Behandlung der chronischen Virushepatitiden - Standards und Perspektiven. Interferon - Zur Zeit einzige effektive Therapie

The only established therapy of chronic viral hepatitis is Interferon-α. Patients suffering from chronic hepatitis B should be treated with 4-6 Mio. units Interferon-α tiw for a period of 4-6 months. Treatment leads to reduction of viral load, normalization of serum transaminases and improvement of liver histology in 25-40% of treated patients. Retherapy should consist of treatment which Interferon-α 9-10 Mio. units tiw for 4-6 months. A new therapeutic approach, esp. in combination with Interferon-α, consists in the use of nucleoside analoga like famcyclovir and lamivudine. Interferon-α-treatment of chronic hepatitis D should be given for a prolonged time period and leads in 10-25% to improvement. Relapses are common unless HBsAg and HDV-RNA disappear. Patients with chronic hepatitis C show a longterm response to Interferon-α-therapy (5-6 Mio. units tiw) in 10-25% when treated for 12 months. Improvement consists of normalization of serum transaminases, reduction of histologic changes and clearance of HCV-RNA from the serum. Combination therapy of Interferon-α with ribavirine is currently studied and preliminary results show improved longterm response rates of combination against monotherapy. Clearly, combination therapy in the treatment of chronic viral hepatitis will evolve further in the future, a parallel development to the treatment of HIV-infection where combination therapy has become a standard. Nevertheless, further research is needed to better understand the molecular biology of hepatitis viruses and to develop in vitro and in vivo models for drug testing.