抄録
Hepatocellular carcinoma (HCC) is strongly associated with chronic liver diseases. Their control is indispensable to suppress hepatocarcinogenesis. Seventy percent or more cases of HCC were based on chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, while the number of cases arising from non-viral liver diseases, especially from non-alcoholic fatty liver disease, is increasing. This goal of therapies for chronic liver diseases is to improve quality of life and survival by preventing progression of the diseases to liver failure, HCC and death. This goal can be achieved if HBV replication can be suppressed in a sustained manner or if HCV can be eradicated. Two different types of drug can be used in the treatment of HBV: interferon and nucleoside/nucleotide analogues. The patients should be considered for treatment when they have HBV DNA levels above 4 log copies/ml and ALT levels above 30 IU/l in chronic hepatitis, and detectable HBV DNA levels in liver cirrhosis. In cases of chronic hepatitis, pegylated interferon or entecavir should be appropriately applied by taking into account viral status, disease severity or age. The cirrhotic patients should be treated with entecavir. On the other hand, the standard-of-care (SOC) for treatment of chronic hepatitis C in difficult-to-treat situations, with genotype 1 infection and high viral load, is triple therapy of telaprevir, pegylated interferon and ribavirin. The sustained viral response rate of naïve case is over 70% with this therapy. Numerous clinical trials using direct acting antivirals are now in progress. All oral, interferon-free therapies will be approved as SOC with greater efficacy and fewer adverse events in the near future.
