Perihepatic limph nodes and anti-viral response in chronic HCV-associated hepatitis

To identify predictive factors of response to interferon alpha (IFN-alpha) plus ribavirin therapy in patients with chronic hepatitis C (CHC), the presence of lymphadenopathy (LyA) of the hepatoduodenal ligament and other variables were investigated. A total of 110 patients with histologically proven CHC were enrolled in this study. Ultrasound (US) was performed at the start and end of therapy and 6 months after stopping therapy. At baseline, LyA was present in 35 (43.7%) of 80 patients with alanine aminotransferase (ALT) values and grading was significantly higher than in the LyA-negative group. LyA was more frequent in nonresponders (nonR) than in relapsers (relR) or sustained responders (susR). Lymph node volume (LyV) was significantly lower in susR than in nonR or relR (p < 0.05). Under antiviral treatment, the reduction in LyV was significantly higher in nonR (p < 0.01); in susR and relR, it was not significantly reduced. LyA totally disappeared in two patients of the susR group. Logistic regression analysis confirmed only a positive association of susR with grading and a negative association with staging (p < 0.02 and p < 0.006). In conclusion, this study suggests that US evidence of LyA is useful in evaluating the severity of a given chronic hepatitis C, but it cannot be proposed as a predictive index of response to antiviral treatment

Evaluation by ultrasound of abdominal lymphadenopathy in chronic hepatitis C

Objective: Abdominal ultrasound has shown a frequent association between abdominal lymphadenopathy (LA) and chronic liver disease, but contradictory data have been reported on its relationship with the main parameters of hepatic function. The aim of this study was to correlate the prevalence of LA in patients who were chronic hepatitis-anti-hepatitis C virus positive prospectively followed-up over the last 3 years and its relationship with biochemical and histological data. Methods: 136 RIBA II confirmed positive patients with ALT levels >2N were included. None of these had been or was at the time of study on interferon treatment. Ultrasound was performed using a Toshiba SSA 240 A apparatus with a 3.75 MHz convex probe; the operator was unaware of the other results. Diagnosis of chronic hepatitis in all cases was made on biopsy specimens; the histological activity index (HAI) score, according to Knodell, and the grading (G) and staging (S) scores, according to Desmet, were also evaluated. Results: LA was found in 54 out of 136 patients (40%); accordingly, patients were divided into two groups: the LN + ve group included 54 patients (M 33, mean age 48.1 ± 11.7 yr) and the LN-ve group included 82 patients (M 69, mean age 45.3 ± 11.9 yr). LN + ve patients showed significantly higher serum levels of AST (p < 0.0005), ALT (p < 0.001), γGLO (p < 0.05) and γGT (p < 0.02) than LN - ve patients. There was a more severe degree of liver disease in LN + ve patients, expressed by the higher HA1 (p < 0.002), G (p < 0.002), and S (p < 0.005). The Ï2test for linear association analysis confirmed the trend toward greater histological severity in LN + ve patients (Ï2MH = 10.2; p < 0.002). Logistic regression confirmed the association between the presence of LA and AST (p < 0.02), ALT (p < 0.03), G (p < 0.02), and S (p < 0.02). Conclusion: This study showed a moderate prevalence of LA in chronic hepatitis C, lower than that reported in other studies. LA was associated with serum parameters of cytolysis, and above all, with the severity of histological damage

Ultrasound detection of abdominal lymphadenomegaly in subjects with hepatitis C virus infection and persistently normal transaminases: a predictive index of liver histology severity

The indications for liver biopsy in anti-HCV-positive patients with persistently normal alanine aminotransferase levels are not clearly established. Recent studies have correlated the presence of abdominal lymphoadenomegaly with disease severity in patients with chronic hepatitis C. Our study aimed to evaluate the frequency of abdominal lymphoadenomegaly in an anti-HCV positive blood donor population with persistently normal alanine aminotransferase and the relationship of abdominal lymphoadenomegaly with the severity of liver changes

Ultrasound detection of abdominal lymph nodes in chronic liver diseases. A retrospective analysis

Aim: To retrospectively evaluate the prevalence of lymph nodes of the hepato-duodenal ligament in a group of patients with chronic liver disease of various aetiologies and to investigate what clinical, aetiological and laboratory data may lead to their appearance. Materials and methods: One thousand and three patients (554 men, 449 women) were studied, including 557 with chronic hepatitis and 446 with liver cirrhosis. The presence of lymph nodes near the trunk of the portal vein, hepatic artery, celiac axis, superior mesenteric vein and pancreas head was investigated using ultrasound. Results: Lymph nodes were detected in 394 out of the 1003 study patients (39.3%); their number ranged from one to four, with a diameter ranging between 0.8 and 4 cm. The highest prevalence was in the subgroup of patients with primary biliary cirrhosis (87.5%), followed by patients with hepatitis C virus (HCV; 42%), patients with HCV and hepatitis B virus (HBV; 41.3%), autoimmune hepatitis (40%), and HBV alone (21.2%). In the alcoholic and idiopathic subgroups prevalence was 9.5%, while in the non-alcoholic steatohepatitis and haemochromatosis subgroups it was 0%. HCV RNA was present in 97 out of 103 lymph node-positive patients and in 141 out of 168 lymph node-negative HCV-negative patients (p < 0.003). Lymphadenopathy frequency increased as the liver disease worsened (X2 MH = 74.3; p < 0.0001). Conclusion: Despite the limitations of a retrospective study, our data indicate a high prevalence of lymphadenopathy in liver disease patients; ultrasound evidence of lymph nodes of the hepato-duodenal ligament in a given liver disease may most likely suggest a HCV or an autoimmune aetiology and a more severe histological picture. © 2003 The Royal College of Radiologists. Published by Elsevier Science Ltd. All rights reserved

Re-treatment of patients with chronic hepatitis C in clinical practice: Results of a multicenter retrospective survey [Ritrattamento dei pazienti con epatite cronica da HCV nella pratica clinica: Risultati di uno studio multicentrico retrospettivo]

Aims. To evaluate in a multicentric retrospective study, carried out at 35 Italian hospitals, the retreatment with interferon (IFN) or interferon-ribavirin (RBV) association in patients with chronic hepatitis C that were non-responder (NR) or responder-relapser (RR) at a previous IFN treatment. Methods. Complete descriptive data of 531 patients were collected from all participant centers by a centralized database (HEPANET). The evaluation of retreatments was done on 256 patients that had completed it on 31 December, 1999. Individuals with no viral genotype data, and those lost for adverse reactions and drop-outs, were excluded from the analysis. Univariate and multivariate statistical analyses were done to evaluate biochemical and virological response, to determine the presence of independent factors of response, and to compare different retreatment strategies. Results. A sustained biochemical response (SBR) was achieved in 30.1% of cases, and a sustained virological response (SVR) in 22.8%. Previous treatment outcome (RR instead of NR), RBV association, and duration of retreatment were independent factors of response. A better efficacy of a 12 months retreatment with IFN alone was confirmed. With the latter, high SVR rates, comparable to IFN+RBV 6 months course, were obtained, both in RR and NR patients. Conclusions. Retrospective multicentric study, as our is, could be a more reliable representation of results obtained in common clinical practice. They may give useful information, together with meta-analyses and randomized studies, for a better cost/benefit evaluation of retreatments in patients with hepatitis C (RR and NR)