Hepatic flares in chronic hepatitis C: Spontaneous exacerbation vs hepatotropic viruses superinfection

doi:10.3748/wjg.v20.i22.6707

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World Journal of Gastroenterology

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1007-9327

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World J Gastroenterol. Jun 14, 2014; 20(22): 6707-6715
Published online Jun 14, 2014. doi: 10.3748/wjg.v20.i22.6707

Hepatic flares in chronic hepatitis C: Spontaneous exacerbation vs hepatotropic viruses superinfection

Evangelista Sagnelli, Caterina Sagnelli, Mariantonietta Pisaturo, Nicola Coppola

Evangelista Sagnelli, Mariantonietta Pisaturo, Nicola Coppola, Section of Infectious Diseases, Department of Mental Health and Public Medicine, Second University of Naples, 80131 Naples, Italy

Evangelista Sagnelli, Mariantonietta Pisaturo, Division of Infectious Diseases, AORN Sant’Anna e San Sebastiano di Caserta, 81100 Caserta, Italy

Caterina Sagnelli, Department of Clinical and Experimental Medicine and Surgery “F Magrassi e A Lanzara”, Second University of Naples, 80131 Naples, Italy

Author contributions: Sagnelli E, Sagnelli C, Pisaturo M and Coppola N contributed to the substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content; and final approval of the version to be published.

Supported by A grant from PRIN 2008, MIUR, Rome, Italy; “Ottimizzazione Della Diagnosi Eziologica dell’epatite Acuta C E Studio dei Fattori Viro-Immunologici di Guarigione, di Cronicizzazione E di Risposta Alla Terapia Con Interferone”; and in part by a grant from Regione Campania “Progetti per il miglioramento della qualità dell’assistenza, diagnosi e terapia del paziente affetto da AIDS nei settori: immunologia, coinfezioni, informazione e prevenzione”, 2008

Correspondence to: Evangelista Sagnelli, Professor, Section of Infectious Diseases, Department of Mental Health and Public Medicine, Second University of Naples, Vico Luigi de Crecchio, 16, 80131 Naples, Italy. evangelista.sagnelli@unina2.it

Telephone: +39-8-15666271 Fax: +39-8-23232296

Received: September 24, 2013
Revised: January 13, 2014
Accepted: April 1, 2014
Published online: June 14, 2014

Core Tip

Core tip: Patients with chronic hepatitis C virus infection may experience hepatic flares due to an acute exacerbation of this disease that is frequently characterized by a significant increase in liver fibrosis and necroinflammation but by a high rate of sustained viral response to Peg-interferon plus ribavirin treatment. A hepatic flare may also be due to superinfection by other hepatotropic viruses, drug injury or a concomitant autoimmune disease. The aim of this review is to be of some help in identifying the cause of the flare in a single patient in order to optimize the follow-up and clinical and therapeutic decisions.