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Update in Hepatology
John Roberts, MD, Series Editor, and Margaret Ring Gillock, Article Editor
Many topics related to hepatology gained attention in 1997, but the areas that currently warrant note here are viral hepatitis, other types of liver disease, complications of cirrhosis, and liver transplantation. Better understanding of clinical pathways in all of these areas has led to an increased ability to manage problems that arise in hepatology.
Hepatitis B Virus
Patients with chronic hepatitis B have persistence of hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), and hepatitis B virus (HBV) DNA in their serum. These patients harbor replicating virus and have histologic evidence of ongoing chronic hepatitis.
At a minimum, we would like to see new therapies that will result in disappearance of HBV DNA, seroconversion of HBeAg to anti-HBe antibody, and disappearance of HBsAg. Interferon is currently the only drug licensed for hepatitis B therapy. When we look at the effectiveness of the drug, it is important to keep in mind that U.S. patients tend to acquire the disease in adulthood, whereas Asian patients are more likely to acquire the disease early in life, particularly through perinatal transmission. Patients who acquire the disease early in life tend to have normal liver enzyme levels and are refractory to interferon therapy. They tolerate the virus much better than patients who acquire the disease in adulthood. Studies of patients who acquired hepatitis B as adults show that approximately 40% of those treated with interferon will lose HBeAg, develop anti-HB e antibody, lose HBV DNA, and eventually lose HBsAg. This, however, is an ideal result, occurring in just part of one portion of the U.S. patient population. It is not the experience in southeast Asia. As a result, there is a desire for newer antiviral drugs to be used in combination with interferon or other …
This 100-word excerpt has been provided in the absence of an abstract.
