Hepatitis aguda para pregrado 2011 dr fainboim

Notas del editor

• #68: ALT, alanine aminotransferase; anti-HBe, antibody to hepatitis B e; CH, chronic hepatitis; HBeAg, hepatitis B e antigen.   This section of the slide illustrates the histology. A patient can develop cirrhosis during any of these different phases but most commonly this occurs when the ALT is oscillating or elevated and HBV DNA is actively replicating.
• #69: ALT, alanine aminotransferase; anti-HBe, antibody to hepatitis B e; CH, chronic hepatitis; HBeAg, hepatitis B e antigen.   This section of the slide illustrates the histology. A patient can develop cirrhosis during any of these different phases but most commonly this occurs when the ALT is oscillating or elevated and HBV DNA is actively replicating.
• #76: All patients in the advanced fibrosis/cirrhosis subset of the Long term Histology Cohort demonstrated histologic improvement and improvement in fibrosis at the time of long-term biopsy • Mean change in Ishak fibrosis score was -2.2 • Mean change in Knodell necroinflammatory and HAI scores were -7.6 and -8.9, respectively • At the time of long-term biopsy (6 years): – All patients had HBV DNA <300 copies/mL – 9/10 of patients had ALT <1 x ULN • For the four patients with cirrhosis at baseline (Ishak score ≥5), median change in Ishak fibrosis score was a 3-point decrease (range: -1 to -4)
• #79: This figure is a simple demonstration of what one might see utilizing these different definitions. In a primary nonresponse, as shown in the yellow line, you can see that there is less than a 1 log reduction at the end of 6-12 months. Shown in the green line is a suboptimal response and where there is a reduction in the HBV DNA, but it does not go to low levels or to undetectability. The blue line is an example of an individual who has virologic breakthrough. First of all, there is a substantial reduction in serum HBV DNA to very low or undetectable levels, but then over time—for example at Month 12—there is breakthrough, defined as a 1 log increase, that becomes apparent very quickly and this represents failure of therapy after it has initially been begun—what we call “virologic breakthrough.” We want to recognize this early so we can intervene with therapy, as we will see later. We do not want to wait until there is biochemical breakthrough because there then could be clinical deterioration associated with this virologic breakthrough.