Viral hepatitis in 2003.
OBJECTIVE
This article discusses over 40 studies in the field of viral hepatitis that were published in 2003. Studies that reported novel findings of clinical relevance were selected after a MEDLINE search. This article focuses on hepatitis B and hepatitis C.


RESULTS
In the United States, all genotypes of hepatitis B virus were reported, and precore and core promoter mutations were found in approximately a third of patients. The response to lamivudine was less durable than that induced by interferon. Adefovir dipivoxil was safe and effective for treatment-naive patients as well as for lamivudine-resistant patients. In acute hepatitis C infection, close monitoring of hepatitis C virus RNA and treatment of patients with persistent viremia is a reasonable alternative to immediate treatment of all patients. Noninvasive indices to predict liver fibrosis are currently being tested. Failure to achieve an early virologic response to pegylated interferon plus ribavirin can identify more than 95% patients who will not have a sustained response.


CONCLUSIONS
The clinical significance of hepatitis B virus genotypes and viral variants continues to be elucidated worldwide. Long-term lamivudine treatment is safe, despite a rising rate of resistance. Adefovir appears to be safe and effective as initial therapy for chronic hepatitis B virus infection or for the management of lamivudine-resistant hepatitis B infection. Noninvasive indices for liver fibrosis require validation but may reduce the need for liver biopsy in the future. Newer agents for the treatment of hepatitis C virus infection show promise.
Fung
Scott K
SK
Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA.
Lok
Anna S F
AS