Book Review

Viral Hepatitis: Diagnosis, treatment, prevention

N Engl J Med 1997; 337:1178October 16, 1997

Article

Viral Hepatitis: Diagnosis, treatment, prevention
(Gastroenterology and Hepatology.) Edited by Richard A. Willson. 532 pp. New York, Marcel Dekker, 1997. $175. ISBN: 0-8247-9416-8

In 1997, a total of 532 pages on the diagnosis, treatment, and prevention of viral hepatitis seems to make this book neither fish nor fowl. On one hand, 532 pages are insufficient for the adequate treatment of the literature on these subjects for hepatologists; when I received this book I looked up “viral hepatitis” on the Internet. In 1996 the total number of citations was 1706, and from 1994 to June 1997 there were 5869 citations. In this book, many chapters seem to have been written in 1995, which is too long ago. In the chapters on treatment there were very few data on the efficacy of lamivudine in nonimmunocompromised patients, patients with human immunodeficiency virus infection, or patients who have received transplants. The chapter on the role of iron was written before the discovery of the hemochromatosis gene.

On the other hand, 532 pages could be too long for nonspecialists. For them, more tables and figures, and perhaps more overviews, would have been helpful. For example, in 1997 it is mandatory that readers be furnished with a meta-analysis of treatment when the results of many randomized trials have been published. Not only have there been many randomized trials of treatments for hepatitis B and hepatitis C, but several meta-analyses have also been published in 1996 or earlier.

The chapter on molecular diagnosis is probably the best one in the book because of its clear and concise style. The chapter on hepatitis A is a well-balanced account of the biology, epidemiology, and clinical aspects of this virus. In contrast, the chapter on hepatitis B concentrates too much on data from the United States.

Even if there is little probability that a reader of the New England Journal of Medicine will see a patient with icterus and hemorrhagic fever, reading the chapter on other hepatitis viruses is worth it. For internists, this chapter is reassuring because it furnishes a complete list of differential diagnoses. The role of G virus in hepatitis is small but worth discussing. The recent avalanche of abstracts and papers concerning this virus indicates that more people have studied it than have suffered from it.

Several chapters go beyond virology; extrahepatic manifestations, autoimmune hepatitis, the immunocompromised host, and hemochromatosis are all discussed. The excellent chapter on marrow and stem-cell transplantation will probably reassure hematologists who have to deal with abnormal liver-test results. It is probably the best paper on the subject you can find.

I regret the absence from this type of book of a global assessment of our capacity to change the natural history of these diseases. A compilation of chapters on specialized topics by eminent colleagues is insufficient. A systematic assessment of the effect of prevention or treatment with drugs or transplantation as compared with natural history would have been useful.

It is frustrating to read hundreds of references concerning factors associated with the normalization of transaminases during interferon treatment in patients with hepatitis C without any word about slowing the progression of fibrosis. Patients with hepatitis C die not from viremia or elevated transaminases but from the progression from fibrosis to cirrhosis. It is also frustrating to see many curves comparing the survival of patients who received liver transplants for hepatitis B with that of those who received them for hepatitis C. What we need is to see survival curves of patients with hepatitis B who underwent transplantation compared with their expected survival without transplantation. Even so, this book is a good guide for internists in the viral-hepatitis jungle.

Thierry Poynard, M.D.
Groupe Hospitalier Pitié–Salpêtrière, 75651 Paris CEDEX 13, France