Related Experiment Videos
Recent progress and new trends in the treatment of hepatitis B
Alfredo Alberti1, Maurizia Rossana Brunetto, Massimo Colombo
1Department of Internal Medicine, University of Padua, Padua, Italy.
Insights
Antiviral therapy for chronic hepatitis B (HBV) aims to prevent cirrhosis and liver cancer (HCC). Current treatments like interferon alpha and lamivudine have limitations, necessitating careful patient selection and further research into combination therapies.
Area of Science:
- Hepatology
- Virology
- Pharmacology
Background:
- Chronic hepatitis B virus (HBV) infection carries significant risks of cirrhosis and hepatocellular carcinoma (HCC).
- Antiviral therapy is crucial for suppressing HBV replication to prevent disease progression.
- Approved treatments, interferon alpha and lamivudine, present distinct efficacy and tolerability profiles.
Purpose of the Study:
- To review the current antiviral treatment options for chronic HBV infection.
- To evaluate the efficacy, safety, and limitations of interferon alpha and lamivudine.
- To discuss treatment strategies based on patient profiles and disease stage.
Main Methods:
- Literature review of studies on chronic HBV antiviral therapies.
- Comparative analysis of interferon alpha and lamivudine.
- Discussion of clinical guidelines and treatment outcomes.
Main Results:
- Interferon alpha has limited efficacy and tolerability; lamivudine has better tolerability but faces resistance issues.
- Treatment choice depends on HBeAg status, liver disease severity, and response to therapy.
- Lamivudine is vital in end-stage liver disease for transplantation preparation.
Conclusions:
- Optimal use of current HBV therapies requires careful patient selection and consideration of long-term outcomes.
- Further research into combination regimens is needed for improved efficacy.
- The role of interferon in HCC prevention requires further investigation.
Abstract:
The annual rate of progression to cirrhosis in patients with chronic HBV is 0.4 to 14.2% and that of death 4 to 10%. HCC risk increases in parallel with the severity and duration of infection, with an annual incidence less than 0.5% in carriers and 6% in patients with cirrhosis. The main aim of antiviral therapy for chronic "wild-type" HBV infection is to suppress viral replication before cirrhosis and HCC develop. Two drugs are approved: IFN alpha and lamivudine. IFN alpha is costly, has a narrow range of efficacy, safety, and tolerability. Lamivudine is active, cheaper, and better tolerated but has limited efficacy, being associated with increasing resistance and loss of clinical response in the long term. IFN may be the first choice treatment in HBeAg-positive patients with a favourable profile and compensated liver disease. Patients with HBeAg-negative active disease can benefit from 12-24 months IFN treatment if early response is observed. Lamivudine should be started only after considering the uncertainties about duration of therapy and risks of stopping it. In patients with slowly progressive liver disease, treatment is better postponed until effective combination regimens are available. Lamivudine is of paramount importance in end-stage chronic liver disease to suppress HBV replication and allow successful transplantation. The role of interferon in preventing HCC is controversial. In two studies comparing the incidence of HCC in patients with HBeAg-negative chronic hepatitis treated with IFN, HCC developed less frequently in sustained responders than in non-responders in Greece (2 vs. 10%, P = 0.045), but not in Milan (7 vs. 10%, P = ns).