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Treatment of chronic hepatitis B virus infection: an Asia-Pacific perspective
G K Lau1, W F Carman, S A Locarnini
1Department of Medicine, Queen Mary Hospital, Hong Kong, China. GKKLau@hkstar.com
Insights
Treatment for chronic hepatitis B infection in Asia remains challenging. Future therapies may combine nucleoside analogues with immunomodulatory treatments for better outcomes.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- Chronic hepatitis B infection poses a significant health risk in the Asia-Pacific region.
- A 1997 consensus meeting in Hong Kong emphasized understanding the natural history for effective treatment.
- Current Food and Drug Administration (FDA)-approved therapy, interferon alpha, shows unsatisfactory response rates in Asian patients.
Framework:
- Interferon alpha achieves low rates of hepatitis B e antigen (15-20%) and hepatitis B surface antigen clearance (<5%).
- Nucleoside analogues like lamivudine and famciclovir demonstrate potent viral replication suppression.
- Further research is needed to define the role of nucleoside analogues as monotherapy and address resistance and withdrawal rebound.
Implementation:
- Newer immunomodulatory therapies are currently under investigation.
- The consensus highlighted the need for evidence-based treatment strategies.
- Ongoing trials explore novel therapeutic approaches for chronic hepatitis B.
Implications:
- Future chronic hepatitis B treatment likely involves combination therapy.
- Combining nucleoside analogues with immunomodulatory agents may offer improved efficacy.
- Addressing treatment challenges is crucial for managing this widespread infection.
Abstract:
Chronic hepatitis B infection is a serious health threat in the Asia-Pacific area. A consensus meeting on the treatment of chronic hepatitis B infection was conducted in Hong Kong, in August 1997. It was generally agreed that treatment of chronic hepatitis B infection should be based on the understanding of the natural history of chronic hepatitis B infection. To date, interferon alpha is the only Food and Drug Administration (FDA)-approved form of therapy for chronic hepatitis B infection. The overall response in Asian patients is unsatisfactory: approximately 15-20% will clear hepatitis B e antigen, but less than 5% will clear hepatitis B surface antigen. Newer immunomodulatory therapies are under trial. In contrast, nucleoside analogues, such as lamivudine (pending FDA approval) and famciclovir, have been shown to be potent suppressors of hepatitis B viral replication; however, their role as monotherapy in the treatment of chronic hepatitis B infection remains to be defined. Also, the issues of resistance to nucleoside analogues and withdrawal rebound need to be carefully studied. The future direction of therapy in chronic hepatitis B infection is probably a combination of nucleoside analogues or nucleoside analogues with immunomodulatory therapy.