Predictors of spontaneous and treatment-induced viral clearance of acute hepatitis C infection : the national research data : Предикторы спонтанного и посттерапевтического вирусного клиренса острого гепатита C : данные национального исследования

Abstract

Background/Aims. Our study retrospectively evaluated the predictors of spontaneous viral clearance and treatment-induced viral clearance of acute viral hepatitis C. Methods. The study included the data of 286 patients (156 male aged 18-79 years and 130 female aged 18-81 years) with acute hepatitis C in Latvia over a 5 year period (from 2008 till 2012). We performed retrospective analysis of the epidemiology, mode of transmission, clinical course, changes of laboratory tests (alanine aminotransferase, aspartate aminotransferase, total bilirubin, INR), changes of ultrasonography in an attempt to identify factors that could predict the outcome of the disease. Results. Among the 286 patients studied, transmission associated with healthcare-related exposure was the primary risk factor in 45% of patients, intravenous drug use in 11%, tattooing, body piercing, manicures in 7%, sexual transmission in 6%, needle stick injuries in 3% and source of infection undetermined in 28% of patients. In our study 92% of patients noted complaints, 79% of patients presenting with jaundice. Hepatomegaly in ultrasound was reported in 13% of cases and intra-abdominal lymphadenopathy was reported in 38% of cases. The spontaneous clearance of acute hepatitis was observed in 41% patients. We did not establish any significant correlation between spontaneous viral clearance and patient age, gender, clinical features or changes of laboratory tests. But we observed that patients with intra-abdominal lymphadenopathy in ultrasonography recovered more often compared to patients without intra-abdominal lymphadenopathy (r=0,219, p=0,016). Treatment with interferon alpha 2b was generally initiated by 228 patients. 86% of patients had a SVR after a 6 months post-treatment follow-up, 4% relapsed. We found that treatment with interferon alpha 2b was more effective in women compared to men (r=0.170, p=0.047). We did not did not determine any significant correlation between efficacy of antiviral therapy and clinical features and changes of laboratory tests. Conclusion. Hepatitis C virus (HCV) infection spontaneously clears in 41% of patients. We cannot predict spontaneous viral clearance by patient age, gender, clinical features or changes of laboratory tests, but patients with intra-abdominal lymphadenopathy in ultrasonography recovered more often compared to patients without intra-abdominal lymphadenopathy. None of the parameters accurately predicts spontaneous resolution at the individual level. Keywords