VIRAL HEPATITIS 

Patients may have nausea and vomiting with or without jaundice. Severity increases with age. Children rarely develop jaundice. Course is usually self-limited. Illness resolves in three to 6 weeks, but may persist for several months. Treatment is supportive.

Treatment of choice is Interferon injections daily for 4-6 months. An alternate is lamivudine (Epivir) which is given by mouth for a year.

Hepatitis B is a preventable disease. Passive immunization (HBIG) is recommended when a person is stuck by a used needle that has been exposed to a HBV patient. In addition, active vaccination is also administered. HBIG is also given to new born babies of mothers infected with HBV.

Active HBV vaccine (Engerix-B and Recombivax HB) is recommended for high risk groups like medical personnel, intravenous drug users, and infants of infected mothers. An initial dose is followed by a booster dose at one and six months.

Hepatitis C can be diagnosed by testing blood for antibodies against the virus, or even the virus itself. Assessment of the damage to the liver however, requires a liver biopsy.

Treatment is generally not recommended for patients whose liver is minimally affected by the HCV and do not have any active inflammation or fibrosis in the liver. Patients with advanced cirrhosis, active alcoholism or intravenous drug abuse are not good candidates for treatment. Treatment of patients with HIV needs to be individualized.

We used to treat patients with alpha-interferon for 6 months. The present trend is to treat for at least 12 months. Side-effects include reduction in blood cell as well as platelet counts, and depression. Despite this very costly and sometimes toxic therapy, the virus can be eradicated only in a small fraction of patients.

Pegylated (long acting) interferons promise to improve compliance and increase eradication rates.

These days, the treatment of choice involves using a combination of alfa-interferon and ribavirin for twenty four to 48 weeks. The combination is marketed as Rebeteron. In contrast to interferon alone, this combination treatment can eradicate the virus in about 38 percent patients.

Ribavirin can be very toxic in as many as a quarter to one-third of

patients. The most common serious side-effect involves breaking down of blood cells causing anemia, which can necessitate cessation of treatment in some cases.

Rebeteron also has very serious toxic-effects on the fetus. Thus, it must not only be not used by women who are pregnant or planning to be pregnant, but also not by men whose sexual partners are pregnant or planning to be pregnant.

HCV is the most common indication for liver transplantation (30-40%) in the U.S.. Recurrence of HCV occurs in nearly all cases after transplantation, but infection is usually mild.

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