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Z Gastroenterol 2009; 47(6): 531-540
DOI: 10.1055/s-0028-1109149
Originalarbeit

© Georg Thieme Verlag KG Stuttgart · New York

The German Hep-Net Acute Hepatitis C Cohort: Impact of Viral and Host Factors on the Initial Presentation of Acute Hepatitis C Virus Infection

Die Hep-Net-akute-Hepatitis-C-Kohorte: Bedeutung von viralen und Wirtsfaktoren für den klinischen Verlauf einer akuten Hepatitis-C-VirusinfektionK. Deterding1 , J. Wiegand1 , 2 , N. Grüner3 , A. Hahn4 , E. Jäckel1 , M. C. Jung4 , P. Buggisch5 , P. Galle6 , T. Berg7 , H. Hinrichsen8 , A. Potthoff1 , S. Zeuzem9 , M. Cornberg1 , M. Manns1 , H. Wedemeyer1
  • 1Gastroenterology, Hepatology and Endocrinology, Hannover Medical School
  • 2Medical Clinic and Policlinic II, University of Leipzig
  • 3Medical Department II and Institute for Immunology, Ludwig-Maximillians-University, Munich
  • 4Institute of Biometrics, Hannover Medical School
  • 5Department of Internal Medicine, University of Hamburg
  • 6I. Department of Internal Medicine, Johannes-Gutenberg University Mainz
  • 7Medical Department Hepatology and Gastroenterology, Charité Campus Virchow Klinikum, Berlin
  • 8Department of Internal Medicine, University Schleswig-Holstein, Campus Kiel
  • 9Dept. of Internal Medicine 1, Johann Wolfgang Goethe-University, Frankfurt
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Publication History

manuscript received: 28.10.2008

manuscript accepted: 16.12.2008

Publication Date:
16 June 2009 (online)

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Zusammenfassung

Der Einfluss von Viruslast, HCV-Genotyp, Alter, Geschlecht und Body-Mass-Index (BMI) auf den klinischen Verlauf einer akuten Hepatitis-C-Virusinfektion ist bis heute weitestgehend unbekannt. Wir untersuchten den Einfluss dieser Faktoren an einem Kollektiv von 259 Patienten mit akuter Hepatitis-C-Virusinfektion. Die Patienten wurden zwischen 1998 und 2008 in die Datenbank des Kompetenznetzes Hepatitis eingeschlossen. Bei 171 Patienten (66 %) wurde innerhalb von 4 Monaten nach der Diagnosestellung eine antivirale Therapie mit Interferon-alpha begonnen. Nach der Analyse der Daten zeigten sich folgende Ergebnisse: 1. der Infektionsweg war mit dem Alter assoziiert; Patienten mit i. v. Drogenkonsum waren signifikant jünger als Patienten ohne i. v. Drogenkonsum, während hingegen die Anzahl der Patienten, die im Rahmen medizinischer Engriffe infiziert wurden, mit zunehmendem Alter anstieg; 2. Patienten jünger als 30 Jahre waren häufiger mit dem HCV-Genotyp 3 infiziert (26 versus 8 % für Patienten älter als 50 Jahre; p = 0.03); 3. 51 % der Patienten hatten einen Ikterus zum Zeitpunkt der Diagnosestellung und 28 % hatten eine 30-fache Erhöhung der Transaminasen, jedoch zeigte keiner der Patienten Zeichen eines akuten Leberversagens; 4. der HCV-Genotyp war nicht assoziiert mit der Schwere der Erkrankung und auch ebenfalls nicht assoziiert mit der Länge des Zeitraums zwischen dem Infektionszeitpunkt und dem Beginn der Symptome; 5. eine niedrige Viruslast war assoziiert mit niedrigerer AST und einem verlängerten Zeitraum zwischen Infektionszeitpunkt und dem Einsetzten der Symptome; die Schwere der Erkrankung zeigte jedoch keine Korrelation mit dem Infektionsweg, dem Alter, dem Geschlecht und BMI. Insgesamt zeigte sich bei dem größten Teil der Patienten in unserer Kohorte ein relativ milder Verlauf der Erkrankung. Die Schwere der Erkrankung war nicht assoziiert mit dem HCV-Genotyp, der Viruslast, dem Alter, dem Geschlecht und dem BMI.

Abstract

Introduction: The impacts of viral load, genotype, age, sex and BMI on the clinical course of acute hepatitis C are poorly defined. Here we studied 259 patients with acute HCV infection recruited in the German Hep-Net data base between 1998 and 2008. Antiviral treatment with interferon alpha was initiated in 171 patients (66 %) within 4 months after the diagnosis of acute hepatitis C. Results: In this cohort (i) the mode of infection was associated with age as iv-drug users were significantly younger than non-iv-drug users while the proportion of patients who acquired HCV by medical procedures increased with age; (ii) patients younger than 30 years were more often infected with genotype 3 (26 % versus 8 % for patients older than 50 years; p = 0.03); (iii) 51 % of patients were icteric and 28 % presented with a 30-fold elevation of liver enzymes, however, no fulminant hepatic failure occurred; (iv) HCV genotype was not associated with disease severity and time to onset of symptoms; (v) low HCV viremia was associated with lower serum AST levels and a longer time from exposure to onset of symptoms; (vi) disease severity was independent from the mode of infection, age, sex and body mass index (BMI). Conclusions: In this large cohort of patients admitted for antiviral therapy, acute hepatitis C took a rather mild course of disease in the majority of patients. Disease severity was not associated with HCV genotype, viral load, age, sex and BMI.

Schlüsselwörter

Virushepatitis - Leber - Hepatitis C

Key words

viral hepatitis - liver - hepatitis C

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PD Dr. Heiner Wedemeyer

Gastroenterology, Hepatology and Endocrinology, Hannover Medical School

Carl-Neuberg-Str.1

30625 Hannover

Email: Wedemeyer.Heiner@mh-hannover.de

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