Management of HBV infection in Japan

Hepatitis B virus (HBV) is usually transmitted from mother to infant, and genotype C is prevalent in Japan. Because of these features, guidelines for HBV treatment from other countries are not directly adaptable to Japanese patients. Age is an important factor in deciding the treatment strategy, because many vertically transmitted HBV carriers naturally show spontaneous remission by the age of 25-30 years. In addition, genotype C is considered more refractory to antiviral therapies than genotypes A and B. Considering these differences, we propose a treatment for HBV in Japanese patients. Although the guidelines indicate who to treat and when therapy should be started, it is unclear for how long patientsshould be treated. This situation arises because current lamivudine and interferon monotherapies are not potent at curing HBV infection. To develop a more efficient treatment, we performed a pilot study of lamivudine/interferon sequential therapy in Japan. The biochemical and virological responses were comparable or superior to lamivudine or interferon monotherapies, and this protocol can be a potent alternative because we can take advantage of both the mild side-effects of lamivudine and finite duration of interferon.