Personalized therapy in chronic viral hepatitis.
Chronic carriers of major hepatitis viruses (i.e., hepatitis B and C viruses, HBV and HCV) account for at least 600 millions people worldwide. About 50% of them are at risk for chronic hepatitis and 20-30% of patients with chronic hepatitis develop progressive liver disease and symptomatic life-threatening liver lesions. Therefore, the identification of the carrier at risk is mandatory to prevent progressive liver disease, avoiding non-appropriate treatments. The decision making has three major steps. The 1st is the identification of the patient who needs to be treated; the 2nd is the choice of the best therapeutic strategy and the most appropriate drugs and timing during the phase of infection and disease; the 3rd is the treatment optimization to reduce non effective therapy and avoid drug resistance virus mutants. This careful evaluation takes into account the individual variability, the host/virus interplays and the drug impact on viral replication with the risk of selection of resistant mutants. The complexity of the virus/host interactions, however, cannot be managed by simple mean of probabilistic statistics and/or step-wise algorithms based on population statistics. A better answer for personalized antiviral therapy may come from the combined use of molecular biology and bio-mathematical modeling that can help the medical doctor to follow the dynamic of viral infection during therapy, like the flight simulator helps the pilot. We provide a concise review of the potentials of this approach in clinical practice.
Brunetto
Maurizia Rossana
MR
Gastroenterology and Hepatology Unit, University Hospital of Pisa, Via Paradisa 2, 56124 Cisanello, Pisa, Italy. brunetto@med-club.com
Colombatto
Piero
P
Bonino
Ferruccio
F
D000998:Antiviral Agents / Q000627:therapeutic use*; D006518:Hepatitis Viruses / Q000187:drug effects; D006521:Hepatitis, Chronic / Q000188:drug therapy* / Q000473:pathology / Q000821:virology; D006525:Hepatitis, Viral, Human / Q000188:drug therapy* / Q000473:pathology / Q000821:virology; D006801:Humans
D000998:Antiviral Agents