Treatment of chronic type B hepatitis

Therapy for chronic hepatitis B virus (HBV) infection is primarily directed at those patients with evidence of replicative infection because they are most at risk for developing chronic hepatitis, cirrhosis, and possibly hepatocellular carcinoma (HCC). Although a number of agents or therapeutic approaches have been tested against HBV infection, only a few have been subjected to controlled clinical trial. Corticosteroid therapy, particularly if prolonged, may be harmful and should be avoided. Adenine arabinoside monophosphate (Ara-AMP) has potent inhibitory effects on HBV replication, but its use is limited by severe neurotoxicity. At present, prolonged treatment with alpha interferon offers the most promise as a beneficial therapy for chronic type B hepatitis. Alpha interferon consistently induces permanent clearance of hepatitis B e antigen (HBeAg) and HBV DNA from serum more often than in untreated patients. Present efforts are directed at determining the factors predictive of a favorable response to interferon, and attempting to increase the response rate by using alpha interferon in combination with other antiviral or immunomodulatory agents.