Alpha-interferon combined with immunomodulation in the treatment of chronic hepatitis B

Interferon has profound anti-viral, anti-proliferative and immunomodulatory effects. Future studies should be directed at observing how the immunomodulatory effects predict a response in certain groups of patients. Interferon is very useful in chronic hepatitis B but may require the addition of a steroid pulse. Individuals with low serum ALT appear to benefit most from a steroid pulse. Therapy should be given with a great deal of caution in patients with decompensated liver disease, as one may precipitate the untimely demise of the patient even though viral replication is decreased. One of the patients in the IFN study in fact did have decompensation after prednisone therapy, which subsequently led, a couple of months later, to a variceal haemorrhage. In summary, in treating hepatitis B viral infection, no single agent is totally effective and perhaps the combination of suppressing viral replication and augmenting the immune system is the optimal way to eradicate the virus. At present, an adequate response is found in only about 30-40% of patients even with 'optimal' therapy.