Acute Viral Hepatitis

1
Chawla Therapy of HEV hepatitis

• Acute Viral Hepatitis
• Subacute Hepatic Failure
• Fulminant Hepatic Failure

2
Chawla Therapy of HEV hepatitis

• Acute Viral Hepatitis (HEV)
• Supportive rather than curative
• Nutrition
• High protein diet 20 ? duration
• No obvious long term benefit
• High calories
• Palatable
• No studies after 1964

3
Chawla Therapy of HEV hepatitis

• Ursodeoxycholic acid
• Cytoprotective, Anti-apoptotic, immunomodulatory,
  choleretic
• 79 Acute viral hepatitis (HBV 43, HCV 11, HAV
  15, HEV 3, NANE 7)
• UDCA x 3 weeks vs no treatment No significant
  transaminase decrease improved cholestatic
  indices. Fabris P. et al 1999
• 78 Acute viral hepatitis (HBV 59) followup 12
  mo, randomization more rapid decline in
  transaminases HBV persistence 1/33 vs 6/25
  Galshy et al J Clin Gastro 199928249-53
• Cochrane database 27 randomised trials none of
  high method-ological quality improvement in
  serum transaminases. Chen et al 2003

4
Chawla Therapy of HEV hepatitis

• Glycyrrhizin
• Anti inflammatory, immunomodulatory
• Inhibits growth of DNA RNA viruses
• 22/62 (36) HEV moderate to severe
• Glycyrrhizin 60 ml IV daily
• S bilirubin ? 69 by 2 weeks
• AST ? 94
• ALT ? 97
• Normalisation in 19 patients (86.4)

5
Chawla Therapy of HEV hepatitis

• Corticosteroids
• ? Effect on HEV replication
• Effect in HAV
• Predisposes to relapse
• Gregory et al S. Bilirubin gt 25 mg albumin lt
  2.5mg
• Steroids Harmful
• Cholestasis 30 mg (1-2 weeks) ? symptoms
• Dushieko et al, Aliment Pharmacol Ther
  198931-20

6
Chawla Therapy of HEV hepatitis

• Drugs ineffective in viral hepatitis
• Silymarin Biodrugs 200115467-89
• Kamalhar Das DG, IJG 199312126-8
• Cyanidanol-3 Blum et al, Lancet 197731153-5
• N Acetyl cysteine Huseyin et al, WJG
  200392698-2700
• Ribavarin Patki et al, Chemotherapy
  198228298-303