Update on viral hepatitis in 2004

乙肝杀手

Fung SK, Lok AS.

Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA.

PURPOSE OF REVIEW: This article highlights recent advances in viral hepatitis published from December 2003 to November 2004. Studies reporting novel and clinically relevant findings were selected after a PubMed search. The aim is to provide an up-to-date summary of important developments in viral hepatitis. RECENT FINDINGS: Lamivudine was shown to reduce the rate of long-term complications of hepatitis B virus-induced cirrhosis. Adefovir was effective in suppressing lamivudine-resistant hepatitis B virus. Pegylated interferon alone was as effective as pegylated interferon plus lamivudine in the management of HBeAg-negative chronic hepatitis B. A 24-week course of pegylated interferon plus low-dose ribavirin was optimal in patients with hepatitis C virus infected with genotype 2 or 3, but a 48-week course and standard dose of ribavirin were needed in patients with genotype 1. Pegylated interferon plus ribavirin was fairly well tolerated in HIV-hepatitis C virus coinfected patients with stable HIV infection and resulted in response rates that were only slightly lower than that in patients with hepatitis C virus infection only. A dramatic reduction in hepatitis C virus RNA level was observed after 2 days of treatment with an hepatitis C virus protease inhibitor. SUMMARY: The optimal management of chronic viral hepatitis is evolving rapidly. Newer treatment options for hepatitis B, including pegylated interferon, tenofovir, and combination regimens were shown to be effective in treatment-naive and treatment-experienced patients. In addition, impressive gains were made in the treatment of hepatitis C virus infection in difficult-to-treat patients, including African Americans and those with HIV-hepatitis C virus coinfection.