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Silva IPL, Batista AD, Lopes EP, Filgueira NA, Carvalho BTD, Santos JC, Medeiros TBD, Melo CRLD, Lima MSD, Lima K, Lacerda C, Lacerda HR. A real-life study on the impact of direct-acting antivirals in the treatment of chronic hepatitis C in liver transplant recipients at two university centers in Northeastern Brazil. Rev Inst Med Trop Sao Paulo 2021; 63:e6. [PMID: 33533809 PMCID: PMC7845936 DOI: 10.1590/s1678-9946202163006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 12/14/2020] [Indexed: 12/24/2022] Open
Abstract
The efficacy of direct-acting antivirals (DAAs) in the treatment of chronic hepatitis C (CHC) in liver transplant recipients is poorly understood, and several factors, including immunosuppression, drug interactions, elevated viraemia, and intolerance to ribavirin (RBV), can reduce cure rates. We conducted a real-life study on liver transplant recipients with CHC treated with a combination of sofosbuvir (SOF) and daclatasvir (DCV) or simeprevir (SIM), with or without RBV, followed-up for 12 to 24 weeks. The treatment effectiveness was assessed by determining the sustained virological response (SVR) rates at 12 or 24 weeks after the treatment cessation. Eighty-four patients were evaluated, with a mean age of 63.4 ± 7.4 years, HCV genotype 1 being the most prevalent (63.1%). Nineteen patients (22.7%) had mild fibrosis (METAVIR < F2) and 41 (48.8%) significant fibrosis (METAVIR ≥ F2). The average time between liver transplantation and the start of treatment was 4 years (2.1-6.6 years). The SOF + DCV regimen was used in 58 patients (69%). RBV in combination with DAAs was used in seven patients (8.3%). SVR was achieved in 82 patients (97.6%), and few relevant adverse events could be attributed to DAA therapy, including a patient who stopped treatment due to a headache. There was a significant reduction in ALT, AST, GGT and FA levels, or the APRI index after 4 weeks of treatment, which remained until 12/24 weeks post-treatment. DAA treatment of CHC in liver-transplanted patients achieved a high SVR rate and resulted in the normalization of serum levels of liver enzymes.
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Affiliation(s)
- Isabella Patrícia Lima Silva
- Universidade Federal de Pernambuco, Centro de Ciências Médicas, Pós-Graduação em Medicina Tropical, Recife, Pernambuco, Brazil
| | - Andrea Dória Batista
- Universidade Federal de Pernambuco, Hospital das Clínicas, Serviço de Gastroenterologia e Hepatologia, Recife, Pernambuco, Brazil
| | - Edmundo Pessoa Lopes
- Universidade Federal de Pernambuco, Centro de Ciências Médicas, Pós-Graduação em Medicina Tropical, Recife, Pernambuco, Brazil
| | - Norma Arteiro Filgueira
- Universidade Federal de Pernambuco, Centro de Ciências Médicas, Departamento de Medicina Clínica, Recife, Pernambuco, Brazil
| | | | - Joelma Carvalho Santos
- Universidade Federal de Pernambuco, Centro de Ciências Médicas, Pós-Graduação em Medicina Tropical, Recife, Pernambuco, Brazil
| | - Tibério Batista de Medeiros
- Instituto Professor Fernando Figueira de Medicina Integral, Unidade de Transplante Geral, Serviço de Hepatologia, Recife, Pernambuco, Brazil
| | | | - Martha Sá de Lima
- Faculdade Maurício de Nassau, Recife, Pernambuco, Brazil.,Hospital Oswaldo Cruz, Serviço de Cirurgia Geral, Recife, Pernambuco, Brazil
| | - Kledoaldo Lima
- Universidade Federal de Pernambuco, Hospital das Clínicas, Laboratório Clínico, Recife, Pernambuco, Brazil.,European Virus Bioinformatics Center, Jena, Germany
| | - Claudio Lacerda
- Universidade de Pernambuco, Unidade de Transplante do Fígado, Recife, Pernambuco, Brazil.,Universidade de Pernambuco, Departamento de Cirurgia, Recife, Pernambuco, Brazil
| | - Heloisa Ramos Lacerda
- Universidade Federal de Pernambuco, Centro de Ciências Médicas, Pós-Graduação em Medicina Tropical, Recife, Pernambuco, Brazil.,Universidade Federal de Pernambuco, Centro de Ciências Médicas, Departamento de Medicina Clínica, Recife, Pernambuco, Brazil
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Frizon K, Alves CFDS, Borchardt AC, Lunge VR, Simon D. Viral genotypes and human rs12979860 polymorphism of the IFNL3 gene in hepatitis C infected patients in Southern Brazil. Braz J Infect Dis 2014; 18:229-30. [PMID: 24389274 PMCID: PMC9427531 DOI: 10.1016/j.bjid.2013.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 12/04/2013] [Accepted: 12/05/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kelen Frizon
- Programa de Pós-Graduação em Biologia Celular e Molecular Aplicada à Saúde, Universidade Luterana do Brasil (ULBRA), Canoas, RS, Brazil
| | - Camila Fernanda da Silveira Alves
- Programa de Pós-Graduação em Biologia Celular e Molecular Aplicada à Saúde, Universidade Luterana do Brasil (ULBRA), Canoas, RS, Brazil
| | - Alessandra Caroline Borchardt
- Programa de Pós-Graduação em Biologia Celular e Molecular Aplicada à Saúde, Universidade Luterana do Brasil (ULBRA), Canoas, RS, Brazil
| | - Vagner Ricardo Lunge
- Programa de Pós-Graduação em Biologia Celular e Molecular Aplicada à Saúde, Universidade Luterana do Brasil (ULBRA), Canoas, RS, Brazil
| | - Daniel Simon
- Programa de Pós-Graduação em Biologia Celular e Molecular Aplicada à Saúde, Universidade Luterana do Brasil (ULBRA), Canoas, RS, Brazil.
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Nishiya AS, de Almeida-Neto C, Ferreira SC, Alencar CS, Di-Lorenzo-Oliveira C, Levi JE, Salles NA, Mendrone A, Sabino EC. HCV genotypes, characterization of mutations conferring drug resistance to protease inhibitors, and risk factors among blood donors in São Paulo, Brazil. PLoS One 2014; 9:e86413. [PMID: 24466079 PMCID: PMC3897703 DOI: 10.1371/journal.pone.0086413] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 12/11/2013] [Indexed: 12/18/2022] Open
Abstract
Background Hepatitis C virus (HCV) infection is a global health problem estimated to affect almost 200 million people worldwide. The aim of this study is to analyze the subtypes and existence of variants resistant to protease inhibitors and their association with potential HCV risk factors among blood donors in Brazil. Methods Repeat anti-HCV reactive blood donors are systematically asked to return for retest, notification, and counseling in which they are interviewed for risk factors for transfusion-transmitted diseases. We analyzed 202 donors who returned for counseling from 2007 to 2010 and presented enzyme immunoassay- and immunoblot-reactive results. The HCV genotypes and resistance mutation analyses were determined by the direct sequencing of the NS5b and NS3 regions, respectively. The HCV viral load was determined using an in-house real-time PCR assay targeting the 5′-NCR. Results HCV subtypes 1b, 1a, and 3a were found in 45.5%, 32.0%, and 18.0% of the donors, respectively. The mean viral load of genotype 1 was significantly higher than that of the genotype 3 isolates. Subtype 1a was more frequent among young donors and 3a was more frequent among older donors. Protease inhibitor-resistant variants were detected in 12.8% of the sequenced samples belonging to genotype 1, and a higher frequency was observed among subtype 1a (20%) in comparison to 1b (8%). There was no difference in the prevalence of HCV risk factors among the genotypes or drug-resistant variants. Conclusions We found a predominance of subtype 1b, with an increase in the frequency of subtype 1a, in young subjects. Mutations conferring resistance to NS3 inhibitors were frequent in treatment-naïve blood donors, particularly those infected with subtype 1a. These variants were detected in the major viral population of HCV quasispecies, have replicative capacities comparable to nonresistant strains, and could be important for predicting the response to antiviral triple therapy.
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Affiliation(s)
- Anna S. Nishiya
- Fundação Pró-Sangue/Hemocentro de São Paulo, São Paulo, Brazil
- Infectious Diseases Division (DIPA), Federal University of São Paulo, São Paulo, Brazil
- * E-mail:
| | - Cesar de Almeida-Neto
- Fundação Pró-Sangue/Hemocentro de São Paulo, São Paulo, Brazil
- Discipline of Medical Science, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Suzete C. Ferreira
- Fundação Pró-Sangue/Hemocentro de São Paulo, São Paulo, Brazil
- Infectious Diseases Division (DIPA), Federal University of São Paulo, São Paulo, Brazil
| | - Cecília S. Alencar
- Infectious Diseases Division (DIPA), Federal University of São Paulo, São Paulo, Brazil
- LIM 03 Lab. Medice Laboratory, Department of Pathology, HCFMUSP, São Paulo, Brazil
| | | | - José E. Levi
- Fundação Pró-Sangue/Hemocentro de São Paulo, São Paulo, Brazil
| | - Nanci A. Salles
- Fundação Pró-Sangue/Hemocentro de São Paulo, São Paulo, Brazil
| | | | - Ester C. Sabino
- Infectious Diseases Division (DIPA), Federal University of São Paulo, São Paulo, Brazil
- Department of Infectious Disease, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
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de Almeida MKC, Dos Santos KN, Fecury AA, de Oliveira CSF, Freitas AS, Quaresma JAS, Fuzii HT, Martins LC. Prevalence of viral hepatitis B and C in riverside communities of the Tucuruí Dam, Pará, Brazil. J Med Virol 2013; 84:1907-12. [PMID: 23080495 DOI: 10.1002/jmv.23356] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Epidemiologically, the relevance of infection caused by hepatitis viruses is related mainly to their wide geographic distribution and the large number of infected individuals in all parts of the world. In this study, 668 residents from the islands around the Tucuruí Dam were selected. Blood samples were collected for investigation of serological markers (HBsAg, total anti-HBc, anti-HBS, and anti-HCV) by enzyme immunoassays. HCV-positive subjects were tested using RT-PCR and RFLP for the identification of viral genotypes. Among the 668 subjects studied, 1.9% were HBsAg positive, 28% were total anti-HBc positive, and 41.9% were anti-HBs positive. The anti-HBs marker alone (vaccine response) was detected in 25.7% of the volunteers. Anti-HCV antibody was detected in 2.2% of the subjects and genotype 1 was the predominant genotype (70%). The results indicate an intermediate level of HBV and HCV endemicity in the region studied, as well as low HBV vaccination coverage.
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Paraboni MLR, Sbeghen MD, Wolff FH, Moreira LB. Risk factors for infection with different hepatitis C virus genotypes in southern Brazil. ScientificWorldJournal 2012; 2012:946954. [PMID: 22666173 PMCID: PMC3366236 DOI: 10.1100/2012/946954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 02/19/2012] [Indexed: 12/19/2022] Open
Abstract
Objectives. To investigate the proportion of different genotypes in countryside microregions in southern Brazil, and their association with risk factors. Methods. Cross-sectional study including a convenience sample of patients who tested positive for HCV-RNA and were referred to a regional health center for genotyping, from December 2003 to January 2008. Data were obtained through the National Disease Surveillance Data System, from laboratory registers and from patient charts. Identification of genotypes was carried out using the Restriction Fragment Length Polymorphism “in house” technique. Independent associations with genotypes were evaluated in multinomial logistic regression and prevalence rates of genotypes were estimated with modified Poisson regression. Results. The sample consisted of 441 individuals, 41.1 ± 12.0 years old, 56.5% men. Genotype 1 was observed in 41.5% (95% CI 37.9–48.1) of patients, genotype 2 in 19.3% (95% CI 15.0–23.6), and genotype 3 in 39.2% (95% CI 35.6–43.0). HCV genotype was significantly associated with gender and age. Dental procedures were associated with higher proportion of genotype 2 independently of age, education, and patient treatment center. Conclusions. The hepatitis C virus genotype 1 was the most frequent. Genotype 2 was associated with female gender, age, and dental procedure exposition.
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Shire NJ, Yin M, Chen J, Railkar RA, Fox-Bosetti S, Johnson SM, Beals CR, Dardzinski BJ, Sanderson SO, Talwalkar JA, Ehman RL. Test-retest repeatability of MR elastography for noninvasive liver fibrosis assessment in hepatitis C. J Magn Reson Imaging 2011; 34:947-55. [PMID: 21751289 DOI: 10.1002/jmri.22716] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 06/17/2011] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To conduct a rigorous evaluation of the repeatability of liver stiffness assessed by MR elastography (MRE) in healthy and hepatitis-C-infected subjects. MATERIALS AND METHODS A biopsy-correlated repeatability study using four-slice MRE was conducted in five healthy and four HCV-infected subjects. Subjects were scanned twice on day 1 and after 7-14 days. Each slice was acquired during a 14-s breath-hold with a commercially available acquisition technique (MR-Touch, GE Healthcare). Results were analyzed by two independent analysts. RESULTS The intraclass correlation coefficient (ICC) was 0.85 (90% confidence interval [CI]: 0.71 to 0.98) for the between-scan average of maximum stiffness within each slice and 0.88 (90% CI: 0.78 to 0.99) for the average of mean stiffness within each slice for the primary analyst. For both analysts, the average of the mean liver stiffness within each slice was highly reproducible with ICC of 0.93 and 0.94. Within-subject coefficients of variation ranged from 6.07% to 10.78% for HCV+ and healthy subjects. CONCLUSION MRE is a highly reproducible modality for assessing liver stiffness in HCV patients and healthy subjects and can discriminate between moderate fibrosis and healthy liver. MRE is a promising modality for noninvasive assessment of liver fibrosis (CLINICALTRIALS.GOV IDENTIFIER: NCT00896233).
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Affiliation(s)
- Norah J Shire
- Merck Sharp and Dohme Corp., Whitehouse Station, New Jersey, USA.
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Kershenobich D, Razavi HA, Sánchez-Avila JF, Bessone F, Coelho HS, Dagher L, Gonçales FL, Quiroz JF, Rodriguez-Perez F, Rosado B, Wallace C, Negro F, Silva M. Trends and projections of hepatitis C virus epidemiology in Latin America. Liver Int 2011; 31 Suppl 2:18-29. [PMID: 21651701 DOI: 10.1111/j.1478-3231.2011.02538.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM The purpose of the present investigation is to provide an analysis of previous works on the epidemiology of the hepatitis C virus (HCV) infection from six countries throughout Latin America, to forecast the future HCV prevalence trends in Argentina, Brazil, Mexico and Puerto Rico, and to outline deficiencies in available data, highlighting the need for further research. METHODS Data references were identified through indexed journals and non-indexed sources. Overall, 1080 articles were reviewed and 150 were selected based on their relevance to this work. When multiple data sources were available for a key assumption, a systematic process using multi-objective decision analysis (MODA) was used to select the most appropriate sources. When data were missing, analogues were used. Data from other countries with similar risk factors and/or population compositions were used as a proxy to help predict the future trends in prevalence. RESULTS The review indicates that the dominant genotype is type 1. HCV prevalence in the analysed countries ranges from 1 to 2.3%. The Latin American countries have been very proactive in screening their blood supplies, thus minimizing the risk of transmission through transfusion. This suggests that other risk factors are set to play a major role in continued new infections. The number of diagnosed and treated patients is low, thereby increasing the burden of complications such as liver cirrhosis or hepatocellular carcinoma. The HCV prevalence, according to our modelling is steady or increasing and the number of infected individuals will increase. CONCLUSIONS The results herein reported should provide a foundation for informed planning efforts to tackle hepatitis.
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Affiliation(s)
- David Kershenobich
- Department of Experimental Medicine, School of Medicine, Universidad Nacional Autónoma de México (UNAM), Hospital General de Mexico, Mexico City, Mexico
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Distribution of hepatitis c virus (hcv) genotypes in patients with chronic infection from Rondônia, Brazil. Virol J 2011; 8:165. [PMID: 21486472 PMCID: PMC3082223 DOI: 10.1186/1743-422x-8-165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 04/12/2011] [Indexed: 02/05/2023] Open
Abstract
Background Hepatitis C virus (HCV) is an important human pathogen affecting around 3% of the human population. In Brazil, it is estimated that there are approximately 2 to 3 million HCV chronic carriers. There are few reports of HCV prevalence in Rondônia State (RO), but it was estimated in 9.7% from 1999 to 2005. The aim of this study was to characterize HCV genotypes in 58 chronic HCV infected patients from Porto Velho, Rondônia (RO), Brazil. Methods A fragment of 380 bp of NS5B region was amplified by nested PCR for genotyping analysis. Viral sequences were characterized by phylogenetic analysis using reference sequences obtained from the GenBank (n = 173). Sequences were aligned using Muscle software and edited in the SE-AL software. Phylogenetic analyses were conducted using Bayesian Markov chain Monte Carlo simulation (MCMC) to obtain the MCC tree using BEAST v.1.5.3. Results From 58 anti-HCV positive samples, 22 were positive to the NS5B fragment and successfully sequenced. Genotype 1b was the most prevalent in this population (50%), followed by 1a (27.2%), 2b (13.6%) and 3a (9.0%). Conclusions This study is the first report of HCV genotypes from Rondônia State and subtype 1b was found to be the most prevalent. This subtype is mostly found among people who have a previous history of blood transfusion but more detailed studies with a larger number of patients are necessary to understand the HCV dynamics in the population of Rondônia State, Brazil.
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High prevalence of hepatitis C associated with familial history of hepatitis in a small town of south Brazil. Efficiency of the rapid test for epidemiological survey. Braz J Infect Dis 2010. [DOI: 10.1016/s1413-8670(10)70097-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Mendes-Correa MC, Cavalheiro NP, Mello C, Barone AA, Gianini RJ. Genotypic distribution of hepatitis C among hepatitis C and HIV co-infected patients in Brazil. Int J STD AIDS 2008; 19:595-9. [DOI: 10.1258/ijsa.2007.007183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Summary: Information on hepatitis C virus (HCV) genotypic distribution among HIV-HCV co-infected patients is lacking in Brazil as well as other Latin American countries. The objective of this study was to evaluate the level of exposure to different risk factors associated with HCV transmission among a group of co-infected patients and to characterize the genotypic distribution of HCV in this cluster. A series of 100 HIV-HCV co-infected patients was analysed. The data to be analysed were collected from specific laboratory tests. Information was collected through a questionnaire. HCV genotyping was carried out by sequencing the 5′ non-coding region of HCV. Chi-square and Fischer association tests or Kruskal-Wallis test were used to study the association between HCV transmission-related variables and the established genotypes. In conclusion, exposure to multiple risk factors associated with HCV transmission was common among HIV co-infected patients and an association between HCV genotype 3 and intravenous drug user was observed.
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Affiliation(s)
- M C Mendes-Correa
- Division of Infectious and Parasitic Diseases, Hospital das Clinicas, Medical School
- Laboratory of Medical Investigation in Hepatitis
| | | | - C Mello
- Laboratory of Medical Investigation in Hepatitis
| | - A A Barone
- Division of Infectious and Parasitic Diseases, Hospital das Clinicas, Medical School
- Laboratory of Medical Investigation in Hepatitis
| | - R J Gianini
- Laboratory of Medical Investigation in Epidemiology and Statistics, Medical School, University of São Paulo, São Paulo, Brazil
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Mendes-Correa MC, Widman A, Brussi MLP, Guastini CF, Cavalheiro NDP, Melo CE, Barone AA, Gianini RJ. Clinical and histological characteristics of HIV and hepatitis C virus-co-infected patients in Brazil: a case series study. Rev Inst Med Trop Sao Paulo 2008; 50:213-7. [DOI: 10.1590/s0036-46652008000400005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Accepted: 07/03/2008] [Indexed: 11/22/2022] Open
Abstract
Hepatitis C virus (HCV) is an important factor contributing to morbidity and mortality in patients co-infected with HIV and HCV. In addition, liver biopsy is an important tool in the clinical management of these patients. Although liver biopsy is controversial, it is recommended for all patients. Data regarding the clinical and histological characteristics of these patients are scarce not only in Brazil but in Latin America as a whole. With the goal of better understanding these characteristics and the benefit of liver biopsy indications in this disease setting, data collected from 234 patients followed from 1996 to 2004 at Casa da AIDS, São Paulo, were analyzed. The following variables were extracted from the patients' medical files at the time of liver biopsy: sex, age, hepatitis C infection risk factors, hepatitis C infection duration, ALT levels, CD4+ T cell counts, history of alcohol abuse, history of antiretroviral therapy, HCV genotype, and liver histological alterations. CONCLUSIONS: 1 - Hepatitis C virus 1 and 3 were the most frequently identified genotypes and were diagnosed in 72% and 25.5% of cases respectively; 2 - Structural liver alterations were found to be mild or absent in 48.2% (113/234) of the analyzed patients; 3 - Fifty-three patients (23%) had normal ALT levels and 4 - Significant liver architectural changes (F2-F3) were evident in 22.5% of the patients with normal ALT levels.
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Martinelli ADLC, Teixeira AC, Souza FF, Sankarankutty AK, Silva ODCE. Hepatitis C: a challenge to hepatologists and to the liver transplantation team. Acta Cir Bras 2006; 21 Suppl 1:15-8. [PMID: 17013506 DOI: 10.1590/s0102-86502006000700004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hepatitis C is the main cause of cirrhosis and hepatocellular carcinoma and the leading indication of liver transplantation. The aim of this article was to review specific epidemiological, clinical and therapeutic aspects of hepatitis C and their implication for the hepatologists belonging to liver transplantation services. These specific aspects were reviewed in the literature mainly using Medline. Data regarding the epidemiological, clinical and therapeutic aspects of hepatitis C are discussed, with emphasis on their consequences for the liver transplantation team. Hepatitis C is a challenge for hepatologists and for the liver transplantation team. The burden we observe today is the late consequence of infection that occurred in the past. Measures for early recognition of complications of liver disease are recommended. HCV treatment should always be performed before liver transplantation if possible, but if not, HCV recurrence should be recognized and treated early after transplantation.
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