Cases reported "Hepatitis D, Chronic"

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1/4. Exacerbation of chronic hepatitis D during interferon alpha administration.

    Acute and severe impairment of liver function with jaundice and ascites occurred in two out of seven patients with chronic hepatitis D during interferon alpha administration (10 MU three times a week). Both of them were young women with histological diagnoses of moderate to severe chronic hepatitis and cirrhosis with no signs of portal hypertension. Only a slow and partial recovery was observed after interferon withdrawal. autoantibodies against basal cell layer tested positive in these two patients. In the remaining five patients with hepatitis D who did not experience liver impairment during interferon administration, basal cell layer antibodies were found only in one case. We conclude that severe decompensation of liver cirrhosis related to hepatitis D may occur during interferon administration. Positivity of basal cell layer antibodies may be associated with the risk of developing such an adverse event but our data are not sufficient to prove this association. ( info)

2/4. Resolution of chronic delta hepatitis after 12 years of interferon alfa therapy.

    Chronic delta hepatitis is an uncommon but severe form of chronic viral hepatitis for which there is currently no satisfactory therapy. A patient with chronic delta hepatitis was treated with interferon alfa, 5 million units daily for 12 years. Serial serum samples were tested for routine liver tests and selected samples for quantitative levels of hepatitis B surface antigen (HBsAg) and hepatitis delta virus rna. Liver biopsies were performed before, during, and after an initial 1-year course of therapy and again after 3 and 10 years of continuous therapy. With initiation of interferon therapy, serum aminotransferase levels decreased to normal range, became abnormal again when the dose was reduced, and increased to pretreatment levels when therapy was stopped. With reinstitution and prolonged therapy, aminotransferase levels became persistently normal; after several years, both hepatitis delta virus rna and serum HBsAg became undetectable. Liver biopsy, which initially revealed cirrhosis, showed gradual improvement in inflammatory and fibrosis scores and, after 10 years, no abnormalities or fibrosis. Therapy was stopped, and the patient remained free of evidence of infection. In conclusion, long-term therapy with interferon alfa in high doses led to resolution of chronic delta hepatitis, disappearance of hepatitis delta and B virus markers, and improvement in fibrosis. ( info)

3/4. The role of HBeAg seroconversion in acute exacerbation of liver disease with termination of hepatitis B and D virus infection in a chronic hepatitis D patient during alpha-interferon therapy.

    We report a severe flare-up in a chronic hepatitis patient due to dual infection with hepatitis B and D viruses during alpha-interferon therapy. Pre-treatment, the patient had detectable levels of both viruses. After 9 months of therapy, an alanine aminotransferase flare with acute hepatic decompensation was detected. Alpha-interferon was discontinued and lamivudine (100 mg once daily) was started, after which the patient reversed slowly. Hepatitis B early antigen (HBeAg) seroconversion with hepatitis b virus-dna clearance was observed 1 month after the flare; 15 months later, the patient had persistently normal alanine aminotransferase levels with negative results for both serum hepatitis b virus-dna and hepatitis D virus-rna. In conclusion, liver disease may be exacerbated during interferon therapy in patients with chronic hepatitis D who are also positive for hepatitis B surface antigen (HBsAg) and HBeAg. Therefore, extra care in monitoring should be considered and strict follow-up is recommended, since clearance of hepatitis D may occur after HBeAg seroconversion in coinfected patients. lamivudine may be administered early in hepatitis D-rna/HBsAg-positive patients at high risk of liver failure once a severe flare-up occurs during interferon therapy. ( info)

4/4. Adefovir dipivoxyl for the treatment of delta-related liver cirrhosis.

    OBJECTIVE: To report a case suggesting the beneficial effect of adefovir dipivoxyl in patients with delta-related decompensated liver cirrhosis ineffectively treated with lamivudine. CASE SUMMARY: A 55-year-old woman with chronic hepatitis b virus (HBV), antihepatitis Be positive, and hepatitis delta virus (HDV)-related decompensated liver cirrhosis (child-Pugh score B9) was awaiting liver transplantation. During this time, she was treated with lamivudine 100 mg/day; however, the drug was stopped after 8 months because it did not produce viral clearance or return serum aminotransferase levels to within normal limits. The patient was not a candidate for interferon alfa therapy but was prescribed adefovir dipivoxyl 10 mg/day. Five months later, serum aminotransferase levels had normalized and, after 7 months of treatment with adefovir, the patient became negative for serum HBV-dna and immunoglobulin m (IgM) antidelta. At the time of writing (20 mo of therapy), the HBV-dna and IgM antidelta remained negative, whereas hepatitis B surface antigen and circulating HDV-rna were positive. No adverse effects associated with adefovir were reported, and the child-Pugh score (A6) had improved. DISCUSSION: This is the first reported case of some beneficial biochemical and serologic effects of adefovir dipivoxyl in the treatment of delta cirrhosis. The virologic pattern of the patient after adefovir is indicative of poor liver disease activity and prospectively enhances liver transplantation outcome, indicating that adefovir might also be useful in the phase prior to liver transplantation. CONCLUSIONS: Although we have no plausible explanation for our patient's favorable response to adefovir treatment, this case contributes to the knowledge regarding treatment of this very difficult condition as well as adefovir efficacy. Given the positive outcome, this report suggests that adefovir might be beneficial in patients with delta-related liver cirrhosis not responsive to previous lamivudine therapy. Based on the high tolerability of this therapy, this case encourages clinical trials. ( info)

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