Antiviral therapy for chronic hepatitis B and C. Which patients are likely to benefit from which agents?

As primary care physicians become increasingly involved in diagnosis and treatment of patients with chronic viral hepatitis, an understanding of the antiviral options available, their limitations, and their side effects takes on a special importance. For chronic HBV infection, interferon alfa-2b requires only a 4-month course. However, it has adverse effects and contraindications and does not produce a universal response. Another option for HBV infection is lamivudine, which is administered orally and causes few side effects. However, relapse may occur when treatment is discontinued, and mutant virus may emerge. For chronic HCV infection, interferon alfa-2a, interferon alfa-2b, consensus interferon, and interferon combined with ribavirin have been used. The combination alternative is emerging as the method of choice in patients who do not have contraindications to oral ribavirin. Adverse effects are common, and durability of response varies according to HCV RNA level and genotype.