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Distinct Features in Natural History and Outcomes of Acute Hepatitis C

BACKGROUND: Acute hepatitis C (AHCV) provides a diagnostic challenge with diverse clinical presentations. GOALS: This study was aimed to examine the clinical and demographic features as well as outcomes in AHCV patients identified from inpatient and outpatient hospital settings. STUDY: Patients with...

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Autores principales: Bunchorntavakul, Chalermrat, Jones, Lisa M., Kikuchi, Masahiro, Valiga, Mary E., Kaplan, David E., Nunes, Frederick A., Aytaman, Ayse, Reddy, K. Rajender, Chang, Kyong-Mi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Raven Press 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112167/
https://www.ncbi.nlm.nih.gov/pubmed/24457946
http://dx.doi.org/10.1097/MCG.0000000000000076
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author Bunchorntavakul, Chalermrat
Jones, Lisa M.
Kikuchi, Masahiro
Valiga, Mary E.
Kaplan, David E.
Nunes, Frederick A.
Aytaman, Ayse
Reddy, K. Rajender
Chang, Kyong-Mi
author_facet Bunchorntavakul, Chalermrat
Jones, Lisa M.
Kikuchi, Masahiro
Valiga, Mary E.
Kaplan, David E.
Nunes, Frederick A.
Aytaman, Ayse
Reddy, K. Rajender
Chang, Kyong-Mi
author_sort Bunchorntavakul, Chalermrat
collection PubMed
description BACKGROUND: Acute hepatitis C (AHCV) provides a diagnostic challenge with diverse clinical presentations. GOALS: This study was aimed to examine the clinical and demographic features as well as outcomes in AHCV patients identified from inpatient and outpatient hospital settings. STUDY: Patients with suspected AHCV were recruited from Philadelphia VA Medical Center, Hospital of University of Pennsylvania and Brooklyn VA Medical Center between 2000 and 2010. AHCV was diagnosed by acute serum alanine aminotransferase elevation with anti-hepatitis C virus (HCV) seroconversion, HCV-RNA fluctuations above 1 log, and/or recent high-risk exposure without prior HCV infection, excluding those with human immunodeficiency virus infection. Clinical and therapeutic outcomes were monitored for at least 6 months. RESULTS: A total of 40 AHCV patients were enrolled with a median follow-up of 129 weeks. They were mostly men (68%) and whites (73%) with median age of 43 years, diverse risk factors (33% injection drugs, 20% health care–associated, 3% sexual, and 45% unknown), and wide variations in peak alanine aminotransferase (143 to 3435 U/L) and total bilirubin levels (0.4 to 19.3 mg/dL). Viremia resolved spontaneously in 23% and persisted without therapy in 27%, whereas 50% received interferon α-based therapy with 90% cure (18/20). Distinct clinical scenarios included: (1) wide viremic fluctuations >1 log (65%) and intermittent HCV-RNA negativity; (2) autoantibodies (25% antinuclear antibodies, 69% antismooth muscle antibodies) or autoimmune features; (3) delayed spontaneous viral clearance in 2 patients; (4) rapid cirrhosis progression in 2 patients. CONCLUSIONS: AHCV is a heterogenous disease that requires careful monitoring. The lack of apparent risk factor in high proportion of patients and its diverse presentations warrant diagnostic vigilance.
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spelling pubmed-41121672015-03-12 Distinct Features in Natural History and Outcomes of Acute Hepatitis C Bunchorntavakul, Chalermrat Jones, Lisa M. Kikuchi, Masahiro Valiga, Mary E. Kaplan, David E. Nunes, Frederick A. Aytaman, Ayse Reddy, K. Rajender Chang, Kyong-Mi J Clin Gastroenterol ONLINE ARTICLE: Original Article BACKGROUND: Acute hepatitis C (AHCV) provides a diagnostic challenge with diverse clinical presentations. GOALS: This study was aimed to examine the clinical and demographic features as well as outcomes in AHCV patients identified from inpatient and outpatient hospital settings. STUDY: Patients with suspected AHCV were recruited from Philadelphia VA Medical Center, Hospital of University of Pennsylvania and Brooklyn VA Medical Center between 2000 and 2010. AHCV was diagnosed by acute serum alanine aminotransferase elevation with anti-hepatitis C virus (HCV) seroconversion, HCV-RNA fluctuations above 1 log, and/or recent high-risk exposure without prior HCV infection, excluding those with human immunodeficiency virus infection. Clinical and therapeutic outcomes were monitored for at least 6 months. RESULTS: A total of 40 AHCV patients were enrolled with a median follow-up of 129 weeks. They were mostly men (68%) and whites (73%) with median age of 43 years, diverse risk factors (33% injection drugs, 20% health care–associated, 3% sexual, and 45% unknown), and wide variations in peak alanine aminotransferase (143 to 3435 U/L) and total bilirubin levels (0.4 to 19.3 mg/dL). Viremia resolved spontaneously in 23% and persisted without therapy in 27%, whereas 50% received interferon α-based therapy with 90% cure (18/20). Distinct clinical scenarios included: (1) wide viremic fluctuations >1 log (65%) and intermittent HCV-RNA negativity; (2) autoantibodies (25% antinuclear antibodies, 69% antismooth muscle antibodies) or autoimmune features; (3) delayed spontaneous viral clearance in 2 patients; (4) rapid cirrhosis progression in 2 patients. CONCLUSIONS: AHCV is a heterogenous disease that requires careful monitoring. The lack of apparent risk factor in high proportion of patients and its diverse presentations warrant diagnostic vigilance. Raven Press 2015-04 2015-03-04 /pmc/articles/PMC4112167/ /pubmed/24457946 http://dx.doi.org/10.1097/MCG.0000000000000076 Text en Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivitives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0.
spellingShingle ONLINE ARTICLE: Original Article
Bunchorntavakul, Chalermrat
Jones, Lisa M.
Kikuchi, Masahiro
Valiga, Mary E.
Kaplan, David E.
Nunes, Frederick A.
Aytaman, Ayse
Reddy, K. Rajender
Chang, Kyong-Mi
Distinct Features in Natural History and Outcomes of Acute Hepatitis C
title Distinct Features in Natural History and Outcomes of Acute Hepatitis C
title_full Distinct Features in Natural History and Outcomes of Acute Hepatitis C
title_fullStr Distinct Features in Natural History and Outcomes of Acute Hepatitis C
title_full_unstemmed Distinct Features in Natural History and Outcomes of Acute Hepatitis C
title_short Distinct Features in Natural History and Outcomes of Acute Hepatitis C
title_sort distinct features in natural history and outcomes of acute hepatitis c
topic ONLINE ARTICLE: Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112167/
https://www.ncbi.nlm.nih.gov/pubmed/24457946
http://dx.doi.org/10.1097/MCG.0000000000000076
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