Vol. 35, pp , hepatitis C virus HCV RNA 8 14 HCV RNA. C Genotype 1. Genotype 1b. 1 2 Genotype 2 : 54 :

Transcription

1 0 Vol. 35, pp. 007, 2007 C : Genotypeb C C hepatitis C virus HCV RNA 8 4 HCV RNA C C Genotype 50 2 Genotype Genotype b C : 54 : C C 45

2 02 Table. Laboratory Findings C : 49 predonisolone, bucillamine 5 losartan potassium : : : 53.3 cm, 53.0 kg, 35.6C 4080 mmhg, 56 : HCV Genotype b 450 KIUml Table : 8 hepatitis C virus HCV AF Figure HCV RNA HCV RNA Figure 2 HCV-RNA 3 KIUml HCV 5A non-structural region 5A; NS5A Interferon sensitivity determining region ISDR 7 Figure 3 C

3 D EF^G SVR N? CH-C 03 Figure. Liver needle biopsy was carried out to evaluate histological activity and degree of fibrosis the tissue showed mild fibrosis of the periportal areas ῌarrow and mild infiltration of inflammatory cells mainly composed of mononuclear cells. Limiting plate was maintained ῌarrowheads. These findings correspond to chronic active hepatitis, A F. ῌa: Masson-trichrome stain, b: hematoxylin-eosin stain. Figure 2. Clinical course. Figure 3. Amino acid substitution in ISDR. Geno- HI?J K/LM N? O0 P5ῌ type b! 6 G Genotype b QRE HCV RNA "#$%&!ῌ'()'! 48 * -.? CS 4 ῌ 6 / ῌ :!ῌ'()'!+, TU I?J K/LM +, 0!"#$%&!ῌ'()'!+, ;<,0=>? 5@ABC 5+, D EFCG EF CG N? VW0 XYZ[ HCV RNA 47!"#$%& 3 KIU ml 0\]

4 04 Martinot-Peignoux HCV-RNA Genotype b HCV 5A non-structural region 5A; NS5 A Interferon sensitivity determining region ISDR 24 Enomoto Genotype b C 82 ISDR Pascu 4 ISDR 7 ISDR 4 9 F Zeuzem Genotype C C 6 Genotype b 93 KIUml ISDR 5 ISDR 7 NS5B Genotypeb C Berg T, von Wagner M, Nssser S, Sarrazin C, Heintges T, Gerlach T, Buggisch P, Goeser T, Rasenack J, Page GR, Schmidt WE, Kallinowski B, Klinker H, Spengler U, Martus P, Alshuth U and Zeuzem S. Extended treatment duration for hepatitis C virus type : comparing 48 versus 72 weeks of peginterferon-alfa-2a plus ribavirin. Gastroenterology 2006; 30: Sanchez-Tapias JM, Diago M, Escartin P, Enriquez J, Romero-Gomez M, Barcena R, Crespo J, Andrade R, Martinez-Bauer E, Perez R, Testillano M, Planas R, Sola R, Garcia- Bengoechea M, Garcia-Samaniego J, Munoz- Sanchez M and Moreno-Otero R; TeraVIC-4 Study Group. Peginterferon-alfa2a plus ribavi- 48

5 SVR CH-C 05 rin for 48 versus 72 weeks in patients with detectable hepatitis C virus RNA at week 4 of treatment. Gastroenterology 2006; 3: Dalgard O, Bjøro K, Hellum KB, Myrvang B, Ritland S, Skaug K, Raknerud N and Bell H. Treatment with pegylated interferon and ribavirin in HCV infection with genotype 2 or 3 for 4 weeks: A pilot study. Hepatology 2004; 40: Mangia A, Santoro R, Minerva N, Ricci GL, Carretta V, Persico M, Vinelli F, Scotto G, Bacca D, Annese M, Romano M, Zechini F, Sogari F, Spirito F and Andriulli A. Peginterferon alfa-2b and ribavirin for 2 vs. 24 weeks in HCV genotype 2 or 3. N Engl J Med 2005; 352: Von Wagner M, Huber M, Berg T, Hinrichsen H, Rasenack J, Heintges T, Bergk A, Bernsmeier C, Häussinger D, Herrmann E and Zeuzem S. Peginterferon-a-2a 40KD and ribavirin for 6 or 24 weeks in patients with genotype 2 or 3 chronic hepatitis C. Gastroenterology 2005; 29: C 2 IFN-a-2bribavirin 2005; 47: Shiratori Y, Kato N, Yokosuka O, Imazeki F, Hashimoto E, Hayashi N, Nakamura A, Asada M, Kuroda H, Tanaka N, Arakawa Y and Omata M. Predictors of the e$cacy of interferon therapy in chronic hepatitis C virus infection. Tokyo-Chiba Hepatitis Research Group. Gastroenterology 997; 3: Yoshioka K, Kobayashi M, Orito E, Watanabe K, Yano M, Sameshima Y, Kusakabe A, Hirofuji H, Fuji A, Kuriki J, Arao M, Murase K, Mizokami M and Kakumu S. Biochemical response to interferon therapy correlates with interferon sensitivity-determining region in hepatitis C virus genotype b infection. J viral hepat 200; 8: Moussalli J, Opollon P and Poynard T. Management of hepatitis C. J Viral Hepat. 998; 5: Genotype C PEG- a-2b 48 a-2b 6 retrospective 2004; 49: Martinot-Peignoux M, Boyer N, Pouteau M, Castelnau C, Giuly N, Duchatelle V, Auperin A, Degott C, Benhamou JP, Erlinger S and Marcellin P. Predictoes of sustained response to alpha interferon therapy in chronic hepatitis C. J Hepatol. 998; 29: Enomoto N, Sakuma I, Asahina Y, Kurosaki M, Murakami T, Yamamoto C, Izumi N, Marumo F and Sato C. Comparison of full-length sequences of interferon-sensitive and resistant hepatitis C virus b. Sensitivity to interferon is conferred by amino acid substitutions in the NS5A region. J Clin Invest. 995; 96: Enomoto N, Sakuma I, Asahina Y, Kurosaki M, Murakami T, Yamamoto C, Ogura Y, Izumi N, Marumo F and Sato C. Mutations in the nonstructural protein 5A gene and response to interferon in patients with chronic hepatitis C virus b infection. N Engl J Med 996; 334: Pascu M, Martus P, Hohne M, Wiedenmann B, Hopf U, Schreier E and Berg T. Sustained virological response in hepatitis C virus type b infected patients is predicted by the number of mutations within the NS 5 A-ISDR: a metaanalysis focused on geographical di#erences. Gut 2004; 53: Zeuzem S, Buti M, Ferenci P, Horsmans Y, Cianciara J, Ibranyi E, Weilamd O, Noviello S, Brass C and Albrecht J. E$cacy of 24 weeks treatment with peginterferon alfa-2b plus ribavirin in patients with chronic hepatitis C infected with genotype and low pretreatment viremia. J Hepatol. 2006; 44:

6 06 6 Okuse C, Adachi K, Katakura Y, Matsunaga K, Ishii T, Matsumoto N, Yotsuyanagi H, Iino S, Suzuki M and Itoh F. A case of deep venous thrombosis associated with pegylated interferon alpha 2 b plus ribavirin treatment of chronic hepatitis C. J Gastroenterol. 2006; 4: Akuta N, Suzuki F, Sezaki H, Suzuki Y, Hosaka T, Someya T, Kobayashi M, Saitoh S, Watahiki S, Sato J, Matsuda M, Kobayashi M, Arase Y, Ikeda K and Kumada H. Association of amino acid substitution pattern in Core protein of hepatitis C virus genotype b high viral load and non-virological response to interferon-ribavirin combination therapy. Intervirology 2005; 48: Hamano K, Sakamoto N, Enomoto N, Izumi N, Asahina Y, Kurosaki M, Ueda E, Tanabe Y, Maekawa S, Itakura J, Watanabe H, Kakinuma S and Watanabe M. Mutations in the NS5B region of the hepatitis C virus genome correlate with clinical outcomes of interferonalpha plus ribavirin combination therapy. J Gastroenterol Hepatol. 2005; 20: ; 47: A

7 SVR CH-C 07 Abstract A Case of Chronic Hepatitis C Obtained Sustained Virological Response Regardless of Premature Discontinuation of Peg-IFN a2b Plus Ribavirin Treatment Kotaro Matsunaga, Chiaki Okuse, Kayo Adachi, Masaru Okamoto, Minoru Kobayashi, Hiroki Ikeda, Hideaki Takahashi, Yoshiki Katakura, Toshiya Ishii, Nobuyuki Matsumoto, Junki Koike 2, Hiroshi Yotsuyanagi 3, Shiro Iino 4, Michihiro Suzuki, and Fumio Itoh A 54-year-old woman, who had been under treatment for rheumatoid arthritis and Sjögren s syndrome, was diagnosed as having chronic hepatitis C CH-C with genotype b and high load viremia. She was admitted to our hospital for pegylated interferon Peg-IFN a2b plus ribavirin treatment for chronic hepatitis C. Her serum hepatitis C virus HCV-RNA level became undetectable 3 weeks after the initiation of peg-ifn a2b plus ribavirin treatment. She su#ered from severe sore throat 8 weeks after the initiation of peg-ifn a2b plus ribavirin treatment. Despite symptomatic medications, sore throat continued. Peg-IFN a2b plus ribavirin treatment was discontinued because a causal relationship between sore throat and Peg-IFN a2b plus ribavirin treatment was suspected. Sore throat improved after discontinuation of Peg-IFN a2b plus ribavirin treatment. Although recurrence of hepatitis and viremia was predisposed because of premature discontinuation of the peg-ifn a2b plus ribavirin treatment, she has remained HCV-RNA negative, subsequently. Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan 2 Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan 3 Division of Infectious Diseases, Department of Internal Medicine, University of Tokyo, Tokyo, Japan 4 Research Center for Liver Disease, Kiyokawa Medical Center, Tokyo, Japan 5