Improving outcomes for patients with chronic hepatitis B.
The ultimate goal in managing patients with chronic hepatitis B (CHB) is to improve long-term outcomes by decreasing deaths and liver transplantation procedures due to hepatitis B virus (HBV)-related cirrhosis and hepatocellular carcinoma. Active intervention and vaccination of individuals susceptible to HBV infection are key steps to decrease the risk of this global public health problem. Large studies have demonstrated that long-term outcomes of CHB are tied to serum levels of HBV DNA. New oral treatments, characterized by potent antiviral effects, good tolerability, improved histology, stable seroconversion, and minimal resistance, are available. Long-term data with oral medications have shown decreased rates of liver cancer development, liver disease reversal, and progression to liver failure. Pegylated interferon trials have demonstrated modest rates of hepatitis B e antigen seroconversion and improved histology after treatment. This paper describes ways to improve outcomes of CHB using vaccines, interferon, lamivudine, adefovir, and newer agents.
Gish
Robert G
RG
Department of Medicine, Division of Hepatology and Complex GI, Physicians Foundation, California Pacific Medical Center, 2340 Clay Street, Room 223, San Francisco, CA 94115, USA. gishr@sutterhealth.org
D000225:Adenine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use*; D024882:Drug Resistance, Viral; D006147:Guanine / Q000031:analogs & derivatives / Q000627:therapeutic use; D017325:Hepatitis B Vaccines; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000517:prevention & control*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D019259:Lamivudine / Q000627:therapeutic use; D009705:Nucleosides / Q000627:therapeutic use; D063065:Organophosphonates / Q000627:therapeutic use; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011744:Pyrimidinones / Q000627:therapeutic use; D011994:Recombinant Proteins; D000077712:Telbivudine; D013936:Thymidine / Q000031:analogs & derivatives; D016896:Treatment Outcome; D019562:Viral Load
D000998:Antiviral Agents; D017325:Hepatitis B Vaccines; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D009705:Nucleosides; D063065:Organophosphonates; D011744:Pyrimidinones; D011994:Recombinant Proteins; D000077712:Telbivudine; D019259:Lamivudine; D011092:Polyethylene Glycols; C413685:entecavir; D006147:Guanine; D000225:Adenine; C100416:peginterferon alfa-2a; C106812:adefovir dipivoxil; D013936:Thymidine