Liver Disease | Liver India | Alcoholic Liver Disease

Chronic Viral Hepatitis


Chronic viral hepatitis is the principal cause of chronic liver disease, cirrhosis and hepatocellular carcinoma in the world. IFNa is the only treatment with proven benefit for chronic viral hepatitis. Treating chronic hepatitis C of 5 years duration or less will provide a better long-term response. Long-term pretreatment with high doses of IFNa of chronic hepatitis C patients with initial transient positive response has been beneficial. Acute hepatitis C patients treated with IFNa have 36-61% chance of developing chronic hepatitis vs. 80-100% if no treatment is given. The combination of ribavirin and IFNa provides a higher rate of long-term response (44-77%) in chronic hepatitis C.


Chronic Hepatitis B.
Indication for Treatment with IFNa

Therapy with IFNa

"Interferon alpha (IFNa) is the only agent known to have a lasting beneficial effect in chronic hepatitis B."


"A course of four to six months duration induces a long-term remission… (disappearance of serum HBeAg)… in 25-40% of patients."


5M IU, daily S.C.x4 months (follow-up x 6 months)


or


10 M IU, TIW S.C. x 4 months (follow-up x 6 months)


Predictors of response

IFNa and atypical forms

New therapies

Chronic Delta Hepatitis.

It is the less common form of chronic viral hepatitis. HDV is a defective RNA virus that only replicates in the presence of HBsAg in serum.


IFN a TREATMENT:

Greater than or equal to 5M IU, DAILY OR 9-10M IU, TIW X 12 MONTHS: Leads to sustained improvement + HBsAg disappearance in 15-25% of patients.


Chronic Hepatitis C

Hepatitis C is the most common cause of chronic viral hepatitis in the Western world. Ranks second, slightly below chronic alcoholism as a cause of cirrhosis, end-stage liver disease, and hepatocellular carcinoma in the United States. Half the patients with chronic HCV infection have normal or only minimally elevated serum aminotransferase concentrations, but can have a marked degree of hepatitis as indicated by histologic evidence


Indication for treatment with IFNa

Therapy with IFN alpha

Patterns of response

TYPE OF RESPONDER:


Predictors of response

The most important independent predictors for response to IFN a therapy are the HCV-RNA serum level and the genotype (> 40% response with type 2 and 3).


IFNa and atypical forms
New Therapies

Corticosteroids, IFNg, thymosin, ursodiol, acyclovir: Little or no evidence of long term benefit.


Ribavirin alone:

Markers return to pretreatment levels when treatment stopped.


Ribavirin + IFNa:

More promising, 40-77% long-term response, lower rate of relapses.


Complementary and Alternative Medicine for Chronic Liver Disease

Leonard B. Seeff, MD, from the National Institute of Health (NIH) in Bethesda, Maryland, gave a report on the recent NIH Symposium focusing on the issue of botanical preparations and herbal preparations available to treat chronic liver diseases. He spoke at the postgraduate course in Dallas held in conjunction with the annual meeting of the American Association for the Study of Liver Disease (AASLD).


Dr. Seeff presented data showing that most patients with chronic liver disease use some type of alternative medicine products and that "conventional" Western science needs to examine these products to find out which ones are effective and helpful and which ones may be harmful. He pointed out some herbal products that appeared to be beneficial and deserve further study.


Some of the potentially beneficial herbal products listed by Dr Seeff included milk thistle and sho-saiko-to (TJ-9) as mentioned above. In addition, he noted that Glycyrrhizin (licorice root extract), a product used in Japan for the treatment of hepatitis, appears to have anti-inflammatory properties and improves ALT levels when given intravenously. Some studies have been reported using glycyrrhizin in pill form for the treatment of viral hepatitis. One study gave interferon only or interferon plus glycyrrhizin to patients that had failed to respond to interferon. ALT levels normalized in 33% of those receiving interferon only, but in 64% of those receiving the glycyrrhizin in addition to the interferon. HCV-RNA became undetectable in 38.5% of those receiving the herbal product, but in only 13% of those treated with interferon only.


Another interesting product is Compound 861. This is a liquid medicine that contains 10 herbs based on traditional Chinese medicine. This compound appears to be anti-fibrotic (prevents or improves the scar tissue in the liver). A study in China gave this compound to patients with hepatitis B and found improvement in most patients.


The NIH has allocated funds to be used for research related to herbal products. Hopefully we will soon be able to tease out those products that are effective from those who may not help at all or even be harmful.

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