Antiviral therapy of HBV- and HCV-induced liver cirrhosis

Antiviral therapy is generally indicated in patients who have histologic ev idence of chronic hepatitis and ongoing viral replication. The aim of treat ment is to normalize alanine aminotransferase levels and to eliminate virus replication. Interferon-alfa (IFN-alpha) is the most used agent. The stand ard treatment regimen for hepatitis B e antigen (HBeAg)-positive cirrhosis is based on IFN-alpha given alone, but the efficacy of new antivirals (famc iclovir, lamivudine) with or without IFN-alpha is currently under investiga tion. Conversely, the therapy of antiHBe-positive cirrhosis is far from bei ng satisfactory. The results of treatment of patients affected by type C ci rrhosis with IFN-alpha alone have been disappointing, as 10-15% of treated patients shows a sustained virologic response. Although current evidence su ggests that the combination of ribavirin and IFN-alpha might be more effica cious than IFN alone in increasing the response rare in patients in the adv anced fibrotic stage, the efficacy of this regimen for patients with well-c ompensated HCV-related cirrhosis is still unknown and prospective well desi gned studies are urgently needed. Patients with decompensated cirrhosis are not generally treated unless they are included in liver transplantation pr ograms. Prospective long-term trials with large sample sizes are needed to determine if responders to IFN-alpha have a low incidence of liver-related complications and hepatocellular carcinoma.