[Monitoring patients with chronic hepatitis during and after therapy]

Abstract

Chronic viral hepatitis C and B are one of the major public health and medical problems. Both viruses cause life threatening liver diseases, i.e. cirrhosis, liver failure and hepatocellular carcinoma (HCC). Effective treatment for both hepatitis B and hepatitis C to reduce the rate of adverse outcomes is now available. There is no recommendation for mass screening for HBV and HCV in the general population but only in the high risk groups. There is wide availability of diagnostic tests for HCV and HBV infection with high sensitivity and specificity. Prior to therapy initiation, serum HCV RNA by quantitative assay and HCV genotype should be determined. Liver biopsy is performed to assess the disease severity, not always including genotype 3. Response to antiviral therapy should be assessed by AST, ALT and qualitative HCV RNA, and in patients with liver cirrhosis early detection of HCC by alpha fetoprotein, ultrasound, CT, or MR should be done every 6 months. Chronic HCV infection with cirrhosis and HCC is the leading indication for liver transplantation. The current hepatitis B vaccination policy is universal neonatal vaccination. HBsAg, HbBeAg and antiHBe positive patients should be qualitatively tested for HBV DNA and liver biopsy is performed according HBV DNA level. Patients are treated with interferon and nucleos(t)ide analogues. Treated patients should be tested for HBsAg, HBeAg and HBV DNA every 3 and 6 months. The optimal duration of therapy for oral drugs is not well established and life long treatment is generally recommended. Chronic HBV infection is the leading cause of HCC and its early detection is essential. Liver transplantation is successfully performed for HBV cirrhosis, liver failure and HCC. Patients with HBV/HDV, HBV/HCV or HIV/HBV/HCV co-infection should be treated accordingly. TTV, GBV-C and HEV hepatitis do not cause chronic liver diseases.