Current treatment strategies for chronic hepatitis B and C

For chronic hepatitis B, treatment with a 4-month course of interferon alfa -2b can achieve hepatitis B e antigen seroconversion, normalization of amin otransferase levels, reduced hepatic inflammation, and possibly reduced pro gression to cirrhosis and improvement in survival in 20%-30% of patients. S imilar results can be achieved with a 12-month course of lamivudine, with r esponse rates increasing to 40%-65% after 3 years of therapy. Interferon ca n also be used in early cirrhotic patients, and lamivudine can be used in a dvanced cirrhotics and immunosuppressed patients. Combination interferon an d lamivudine therapy does not confer additional benefits. For chronic hepat itis C, the combination of interferon alfa-2b and ribavirin is the treatmen t of choice, offering superior sustained response rates (40%) compared with interferon alone (15%). Therapy should be administered for 12 months to pa tients with genotype 1 virus but for only 6 months to patients with genotyp es 2 and 3. Patients experiencing relapse after 6 months of interferon mono therapy can be re-treated with interferon and ribavirin or high-dose interf eron, with 45%-56% sustained response rates. However, relatively few patien ts who are prior nonresponders to interferon monotherapy will have sustaine d response to further interferon-based treatments, including combination th erapy with ribavirin. Successful therapy not only leads to the eradication of viral RNA but also may delay progression to cirrhosis and hepatocellular carcinoma. Interferon combined with polyethylene glycol (PEG), shows promi se as an improved formulation of interferon with yet higher sustained respo nse rates.