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Chronic viral hepatitis is a syndrome of persisting hepatotropic viral infection usually associated with chronic inflammation, hepatocyte injury and progressive fibrosis. Chronic viral hepatitis is typically classified by the responsible infecting virus and modified by the extent of pathological injury and clinical compensation. Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections represent the two major causes of chronic liver disease and hepatocellular carcinoma. Despite inducing shared pathological events leading to oncogenic transformation, these two viruses present profound differences in their molecular features, life cycle and interplay with host factors, which significantly differentiate the prognostic and therapeutic approach to the related diseases. The liver injury present in chronic hepatitis may be variable, but the basic morphologic changes in all types of chronic viral hepatitis are similar. In this regard, the liver biopsy remains the gold standard and is an important tool in the evaluation of patients with liver disease.
The state of the art in the field of CHB treatment reveals several limitations of currently approved therapies. Fortunately, the recent understanding of the immunology and physiology of chronic hepatitis B infection is leading to several innovative therapeutic strategies for chronic hepatitis B. Novel therapies support the global efforts by the World Health Organization in order to prevent disease progression and mortality by liver cirrhosis and hepatocellular carcinoma as a result of viral hepatitis, a disease with a mortality trend on the rise worldwide. The results of the most advanced products for chronic hepatitis B treatment will be considered in the present revision of the statu quo of therapies. Special attention is given to therapeutic vaccination. The main pharmacological and clinical trials as well as the notorious case of therapeutic vaccination in patients with viral suppression as the result of combined treatment with antivirals. These areas of research deserve in deep analysis and discussion. The products in the more advanced clinical status will be highlighted as well as the recent registration of a novel therapeutic vaccine.
Chronic hepatitis B (CHB) is a chronic infectious disease caused by hepatitis B virus, which represents a significant challenge to public health. A long-term CHB treatment using the antiviral agents such as necleos(t)ide analogues and interferon-alpha raise up obvious drug resistance and side effects. Traditional Chinese medicine (TCM) as an important part of complementary and alternative medicine, is using in clinical for CHB treatment in China. The effective CHB treatment is based on the accurate TCM syndrome (ZHENG) differentiation. Here, we reviewed the situation of TCM application in CHB treatment, and summarized the potential effects and mechanisms of Chinese herbal formulae (CHFs), Chinese herbal medicines (CHMs) and their extracts or bioactive compounds in vitro and in vivo.
About 130-170 million people, is estimated to be infected with the hepatitis C virus (HCV). Chronic HCV infection is one of the leading causes of liver-related death and in many countries it is the primary reason for having a liver transplant. In 2011 approval was given for the first direct acting antiviral agents (DAA), boceprevir and telaprevir, for treatment of genotype 1, in combination with traditional dual therapy. This strategy managed to increase the rates of sustained viral response (SVR) in both naive patients and in retreated patients, but with greater toxicity, interactions and cost, as well as being less safe in patients with advanced disease, in whom this treatment can trigger decompensation or even death. The recent, accelerated incorporation since 2013 of new more effective DAA, with pan-genomic properties and excellent tolerance, besides increasing the rates of SVR (even up to 100%), has also created a new scenario: shorter therapies, less toxicity and regimens free of PEG/RBV.
Hepatitis C virus (HCV) chronic infection is characterized by both hepato- and lymphotropism responsible for either liver involvement and one or more extrahepatic manifestations (HCV-EHMs). In particular, HCV lymphotropism may represent a chronic stimulus for the immune-system leading to poly-oligoclonal B-lymphocyte expansion in a high percentage of HCV-infected individuals. The consequent production of auto antibodies and immune-complexes, among which mixed cryoglobulins, may produce different immune-mediated organ- and non-organ-specific disorders. The presence of serum cryoprecipitable immune-complexes, characterizes the mixed cryoglobulinemia syndrome (MCs); this is a small-vessel systemic vasculitis (also termed 'cryoglobulinemic vasculitis'), represents the prototypic disorder of HCV-EHMs. Noteworthy, HCV-infected patients with MCs may develop a frank malignant B-cell non-Hodgkin's lymphoma (B-NHL); this finding suggested a possible link between HCV itself and apparently 'idiopathic' B-NHL.