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hepatology2009.pdf Flying Publisher hePatology www.HepatologyTextbook.com a clinical textbook Mauss - Berg - Rockstroh - Sarrazin - Wedemeyer This textbook was made possible through unrestricted educational grants from Hoffmann–La Roche, Germany – www.Roche.com Gilead Sciences, Germany – www.Gilead.com Hepatology 2009 www.HepatologyTextbook.com Editors Stefan Mauss Thomas Berg Juergen Rockstroh Christoph Sarrazin Heiner Wedemeyer Flying Publisher 4 Disclaimer Hepatology is an ever-changing field. The editors and authors of Hepatology - A Clinical Textbook have made every effort to provide information that is accurate and complete as of the date of publication. However, in view of the rapid changes occurring in medical science, as well as the possibility of human error, this site may contain technical inaccuracies, typographical or other errors. Readers are advised to check the product information currently provided by the manufacturer of each drug to be administered to verify the recommended dose, the method and duration of administration, and contraindications. It is the responsibility of the treating physician who relies on experience and knowledge about the patient to determine dosages and the best treatment for the patient. The information contained herein is provided "as is" and without warranty of any kind. The editors and Flying Publisher disclaim responsibility for any errors or omissions or for results obtained from the use of information contained herein. © 2009 by Mauss, Berg, Rockstroh, Sarrazin, Wedemeyer D-40237 Duesseldorf Printed in Germany ISBN: 978-3-924774-63-9 English language and style: Rob Camp Layout: Ismael Sala Salas 5 Preface (S. Zeuzem) Hepatology is a rapidly evolving medical field that will continue to grow and maintain our excitement over the next few decades. Viral hepatitis is not unlike HIV was 10 or 15 years ago when the retrovirus began to be better understood and treatable. Today, hepatitis B viral replication can be suppressed by potent antiviral drugs, although there are risks regarding the emergence of resistance. Strategies to enhance the eradication rates of HBV infection still need to be developed. On the other hand, hepatitis C virus infection can be eradicated by treatment with pegylated interferon plus ribavirin. However, particularly in those infected by HCV genotype 1, the sustained virologic response rates are still suboptimal. Many new antiviral drugs, especially protease and polymerase inhibitors, are currently in preclinical and clinical development, and the first data from larger clinical trials provide some optimism that the cure rates for patients with chronic hepatitis C will be enhanced with these new agents. In other areas of hepatology, e.g., hereditary and metabolic liver diseases, our knowledge is rapidly increasing and new therapeutic options are on the horizon. Are books in rapidly evolving areas such as hepatology the right medium to gather and summarise the current knowledge? Are these books not likely to be outdated the very day they are published? This is indeed a challenge that can be convincingly overcome only by rapid internet-based publishing with regular updates. Another unmatched advantage of a web-based book is the free and unrestricted access everywhere. Viral hepatitis and other liver diseases are a global burden and timely information is important for physicians, scientists, patients and health care officials all around the world. The editors of this web-based book – Thomas Berg, Stefan Mauss, Jürgen Rockstroh, Christoph Sarrazin and Heiner Wedemeyer – are young, bright, and internationally renowned hepatologists who have created an excellent state-of-the- art textbook on clinical hepatology. The book is well structured and written and provides in-depth information without being lengthy or redundant. I am convinced that all five will remain very active in the field and will update this book regularly as the science progresses. This e-book should rapidly become an international standard. Stefan Zeuzem – Frankfurt, 24 January 2009 Preface (M. P. Manns) Therapeutic options and diagnostic procedures in hepatology have quickly advanced during the last decade. In particular, the management of viral hepatitis has completely changed since the early nineties. Before nucleoside and nucleotide analogues were licensed to treat hepatitis B and before interferon alpha / ribavirin combination therapy were approved for the treatment of chronic hepatitis C, only very few patients infected with HBV or HCV could be treated successfully. The only option for most patients with end-stage liver disease or hepatocellular carcinoma was liver transplantation. However, even if the patients were lucky to be successfully transplanted, re-infection of the transplanted organs remained major ...