Glucocorticosteroids for viral hepatitis C

Virus-drug interactions--molecular insight into immunosuppression and HCV

Liver transplantation is an effective treatment for end-stage liver disease that is attributable to chronic HCV infection. However, long-term outcomes are compromised by universal virological recurrence in the graft. Reinfection that occurs after transplantation has increased resistance to current interferon-based antiviral therapy and often leads to accelerated development of cirrhosis. Important risk factors for severe HCV recurrence are linked to immunosuppression. Owing to the lack of good randomized, controlled trials, the optimal choice of immunosuppressants is still debated. By contrast, much progress has been made in the understanding of HCV biology and the antiviral action of interferons. These new insights have greatly expanded our knowledge of the molecular interplay between HCV and immunosuppressive drugs. In this article, we explore the effect of different immunosuppressants on the complex cellular events involved in HCV infection and interferon signalling. Potential implications for clinical practice and future drug development are discussed.

Hepatitis C-related arthropathy: Diagnostic and treatment considerations

Hepatitis C-related arthropathy is one of the most common extrahepatic manifestations of hepatitis C virus (HCV) infection. Although symptoms can be disabling, the prognosis typically is benign. Patients who have atypical chronic inflammatory arthritis with an unknown cause should be evaluated for HCV infection. Testing for antibodies against cyclic citrullinated peptide is useful for distinguishing HCV-related arthropathy from rheumatoid arthritis. Early recognition of HCV infection greatly influences the selection of drug therapy. Although no clinical guidelines are available, many liver disease specialists favor using a stepwise approach to treatment. Future research efforts that focus on the pathogenesis of HCV-related arthropathy and novel therapeutic approaches are needed. (J Musculoskel Med. 2010;27:351-354).

Hepatitis C and arthritis: an update

Extrahepatic symptoms during chronic hepatitis C virus (HCV) infection are common and varied. Arthritis can be seen either as part of autoimmune processes (eg, associated with cryoglobulinemia) or independently. Whether the manifestation is specifically attributable to HCV infection or rather to the nonspecific result of a chronic inflammatory process is not clear. The literature available at this time is insufficient to guide the most appropriate course of treatment of HCV arthritis. Standard antirheumatic treatment can be considered, but with caution, because some of these medications occasionally may be hepatotoxic and response to therapy seems variable. Treatment decisions should be determined on a case-by-case basis.

Clinical review: a systematic review of corticosteroid use in infections

Traditional teaching suggests that corticosteroids should be avoided during acute infectious episodes for fear of compromising the immune response. However, the outcome benefit shown through steroid administration in early septic shock implies this paranoia may be misplaced. We therefore performed a systematic review of the literature to identify the current strength of evidence for the use of corticosteroids in specified infections, and to make appropriate graded recommendations.