Erschienen in:
29.03.2019 | Original Article
Importance of Hepatitis C Virus RNA Testing in Patients with Suspected Drug-Induced Liver Injury
verfasst von:
Jawad Ahmad, K. Rajender Reddy, Hans L. Tillmann, Paul H. Hayashi, Naga Chalasani, Robert J. Fontana, Victor J. Navarro, Andrew Stolz, Huiman Barnhart, Gavin A. Cloherty, Jay H. Hoofnagle
Erschienen in:
Digestive Diseases and Sciences
|
Ausgabe 9/2019
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Abstract
Background and Aims
The aims were to review the diagnosis, testing and presentation of acute hepatitis C (HCV) in patients initially diagnosed to have drug-induced liver injury (DILI) enrolled in the US DILI Network.
Methods
All patients with suspected DILI underwent testing for competing causes of liver injury and returned for 6-month follow-up. Causality was adjudicated by consensus expert opinion.
Results
Between 2004 and 2016, 1518 patients were enrolled and adjudicated and underwent 6 months of follow-up. Initial locally acquired anti-HCV results were available in 1457 (96%), but HCV RNA in only 795 (52%). Stored sera were available for repeat testing, so that results were available on all 1518 patients (1457 for anti-HCV and 1482 for HCV RNA). A total of 104 subjects (6.9%) had evidence of HCV infection—10 positive for HCV RNA alone, 16 for anti-HCV alone and 78 for both. All 104 HCV-positive cases were reviewed, and 23 cases were adjudicated as acute HCV. All presented with acute hepatocellular injury with median ALT 1448 U/L, alkaline phosphatase 232 U/L and total bilirubin 10.8 mg/dL. Twenty-two (96%) patients were jaundiced. While all 23 cases initially had been suspected of having DILI, 19 were adjudicated as acute HCV and not DILI at the 6-month follow-up; while 4 were still considered DILI.
Conclusions
Twenty-three of 1518 (1.5%) cases of suspected DILI were due to acute HCV infection. We recommend that initial and follow-up HCV RNA testing should be performed to exclude HCV in patients with acute hepatocellular injury and suspected DILI.