User:Samir/C

=Hepatitis C=
 * Need refs for the following to put into articles!!
 * Flaviviridae, components

Acute Hepatitis C

 * 1) Rare (most Acute C) is asymptomatic
 * 2) Jaeckel study (2001 NEJM) -> 98% of patients with acute symptomatic C (how did they find so many patients) responded to interferon-alfa (not PEG)
 * 3) Data that up to 70% of acute C cleared

Biopsy of chronic C

 * Fatty
 * DDx macrovesicular steatosis: EtOH, NAFLD, Wilson's, TPN, jejunal bypass, starvation, refeeding, drugs: amiodarone, diltiazem, tamoxifen, estrogens, HCV,
 * DDx microvesicular steatosis: AFLP, LCHAD def, other metabolic Dz, Reye syndrome, NRTI, tetracycline (note minocycline -> AIH like, same as INH?), valproic acid, Jamaican vomiting sickness
 * Patchy inflammation (ballooning of hepatocytes, foamy degradation, Counselman bodies, may proceed to piecemeal necrosis -> bridging fibrosis)
 * Does it mimic CCR? ductopenia (ductopenia DDx !!!!)
 * Fibrosing cholestatic C -> rapid onset post OLTx/LRDLTx

RF
Good response:
 * Young
 * Female
 * Low ALT
 * Low F
 * Low BMI
 * Genotype non-1
 * No dose reductions

Therapy

 * Peg-intron (2b) per weight 1.5 mg/kg/wk
 * Pegasys (2a) 180 ug to all
 * +RIBA 800 (non-1) vs. 1000 (<75 kg) vs. 1200 (>75 kg) dep on wt
 * SE=Hemolysis, Sinusitis, Fatigue, CI CRF, Itchiness, Rash, ppt Gout
 * adv of PEG -> longer t1/2
 * differences b/w 2a/2b: weight based, single vs. multiple injections, cost, manufacturer

Literature
Landmark studies: Fried, Manns, Hadyiannis studies Which were PEG 2a/2b????
 * 1) Genotype 1: 42-48 % (Fried/Manns)
 * 2) Genotype non-1: 72-80% (re-check numbers)!
 * Duration 48 wks. vs. 12-24 weeks

Biopsy and defs

 * Defs: EVR = 12 wks, only genotype 1, need 2 log drop in RNA or undetectable
 * SVR = 6/12 post, undetectable
 * qualitiative vs. quantitative!!
 * biopsy = 1+ 2,3- 4+

=Drugs and hepatitis= Representative drugs (NEJM review 2006!!!)
 * Macrovesicular steatosis: amio, MTX, diltiazem, tamoxifen, estrogens
 * Microvesicular steatosis: NRTIs, valproic acid
 * Necrosis: paracetamol
 * AIH like: diclofenac, minocycline
 * Ductopenia/cholestasis: OCP
 * Fibrosis: MTX