The treatment of chronic hepatitis B

The diagnosis of chronic hepatitis does not necessarily imply a treatment. This statement is endorsed by the fact that many forms of the disease are non-evolving or very slow evolving, and therefore development of cirrhosis or hepatocarcinoma is extremely unlikely in these minimal and mild forms of the disease. Furthermore, drugs used today occasionally lead to virus annihilation and, in any case, do not operate upon virus integration into the hepatocyte genome. However, at present there is a consensus regarding the opportunity of therapeutical intervention in chronic hepatitis B with major biological and histological signs of activity, although there remain two important issues to approach. The first one is the relatively low efficacy of therapy referred to the cost (i.e. a maximum of 40% of cases with long-lasting therapeutic response to interferon), while the second is the presence of various side effects, which can force the reducing of dosage or even the discontinuation of treatment. Antiviral therapies, which were using acyclovir, didanosine, zidovudine and vidarabine, have demonstrated their inefficiency. Therefore, two groups are still used nowadays: interferon and nucleosides analogues. Each of the medication enounced has defined dosages, treatment extent, indications and contraindications, side effects and therapy expectancies. Proper management in chronic hepatitis B can achieve the following end-points: obtaining HBeAg-to-anti-HBe seroconversion, prevention of the disease progression and quality-of-life improvement. The treatment of chronic hepatitis B is an ever-changing issue and our expectation for better results grows proportionally with the knowledge brought everyday by new research and clinical experience.