Clinical Review Regular review

Treatment of chronic hepatitis

BMJ 2001; 323 doi: http://dx.doi.org/10.1136/bmj.323.7322.1164 (Published 17 November 2001) Cite this as: BMJ 2001;323:1164
  1. Paul J Gow, hepatologist ([email protected])a,
  2. David Mutimer, hepatologistb
  1. a Gastroenterology and Liver Transplant Unit, Austin and Repatriation Medical Centre, Heidelberg 3084, Victoria, Australia
  2. b Liver and Hepatobiliary Unit, Nuffield House, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH
  1. Correspondence to: P J Gow

    Viral hepatitis is the major cause of chronic liver disease worldwide. An estimated 300 million people are carriers of the hepatitis B virus, and 120 million are infected with hepatitis C. Untreated, these infections may progress to cirrhosis, liver failure, and hepatoma. Public health measures to limit new infection, including immunisation against hepatitis B and screening of blood products for hepatitis B and C viruses, have now been implemented in most developed countries and are being implemented in many developing counties.

    This review focuses on the treatment of chronic hepatitis B and C, which has undergone dramatic improvement in the past few years.

    Summary points

    Lamivudine is a safe effective antiviral drug for treating chronic hepatitis B virus infection

    Lamivudine is most effective in patients with substantially elevated transaminase concentrations and those with advanced cirrhosis

    Lamivudine treatment is hampered by the frequent development of resistance; in the near future combinations of antiviral agents may become standard treatment

    Ribavirin in combination with interferon is effective for selected patients with chronic hepatitis C virus infection

    Overall, about 30-40% of all patients can expect to be cured by this treatment, and in selected subgroups of patients cure rates of 80-90% can be achieved

    Treatment with interferon alfa (as part of combination therapy) reduces the risk of developing hepatocellular carcinoma and may partially reverse hepatic fibrosis

    Methods

    The information used in the preparation of this article was based on a Medline search to identify key papers in addition to searching abstracts from the meetings of the American Association for the Study of Liver Disease and European Association for the Study of the Liver between 1997 and 2001. Search terms included hepatitis B virus, hepatitis C virus, treatment, lamivudine, tribavirin (ribavirin), interferon, pegylated interferon, and combination therapy.

    Hepatitis B

    Of the world's 300 million people with chronic hepatitis B, most …

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