Viral hepatitis in the 1990s, part I: current principles of management
William D. Carey, MDAddress reprint requests to W.D.C., Department of Gastroenterology, S40, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
Girish Patel, MD
Recent years have brought major advances in the diagnosis and treatment of viral hepatitis. Treatment of acute uncomplicated hepatitis is supportive rather than curative. Treatment of fulminant hepatic necrosis is directed towards preventing and treating complications while preparing suitable patients for liver transplantation. Corticosteroids do not improve survival rates in patients with fulminant hepatic necrosis and should be avoided in nearly all patients with hepatitis A. Although liver histology in acute viral hepatitis is highly characteristic, biopsy is usually superfluous, except in transplant patients with acute hepatic dysfunction. Hepatitis A virus infection is frequently asymptomatic, and data on its incidence are poor. The virus is frequently transmitted before the patient becomes ill; therefore, curtailing hepatitis A spread depends in large measure on hygienic practices. Passive immunization is possible with immune globulin. Inactivated and attenuated vaccines may be licensed within the next 2 years.