acyclovir and Hepatitis-D

Topics: Acyclovir; Hepatitis B; Hepatitis C; Hepatitis D; Hepatitis, Chronic; Humans; Interferons; Prednisolone; Vidarabine; Vidarabine Phosphate; Zidovudine

A clearer view of the natural history of chronic hepatitis B virus (HBV) infection has permitted recognition of a phase of viral replication associated with progressive liver damage, and one of absent replication when the disease is inactive and when continued presence of hepatitis B surface antigen (HBs) is due to the integration of viral genes with the host genome. These two phases can be identified by HBe antigenaemia and anti-HBe, respectively. Several active antiviral drugs are available and may significantly benefit certain HBe Ag-positive groups. The antiviral activity of vidarabine and its analogues and of alpha-interferons is established, and insight is being gained into factors that predict response. In general, results depend on duration of infection, and integrity of the patient's immune response. Anti-HBe positive carriers usually need no treatment, but in those with continuing low-level HBV replication or delta superinfection antiviral therapy, although of unproven value, may be tried. In patients without HBV or hepatitis delta virus (HDV) replication who have signs of active disease, immunosuppressants may be tried with benefit.

Topics: Acyclovir; Clinical Trials as Topic; Hepatitis B; Hepatitis B Antibodies; Hepatitis B e Antigens; Hepatitis B Surface Antigens; Hepatitis D; Hepatitis, Chronic; Humans; Interferon Type I; Vidarabine

Ten patients with chronic hepatitis type D were treated during 4 months with alpha lymphoblastoid interferon in combination with two 2-week courses of acyclovir. Median percentage of HDAg-positive hepatocytes decreased from 11 to 1, p = 0.0225. Patients with no liver HDAg expression after treatment (n = 5) showed improved AST levels (normal in 4) and diminished liver cell inflammation. One patient, who cleared HDAg has complete biochemical remission of his liver disease with 2 years of follow-up. Five patients with persistent, albeit low, HDAg expression in the liver, had continued liver cell destruction (AST elevated and/or abnormal biopsy). No evidence for an enhancing effect of acyclovir for interferon therapy was observed.

Topics: Acyclovir; Adult; Antigens, Viral; Aspartate Aminotransferases; Follow-Up Studies; Hepatitis B e Antigens; Hepatitis D; Hepatitis delta Antigens; Hepatitis Delta Virus; Humans; Interferon Type I; Liver; Male; Middle Aged; Virus Replication

Acyclovir only demonstrated activity in CAH patients with low HBV replication (DNA-p less than or equal to 80 cpm). In those, oral acyclovir 4 g/day for 4 months was able to permanently inhibit DNA-p in 5/5 cases without significant side-effects.

Topics: Acyclovir; Hepatitis B; Hepatitis B virus; Hepatitis D; Hepatitis, Chronic; Humans; Interferons; Vidarabine; Virus Replication