ABSTRACT
CONTEXT: Orthotopic liver transplantation (OLT) is the treatment of choice for end-stage liver disease. Cirrhosis due to hepatitis C infection is the leading indication for liver transplantation worldwide. However, patients who are given transplants because of viral liver diseases often present clinical coinfections, including hepatitis B together with hepatitis D. Currently, different strategies exist for patient management before and after liver transplantation, and these are based on different protocols developed by the specialized transplantation centers. CASE REPORT: We present a rare case of a 58-year-old man with chronic hepatitis B, C and D coinfection. The patient developed cirrhosis and hepatocellular carcinoma. His treatment comprised antiviral therapy for the three viruses and OLT. The patient's outcome was satisfactory. CONCLUSION: OLT, in association with antiviral therapy using entecavir, which was administered before and after transplantation, was effective for sustained clearance of the hepatitis B and D viruses. A recurrence of hepatitis C infection after transplantation responded successfully to standard treatment comprising peginterferon alfa-2A and ribavirin.
CONTEXTO: O transplante ortotópico de fígado (TOF) é o tratamento de escolha em pacientes com doença hepática terminal. A cirrose por hepatite C é a principal indicação de transplante hepático no mundo. No entanto, pacientes transplantados por hepatopatias virais frequentemente apresentam coinfecções, como hepatite B associada a hepatite D. Atualmente, existem diferentes estratégias de manejo em pacientes pré e pós-transplantados conforme diferentes protocolos de conduta de serviços especializados em transplante. RELATO DE CASO: Apresentamos o raro caso de um homem de 58 anos diagnosticado com as hepatites crônicas B, C e D. O paciente evoluiu com cirrose e carcinoma hepatocelular. O tratamento consistiu de terapia antiviral para os três vírus e de transplante ortotópico de fígado. O desfecho do paciente foi satisfatório. CONCLUSÃO: O transplante ortotópico de fígado, associado à terapia antiviral com entecavir antes e após o procedimento, foi eficaz na depuração sustentada dos vírus B e D. A recidiva do vírus C após o transplante respondeu com sucesso ao tratamento padrão com alfapeginterferon 2A e ribavirina.
Subject(s)
Humans , Male , Middle Aged , Carcinoma, Hepatocellular/surgery , Hepatitis, Viral, Human/drug therapy , Hepatitis, Viral, Human/surgery , Liver Cirrhosis/surgery , Liver Neoplasms/surgery , Liver Transplantation/methods , Antiviral Agents/therapeutic use , Coinfection/drug therapy , Coinfection/surgery , Hepatitis B/drug therapy , Hepatitis B/surgery , Hepatitis C/drug therapy , Hepatitis C/surgery , Hepatitis D/drug therapy , Hepatitis D/surgery , Interferon-alpha/therapeutic use , Liver Cirrhosis/virology , Polyethylene Glycols/therapeutic use , Recombinant Proteins/therapeutic use , Recurrence , Ribavirin/therapeutic use , Treatment OutcomeABSTRACT
Combination therapy with pegylated interferon and ribavirin is considered the new standard therapy for naïve patients with chronic hepatitis C. We evaluated the efficacy and safety of treatment with weight-based peginterferon alpha-2b (1.5 mg/kg per week) plus ribavirin (800-1,200 mg/day) for 48 weeks in naïve, relapser and non-responder (to previous treatment with interferon plus ribavirin) patients with chronic hepatitis C. Sixty-seven naïve, 26 relapser and 40 non-responder patients were enrolled. The overall sustained virological response (SVR) for the intention-to-treat population was 54 percent for naïve, 62 percent for relapser and 38 percent for non-responder patients. In the naïve subgroup, SVR was significantly higher in patients with the non-1 genotype (67 percent) compared to those with genotype 1 (45 percent). In relapsers and non-responders, SVR was, respectively, 69 percent and 24 percent in patients with genotype 1 and 43 percent and 73 percent in those with genotype non-1. There were no significant differences in SVR rates among the three body weight ranges (< 65 kg, 65-85 kg and > 85 kg) in any of the subgroups. Early virological response (EVR) was reached by 78 percent, 81 percent and 58 percent of naïve, relapser and non-responder patients, respectively, and among those with EVR, 63 percent, 67 percent and 61 percent, respectively, subsequently achieved SVR. All of the non-responder patients who did not have EVR reached SVR. Treatment was discontinued in 13 percent of the patients, due to loss to follow-up, hematological abnormalities or depression.
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Antiviral Agents/administration & dosage , Body Weight , Hepatitis C, Chronic/drug therapy , Interferon-alpha , Ribavirin/administration & dosage , Drug Administration Schedule , Drug Therapy, Combination , Genotype , Hepacivirus/drug effects , Hepacivirus/genetics , Prospective Studies , RNA, Viral/blood , Treatment Outcome , Viral LoadABSTRACT
Dois casos de hidatidose policística (HP) säo relatados, oriundos do mesmo município da regiäo amazônica brasileira (Sena Madureira, Acre). Ambos tiveram a mesma apresentaçäo e evoluçäo clínica ao longo de dois anos de acompanhamento. Inicialmente os pacientes queixaram-se de dor abdominal no andar superior ou no hipocôndrio direito e apresentaram icterícia obstrutiva, febre, aumento de volume abdominal e emagrecimento. Por exame de imagem, além de esplenomegalia, cistos múltiplos e coalescentes foram detectados no fígado. Amostras de soro foram reagentes por contraimunoeletroforese. O tratamento com albendazol resultou em melhora parcial, com alívio sintomático e reduçäo no tamanho das lesöes. Este relato reforça a importância de estudos clínico-epidemiológicos da hidatidose policística na regiäo amazônica brasileira, especialmente no município de Sena Madureira, onde outros pacientes com HP podem estar sem diagnóstico