A 44-year-old, human immunodeficiency virus (HIV)-infected man is referred for evaluation of elevated serum liver enzymes. Ten years ago, he contracted acute hepatitis B, which has subsequently cleared completely. He is a known carrier of the hepatitis C virus (HCV). He has been treated for HIV with zidovudine, lamivudine and efavirenz for one year. Three months ago, measurement of the HIV viral load showed that viral replication was under control. However, antiviral treatment was stopped four weeks ago when aspartate transaminase and alanine transaminase levels rose from 40 to greater than 100 U/L. The patient does not drink alcohol and is not obese. Currently, the aspartate transaminase level is 396 U/L, the alanine transaminase level is 460 U/L and the alkaline phosphatase level is 119 U/L. An abdominal ultrasound reveals normal liver echogenicity without splenic enlargement. A liver biopsy shows significant inflammation consistent with a diagnosis of chronic, active hepatitis C. The activity index is 12/18 and the fibrosis score is I/IV. Inflammation is especially prominent in the liver lobules with abundant apoptotic figures. Take advantage of this unique opportunity to pay less money and get yourself a trusted pharmacy where you can always enjoy a chance to order antibiotics online buy here and be sure you will enjoy lowest prices online.
The term ‘apoptosis’ is increasingly mentioned in medical meetings, scientific articles and pathology reports. Many new drugs are being developed with the aim of modifying this process. The Nobel Prize in Medicine and Physiology was recently awarded to three researchers who unraveled the genetics of cell death. This has illustrated the importance of apoptosis as one of the basic cell processes, in the same league as DNA replication, gene expression and protein synthesis.
Therefore, it is a good time to review what we know about liver cell apoptosis and how research in the field is evolving.