersley DL, et al.: Effect of immune globulin on the prevention of experimental hepatitis C virus infection. J Infect Dis 1996, 173:822–828.PubMedGoogle Scholar
  15. 15.
    Freitag-Koontz MJ: Prevention of hepatitis B and C transmission during pregnancy and the first year of life. J Perinat Neonat Nurs 1996, 10:40–55.Google Scholar
  16. 16.
    Myers M, Gregor J, Marotta P: Cost effectiveness of hepatitis A vaccination in patients with chronic hepatitis C. In DDW-AASLD Poster Session, L314. Orlando, 1999.Google Scholar
  17. 17.
    Dube C, Nichol G, Laupacis A: A cost-effectiveness analysis of screening for hepatocellular carcinoma (HCC) in hepatitis Crelated compensated cirrhosis. In DDW-AASLD Poster Session L109. Orlando, 1999.Google Scholar
  18. 18.
    Nutt A, et al.: The histological spectrum of chronic hepatitis C in patients with repeatedly normal alanine aminotransferase (ALT): does liver biopsy make a difference? In DDW-AASLD Poster Session L332. Orlando, 1999.Google Scholar
  19. 19.
    Perrillo RP: The role of liver biopsy in hepatitis C. Hepatology 1997, 26(3 suppl 1):57S-61S.PubMedCrossRefGoogle Scholar
  20. 20.
    McHutchison JG, Gordon SC, Schiff ER, et al.: Interferon alfa-2b alone or in combination with ribavirin as initial treatment for chronic hepatitis C. Hepatitis Interventional Therapy Group. N Engl J Med 1998, 339:1485–1492. It has been shown that combination therapy is more effective than interferon monotherapy, regardless of HCV genotype.PubMedCrossRefGoogle Scholar
  21. 21.
    Pugh RN, Murray-Lyon IM, Dawson JL, et al.: Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973, 60:646–649.PubMedCrossRefGoogle Scholar
  22. 22.
    Gish R: Standards of treatment in chronic hepatitis C. Semin Liver Dis 1999, 19(suppl 1):35–47.PubMedGoogle Scholar
  23. 23.
    Lindsay KL: Therapy of hepatitis C: overview. Hepatology 1997, 26(3suppl 1):71S-77S.PubMedCrossRefGoogle Scholar
  24. 24.
    Tilg H: New insights into the mechanisms of interferon alfa: an immunoregulatory and anti-inflammatory cytokine. Gastroenterology 1997, 112:1017–1021.PubMedCrossRefGoogle Scholar
  25. 25.
    Reichard O, Norkrans G, Fryden A, et al.: Randomised, doubleblind, placebo-controlled trial of interferon alpha-2b with and without ribavirin for chronic hepatitis C. The Swedish Study Group. Lancet 1998, 351:83–87.PubMedCrossRefGoogle Scholar
  26. 26.
    Poynard T, Marcellin P, Lee SS, et al.: Randomised trial of interferon alpha2b plus ribavirin for 48 weeks or for 24 weeks versus interferon alpha2b plus placebo for 48 weeks for treatment of chronic infection with hepatitis C virus. International Hepatitis Interventional Therapy Group (IHIT). Lancet 1998, 352:1426–1432.PubMedCrossRefGoogle Scholar
  27. 27.
    Davis GL, Esteban-Mur R, Rustgi V, et al.: Interferon alfa-2b alone or in combination with ribavirin for the treatment of relapse of chronic hepatitis C. International Hepatitis Interventional Therapy Group. N Engl J Med 1998, 339:1493–1499. This study, among others, showed improved efficacy with the combination of interferon-a and oral ribavirin for treatment of chronic HCV.PubMedCrossRefGoogle Scholar
  28. 28.
    Barbaro G, Lorenzo G, Soldini M, et al.: Interferon-alpha-2B and ribavirin in combination for chronic hepatitis C patients not responding to interferon-alpha alone: an Italian multicenter, randomized, controlled, clinical study. Am J Gastroenterol 1998, 93:2445–2451.PubMedGoogle Scholar
  29. 29.
    Lai MY, Kao JH, Yang PM, et al.: Long-term efficacy of ribavirin plus interferon alfa in the treatment of chronic hepatitis C. Gastroenterology 1996, 111:1307–1312.PubMedCrossRefGoogle Scholar
  30. 30.
    Ning Q, et al.: Ribavirin inhibits viral-induced macrophage production of TNF, IL-1, the procoagulant fgl2 prothrombinase and preserves Th1 cytokine production but inhibits Th2 cytokine response. J Immunol 1998, 160:3487–3493. Ribavirin inhibits induction of macrophage proinflammatory cytokines and Th2 cytokines while preserving Th1 cytokines.PubMedGoogle Scholar
  31. 31.
    Xu Z, Hoffman J: Single-dose safety/tolerability and pharmacokinetic/pharmacodynamics (PK/PD) following administration of ascending subcutaneous doses of pegylated-interferon (PEG-IFN) and interferon alfa-2a to healthy subjects [abstract]. J Hepatol 1998, 28(pt 2):2157.Google Scholar
  32. 32.
    Dusheiko G: Side effects of alpha interferon in chronic hepatitis C. Hepatology 1997, 26(3 suppl 1):112S-121S.PubMedCrossRefGoogle Scholar
  33. 33.
    Maddrey W: Safety of combination interferon alfa-2b/ ribavirin therapy in chronic hepatitis C-relapsed and treatment naive patients. Semin Liver Dis 1999, 19(suppl_1):67–75.PubMedGoogle Scholar
  34. 34.
    Merrick S, Sepkowitz K, Boyle B, Jacobs J: Seroprevalence of hepatitis C antibody and hepatitis B surface antigenemia in a large urban HIV clinic [abstract]. In 12th World AIDS Conference. Geneva, 1998:A22263.Google Scholar
  35. 35.
    Zylberberg H, Pol S: Reciprocal interactions between human immunodeficiency virus and hepatitis C virus infections. Clin Infect Dis 1996, 23:1117–1125.PubMedGoogle Scholar
  36. 36.
    Thomas DL, Villano SA, Riester KA, et al.: Perinatal transmission of hepatitis C virus from human immunodeficiency virus type 1-infected mothers. Women and Infants Transmission Study. J Infect Dis 1998, 177:1480–1488. Risk for vertical transmission of HCV is increased almost threefold in women coinfected with HIV.PubMedCrossRefGoogle Scholar
  37. 37.
    Collier J, Heathcote J: Hepatitis C viral infection in the immunosuppressed patient. Hepatology 1998, 27:2–6.PubMedCrossRefGoogle Scholar
  38. 38.
    Thomas DL, Shih JW, Alter HJ, et al.: Effect of human immunodeficiency virus on hepatitis C virus infection among injecting drug users. J Infect Dis 1996, 174:690–695.PubMedGoogle Scholar
  39. 39.
    Eyster M, Fried M, Di Bisceglie A, Goedert J: Increasing hepatitis C virus RNA levels in hemophiliacs: relationship to human immunodeficiency virus infection and liver disease. Blood 1994, 84:1020–1023. 40. Soto B, Sanchez-Quijano A, Rodrigo L, et al.: Human immunodeficiency virus infection modifies the natural history of chronic parenterally-acquired hepatitis C with an unusually rapid progression to cirrhosis. J Hepatol 1997, 26:1-5.PubMedGoogle Scholar
  40. 41.
    Rockstroh JK, Spengler U, Sudhop T, et al.: Immunosuppression may lead to progression of hepatitis C virus-associated liver disease in hemophiliacs coinfected with HIV. Am J Gastroenterol 1996, 91:2563–2568.PubMedGoogle Scholar
  41. 42.
    Eyster M, Diamondstone L, Lien J-M, et al.: Natural history of hepatitis C virus infection in multitransfused hemophiliacs: effect of coinfection with human immunodeficiency virus. J Acquir Immune Defic Syndr Hum Retrovirol 1993, 6:602–610.Google Scholar
  42. 43.
    Dieterich D, Purow J, Rajapaksa R: Activity of combination therapy with interferon alfa-2b plus ribavirin in chronic hepatitis C patients co-infected with HIV. Semin Liver Dis 1999, 19(suppl 1):87–94.PubMedGoogle Scholar
  43. 44.
    Ungo J, Jones D, Ashkin D, et al.: Antituberculosis druginduced hepatotoxicity. The role of hepatitis C virus and the human immunodeficiency virus. Am J Respir Crit Care Med 1998, 157:1871–1876.PubMedGoogle Scholar
  44. 45.
    Feray C, Gigou M, Samuel D, et al.: The course of hepatitis C virus infection after liver transplantation. Hepatology 1994, 20:1137–1143.PubMedGoogle Scholar
  45. 46.
    Di Bisceglie AM, Shindo M, Fong TL, et al.: A pilot study of ribavirin therapy for chronic hepatitis C. Hepatology 1992, 16:649–654.PubMedCrossRefGoogle Scholar
  46. 47.
    Singh N, Gayowski T, Wannstedt CF, et al.: Interferon-alpha for prophylaxis of recurrent viral hepatitis C in liver transplant recipients: a prospective, randomized, controlled trial. Transplantation 1998, 65:82–86.PubMedCrossRefGoogle Scholar
  47. 48.
    Sheiner PA, Boros P, Klion FM, et al.: The efficacy of prophylactic interferon alfa-2b in preventing recurrent hepatitis C after liver transplantation. Hepatology 1998, 28:831–838.PubMedCrossRefGoogle Scholar
  48. 49.
    Bizollon T, Palazzo U, Ducerf C, et al.: Pilot study of the combination of interferon alfa and ribavirin as therapy of recurrent hepatitis C after liver transplantation. Hepatology 1997, 26:500–504.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc. 2000

Authors and Affiliations

  • Mark P. Epstein
    • 1
  • Tamsin Knox
    • 1
  1. 1.Gastroenterology DivisionNew England Medical Center HospitalsBostonUSA

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