[Management of hepatitis B].
Treatment of chronic hepatitis B needs to consider two aspects. First, a certain proportion of patients will spontaneously undergo a stable remission of the underlying liver disease, i.e. without therapeutic intervention, on occasion of the HBeAg --> anti-HBe seroconversion. Second, all drugs that have been used so far in the treatment of HBV have rarely resulted in the definitive eradication of the viral infection, i.e. a permanent disappearance of HBsAg with development of anti-HBs. Thus, the most reasonable, albeit surrogate endpoint of treatment is the acceleration towards HBeAg --> anti-HBe seroconversion and/or the stable suppression of HBV replication at levels below 500000 copies/ml, which is associated with disappearance of intrahepatic necrosis and inflammation and slowing down of the fibrosis progression. Two drugs are currently available--interferon-alpha and lamivudine--and a third antiviral compound (adefovir dipivoxil) will soon appear in the market. Advantages and disadvantages of different therapeutic options are discussed below.
Departement für Klinische Pathologie, Universitätsspital HUG, Genf.
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de Gottardi
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Negro
D000225:Adenine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006513:Hepatitis B e Antigens / Q000097:blood / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D016898:Interferon-alpha / Q000627:therapeutic use; D019259:Lamivudine / Q000627:therapeutic use; D008875:Middle Aged; D063065:Organophosphonates; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D013997:Time Factors
D000998:Antiviral Agents; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens; D016898:Interferon-alpha; D063065:Organophosphonates; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D000225:Adenine; C106812:adefovir dipivoxil