Viral hepatitis.
Viral hepatitis affects millions of people worldwide, making it one of the most important diseases in the field of hepatology. The response to the hepatitis A vaccine is optimal when targeted to patients with chronic hepatitis before development of hepatic decompensation. A new triple antigen vaccine for hepatitis B virus produces a greater degree of protection. Lamivudine can achieve a 3-to 4-log reduction in serum viral levels in patients with chronic hepatitis B infection. Lamivudine-resistant mutants appear in more than 50% of patients after prolonged treatment. Entecavir can be given safely for a short time and causes a pronounced reduction in hepatitis B viral DNA levels with slower rebound after stopping therapy than has been reported with lamivudine. Pegylated interferon has sustained absorption, a slower rate of clearance and a longer half-life than unmodified interferon alfa. Pegylated interferon alfa-2a administered once weekly is more effective than standard interferon alfa-2a administered three times weekly. In patients with chronic hepatitis C infection, the most effective therapy is the combination of pegylated interferon plus ribavirin. Other major advances in the field of viral hepatitis during the past year are highlighted.
Marrero
Ricardo
R
Center for Liver Diseases, University of Miami School of Medicine, Miami, Florida 33136, USA.
Schiff
Eugene
E