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Z Gastroenterol 2004; 42(8): 707-713
DOI: 10.1055/s-2004-813443
Leitlinie

© Karl Demeter Verlag im Georg Thieme Verlag KG Stuttgart · New York

Indikationsstellung akute/chronische Hepatitis C

Criteria for the Definition of Acute and Chronic Hepatitis CW. E. Fleig1 , P. Krummener1 , J. Leßke1
  • 1Universitätsklinik und Poliklinik für Innere Medizin I, Halle
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Publication Date:
16 August 2004 (online)

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Natürlicher Verlauf

Unbehandelt geht eine akute Hepatitis-C-Infektion bei einem erheblichen Anteil der Patienten in eine chronische Hepatitis über (B).

Liegt eine chronische Hepatitis C vor, entwickelt sich bei bis zu einem Drittel der Patienten eine Leberzirrhose (B).

Der Progress zur Leberzirrhose ist ein Risikofaktor für die Entwicklung eines hepatozellulären Karzinoms (HCC) (B).

Erläuterungen

Die akute Hepatitis-C-Infektion geht unbehandelt bei etwa 50 - 80 % der Patienten in eine chronische Hepatitis über [1]. Die Aktivität der Fibroseentwicklung bei chronischer Hepatitis C weist eine große Variabilität auf. Bei 2 - 35 % der Patienten erreicht der Krankheitsprozess nach 20 - 25 Jahren das Stadium der Leberzirrhose [2] [3].

Liegt eine Leberzirrhose vor, ist bei etwa 2 - 5 % der Patienten pro Jahr mit der Entwicklung eines HCC zu rechnen [4] [5] [6].

Literatur

  • 1 Hoofnagle J H. Hepatitis C: the clinical spectrum of disease.  Hepatology. 1997;  26 (Suppl. 1) 15S-20S (Übersicht)
    CrossrefPubMedGoogle Scholar
  • 2 Seeff L B. Natural history of hepatitis C.  Hepatology. 1997;  26 (Suppl. 1) 21S (Übersicht)
    PubMedGoogle Scholar
  • 3 Poynard T, Bedossa P, Opolon P. Natural history of liver fibrosis progression in patients with chronic hepatitis C.  Lancet. 1997;  349 825-832 (III)
    CrossrefPubMedGoogle Scholar
  • 4 Rockstroh J K, Woiotas R P, Spengler U. Human immunodeficiency virus and hepatitis C virus coinfection.  Eur J Med Res. 1998;  3 269-277 (Übersicht)
    PubMedGoogle Scholar
  • 5 Di Bisceglie A H. Hepatitis C and hepatocellular carcinoma.  Hepatology. 1997;  26 (Suppl. 1) 34S (Übersicht)
    PubMedGoogle Scholar
  • 6 Hsukuma H, Hiyama T, Tanaka. et al . Risk factors for hapatocellular carcinoma among patients with chronic liver disease.  N Engl J Med. 1993;  328 1797-1801 (III)
    CrossrefPubMedGoogle Scholar
  • 7 Pessione F, Degos F, Marcellin P. et al . Effect of alcohol consumption on serum hepatitis C virus RNA and histological lesions in chronic hepatitis C.  Hepatology. 1998;  27 1717-1722 (III)
    CrossrefPubMedGoogle Scholar
  • 8 Eyster M E, Diamondstone L S, Lien J M. et al . Natural history of hepatitis C virus in multitransfused hemophiliacs: effect of co-infection with human immunodeficiency virus. The multicenter hemophilia cohort study.  J Acquir Immune Defic Syndr. 1993;  6 602-610 (III)
    PubMedGoogle Scholar
  • 9 Weltman M, Brotodihardjo A, Crewe E. et al . Coinfection with hepatitis B and C, C and D viruses results in severe chronic liver disease and responds poorly to interferon-treatment.  J Viral Hepatitis. 1995;  2 39-45 (III)
    PubMedGoogle Scholar
  • 10 Perillo R P. The role of liver biopsy in Hepatitis C.  Hepatology. 1997;  26 (Suppl. 1) 57-61 (III)
    CrossrefPubMedGoogle Scholar
  • 11 Liang T J, Rehermann B, Seef L B. et al . Pathogenesis, natural history, treatment, and prevention of hepatitis C. NIH Conference.  Ann Intern Med. 2000;  132 296-305 (III)
    PubMedGoogle Scholar
  • 12 Niederau C, Lange S, Heintges T. et al . Prognosis of chronic hepatitis C: results of a large, prospective cohort study.  Hepatology. 1998;  28 1687-1695 (III)
    CrossrefPubMedGoogle Scholar
  • 13 Mathurin P, Moussalli J, Cadranal J F. et al . Slow progression rate of fibrosis in hepatitis C virus patients with persistently normal alanine transaminase activity.  Hepatology. 1998;  27 868-872 (IIa)
    CrossrefPubMedGoogle Scholar
  • 14 Ohata K, Hamasaki K, Toriyama K. et al . Hepatic steatosis is a risk factor for hepatocellular carcinoma in patients with chronic hepatitis C virus infection.  Cancer. 2003;  97 3036-3034 (IV)
    CrossrefPubMedGoogle Scholar
  • 15 El-Serag H B, Mason A C. Rising incidence of hepatocellular carcinoma in the United states.  N Engl J Med. 1999;  340 745-750 (III)
    CrossrefPubMedGoogle Scholar
  • 16 Alter M J. Epidemiology of hepatitis C.  Hepatology. 1997;  26 62S-65S (Übersicht)
    CrossrefPubMedGoogle Scholar
  • 17 Eyster M E, Alter H J, Aledort L M. et al . Heterosexual co-transmission of hepatitis C virus (HCV) and human immunodeficiency virus (HIV).  Ann Inern Med. 1991;  115 764-768 (IV)
    PubMedGoogle Scholar
  • 18 Schreiber G B, Busch M P, Kleinmann S H. et al . The risk of transfusion-transmitted viral infection.  N Engl J Med. 1996;  334 1685-1690 (III)
    CrossrefPubMedGoogle Scholar
  • 19 Everhart J E, Di Bisceglie A M, Murray L M. et al . Risk for non-A, non-B (type C) hepatitis through sexual and household contact with chronic carriers.  Ann Intern Med. 1990;  112 544-555 (III)
    PubMedGoogle Scholar
  • 20 Dienstag J L. Sexual and perinatal transmission of hepatitis C.  Hepatology. 1997;  26 (Suppl. 1) 665-705 (III)
    PubMedGoogle Scholar
  • 21 Neumayr G, Probst A, Schwaighofer H. et al . Lack of evidence for sexual transmission of hepatitis C.  QJM Sep. 1999;  92 505-508 (III)
    PubMedGoogle Scholar
  • 22 Meisel H, Reip A, Faltus B. et al . Transmission of hepatitis C virus to children and husbands by woman infected with contaminated anti-D immunoglobulin.  Lancet. 1995;  345 1209-1211 (III)
    CrossrefPubMedGoogle Scholar
  • 23 Thomas D L, Zenilman J M, Alter H J. et al . Sexual transmission of hepatitis C virus among patients attending sexually transmitted diseases clinics in Baltimore - analysis of 309 sex partnerships.  J Infect Dis. 1995;  171 768-775 (III)
    PubMedGoogle Scholar
  • 24 Hon C H, Chen W V, Kao D S. Intrafamilial transmission of hepatitis C virus in hemodialysis patients.  J Med Virol. 1995;  45 381-385 (III)
    PubMedGoogle Scholar
  • 25 Tokars J I, Miller E R, Alter M J. et al . National surveillance of dialysis associated diseases in the United States 1995.  ASAIO J. 1998;  44 98-107 (IV)
    PubMedGoogle Scholar
  • 26 Caramelo C, Navas S, Alberola M L. Evidence against transmission of hepatitis C virus through hemodialysis ultrafiltrate and peritoneal fluid.  Nephron. 1994;  66 470-473 (III)
    PubMedGoogle Scholar
  • 27 Terekerz P M, Pearson R, Jagger J. Infected physicans and invasive procedures: national policy and legal reality.  Milbank Q. 1999;  77 511-529 (IV)
    CrossrefPubMedGoogle Scholar
  • 28 Haley R W, Fischer R P. Commercial tattoing as a potential important source of hepatitis C infection.  Medicine. 2001;  80 134-151 (III)
    CrossrefPubMedGoogle Scholar
  • 29 Enders G, Braun R. Prä- und perinatale Übertragung des Hepatitis C Virus.  Internist. 2000;  7 676-678 (III)
    PubMedGoogle Scholar
  • 30 Johnson R J, Gretch D R, Couser W G. et al . Hepatitis C virus-associated glomerulonephritis. Effect of alpha-interferon therapy.  Kidney Int. 1994;  46 1700-1704 (IIb)
    PubMedGoogle Scholar
  • 31 Zuckerman E, Keren D, Rozenbaum M. et al . Hepatitis C virus-related arthritis: characteristics and response to therapy with interferon alpha.  Clin Exp Rheumatol. 2000;  18 579-584 (IIb)
    PubMedGoogle Scholar
  • 32 Misiani R, Bellavita P, Fenili D. et al . Interferon alpha-2 a therapy in cryoglobulinemia associated with hepatitis c virus.  N Engl J Med. 1994;  330 751-756 (Ib)
    CrossrefPubMedGoogle Scholar
  • 33 Zuckermann E, Keren D, Slobodin G. et al . Treatment of refractory, sympotmatic, hepatitis c virus-related mixed cryoglobulinemia with ribavirin and interferon alpha.  J Rheumatol. 2000;  27 2172-2178 (IIb)
    PubMedGoogle Scholar
  • 34 Foster G R, Goldin R D, Thomas H C. Chronic hepatitis C virus infection causes a significant reduction in quality of life in the absence of cirrhosis.  Hepatology. 1998;  27 209-212 (III)
    CrossrefPubMedGoogle Scholar
  • 35 Okuda K. Hepatocellular carcinoma.  J Hepatol. 2000;  32 225-237 (Übersicht)
    PubMedGoogle Scholar
  • 36 Niederau C, Lange S, Heintges T. et al . Prognosis of chronic hepatitis C: results of a large, prospective cohort study.  Hepatology. 1998;  28 1687-1695 (III)
    CrossrefPubMedGoogle Scholar
  • 37 Poynard T, Marcellin P, Lee S S. et al . Randomized trial of interferon alpha 2 b plus ribavirin for 48 weeks or for 24 weeks versus interferon alpha 2 b plus placebo for 48 weeks for treatment of chronic infection with hepatitis C virus.  Lancet. 1998;  352 1426-1432 (Ib)
    CrossrefPubMedGoogle Scholar
  • 38 Poynard T, McHutchinson J, Gopodmann Z. et al . Is an „A la carte” combination interferon alpha 2 b regime possible for the first line treatment in patients with chronic hepatitis C.  Hepatology. 2000;  31 211-217 (III)
    CrossrefPubMedGoogle Scholar
  • 39 Manns M P, McHutchinson J G, Gordon S. et al . Peginterferon alfa 2 b plus ribavirin compared to interferon alfa 2 b plus ribavirin for treatment of chronic hepatitis C: a randomized trial.  Lancet. 2001;  358 958-965 (Ib)
    CrossrefPubMedGoogle Scholar
  • 40 Meisel H, Reip A, Faltus B. et al . Transmission of hepatitis C virus to children and husbands by women infected with contaminated anti-D immunglobulin.  Lancet. 1995;  345 1209-1211 (III)
    CrossrefPubMedGoogle Scholar
  • 41 Vogt M, Lang T, Frosner G. et al . Prevalence and clinical outcome of hepatitis C infection in children whounderwent cardiac surgery before the implementation of blood-donor screening.  N Engl J Med. 1999;  341 866-870 (III)
    CrossrefPubMedGoogle Scholar
  • 42 Jonas M M, Ott M J, Nelson S P. et al . Interferon-α treatment of chronic hepatitis C virus infection in children.  Pediatr Infect Dis J. 1998;  17 241-246 (IIb)
    CrossrefPubMedGoogle Scholar
  • 43 Boyer N, Marcellin P, Degott C. et al . Recombinant interferon-alpha for chronic hepatitis C in patients positive for antibody to human immunodeficiency virus. Comite des Anti-Viraux.  J Infect Dis. 1992;  165 723-726 (III)
    PubMedGoogle Scholar
  • 44 Causse X, Payen J L, Izopet J. et al . Does HIV-Infection influence the response of chronic hepatitis C to interferon treatment? A French multicenter prospective study. French Multicenter Study Group.  J Hepatol. 2000;  32 1003-1010 (III)
    CrossrefPubMedGoogle Scholar
  • 45 Zylberberg H, Benhamou Y, Lagneaux J L. et al . Safety and efficiacy of interferon-ribavirin combination therapy in HCV-HIV coinfected subjects: an early report.  GUT. 2000;  47 694-697 (III)
    CrossrefPubMedGoogle Scholar
  • 46 Jannssen H L, Brouwer J T, van der Mast R C. et al . Suicide associated with alfa-interferon therapy for chronic viral hepatitis.  J Hepatol. 1994;  21 241-243 (IV)
    CrossrefPubMedGoogle Scholar
  • 47 Heathcote E J, Shiffman M L, Cooksley W G. et al . Peginterferon alfa-2 a in patients with chronic hepatitis C and cirrhosis.  N Engl J Med. 2000;  343 1673-1680 (Ib)
    CrossrefPubMedGoogle Scholar
  • 48 Persico M, Persico E, Suozzo R. et al . Natural history of hepatitis C virus carriers with persistently normal aminotransferase levels.  Gastroenterology. 2000;  118 760-764 (III)
    PubMedGoogle Scholar
  • 49 Puoti C, Magrini A, Stati T. et al . Clinical, histological, and virological features of hepatitis C virus carriers with persistently normal or abnormal alanine transaminase levels.  Hepatology. 1997;  26 1393-1398 (III)
    PubMedGoogle Scholar
  • 50 Jaeckel E, Manns M P. The course and therapy of acute hepatitis C viral infection. Is a prevention of its becoming chronic possible?.  Z Gastroenterol. 2000;  38 387-395 (Übersicht)
    Article in Thieme ConnectPubMedGoogle Scholar
  • 51 Jaeckel E, Cornberg M, Wedemeyer H. et al . German Acute Hepatitis C Therapy Group: Treatment of acute hepatitis C with interferon alfa-2 b.  N Engl J Med. 2001;  345 1452-1457 (IIb)
    CrossrefPubMedGoogle Scholar

Prof. Dr. med. W. E. Fleig

Universitätsklinik und Poliklinik für Innere Medizin I, Martin-Luther-Universität Halle-Wittenberg

Ernst-Grube-Straße 40

06120 Halle

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