One Year of Lamivudine - Conclusions

Virology

•Suppresses serum HBV DNA

•Leads to HBeAg seroconversion Liver disease

•Improves hepatic necro-inflammation

•Reduces progression of fibrosis

•Reduces progression to cirrhosis

•Normalises serum ALT

•Improves liver histology irrespective of baseline ALT

Resistance to Anti-Viral Drugs

Genotypic resistance – changes in the virus that disrupt interactions between the drug and its molecular target

Clinical resistance – loss of efficacy due to above changes

Concurrent immunologic diseases in type 1 autoimmune hepatitis.

Probabilities of clinical, biochemical, and histologic remission during corticosteroid therapy.

Clinical features of type 2 autoimmune hepatitis.

•The diagnosis requires the presence of antibodies to liver–kidney microsome type 1 (Anti-LKM1)But antibodies to hepatitis C virus and hepatitis C virus RNA may be present

•The disease has been described mainly in pediatric patients in Western Europe, but adults may also be afflicted]. In the United States, seropositivity for Anti-LKM1 has been found in only 4% of adults and hepatitis C virus infection has not been a feature of the disease.

•Patients with type 2 autoimmune hepatitis typically have concurrent immunologic diseases, including autoimmune thyroiditis, insulin- dependent diabetes, vitiligo, and ulcerative colitis

•They have a high frequency of organ-specific autoantibodies, such as parietal cell antibodies, antibodies to the islets of Langerhans, and thyroid antibodies .

•An acute, even fulminant, presentation may occur, and patients uncommonly have a pronounced hypergammaglobulinemia

Liver transplantation for autoimmune hepatitis.

•Decompensated patients should be considered for liver transplantation.

•The 5-year survival rate after transplantation is 92%.

•Recurrence of disease is rare but possible in inadequately immunosuppressed recipients and in HLA-DR3–positive recipients of HLA- DR3–negative grafts

Survival expectations and probability of developing cirrhosis during and after corticosteroid treatment.

•Patients without cirrhosis at presentation have better 5- and 10-year survival rates than patients with cirrhosis at presentation

•Cirrhosis develops in 47% of patients within 10 years after presentation despite corticosteroid treatment

•The highest probability of cirrhosis is during initial therapy when the disease is most active. The mean annual incidence of cirrhosis after initial remission is 2.6%

•Survival after the development of cirrhosis during or after treatment is similar to that of patients without cirrhosis

ALCOHOLIC LIVER DISEASE

Principal alcohol-induced hepatic lesions

•alcoholic fatty liver (steatosis)

•alcoholic hepatitis (steatohepatitis)

•alcoholic cirrhosis

•hepatocellular carcinoma

•These morphologic categories are rarely found in a pure form

•Features of each may be present to varying degrees in an individual patient.