title: Hepatic flares in chronic hepatitis C: spontaneous exacerbation vs hepatotropic viruses superinfection.
abstract: The hepatitis C virus (HCV) causes an acute infection that is frequently asymptomatic, but a spontaneous eradication of HCV infection occurs only in one-third of patients. The remaining two-thirds develop a chronic infection that, in most cases, shows an indolent course and a slow progression to the more advanced stages of the illness. Nearly a quarter of cases with chronic hepatitis C (CHC) develop liver cirrhosis with or without hepatocellular carcinoma. The indolent course of the illness may be troubled by the occurrence of a hepatic flare, i.e., a spontaneous acute exacerbation of CHC due to changes in the immune response, immunosuppression and subsequent restoration, and is characterized by an increase in serum aminotransferase values, a frequent deterioration in liver fibrosis and necroinflammation but also a high frequency of sustained viral response to pegylated interferon plus ribavirin treatment. A substantial increase in serum aminotransferase values during the clinical course of CHC may also be a consequence of a superinfection by other hepatotropic viruses, namely hepatitis B virus (HBV), HBV plus hepatitis D virus, hepatitis E virus, cytomegalovirus, particularly in geographical areas with high endemicity levels. The etiology of a hepatic flare in patients with CHC should always be defined to optimize follow-up procedures and clinical and therapeutic decisions.
authors.affiliation: Evangelista Sagnelli, Mariantonietta Pisaturo, Nicola Coppola, Section of Infectious Diseases, Department of Mental Health and Public Medicine, Second University of Naples, 80131 Naples, Italy.
authors.forename: Evangelista
authors.initials: E
authors.lastname: Sagnelli
authors.affiliation: Evangelista Sagnelli, Mariantonietta Pisaturo, Nicola Coppola, Section of Infectious Diseases, Department of Mental Health and Public Medicine, Second University of Naples, 80131 Naples, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Sagnelli
authors.affiliation: Evangelista Sagnelli, Mariantonietta Pisaturo, Nicola Coppola, Section of Infectious Diseases, Department of Mental Health and Public Medicine, Second University of Naples, 80131 Naples, Italy.
authors.forename: Mariantonietta
authors.initials: M
authors.lastname: Pisaturo
authors.affiliation: Evangelista Sagnelli, Mariantonietta Pisaturo, Nicola Coppola, Section of Infectious Diseases, Department of Mental Health and Public Medicine, Second University of Naples, 80131 Naples, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Coppola
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D018450:Disease Progression; D016174:Hepacivirus / Q000187:drug effects / Q000276:immunology / Q000472:pathogenicity*; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D012307:Risk Factors; D015163:Superinfection; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents
keywords: Chronic hepatitis C virus infection; Hepatic flares; Hepatic flares in immunocompromised patients; Hepatitis A virus superinfection; Immunocompromised patients