Therapeutic management of hepatitis B-related cirrhosis.
Hepatitis B virus (HBV) infection has a world-wide distribution, and may lead to cirrhosis, end-stage liver disease and hepatocellular carcinoma. Therapeutic strategies for HBV cirrhosis are changing rapidly. Treatment with interferon (IFN)-alpha may be hazardous and often can only be administered at low doses. The availability of lamivudine has revolutionized the treatment of chronic hepatitis B and opened up new options for the management of patients with decompensated cirrhosis or recurrent hepatitis B post-liver transplantation. However, lamivudine therapy should be weighed against the risk of selection of resistant mutants and randomized control trials are needed. Hopefully, in the near future, new antiviral drugs such as adefovir dipivoxil which is active on lamivudine-resistant mutants will become available. IFN-alpha is still the only molecule which may prevent HBV-induced hepatocarcinogenesis in humans. Whether other antivirals will also prove useful warrants further follow-up studies.
Merle
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P
Hepato-Gastroenterology Department, Hotel-Dieu Hospital, and Hepatitis Research Unit, INSERM U271, Lyon, France.
Trepo
C
C
D000998:Antiviral Agents / Q000494:pharmacology / Q000627:therapeutic use*; D018849:Controlled Clinical Trials as Topic; D006515:Hepatitis B virus / Q000472:pathogenicity; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use*; D019259:Lamivudine / Q000494:pharmacology / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000209:etiology; D011994:Recombinant Proteins
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D019259:Lamivudine