Importance of Hepatitis C Virus RNA Testing in Patients with Suspected Drug-Induced Liver Injury

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

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
JournalDigestive Diseases and Sciences
DOIs
StatePublished - Jan 1 2019

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Chemical and Drug Induced Liver Injury
Hepacivirus
RNA
Wounds and Injuries
Expert Testimony
Hepatitis C
Jaundice
Bilirubin
Causality
Alkaline Phosphatase
Liver

Keywords

  • Acute hepatitis C
  • Drug-induced liver injury
  • Hepatitis C RNA

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

Cite this

Importance of Hepatitis C Virus RNA Testing in Patients with Suspected Drug-Induced Liver Injury. / Ahmad, Jawad; Reddy, K. Rajender; Tillmann, Hans L.; Hayashi, Paul H.; Chalasani, Naga; Fontana, Robert J.; Navarro, Victor J.; Stolz, Andrew; Barnhart, Huiman; Cloherty, Gavin A.; Hoofnagle, Jay H.

In: Digestive Diseases and Sciences, 01.01.2019.

Research output: Contribution to journalArticle

Ahmad, J, Reddy, KR, Tillmann, HL, Hayashi, PH, Chalasani, N, Fontana, RJ, Navarro, VJ, Stolz, A, Barnhart, H, Cloherty, GA & Hoofnagle, JH 2019, 'Importance of Hepatitis C Virus RNA Testing in Patients with Suspected Drug-Induced Liver Injury', Digestive Diseases and Sciences. https://doi.org/10.1007/s10620-019-05591-w
Ahmad, Jawad ; Reddy, K. Rajender ; Tillmann, Hans L. ; Hayashi, Paul H. ; Chalasani, Naga ; Fontana, Robert J. ; Navarro, Victor J. ; Stolz, Andrew ; Barnhart, Huiman ; Cloherty, Gavin A. ; Hoofnagle, Jay H. / Importance of Hepatitis C Virus RNA Testing in Patients with Suspected Drug-Induced Liver Injury. In: Digestive Diseases and Sciences. 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.",
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T1 - Importance of Hepatitis C Virus RNA Testing in Patients with Suspected Drug-Induced Liver Injury

AU - Ahmad, Jawad

AU - Reddy, K. Rajender

AU - Tillmann, Hans L.

AU - Hayashi, Paul H.

AU - Chalasani, Naga

AU - Fontana, Robert J.

AU - Navarro, Victor J.

AU - Stolz, Andrew

AU - Barnhart, Huiman

AU - Cloherty, Gavin A.

AU - Hoofnagle, Jay H.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Acute hepatitis C

KW - Drug-induced liver injury

KW - Hepatitis C RNA

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