Dupla hepatite aguda por vírus da hepatite C

A. Cruz, S. C. Lima, J. Cotter

 

Resumo

 Apresenta-se o caso clínico de um doente toxicómano, com diagnóstico de hepatite aguda por vírus da hepatite C (genótipo 3a). Após iniciar tratamento com interferão alfa 2b e se assistir a uma boa resposta terapêutica, às 12 semanas de tratamento verificou-se um súbito agravamento, cuja investigação mostrou tratar-se de nova hepatite aguda por vírus C (genótipo 1a). O doente tinha mantido consumo de drogas intravenosas. A continuação da terapêutica anteriormente iniciada levou à recuperação clínica e analítica. Aos 6 meses de tratamento, teve aquela de ser interrompida devido a depressão grave. Apesar disto, na avaliação trinta e seis meses após suspensão da terapêutica, o doente mantinha-se assintomático, com aminotransferases normais e determinação negativa do RNA do vírus da hepatite C.

Os autores destacam a raridade do caso, nomeadamente a dupla infecção aguda sequencial por diferentes genótipos do vírus da hepatite C e o facto da segunda infecção ocorrer em pleno período de tratamento com interferão, salientando-se mais uma vez a reconhecida importância da abstinência de consumo de drogas.

Summary

The authors report a case of an intravenous drug user diagnosed with acute hepatitis C virus (genotype 3a). After initial improvement when treatment was begun, sudden decompensation occurred, compatible with the onset of a new acute hepatitis C virus (genotype 1a). The patient had continued using intravenous drugs. Clinical recovery and normalisation of laboratory values were achieved with continuation of the initial therapy. Six months later, treatment had to be discontinued because of the patient’s severe depression. Nevertheless, thirty-six months after treatment was stopped, serum HCV RNA levels were undetectable, ALT levels were normal and the patient was symptom free.

This case shows a rare clinical course, namely double acute sequential infection by different genotypes of hepatitis C virus with the second infection occurring during treatment with interferon. This once again highlights the importance of drug abstinence.

 

 

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Bibliografia

 

1. World Health Organization. Weekly Epidemiological Record 1997; 72: 341-48.        [ Links ]

2. EASL International Consensus Conference on Hepatitis C. Consensus Statement. J Hepatol 1999; 30: 956-61.

3. Jaeckel E, et al. Treatment of acute hepatitis C with interferon alfa-2b.N Engl J Med. 2001 Nov 15; 340 (20): 1452-7.

4. Augusto F. e Lobo C. Hepatites Víricas. Núcleo de Gastrenterologia dos Hospitais Distritais. 2003 Jun; 108-12.

5. Gerlach JT. et al. Acute hepatitis C: high rate of both spontaneous and treatment induced viral clearance. Gastroenterology. 2003 Jul; 125: 80-8.

6. Vega Palomares R. et al. Acute hepatitis C: response to treatment with interferon alfa plus ribavirin. Gastroenterol Hepatol. 2002 Oct; 25: 483-86.

7. Santantonio T. et al. Natural course of acute hepatitis C: a long term prospective study. Dig Liver Dis. 2003 Feb; 35: 104-13.

8. Rocca P. et al. Early treatment of acute hepatitis C with interferon alpha-2b and interferon alpha-2b plus ribavirin: study of sixteen patients. Gastroenterol Clin Biol. 2003 Mai; 27 (3 Pt 1):249-9.

9. Santantonio T. et al. Efficacy of a 24-week course of Peg-interferon alpha-2b monotherapy in patients with acute hepatitis C after failure of spontaneous clearance. J Hepatol 2005; 42: 329-333.

10. Poynard T. et al. Interferon for acute hepatitis C (Cochrane Review). In: The Cochrane Library, Issue 1, Oxford, UK, 2002.

11. Alberti A. et al. Therapy of acute hepatitis C. Hepatology. 2002 Nov; 36 (5 Suppl 1): S 195-200.

12. Medical position statement on the management of hepatitis C. Gastroenterology 2006; 130: 225-230.

13. Callery G. et al. Short course of Peg Intron ( pegylated interferon alfa-2b) in acute HCV hepatitis. J Hepatol 2004; 40: 469.

14. Asselah T. et al. Second infection with a different hepatitis C genotype in a intravenous drug user during interferon therapy. Gut 2003; 52: 900-902.

15. Long-term follow-up after successful interferon therapy of acute hepatitis C. Hepatology 2004; 40: 98-107.

 

Correspondência:

Armanda Cruz

Serviço de Gastrenterologia

Hospital da Senhora da Oliveira

Rua dos Cutileiros, Creixomil

4800 Guimarães

 

Serviço de Gastrenterologia do Hospital da Senhora da Oliveira, Guimarães, Portugal.

 

Recebido para publicação: 24/02/2006

Aceite para publicação: 12/07/2006