Chronic hepatitis B: problem patients (including patients with decompensated disease)

Most patients with chronic hepatitis B do not respond to a 4-month course of interferon alpha (IFN-alpha) and require alternative therapy. This paper focuses on alternative treatments for patients who are resistant to conventional IFN regimens (primary nonresponders) and those in whom therapy presents a special challenge. Problem patients include healthy hepatitis B surface antigen (HBsAg) carriers and those with minimal serum aminotransferase elevations, immunosuppressed patients, and patients with end-stage liver disease. Special emphasis is given to patients with decompensated liver disease. While dramatic responses to IFN-alpha can occasionally occur in these patients, serious side-effects are common.