Antiviral therapy effects upon hepatitis C cholestatic syndrome

Vol. 48 No. 1, 2007

ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY

C. C. Vere, Eliza Gofița, C. Forțofoiu, Letiția Adela Maria Streba, Amelia Genunche

Cholestasis includes, as a syndrome, all clinical and biological manifestations caused by the deficient or simply absent biliar secretion or caused by the obstruction of the biliary ducts. The hepatic cholestasis from the chronic hepatitis C (HC VHC) is a result of the altered interlobular biliary canalicules, caused by the modified cellular transport mechanisms and it is associated with a medium to severe degree of fibrosis. The aim of this study was to evaluate the efficiency of antiviral therapy in HC VHC patients. The study included a number of 37 HC VHC patients admitted at the Medical Department no. 1 of the Emergency County Hospital of Craiova; they were treated with Pegasys, 180 micro-g/week and Copegus, 1000 or 1200 mg/day, taking in consideration their weight, for 48 weeks and they were monitored for 24 weeks after the treatment. The following parameters were analyzed: direct bilirubine, total cholesterol, alkaline phosphatase, gamma-glutamiltranspeptidase and leucin-aminopeptidase. Under treatment, the clinical status caused by the cholestasis (pruritus, icteric syndrome, hemoragipary syndrome) was improved in six of the given cases (16.22%). Before therapy, the hepatic cholestasis was present in 20 patients (54.05%), and after treatment in 14 patients (37.83%). During therapy, the average values for all the monitored parameters decreased: direct bilirubine (0.38 +/- 0.18 mg/dL vs. 0.34 +/- 0.24 mg/dL, p = 0.0867), total cholesterol (198.53 md/dL vs. 183.16 mg/dL, p = 0.0808), alkaline phosphatase (236.99 +/- 79.09 IU/L vs. 227.82 +/- 87.59 IU/L, p = 0.0845), gamma-glutamiltranspeptidase (47 +/- 32.89 IU/L vs. 43.91 +/- 29.66 IU/L, p = 0.1509), and leucin-aminopeptidase (32.33 +/- 13.22 IU/L vs. 28.95 +/- 14.22 IU/L, p = 0.0038). Under antiviral treatment there was noticed an improvement of the cholestasis clinical status in a small number of cases. Antiviral therapy favorably influenced the liver cholestasis associated in patients with chronic hepatitis C in a rather small proportion. Under Interferon pegylate and Ribavirine treatment, low levels of direct bilirubine, cholesterol and enzymes were found. Hepatic cholestasis and, especially, the high serum values of gamma-glutamiltranspeptidase have a negative influence upon antiviral therapy, causing the low sustained virological response.

Corresponding author: Cristin Constantin Vere, MD, PhD, e-mail: vere_cristin@yahoo.com

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