Volume 8 Issue 5, May 2011

Most children with chronic hepatitis C have minimal liver disease before adulthood, but could be at risk of progression to cirrhosis and hepatocellular carcinoma because of persistent virus replication. The results of the first controlled trial with PEG-IFN-α2a plus ribavirin are a step towards an appropriate treatment for these children.

Combination therapy for chronic hepatitis C is associated with adverse effects that can lead to dose reduction or even discontinuation of treatment. A prospective, real-time, observational study by Marcellin and colleagues provides useful information for physicians regarding the role of patient adherence in tailoring patient management and optimizing treatment outcomes.

Antibodies that target tumor necrosis factor are effective at inducing and maintaining remission in both Crohn's disease (infliximab, adalimumab and certolizumab) and ulcerative colitis (infliximab). The results of a randomized controlled trial of adalimumab for inducing remission in moderately to severely active ulcerative colitis have now been published.

Minimizing donor risks during living donor liver transplantation is important. A recent study recommends that a right lobe graft with the middle hepatic vein is obtained from donors <50 years old who have an intact segment four drainage vein and remnant liver volume >30%.

A new staging system for perihilar cholangiocarcinoma has recently been proposed to standardize the reporting of this intractable disease. However, the system has several flaws; thus, many revisions are needed before a registry can be established that uses this system.

Although endoscopic retrograde cholangiopancreatography (ERCP) is a well-established technique for both the diagnosis and treatment of biliary and pancreatic disorders in adults, indications for some pediatric applications, such as idiopathic and recurrent pancreatitis, remain contentious. This News & Views article discusses a recent study that evaluated the technical outcomes and safety of 231 ERCPs in children.

Over 170 million individuals are chronically infected with HCV. The current standard of care for these patients is 24–48 weeks of PEG-IFN-α and ribavirin; however, many patients do not respond to this treatment. This article summarizes the findings from phase III clinical trials on the introduction of telaprevir and boceprevir to this standard therapy.

The asymptomatic nature of acute HCV infection and difficulties in identifying and following those at risk of acquiring infection has hampered our knowledge regarding treatment for this condition. This Review highlights current knowledge of the epidemiology, diagnosis, natural history and treatment of acute HCV infection, and includes proposed recommendations for the assessment and treatment of this infection.

Substantial progress had been made in the treatment of hepatitis B in the past decade; many safe and effective drugs are now available. However, these drugs suppress but do not eradicate HBV. In addition, these agents may be associated with drug resistance and adverse effects. Hellan Kwon and Anna Lok address important questions regarding the optimization of treatment in patients with hepatitis B.

Managing patients with decompensated cirrhosis related to hepatitis B or hepatitis C is challenging, and liver transplantation is often seen as the only viable option. However, the authors of this Review discuss other treatment options that are available. Treatment should focus on controlling the complications of cirrhosis, surveillance for hepatocellular carcinoma and, if applicable, preparation for liver transplantation.

This Focus contains specially-commissioned articles that provide a state-of-the-art overview of real-life issues pertinent to the present and future treatment and management of hepatitis B and C—from acute infection through to decompensated disease.