title: Clinical presentation, outcome, and response to therapy among patients with acute exacerbation of chronic hepatitis C.
abstract: OBJECTIVE
  The slow asymptomatic progression of chronic hepatitis C (CHC) can be interrupted by an acute exacerbation, characterized by increased serum levels of alanine aminotransferase (ALT) and bilirubin and other symptoms of acute hepatitis. We aimed to provide more information about the clinical presentation of acute exacerbation of CHC.
  
  
  METHODS
  We identified 82 consecutive patients, from 2 locations in Italy, who had an acute exacerbation of CHC from January 2005 through June 2010; we followed them up for a median period of 36 months. These cases were hepatitis C virus (HCV) RNA positive, hepatitis B surface antigen-negative, and had not received anti-HCV therapy. They were matched with 82 subjects with hepatitis C without reactivation for age, sex, and HCV genotype (controls). Sixty-nine cases and 73 controls were followed up for at least 2 years. Liver biopsy specimens had been taken from 23 cases and 31 controls-once before enrollment in the study and once during the follow-up period.
  
  
  RESULTS
  HCV genotype 2 was detected in 46.4% of cases, and HCV genotype 1 was detected in 43.9%. Among cases, the mean ALT level was 1063 ± 1038 IU/dL, and the mean total bilirubin level was 15.87 ± 7.15 mg/dL. A higher percentage of cases carried the interleukin-28B CC genotype than controls (40.2% vs 24.4%; P < .05). Among cases, 43.5% had a steady increase in ALT level (>2-fold baseline value); for 56.5% of these patients, ALT levels returned to baseline values before the acute exacerbation of chronic hepatitis. Based on comparisons of biopsy specimens, 18 cases (78.3%) and 11 controls (35.5%) had increasing fibrosis, with Ishak scores increasing by more than 2 (P < .005); 14 cases (60.9%) and 3 controls (9.6%) had increases in necroinflammation of more than 2 points (P < .005). Thirty-two cases (46.4%) and 38 controls (52%) received treatment with pegylated interferon and ribavirin; a sustained virologic response was achieved in 26 cases (81.2%) and 23 controls (60.5%).
  
  
  CONCLUSIONS
  Although an acute exacerbation of chronic hepatitis is a serious medical condition, most patients achieve a sustained virologic response after treatment with pegylated interferon and ribavirin.
authors.affiliation: Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, Naples, Italy. evangelista.sagnelli@unina2.it
authors.forename: Evangelista
authors.initials: E
authors.lastname: Sagnelli
authors.forename: Mariantonietta
authors.initials: M
authors.lastname: Pisaturo
authors.forename: Maria
authors.initials: M
authors.lastname: Stanzione
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Messina
authors.forename: Loredana
authors.initials: L
authors.lastname: Alessio
authors.forename: Caterina
authors.initials: C
authors.lastname: Sagnelli
authors.forename: Mario
authors.initials: M
authors.lastname: Starace
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pasquale
authors.forename: Nicola
authors.initials: N
authors.lastname: Coppola
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use*; D001663:Bilirubin / Q000097:blood; D001706:Biopsy; D005260:Female; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use*; D007558:Italy; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D012367:RNA, Viral / Q000097:blood; D011994:Recombinant Proteins / Q000627:therapeutic use; D012254:Ribavirin / Q000627:therapeutic use*; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D012367:RNA, Viral; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; D000410:Alanine Transaminase; C417083:peginterferon alfa-2b; C100416:peginterferon alfa-2a; D001663:Bilirubin
keywords: ALT; AST; CHC; Cirrhosis; Complication; HAI; HAV; HBsAg; HCC; HCV; HDV; HEV; Hepatic Flare; Histologic Activity Index; IL; LB; Response to Therapy; SVR; alanine aminotransferase; aspartate aminotransferase; chronic hepatitis C; hepatitis A virus; hepatitis B surface antigen; hepatitis C virus; hepatitis D virus; hepatitis E virus; hepatocellular carcinoma; interleukin; liver biopsy; peg-IFN; pegylated interferon; sustained virologic response