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[Chronic viral hepatitis: diagnosis and treatment]
1I Divisione Medicina Generale, Complesso Ospedaliero San Giovanni-Addolorata, Roma.
Insights
Hepatitis B (HBV) and C (HCV) cause chronic hepatitis, diagnosed via serologic tests and viral DNA/RNA detection. Interferon shows promise, but liver transplants and ribavirin have yielded limited success.
Area of Science:
- Hepatology
- Virology
- Immunology
Context:
- Hepatitis B virus (HBV) and Hepatitis C virus (HCV) are primary causes of chronic hepatitis.
- Hepatitis D virus (HDV) requires HBV for replication, while Hepatitis A (HAV) and E (HEV) do not cause chronic infections.
- The etiology of chronic hepatitis is diverse and geographically variable, with distinctions between persistent and active forms being clinically fluid.
Purpose:
- To review the etiology, diagnosis, and treatment of chronic viral hepatitis.
- To evaluate the efficacy of current therapeutic strategies, including interferon, liver transplantation, and antiviral agents.
Summary:
- Chronic hepatitis is predominantly caused by HBV and HCV, with HDV acting as a dependent co-infecting agent.
- Diagnosis relies on serological markers and molecular detection of HBV DNA and HCV RNA.
- Interferon therapy offers approximately 50% efficacy for HBV, HCV, and HDV infections, though long-term treatment is often required for HDV.
Impact:
- Interferon remains a key therapeutic option for chronic viral hepatitis, achieving moderate success rates.
- Liver transplantation results for chronic hepatitis are currently disappointing.
- Further research is needed to optimize treatment for non-responders and explore novel antiviral therapies.
Abstract:
HBV and HCV cause most of chronic hepatitis; the HDV is a co-infectious virus and it rend the help of HBV to duplicate; HAV and HEV do not induce chronic hepatitis. Etiology is not the same, without apparent reasons, in all the world and the distinction between persistent chronic hepatitis and active idiopathic chronic hepatitis is meaningless, because one can shift in the other. Diagnosis is possible using serologic tests and by determination of the DNA of the HBV and RNA of the HCV. Interferon is a good therapeutic tool either for B hepatitis than for C hepatitis in about 50% of case. On the contrary, the results obtained with liver transplantation are disappointing and those achieved with ribavirin have not been conclusive yet. The treatment with INF for more than one year and with full dosages, gives good results in about 50% of patients with hepatitis D. In the other patients it is not useful a second cycle with INF or the introduction of pure antiviral drugs alone or in association with INF.