Management of Hepatitis

Ribavirin has no effect on hepatitis B replication, but used in combination with interferon is more effective than ribavirin alone in eradicating chronic infection with hepatitis C.

Interferon was until recently first line treatment for chronic hepatitis B infection associated with elevated serum transaminases. However, there is often a flare in ALT (alamine aminotransferase) on starting treatment, which in the presence of end stage liver disease (elevated PT, bilirubin and ascites here) can lead to liver failure so, in these circumstances, it is contra-indicated.

Lamivudine suppresses HBV replication and is safe to use in decompensated end-stage cirrhosis.

Reference

• Yao FY, Terrault NA, Freise C, Maslow L, Bass NM. Lamivudine treatment is beneficial in patients with severly decompensated cirrhosis and actively replicating hepatitis B viral infection awaiting liver transplantation: a comparative study using matched untreated controls. Hepatology 2001; 34: 411-6