[Chronic viral hepatitis--diagnosis, therapy and prognosis]

Abstract

Infections with the hepatitis B, C or D virus can all lead to chronic hepatitis. Serological and molecular methods are essential for diagnosis and for differentiation between the different forms of chronic virus hepatitis. In adults between 5 and 10% of all infections with the hepatitis B virus become chronic while the rate is as high as 80% with the hepatitis C virus. All forms of chronic hepatitis are frequently asymptomatic for a long period of time. Complications are liver cirrhosis and hepatocellular carcinoma. During chronic hepatitis B infection in around 1% of the patients per year the virus is eliminated spontaneously while virus elimination occurs rarely in patients with chronic hepatitis C infection. In patients with chronic hepatitis C infection over a period of 30 years around 3% of the patients die due to chronic hepatitis C infection. As soon as chronic virus hepatitis is diagnosed treatment should be considered. Standard therapy for all forms of chronic viral hepatitis is interferon alpha. Additionally recent results indicate that nucleoside analogous are effective for chronic hepatitis B and C virus infection. For chronic hepatitis B infection studies with famciclovir and lamivudine show that viral replication can be effectively blocked. For chronic hepatitis C infection a combination therapy with interferon and ribavirin has been shown to reach higher elimination rates compared to interferon mono-therapy. The last treatment option for all forms of viral hepatitis is liver transplantation.