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Maßgeschneiderte Therapie der Virushepatitis der Gegenwart und Zukunft

Hepatitis B, C, Delta und E

Personalized treatment of viral hepatitis of the present and the future

Hepatitis B, C, delta, and E

  • Schwerpunkt: Individualisierte Infektionsmedizin
  • Published:
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Zusammenfassung

Auch in der Infektionsmedizin sind maßgeschneiderte Therapien möglich, wie das Beispiel der chronischen Virushepatitis zeigt, insbesondere wenn es bereits verschiedene Therapieoptionen gibt. Bei der Hepatitis-B-Virus(HBV)-Infektion wird zunächst die Therapieindikation anhand von Virusmarkern und Leberwerten des Patienten gestellt. Anschließend wird anhand der Virus- und Patientendaten die Auswahl der Therapieform sowie die Entscheidung über das Therapieende getroffen. Zukünftig wird es vielfältigere Therapieoptionen geben, die vor allem auf die funktionale Kontrolle oder gar Elimination der chronischen HBV-Infektion abzielen und die auch die Therapiechancen bei der Hepatitis Delta erhöhen. Letztere kann bislang nur mit pegyliertem Interferon behandelt werden. Die chronische Hepatitis C ist ein Paradebeispiel für die maßgeschneiderte Therapie anhand von Virus- und Wirtsfaktoren. Die Hauptmotivation ist allerdings, Kosten zu sparen. Aufgrund der hohen Erfolgsraten der direkt antiviral wirkenden Therapie von über 95 % ist eine länderweite oder gar globale Elimination der HCV-Infektion prinzipiell möglich. Dennoch muss aufgrund der hohen Reinfektionsraten in Hochrisikogruppen sowie der mangelnden Verfügbarkeit der Medikamente weiterhin die Notwendigkeit einer Impfung oder Präexpositionsprophylaxe ernsthaft diskutiert werden. Bei der Hepatitis E gibt es bislang nicht viele Optionen. Hier ist die Therapieindividualisierung noch stark limitiert.

Abstract

Precision medicine is also possible for infectious diseases as shown for the treatment of chronic viral hepatitis, especially if different options are available. In hepatitis B virus (HBV) infection, treatment indication as well as the choice of treatment and the decisions to stop treatment are based on viral markers and alanine aminotransferase (ALT) level. Future therapies for HBV infection aiming for functional cure or even virus elimination may be even more personalized and have to take into account the immune status of a given patient. Such treatment modalities might also increase the chance for successful treatment of chronic hepatitis delta where treatment options are still very limited. Some new therapeutic concepts targeting host receptors or host enzymes are promising, but may require individualized approaches. Chronic hepatitis C is a good example for precision medicine based on viral and host factors. However, the main reason for individualized direct-acting antiviral (DAA) treatment is to save costs. As DAAs are effective in more than 95% of patients, elimination of HCV seems to be possible at the level of a given country or even on a global scale. However, owing to high reinfection rates in high-risk groups and limited availability of antiviral therapy in many high endemic countries, it must still be decided whether an HCV vaccine or pre-exposure prophylaxis is required to achieve this goal. Hepatitis E is an emerging topic as this is the most frequent acute hepatitis virus infection. It can result in a chronic infection in immunosuppressed individuals. Treatment options are still limited and individualized management is based on tailoring immunosuppressive therapy and therapy with ribavirin. Thus, personalized therapy of hepatitis E virus infection is still limited.

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Authors and Affiliations

  1. Zentrum für Infektiologie, Molekulare Virologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 345, 69120, Heidelberg, Deutschland

    R. Bartenschlager

  2. Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland

    R. Bartenschlager

  3. Deutsches Zentrum für Infektionsforschung (DZIF), Standort Heidelberg, Heidelberg, Deutschland

    R. Bartenschlager

  4. Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    M. Cornberg

  5. Centre for Individualised Infection Medicine (CIIM), c/o CRC Hannover, Feodor-Lynen-Str. 15, 30625, Hannover, Deutschland

    M. Cornberg &  T. Pietschmann

  6. Deutsches Zentrum für Infektionsforschung (DZIF), Standort Hannover-Braunschweig, Hannover/Braunschweig, Deutschland

    M. Cornberg &  T. Pietschmann

  7. Institut für Experimentelle Virologie, Twincore, Zentrum für Experimentelle und Klinische Infektionsforschung, Feodor-Lynen-Str. 7, 30625, Hannover, Deutschland

    T. Pietschmann

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Correspondence to M. Cornberg.

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Interessenkonflikt

R. Bartenschlager gibt an, dass kein Interessenkonflikt besteht. M. Cornberg: Honorare für Vortragstätigkeit oder Beratertätigkeit von AbbVie, Bristol-Myers Squibb, Falk Foundation, Gilead Science, Merck (MSD), Novartis, Roche Pharma, Roche Diagnostics, Siemens. Forschungsunterstützung durch Roche Pharma. T. Pietschmann: Honorare für Vortragstätigkeit von AbbVie.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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D. Heinz, Braunschweig

M.P. Manns, Hannover

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Bartenschlager, R., Cornberg, M. & Pietschmann, T. Maßgeschneiderte Therapie der Virushepatitis der Gegenwart und Zukunft. Internist 58, 666–674 (2017). https://doi.org/10.1007/s00108-017-0262-8

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