viral-hepatitis.pptVIP

Recommend treatment if: HCV-RNA is detectable ALT above the upper normal reference level No contraindications for treatment Liver biopsy showing fibrosis stage =2 and ongoing inflammation or/ fibrosis stage 1 and inflammation grade 2 Treatment with: -alfa-IFN 3MU s.c., 3 times a week + ribavirin 1000-1200 mg /day. Non-responders to previous IFN monotherapy: -Lack of sufficient information - no recommendation given. Pegylated Interferon Indication of pegylated interferon (with ribavirin): first intention therapy of patients with: fibrosis-stage 3 (Knodell or Metavir score), necroinflamatory score9, hemophilia/thalasemia, age55 years recurrences /absence of response after the standard therapy with interferon and ribavirin, coinfections. Inhibition of viral replication might also be achieved by: - Antisense oligonucleotides that bind to specific sequences in the HCV RNA. -Ribozymes that catalyze cleavage of HCV RNA. - Gene transfer of interfering proteins, that specifically interrupt virion assembly in the hepatocyte. HEPATITIS E Hepatitis E virus was identified by Balayan et al. (1983) in human fecal samples. In 1995 this virus has been classified within the Caliciviridae. HEV is a non-enveloped, RNA virus with single-stranded genome Epidemiology Hepatitis E could be a sporadic disease or may evolve in outbreaks with contaminated drinking water as the source of infection. The most frequently involved regions are: India, China, Pakistan, Egypt, Algeria, Sudan, Ethiopia, Mexico. HEV infections generally occurred after the age of 16 years Pathogenesis Pathological changes in the liver include hepatocyte necrosis and inflammatory cell infiltration Clinical manifestations Incubation period has an average of 40 days. HEV produces an acute, self-limited disease without progression through chronic hepatitis. The prodromal symptoms include: malaise, anorexia, abdominal discomfort. In women infected during the third trimester of pregnancy was noted