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Management of Chronic Viral Hepatitis
  1. M Cramp

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Management of Chronic Viral Hepatitis is an A5 sized multiauthor textbook of over 300 pages which forms one of eight books in a gastroenterology and hepatology series. Curiously, the only other hepatological title in this series is a book entitled Viral Hepatitis: Diagnosis, Treatment, Prevention by a different editor. The stated intention of the book is to bring the recent advances in clinical and basic research into the doctor's office. Through the use of clinical vignettes, it tries to cover some of the recent advances in the treatment of viral hepatitis and to demonstrate how these treatments are incorporated into everyday practice. This is a good idea, which works well, particularly in those chapters concerning treatment. In addition to looking at the general treatment of viral hepatitis, the book also has informative chapters on specific disease subsets such as those with chronic hepatitis C and normal alanine aminotransferase levels or those with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfection. The authors include an interesting sounding chapter on alternative therapies for hepatitis C but this focuses primarily on conventional allopathic treatments that have been shown to be of little or no benefit for hepatitis C and disappointingly only touches on the frequently used alternatives such as herbal products and glycyrrhizin.

There are several chapters on hepatitis B virus (HBV) covering treatment, future treatments, management of post-transplant hepatitis B, and HIV-HBV coinfection. The chapter on the treatment of HBV covers the debate on interferon versus lamivudine or interferon and lamivudine combination therapy fairly well, but in all of these chapters there is surprisingly little reference to the management of the widespread pre-core mutant strain.

Additional chapters cover diagnostic techniques and some molecular virology. The chapter on HBV virology and the review of various molecular mechanisms that can be used as targets for antiviral treatment included in the chapter on future HCV therapy were particularly well written. The pace of change in viral hepatitis is fast, and as ever with multiauthor texts, delays are inevitable between writing and publishing. There are several indicators that the publishers have tried to keep this delay to a minimum, such as the figures that have clearly been lifted straight out of someone's powerpoint slide presentation, the references that are left in a reference manager format, and a few minor inaccuracies in the text. Despite these measures to speed publication, there have been predictable advances in treatment that are not well covered, such as the rapidly accumulating data on the efficacy of pegylated interferon alpha in combination with ribavirin in the treatment of hepatitis C.

Despite these criticisms, there are a number of very good chapters and the book provides a good overview and a fairly up to date understanding of hepatitis and its management. The target audience is hard to define but anyone involved in looking after patients with viral hepatitis will find something of use. For those new to viral hepatitis this is a helpful textbook that shows how an understanding of both the natural history and treatment options should be used to guide management decisions.