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Medline ® Abstract for Reference 48

of 'Gilbert syndrome and unconjugated hyperbilirubinemia due to bilirubin overproduction'

Gilbert's syndrome and antiviral therapy of hepatitis C.
Deterding K, Grüngreiff K, Lankisch TO, Potthoff A, Bahr MJ, Manns MP, Wedemeyer H, Strassburg CP
Ann Hepatol. 2009;8(3):246.
Treatment of chronic hepatitis C with type I interferons and ribavirin can be associated with exacerbation of hepatitis and sometimes liver decompensation. We report two patients with chronic hepatitis C virus infection who experienced a severe increase of bilirubin levels of up to 17 times upper the limit of normal value in the absence of deterioration of hepatic function during therapy with pegylated-interferon and ribavirin. A genetic disposition for Gilbert's syndrome explained the adverse events and permitted a continuation of therapy leading to a sustained clearance of chronic hepatitis C infection. Since one patient jaundiced already during a lead-in treatment period with ribavirin monotherapy we suggest that hyperbilirubinaemia during combination therapy is primarily caused by ribavirin rather than by effects of interferon alpha on UDP-glucuronosyltransferase activities. Of note, both patients recovered from their initial unconjugated hyperbilirubinemia despite continuation of ribavirin therapy, which indicates that compensatory mechanisms leading to a normalization of UGT1A1 activity are likely.
Dept. of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.