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2000
Volume 14, Issue 17
  • ISSN: 1381-6128
  • E-ISSN: 1873-4286

Abstract

HCV (Hepatitis C Virus) infection is a serious problem worldwide. It has been estimated that around 2% of population is HCV infected . Most importantly, chronic HCV infection accounts for 40% to 60% of end-stage liver disease (ESLD) cases and is the most frequent indication for orthotopic liver transplantation (OLT) either in the United States or in Europe. In the first chapter of this issue Baldo et al. [1] provides a complete overview of HCV epidemiology around the world. It emerges that the incidence of HCV infection has declined since the late 1980s. In 2005, as in previous years, the majority of such cases in North America and Northern Europe occurred among young adults and injected drug use was the most common risk factor. Less common modes of HCV acquisition remain occupational exposure to blood, high-risk sexual activity, tattooing, body piercing and other forms of skin penetration. Finally, the overall rate of mother-to-child transmission from HCV-infected, HIV-negative mothers has been estimated at around 5% (co-infection with HIV raises this figure to 19.4%). Tramarin et al. [2] evaluated using cost effectiveness analysis the impact of anti-HCV screening in two cohorts: Injecting Drug Users (IDUs) and Individuals With Surgery (IWSs), who represent people potentially exposed to HCV infection, using a Markov model of the natural history of HCV infection they derive costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness related to screening versus no-screening strategies. The main conclusion of this interesting study is that only in the setting of IDUs, the screening strategy can result in a substantial difference in premature deaths and dominates (less costs better outcomes) the no-screening one. The number of premature deaths prevented in the IWSs cohort is lower and there seems to be an unacceptable incremental cost per QALY gained, which may be unsustainable for society. Although most acute HCV infections are asymptomatic, in a proportion of them the onset of the disease in accompanied by typical signs and symptoms of acute hepatitis while acute liver failure due to acute hepatitis C infection is rarely reported. From a clinical point of view, symptomatic infections recover more frequently than asymptomatic infections. The progression of acute hepatitis C virus (HCV) infection to chronic disease ranges from 50% to 84% of cases. The mechanisms related to clearance of HCV or persistence are still incompletely understood. Clinical aspects, diagnosis, and outcome of acute HCV infection are provided in a specific chapter [3] .In the same chapter the role of quasispecies and the relationship with the persistence of infection are deeply discussed. They include host and viral factors. HCV infection becomes chronic most frequently in immune-compromised patients, such us HIV infected people and in other conditions. T cells response play a key role during the acute phase, but other mechanism may be involved, including innate responses and antibodies. The extensive and elegant review by Fitzmaurice and Klenerman analyzed all aspects of cellular immunity during acute hepatitis C [5]. In particular, the key role of CD4+ T cells for priming CD8+ T cells in the clearance or persistence HCV infection is extensively explained. Persistent HCV infection is a leading cause of chronic liver diseases but it is also associated with a wide spectrum of extra-hepatic manifestations often symptomatic, due to autoimmune phenomena triggered by HCV. In fact, Hepatitis C virus infection is characterized by a number of autoreactive manifestations, such as autoantibody production, cryoglobulinemia and thyroid disorders. In the review by Ferri et al. the authors have highlighted potential mechanisms responsible for such manifestations: clinical and laboratory immunopathological manifestations have been reviewed within the setting of available experimental evidence describing, in turn, roles for molecular mimicry between self and HCV in promoting autoantibody production and in favouring clinical autoimmune manifestations such as thyroiditis; HCV lymphocyte infection as a possible step towards cryoglobulinemia and B cell lymphoma. These information provide further insights supporting the idea that HCV infection is a systemic disease affecting deeply the immune system. The goal of treatment for acute hepatitis C patients is to eradicate the virus in the early phase of infection, thus preventing progression to chronicity. According to the review by Santantonio, several studies have demonstrated that Interferon treatment, used during or just after the acute phase of hepatitis C infection, is able to obtain a favourable response (Sustained Virological Response) in over 80% of patients [6]. However, is not yet demonstrated whether Interferon plus ribavirin is more effective than Interferon used in mono-therapy. Delaying treatment for 3 months after disease onset does not appear to reduce treatment efficacy and allows the identification of subjects with spontaneous resolution.

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/content/journals/cpd/10.2174/138161208784746815
2008-06-01
2025-05-24
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  • Article Type:
    Research Article
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