Prophylaxis and therapy of HBsAg positive hepatitis

Different forms of prophylaxis and therapy of HBsAg positive hepatitis are discussed. Prevention of HBsAg positive hepatitis has been attempted by passive and active immunisation. For passive immunisation against parenteral infections hepatitis B immunoglobulin (HBIG) of high titer has to be used. However, the protection provided by HBIG is incomplete and temporary. Therefore active immunisation is to be preferred for protection of high risk groups. Experiments using the 22 nm spheric particles prepared from plasma of chronic carriers showed the efficacy of this type of vaccine. The direct way to treat the different forms of hepatitis B is the eradication of the virus from the body. Success has been claimed with the use of interferon and adenine arabinoside. However, this antiviral therapy is still in an experimental stage. In some forms of HBsAg positive hepatitis the liver damage is supposed to be the result of an immune response against the virus. Immunosuppression in these conditions failed, however, to show a beneficial effect. Corticosteroids turned out to be harmful in all forms of acute hepatitis and are therefore contraindicated. Chronic hepatitis B seems to be caused by the inability of the immune system to clear the virus. Successful results have been claimed employing immune stimulative agents like BCG, levamisole, and transfer factor. Most of these reports, however, are anecdotycal and the more comprehensive studies are uncontrolled.