Treatment of Acute Hepatitis
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"documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Ann Hepatol. 2006;5 Supl 1:S24-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 54 "formatos" => array:3 [ "EPUB" => 7 "HTML" => 30 "PDF" => 17 ] ] "en" => array:8 [ "idiomaDefecto" => true "titulo" => "Predictive factors for response to treatment of chronic hepatitis C" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "S24" "paginaFinal" => "S28" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Blanca Olaechea de Careaga" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Blanca" "apellidos" => "Olaechea de Careaga" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119319659?idApp=UINPBA00004N" "url" => "/16652681/00000005000000S1/v1_201906280857/S1665268119319659/v1_201906280857/en/main.assets" ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "Treatment of Acute Hepatitis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "S29" "paginaFinal" => "S31" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Marco Antonio Olivera Martínez" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Marco" "apellidos" => "Antonio Olivera Martínez" "email" => array:1 [ 0 => "maoma@quetzal.innsz.mx" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Instituto Nacional de Nutrición y Ciencias Médicas “Salvador Zubirán”, México, D.F., México" "etiqueta" => "1" "identificador" => "aff1" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Address for correspondence:" ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="p0005" class="elsevierStylePara elsevierViewall">At present, hepatitis C is considered the main cause of liver disease in the Western world. Estimates show that 170,000,000 individuals worldwide (3% of world population) have the disease. Although most attention has been given to chronic hepatitis C, an acute form of the disease has also been detected.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="p0010" class="elsevierStylePara elsevierViewall">The main route of transmission of the hepatitis C virus (HCV) was via transfusion with contaminated blood or blood derivatives, but the frequency of infection via this route has decreased since the 1990s, when screening of all donated blood for HCV was introduced. Although the incidence of HCV infection is decreasing, the prevalence of this disease is increasing continuously. This is due mainly to the long interval (sometimes more than 20 years) between detection of the infection and development of symptoms of chronic liver disease. Even though the HCV can be transmitted via several routes, development of the infection depends greatly on reexposure to the virus or percutaneous entry of a large amount of the virus. For this reason, individuals most susceptible to hepatitis C are either addicted to intravenous drugs, have multiple tattoos or body piercings, or are health workers who have been injured with needles or other sharp elements. <a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Health workers and exposure to HCV</span><p id="p0015" class="elsevierStylePara elsevierViewall">Because there is no vaccine against HCV, the best way for health workers to avoid contracting hepatitis C is to avoid exposure to blood and potentially infectious body fluids.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Because chronic infection develops in 80% of those exposed to HCV, some groups<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> consider that early treatment of the infection reduces the probability of development of quasispecies and the risk of developing chronic disease. The following factors should be taken into account to minimize occupational exposure to HCV.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="p0020" class="elsevierStylePara elsevierViewall">1. Personnel at risk of contracting HCV are those involved in caring for patients, collection of body fluids, and laboratory work, students of medicine and related occupations, employees of hospitals and health centers, physicians, surgeons, administrative personnel, and voluntary workers who care for potentially infectious patients.</p><p id="p0025" class="elsevierStylePara elsevierViewall">2. Occupational exposure to HCV may occur via percutaneous lesions (needle punctures or injuries made by a sharp instruments) or contact with mucous, skin wounds, blood, fluids containing blood, nasal mucus, semen, or vaginal secretions. Cerebrospinal fluid, pleural fluid, synovial fluid, amniotic fluid, pericardial fluid, and peritoneal fluid are also considered infectious.</p><p id="p0030" class="elsevierStylePara elsevierViewall">3. Nasal secretion, saliva, grounds, expectorate, sweat, and tears are only considered infectious if they contain blood.</p><p id="p0035" class="elsevierStylePara elsevierViewall">4. Any exposure in a laboratory to concentrated forms of samples containing HCV is considered clinically significant.</p><p id="p0040" class="elsevierStylePara elsevierViewall">It is necessary to report any event that could potentially result in HCV transmission, even if it is not considered important at the time. However, surgical and infirmary personnel have a tendency to underestimate the risks associated with certain types of incidents. In Canada, 39% of incidents involving potential HCV infections are not registered, and in the United States 30% of such incidents are not reported.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Occupational risk of HCV infection</span><p id="p0045" class="elsevierStylePara elsevierViewall">The possibility of developing hepatitis C depends on the quantity of virus that an individual is exposed to<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> HCV infection rates among surgical personnel exposed to sharp instruments are 0%–7%, but among surgical personnel exposed to sharping instruments, the infection rate is 10%.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The mean rate of HCV infection of all personnel involved in the health industry is 1.8%–3%.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="p0050" class="elsevierStylePara elsevierViewall">Needles harboring hematic residues are more frequently involved in transmission of HCV than any other type of medical equipment. HCV is not transmitted via contact with intact skin.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Management of health personnel after exposure to HCV</span><p id="p0055" class="elsevierStylePara elsevierViewall">To date, there are no long-term clinical studies that have proved the usefulness of immunomodulatory agents (interferons), antiviral drugs, or combinations of immunomodulatory and antiviral drugs after exposure to HCV. Experimental data derived from chimpanzees suggest that administration of immunoglobulin does not prevent the development of HCV infection. It has been concluded that the disease must be determined for interferon to be effective.</p><p id="p0060" class="elsevierStylePara elsevierViewall">Studies of viral kinetics suggest that agents for treatment of the chronic form of the disease are not useful for prophylaxis of acute infection because of their mechanism of action. Interferon acts by blocking the production and release of the virus from infected cells and eradicating the virus from infected cells.</p><p id="p0065" class="elsevierStylePara elsevierViewall">There is no valid reason for initiating prophylaxis after exposure to HCV; however, individuals who have been exposed should be followed up to monitor their seroconversion. <a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Individuals identified as the sources of potential exposure of health workers to HCV (index cases) should be screened and monitored for HCV and other viruses that are capable of percutaneous transmission (e.g., hepatitis B virus, human immunodeficiency virus).<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Other populations at risk of infection with HCV</span><p id="p0070" class="elsevierStylePara elsevierViewall">An Australian study showed that prisoners who share needles for intravenous drug administration have a higher risk of infection with HCV than with hepatitis B virus or HIV.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> People who share spring-loaded finger-stick devices for self monitoring of capillary blood glucose levels are also at risk of exposure to HCV, even if they do not share needles.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Estimates of the frequency of sexual transmission of HCV vary between 0% and 30%. A study by the University of Naples suggests that administration of human polyvalent immunoglobulin prevents sexual transmission of HCV.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Postexposure management of hepatitis C patients<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></span><p id="p0075" class="elsevierStylePara elsevierViewall">Each institution should establish policies and protocols to be followed after exposure of personnel to HCV and familiarize all personnel with the procedures.</p><p id="p0080" class="elsevierStylePara elsevierViewall">The policies should include:</p><p id="p0085" class="elsevierStylePara elsevierViewall">1. types of tests to be conducted on the index case,</p><p id="p0090" class="elsevierStylePara elsevierViewall">2. types of tests to be conducted on the exposed individual at baseline and at weeks 4-6, month 3, and month 6 thereafter, and</p><p id="p0100" class="elsevierStylePara elsevierViewall">3. provision for confirmation of a positive HCV ELISA</p><p id="p0105" class="elsevierStylePara elsevierViewall">by RIBA.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Management of acute hepatitis C</span><p id="p0110" class="elsevierStylePara elsevierViewall">As there is no evidence that prophylactic treatment is indicated after exposure to HCV,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> several groups have standardized protocols for the treatment of acute infections. Because 80% of patients with hepatitis C develop the chronic form of the disease, effective treatment of the acute form represents an opportunity for preventing unfavorable progression of the disease. There is evidence that acute hepatitis C is sensitive to treatment.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In Germany, Jaeckel et al. achieved a 98% sustained viral response (SVR) to interferon monotherapy in 44 patients with acute hepatitis C.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> On the other hand, the French group of Trépo et al. evaluated 13 patients who received various doses of interferon α-2b (3 to 5 million IU once a day and three times per week thereafter) with or without ribavirin.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Only one patient developed chronicity, but the dose, regime, and duration of treatment were not standardized, and the preventative effect of the treatments on the evolution of hepatitis C to the chronic form only became evident after at least 6 months of treatment.</p><p id="p0115" class="elsevierStylePara elsevierViewall">Irrespective of whether acute hepatitis C is treated with interferon monotherapy or a combination of interferon and ribavirin, therapy must be initiated between 4 and 8 weeks after symptoms of acute infection appear. If therapy is initiated at an early stage, an SVR of 87% to 100% may be expected, but if treatment is delayed, an SVR of up to 53% may be anticipated.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> A Spanish study reported that treatment of an acute hepatitis C patient with pegylated interferon and ribavirin resulted in SVR 24 weeks after conclusion of the treatment.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Comments</span><p id="p0120" class="elsevierStylePara elsevierViewall">There is no consensus on the best treatment for acute hepatitis C. As pegylated interferons are the gold standards for therapy of chronic diseases, it is suggested that they be administered for 12 to 24 weeks for treatment of acute hepatitis C. This will contribute significantly to reducing the side effects of treatment as suggested in previous reports.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="p0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Recommendations of the consensus panel</span></p><p id="p0130" class="elsevierStylePara elsevierViewall">1. What are the criteria for diagnosis of acute hepatitis C? The following criteria were established by the panel.</p><p id="p0135" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="li0005"><li class="elsevierStyleListItem" id="list0005"><span class="elsevierStyleLabel">•</span><p id="p0140" class="elsevierStylePara elsevierViewall">the presence of a risk factor</p></li><li class="elsevierStyleListItem" id="list0010"><span class="elsevierStyleLabel">•</span><p id="p0145" class="elsevierStylePara elsevierViewall">an elevated aminotransferase level</p></li><li class="elsevierStyleListItem" id="list0015"><span class="elsevierStyleLabel">•</span><p id="p0150" class="elsevierStylePara elsevierViewall">the presence of HCV RNA</p></li><li class="elsevierStyleListItem" id="list0020"><span class="elsevierStyleLabel">•</span><p id="p0155" class="elsevierStylePara elsevierViewall">seroconversion</p></li></ul></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">The quality of evidence for this recommendation was given a rating of 2</span><p id="p0160" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What is the best time to treat acute HCV infection?</span></p><p id="p0165" class="elsevierStylePara elsevierViewall">Treatment should be initiated 12 weeks after of symptoms of acute hepatitis C become evident. Consensus was not reached on the best treatment for acute HCV infection, but most of the panel members preferred combined therapy (pegylated interferon + ribavirin) to interferon monotherapy (pegylated interferon). Studies published to date indicate that treatment should be continued for 24 weeks</p></span><p id="p0170" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">The quality of evidence for this recommendation was given a rating of 2</span></p></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Health workers and exposure to HCV" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Occupational risk of HCV infection" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Management of health personnel after exposure to HCV" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Other populations at risk of infection with HCV" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Postexposure management of hepatitis C patients" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Management of acute hepatitis C" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Comments" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "The quality of evidence for this recommendation was given a rating of 2" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0005" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early treatment of acute hepatitis C with interferon alpha 2b or interferon alpha 2 b plus ribavirin: study of sixteen patients." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Rocca P" 1 => "Bailly F" 2 => "Chevalier M" 3 => "Chevalier P" 4 => "Zoulim F" 5 => "Trepo C" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gastroenterol Clin Biol" "fecha" => "2003" "volumen" => "27" "paginaInicial" => "294" "paginaFinal" => "299" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12700516" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The epidemiology of hepatitis C virus infection. An update for clinicians." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 2 | 12 |
| 2024 October | 59 | 8 | 67 |
| 2024 September | 85 | 2 | 87 |
| 2024 August | 57 | 7 | 64 |
| 2024 July | 53 | 8 | 61 |
| 2024 June | 75 | 6 | 81 |
| 2024 May | 66 | 8 | 74 |
| 2024 April | 78 | 8 | 86 |
| 2024 March | 71 | 4 | 75 |
| 2024 February | 74 | 5 | 79 |
| 2024 January | 92 | 11 | 103 |
| 2023 December | 93 | 19 | 112 |
| 2023 November | 102 | 12 | 114 |
| 2023 October | 119 | 17 | 136 |
| 2023 September | 96 | 9 | 105 |
| 2023 August | 128 | 8 | 136 |
| 2023 July | 149 | 3 | 152 |
| 2023 June | 133 | 10 | 143 |
| 2023 May | 161 | 13 | 174 |
| 2023 April | 133 | 5 | 138 |
| 2023 March | 145 | 8 | 153 |
| 2023 February | 147 | 18 | 165 |
| 2023 January | 123 | 10 | 133 |
| 2022 December | 92 | 5 | 97 |
| 2022 November | 172 | 23 | 195 |
| 2022 October | 140 | 20 | 160 |
| 2022 September | 119 | 21 | 140 |
| 2022 August | 138 | 22 | 160 |
| 2022 July | 109 | 15 | 124 |
| 2022 June | 109 | 24 | 133 |
| 2022 May | 163 | 37 | 200 |
| 2022 April | 134 | 26 | 160 |
| 2022 March | 154 | 18 | 172 |
| 2022 February | 179 | 17 | 196 |
| 2022 January | 177 | 14 | 191 |
| 2021 December | 146 | 27 | 173 |
| 2021 November | 177 | 19 | 196 |
| 2021 October | 185 | 27 | 212 |
| 2021 September | 207 | 19 | 226 |
| 2021 August | 195 | 14 | 209 |
| 2021 July | 192 | 29 | 221 |
| 2021 June | 208 | 22 | 230 |
| 2021 May | 157 | 10 | 167 |
| 2021 April | 162 | 18 | 180 |
| 2021 March | 83 | 6 | 89 |
| 2021 February | 12 | 4 | 16 |
| 2021 January | 2 | 5 | 7 |
| 2020 December | 7 | 6 | 13 |
| 2020 November | 2 | 4 | 6 |
| 2020 October | 6 | 2 | 8 |
| 2020 September | 4 | 2 | 6 |
| 2020 August | 3 | 0 | 3 |
| 2020 July | 1 | 1 | 2 |
| 2020 June | 4 | 1 | 5 |
| 2020 May | 1 | 5 | 6 |
| 2020 April | 2 | 2 | 4 |
| 2020 March | 6 | 0 | 6 |
| 2020 February | 1 | 1 | 2 |
| 2020 January | 3 | 5 | 8 |
| 2019 December | 5 | 3 | 8 |
| 2019 November | 2 | 0 | 2 |
| 2019 October | 2 | 0 | 2 |
| 2019 September | 0 | 1 | 1 |
| 2019 August | 1 | 0 | 1 |
| 2019 July | 2 | 6 | 8 |
| 2019 June | 2 | 6 | 8 |
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