Views And Reviews

Viral Hepatitis: Scientific Basis and Clinical Management

BMJ 1994; 309 doi: (Published 23 July 1994) Cite this as: BMJ 1994;309:281
  1. E H Boxall

    The editors of Viral Hepatitis have gathered a formidable international collection of authors representing many major research groups. The first part of the book is an alphabetical approach to hepatitis virology, topics including, for each virus: structure and molecular virology; natural history and epidemiology (for all except hepatitis B); diagnosis and, when appropriate, prevention; treatment; and liver cancer (heapatitis B and C). It is a good time to review progress in hepatitis C virology since the molecular cloning of the virus in 1989 - and a sobering thought that we are capable of providing diagnostic tests for a virus that has never been visualised or grown in culture but whose genome has been almost completely mapped. The hepatitis virus alphabet has progressed as far as hepatitis E (“E”= epidemic, enterically transmitted, non-A), and although this virus has been visualised, molecular cloning has been used to produce recombinant protein for diagnostic assays. Hepatitis E virology is in its infancy.

    * Staging of testicular cancer from Color Atlas of Urology (2nd edn, Wolfe, pounds sterling 65, ISBN 0-7234-1912-4), a text which combines clinical, imaging, and histological data to provide an integrated approach to individual urological problems.

    The second part of the book covers clinical aspects and takes a general approach with all viruses being considered together. It is particularly interesting to have the subject presented from different points of view. How do hepatitis viruses affect the clinical practice of other specialties such as occupational medicine, the treatment of haemophilia, paediatrics, and blood transfusion? Christian Brechot's chapter on the application of molecular biology to diagnosis is particularly valuable in evaluating the advantages and limitations of various techniques.

    What questions remain unanswered? For hepatitis A we do not yet fully understand the mechanism of relapsing recurrent infection, and in hepatitis B the discovery and investigation of mutants are important aspects. The association of hepatitis C virus with hepatocellular carcinoma is particularly interesting as no viral reverse transcriptase which would allow viral integration has been described. The most intriguing question with regard to hepatitis D (the “parasite of hepatitis B”) is how did it evolve? The similarities of hepatitis D virus to viroids and virusoids at the molecular level may answer this question.

    We understand the route of transmission of hepatitis E virus in epidemics and the physical properties of the virus and have noted differences between isolates from different parts of the world. The high mortality in pregnancy is still unexplained.

    In a topic where over 1000 papers are published each year, some of them constituting small steps forward (or backwards), it is impossible for working clinical virologists or general physicians to keep up to date. Viral Hepatitis is well referenced and presented. Many chapters make interesting general reading, and others, such as Wolfram Gerlich's comprehensive chapter on the molecular virology of hepatitis B, I shall refer to regularly.

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