[Management of chronic viral hepatitis]. / Prise en charge des hépatites virales chroniques.

This review highlights recent progress in the management of chronic hepatitis B, C and D. New nucleoside and nucleotide analogs have recently been approved and are currently being evaluated for the treatment of chronic hepatitis B. At the same time, resistance is becoming an increasingly common clinical problem. Efforts are currently being made to individualize treatment regimens for patients with chronic hepatitis C, with the aim of enhancing efficacy and improving tolerability. Finally, recent studies using pegylated interferon-alpha have shown promising results for the treatment of chronic hepatitis D.

Elevated hepatocyte paraffin 1 and neprilysin expression in hepatocellular carcinoma are correlated with longer survival.

Hepatocyte paraffin 1 (Hep Par 1) and neprilysin (CD10) are well-known markers of hepatocellular carcinoma (HCC). To assess their potential prognostic role, we conducted a retrospective analysis of 97 formalin-fixed and paraffin-embedded HCC from patients treated by surgery with curative intent, using standard immunohistochemical procedures and semiquantitative analysis. Strong Hep Par 1 expression and canalicular CD10 staining pattern were significantly correlated with smaller tumor size (p=0.007 and 0.04, respectively). On univariate analysis, longer overall survival was observed in patients with strong Hep Par 1 expression (p=0.0005) and in patients with a CD10can staining pattern (p=0.02). On multivariate analysis, the combined immunohistochemical score (CIS) obtained by addition of Hep Par 1 and CD10can scores and subtraction of cytoplasmic CD10 score was retained as the single most important prognostic factor (p=0.001). Patients with a CIS <4 had a 3.5-fold increased risk of death, as compared to those with a CIS >or=4. In conclusion, strong Hep Par 1 expression, presence of CD10can labeling, and absence of CD10cyt staining are favorable prognostic factors in HCC, which can be easily combined into a single immunohistochemical score for routine clinical use.