Postpartum acute exacerbation of chronic hepatitis C with complete response to interferon-alpha

We describe a patient with chronic hepatitis C who had severe postpartum acute exacerbation of the disease, with marked aminotransferase elevations and jaundice. The viral genotype was 2a, and the patient had a low viral load. Neither superinfection with another hepatotropic virus nor autoantibodies were evident. Markedly increased serum concentrations of T-helper (Th) 1-type cytokines and cytokine receptors, including interleukin (IL)-8, tumor necrosis factor (TNF)-alpha, soluble TNF receptor (sTNFR)-p55, sTNFR-p75, and soluble Fas antigen (sFas), as well as that of the Th 2-type cytokine, IL-10, were present. Complete biochemical and virologic response was achieved with interferon (IFN)-alpha treatment, which decreased cytokine elevations while favoring Th 1 dominance. Acute exacerbation of hepatitis C may occur when cellular immune responses are activated, as in late pregnancy and in the postpartum period. Treating such acute exacerbations immediately with IFN may be highly efficacious.