T. Jake Liang, MD; Barbara Rehermann, MD; Leonard B. Seeff, MD; Jay H. Hoofnagle, MD
Authors who wish to cite a section of the conference and specifically indicate its author may use this example for the form of the reference: Rehermann B. Immunopathogenesis of hepatitis C. In: Liang TJ, moderator. Pathogenesis, natural history, treatment, and prevention of hepatitis C. Ann Intern Med. 2000; 132:297-299.
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Current Author Addresses: Drs. Liang and Rehermann: Liver Diseases Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 10 Center Drive, Room 9B16, Bethesda, MD 20892-1800.
Drs. Seeff and Hoofnagle: Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 31, Room 9A23, Bethesda, MD 20892.
Approximately 4 million persons in the United States and probably more than 100 million persons worldwide are infected with hepatitis C virus. The virus has the unique ability to cause persistent infection in susceptible hosts after parenteral or percutaneous transmission, and its underlying mechanisms are not well understood. The immunologic correlates of protection and viral clearance and the pathogenesis of liver injury are yet to be defined, but recent studies suggest the importance of cell-mediated immune responses. Although 70% to 80% of infected persons become chronic carriers, most have relatively mild disease with slow progression. However, chronic and progressive hepatitis C carries significant morbidity and mortality and is a major cause of cirrhosis, end-stage liver disease, and liver cancer. Development of an effective hepatitis C virus vaccine is not imminent, but recent advances in technology and basic knowledge of molecular virology and immunology have engendered novel approaches to the fundamental problems encountered in vaccine development. Current therapy for hepatitis C, although effective in some patients, is problematic and still evolving. Advances in modern biology and immunology promise new therapies for this important disease.
Schematic diagram of the hepatitis C virus genome.5′UTR3′XR
Table 1. Functions of Genetic Elements of Hepatitis C Virus
Components of the antiviral immune response.HCV
Survival curves comparing patients with non-A, non-B transfusion-associated, predominantly type C hepatitis (solid line); matched transfusion recipients without hepatitis (controls) (dashed line); and the general U.S. population (dotted line).
Rates of virologic response in patients with chronic hepatitis C treated with interferon-α for 24 weeks (IFN 24 wk) or 48 weeks (IFN 48 wk) or interferon-α plus ribavirin for 24 weeks (IFN and RBV 24 wk) or 48 weeks (IFN and RBV 48 wk).
Rates of sustained virologic response in patients with chronic hepatitis C treated with interferon-α for 24 weeks (IFN 24 wk) or 48 weeks (IFN 48 wk) or interferon-α plus ribavirin for 24 weeks (IFN and RBV 24 wk) or 48 weeks (IFN and RBV 48 wk), by viral genotype.
Table 2. Major Side Effects of Combination Therapy with Interferon-α and Ribavirin
Table 3. Current Recommendations for Treatment of Hepatitis C
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Liang TJ, Rehermann B, Seeff LB, Hoofnagle JH. Pathogenesis, Natural History, Treatment, and Prevention of Hepatitis C. Ann Intern Med. 2000;132:296–305. doi: 10.7326/0003-4819-132-4-200002150-00008
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Published: Ann Intern Med. 2000;132(4):296-305.
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