HEPATITIS C
How do pegylated interferons compare in treating chronic hepatitis C?
Acute infection with viral hepatitis C manifests most commonly no symptoms, but frequently results in chronic infection. Chronic hepatitis C is in most cases benign, but may progress to severe illness and liver‐related death. This review found no significant effect of glucocorticosteroids on chronic hepatitis, but the amount of data is sparse. Accordingly there is insufficient evidence to neither confirm nor exclude beneficial and harmful effects of glucocorticosteroids for hepatitis C. Further, the evidence is unclear as to whether glucocorticosteroids treatment can be safely administered for other diseases in patients with concomitant hepatitis C. The authors were unable to identify randomised clinical trials on glucocorticosteroids for acute hepatitis C.
Hepatitis C virus (HCV) is the most common chronic blood borne pathogen in the United States. Chronic HCV infection has a variable course but can cause cirrhosis, liver failure, and hepatocellular cancer after a number of years. Dual therapy with pegylated interferon and ribavirin is now recommended as the antiviral regimen of choice for chronic HCV infection in patients who meet criteria for treatment. However, current guidelines make no recommendation for one pegylated interferon over the other, and it is unclear if there are clinically significant differences between dual therapy with pegylated interferon-alfa 2a versus pegylated interferon-alfa 2b. There is also uncertainty about comparative effectiveness and safety of dual therapy with pegylated interferons in subgroups of patients with HCV (such as those co-infected with HIV infection, those with higher fibrosis stage or higher viral load, those infected with genotype 1, or those who have already failed interferon-based therapy) and in how differences in duration of therapy or dose affect estimates of benefits and harms. The purpose of this review is to compare the benefits and harms of different pharmacologic treatments for chronic hepatitis C infection
End‐stage liver disease due to chronic hepatitis C is the leading cause of death among patients with stable HIV. The recommended treatment for chronic hepatitis Camong patients without HIV is peginterferon plus ribavirin. Based on evidence from trials on HIV‐negative patients with hepatitis C, the viral genotype, dose of treatment and duration of therapy may affect the treatment response. This review is the first to evaluate the antiviral effect of peginterferon, ribavirin or amantadine administered in different combinations for a patient group, which has not previously been treated for hepatitis C. A total of 14 randomised clinical trials with at total of 2269 patients have been included in this review.The present review suggests that peginterferon plus ribavirin may also be considered if patients have HIV. The dose of peginterferon was similar to that assessed in trials on patients without HIV (180 microgram or 1.5 microgram/kg once weekly), but the dose of ribavirin was somewhat lower in most trials (800 mg daily). There were considerable differences between the trials possibly related to the dose and duration of treatment or the proportion of patients with different hepatitis C virus genotypes. The benefit of treatment was seen when assessing the proportion of patients with a sustained loss of the hepatitis C virus from the blood and the proportion with improved liver biopsies. No significant differences were seen in clinical outcome measures, including mortality (1%, irrespective of treatment). There were several adverse events. Fatal lactic acidosis and liver failure occurred. Other adverse events included anaemia and flu‐like symptoms that occurred more frequently among patients receiving peginterferon plus ribavirin. No significant differences were seen regarding the risk of depression, mortality, and progression to cirrhosis or to AIDS. Additional randomised trials are necessary to assess the effect in HIV and HCV co‐infected patients of peginterferon plus ribavirin in relation to the duration of therapy, especially in patients with hepatitis C genotype 2 or 3. Additional trials comparing peginterferon plus ribavirin versus interferon plus ribavirin or peginterferon alone do not seem warranted.
It is not clear whether antiviral therapy is indicated in patients undergoing liver transplantation for chronic liver disease incompatible with long‐term survival resulting from hepatitis C virus (HCV) infection. We performed a Cochrane review of randomised clinical trials to assess the benefits and adverse events of the different antiviral treatments used for preventing the recurrence of chronic liver disease due to HCV infection. A total of 477 liver transplant recipients undergoing liver transplantation for chronic HCV infection were randomised in eleven trials to various interventions and controls. The proportion of genotype I (a subtype, which is more difficult to treat than other subtypes) varied between 49% to 88% in the five trials that reported the genotype. Only one or two trials were included under each comparison. All the trials were of high risk of systematic error bias. There was no statistically significant difference in the patient survival, liver graft survival (ie, requirement for retransplantation), or incidence of chronic liver disease due to HCV reinfection. None of the trials reported liver decompensation, primary graft non‐function (graft failure before the liver graft starts functioning), intensive therapy unit stay, hospital stay, or quality of life. Life‐threatening adverse events were not reported in either group in any of the comparisons. Up to 91% of patients required reduction in dose and up to 36% of patients required cessation of treatment in the various comparisons because of adverse events or because of patient's choice to stop treatment. Due to the limited number of patients and observed outcomes as well as due to the trials of systematic errors, it is not possible to advocate or refute prophylactic antivirals in patients undergoing liver transplantation. Further randomised clinical trials at low risk of random errors or systematic errors are necessary to assess the long‐term survival benefits for various treatment options in these patients
Bicyclol is a novel synthetic 'anti‐hepatitis' drug, used primarily in China for patients with chronic hepatitis C. Only one small, short‐term randomised clinical trial was found evaluating the efficacy of bicyclol for patients with chronic hepatitis C. Clinicians should be aware of the lack of evidence for bicyclol.
Globally, about 170 million people are chronically infected with hepatitis C virus.Hepatitis C is a blood‐borne virus and routes of transmission include intravenous drug use, mother‐to‐infant transmission, unsafe medical practices, high‐risk sexual behaviour, and blood transfusion. Chronic hepatitis C is in most patients a benign viral infection, but a minority of patients develop liver cirrhosis and may suffer from complications due to cirrhosis or die from it.
No good evidence to support using caesarean section for reducing mother to baby transmission of hepatitis C during labour and birth.
Hepatitis C is an infectious disease of the liver caused by hepatitis C virus. Around 170 million people world‐wide are chronically infected with this virus. The infection is associated with severe sequelae such as liver cirrhosis, liver cancer, or liver failure. Herbal medicines have been used for treating hepatitis C. This systematic review evaluates the effects of herbal medicines for treating acute and chronic hepatitis Cinfection.
This report focuses on whether it is useful to order a hepatitis C virus (HCV) antibody test in either the general population of asymptomatic adults or selected high-risk subpopulations who have no history of liver disease or known liver function test abnormalitie.
Globally about 170 million people are chronically infected with hepatitis C virus.Hepatitis C is a blood‐borne virus and routes of transmission include intravenous drug use, mother‐to‐infant transmission, unsafe medical practices, high‐risk sexual behavior, and blood transfusion. Chronic hepatitis C is in most patients a benign viral infection, but a minority of patients develop liver cirrhosis and may suffer from complications due to cirrhosis or die.
Acute hepatitis C is rarely diagnosed because in most cases it is asymptomatic. Treatment of patients with chronic hepatitis C with interferon can achieve viral clearance and improve liver biochemistry and histology. In this review, treatment with interferon alfa in the acute stage of transfusion‐acquired hepatitis C infection improved liver biochemistry and enhanced viral clearance compared to the natural history of the disease. We cannot ascertain, however, the effect of interferon on clinical outcomes due to a lack of data. Because of the effect of therapy on biochemical and virologic outcomes, we recommend the treatment of acutehepatitis C with at least interferon alfa at a dosage of three million units thrice weekly for three months. Future trials should focus on the efficacy of combination therapy with ribavirin and pegylated interferons, which have shown superiority to interferon alfa in chronic hepatitis C.
Antiviral therapy to treat recurrent hepatitis C infection after liver transplantation is controversial due to unresolved balance between benefits and harms. This systematic review of randomised clinical trials was performed to compare the benefits and harms of different antiviral therapies in patients with hepatitis C re‐infected grafts after liver transplantation. A total of 425 liver transplant recipients with proven hepatitis C recurrence were randomised in 12 trials to various interventions and controls (including single drug regimen or multidrug regimen of interferon, ribavirin, and amantadine). Nine trials reported the proportion of patients belonging to genotype I (a subtype, which is more difficult to treat than other subtypes). More than three‐quarters of the patients belonged to genotype I in these nine trials. Only one or two trials were included under each comparison. All the trials were of high risk of bias (risk of systematic error due to inadequate methodological quality) and high risk of play of chance (risk of random error due to few patients randomised). There were no significant differences in the mortality, graft rejection, or in re‐transplantation between intervention and control in any of the comparisons that reported these outcomes. None of the trials reported liver decompensation or quality of life. Life threatening adverse effects were not reported in either group in any of the comparisons. Up to 87.5% of patients required reduction in dose and up to 42.9% of patients required cessation of treatment in the various comparisons because of adverse effects or because of patient's choice to stop treatment. Further randomised clinical trials at low risk of systematic errors or random errors are necessary to assess the long‐term survival benefits for various treatment options, particularly combination pegylated interferon and ribavirin therapy with or without the use of granulocyte colony‐stimulating‐factor and synthetic erythropoietin, which may be helpful in treating the adverse effects of the therapies without reducing the dosage.
Interferon leads to sustained clearance of the hepatitis C virus from the blood in less than 20 per cent of patients. In the remaining patients, nonresponders and relapsers, additional treatment options have been studied. This systematic Review shows that retreatment with interferon leads to sustained clearance of the virus in a small proportion of these patients. Prolonging the treatment duration from 24 to 48 weeks enhances the rate of response. This Review could not determine the impact of interferon retreatment on clinical outcomes such as the need for liver transplantation or death. The methodological quality of the included trials and reporting of adverse events were suboptimal.
Hepatitis C virus infection can progress to chronic hepatitis, cirrhosis, and hepatocellular carcinoma. The goal of this systematic review was to examine the effects of interferon treatment for interferon naive (previously untreated) patients with chronic hepatitis C. This review confirmed the efficacy of interferon on surrogate outcomes as well as a favourable effect of higher treatment doses and prolonged durations. However, these effects were associated with more adverse events. Compared with non‐cirrhotic patients, cirrhotic patients respond similarly, but the efficacy of interferon in patients with normal liver biochemistry is not substantiated by the data. Although interferon monotherapy is no longer considered the standard therapy for chronic hepatitis C, this review defines the optimal dose and duration of interferon monotherapy, which may be useful for patients who cannot tolerate combination therapy including interferon and ribavirin, the most effective therapy currently available.
The review found only modest sustained virological response rates to re-treatment of patients who had failed to respond to pegylated or standard interferon plus ribavirin. The authors recommended restricting re-treatment to 24 weeks, patients who were not overweight, or genotype 2/3 infected patients. The reliability of the authors' conclusions is unclear due to insufficient high-quality evidence
BACKGROUND: Appropriate treatment of acute hepatitis C is still a matter of controversy due to the lack of large controlled trials.
This review assessed hepatitis C treatment outcomes, compliance and completion rates among injecting drug users and concluded that injecting drug users can be successfully treated for both chronic and acute hepatitis. Given the potential for missed studies, poor reporting of review methods and included studies of unknown quality, this finding should be interpreted with caution.
BACKGROUND: The conventional therapy for chronic hepatitis C is the combination of interferon-alpha and ribavirin. However, it has some adverse effects and does not response to some patients, and it is also very expensive
The authors concluded that there was insufficient evidence to conclude that one pegylated interferon (alfa 2a or 2b) was superior to another for the treatment of chronic hepatitis C virus infection. There were limitations in the search and reporting of review methods, but overall the authors' conclusions reflected the evidence and are likely to be reliable.
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