Alpha-interferon therapy of chronic hepatitis B. Current status and recommendations

Antiviral therapy for chronic hepatitis B is still experimental. Recent studies suggest that a 3- to 6-month course of alpha-interferon in doses ranging from 5-10 million units (5 million units/m2) given daily or three times weekly will result in a clinical, biochemical and serological remission in 30-40% of patients with well compensated liver disease and with hepatitis B virus DNA and hepatitis B e antigen in serum. Features that predict a beneficial response to treatment include high initial serum aminotransferase activities and low levels of circulating viral DNA. Asian patients and children may be less likely to respond to treatment than Caucasian adults. Pre-treatment of patients with a 6-week course of high doses of prednisone may help to increase the response rate to alpha-interferon alone, but this approach should be used only in patients with mild disease and perhaps in patients who have previously failed to respond to alpha-interferon alone. The best approach to treatment of patients with complications of chronic hepatitis B and atypical serological patterns is still uncertain. The efficacy and the side effects of alpha-interferon therapy should be carefully balanced in the decision to treat patients with chronic hepatitis B. Future studies should focus upon the use of newer antiviral agents alone or in combination with alpha-interferon.