The return of hepatitis B

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World J Gastroenterol 2006 November;12(44):7081-7086

The " return " of hepatitis B

Krastev ZA.

Clinic of Gastroenterology, St. Ivan Rilsky University Hospital, 15, Acad.

Ivan Geshov Blvd., Sofia 1431, Bulgaria. zahkrastev@...

There has been a significant advance in the treatment of chronic Hepatitis B

virus (HBV) infection and the following drugs were approved for therapy:

Conventional interferon (IFN), pegylated interferon alfa-2a (PEG IFN

alpha2a), lamivudine, adefovir and entecavir. Compared to nucleoside

analogues IFN induces higher rates of sustained remission and HBsAg loss.

Conventional IFN in lower doses (1, 5-3 MIU) tiw for 4-6 mo has similar

efficacy in comparison to " standard IFN therapy " . Longer IFN treatment is a

significant factor for long-term remission in HBeAg-negative CHB, but the

higher actual IFN dose is not such a factor. PEG IFN is superior to

conventional IFN. There is no significant difference between PEG IFN alpha2a

at doses 90 mcg/wk and 180 mcg/wk in HBeAg-positive patients. These results

provide a rational for further clinical trials with lower doses PEG IFN

alpha2a given in prolonged course as maintenance or intermittent treatment.

Serious new problems arose after the introduction of nucleoside/nucleotide

analogues in clinical practice. The most important ones are drug-resistance

and the high rates of relapse after treatment discontinuation. Therapy

should only be recommended if the expected benefit exceeds significantly the

abstain from treatment. The choice of therapy should take into account the

patient's age, co-morbidity, severity of liver disease and the risk of

drug-resistance. New antivirals significantly suppress HBV-replication, but

have no effect on cccDNA in hepatocytes, and after the treatment

discontinuation viral relapses occurs. At the present level of knowledge it

is impossible " to eradicate the virus " The realistic treatment goal is to

achieve durable response by clearance of HBeAg, sustained decrease of serum

HBV DNA levels, normalization of ALT, improvement of liver histology and

stopping of liver fibrogenesis. The competition between IFN based therapy

and nucleoside or nucleotide analogues still remains. IFN can cure the liver

disease while nucleotide analogues only suppress the viral replication

during therapy and can reduce the liver fibrosis. Treatment should be

prolonged for 24-mo or longer by using maintenance or intermittent treatment

course with the lowest effective IFN and PEG IFN doses.

Nucleoside/nucleotide analogues are a promising treatment option, but

additional data for treatment duration and long-term post-treatment outcome

are necessary.

http://www.wjgnet.com/1007-9327/abstract_en.asp?f=7081 & v=12

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[Guest guest]

World J Gastroenterol 2006 November;12(44):7081-7086

The " return " of hepatitis B

Krastev ZA.

Clinic of Gastroenterology, St. Ivan Rilsky University Hospital, 15, Acad.

Ivan Geshov Blvd., Sofia 1431, Bulgaria. zahkrastev@...

There has been a significant advance in the treatment of chronic Hepatitis B

virus (HBV) infection and the following drugs were approved for therapy:

Conventional interferon (IFN), pegylated interferon alfa-2a (PEG IFN

alpha2a), lamivudine, adefovir and entecavir. Compared to nucleoside

analogues IFN induces higher rates of sustained remission and HBsAg loss.

Conventional IFN in lower doses (1, 5-3 MIU) tiw for 4-6 mo has similar

efficacy in comparison to " standard IFN therapy " . Longer IFN treatment is a

significant factor for long-term remission in HBeAg-negative CHB, but the

higher actual IFN dose is not such a factor. PEG IFN is superior to

conventional IFN. There is no significant difference between PEG IFN alpha2a

at doses 90 mcg/wk and 180 mcg/wk in HBeAg-positive patients. These results

provide a rational for further clinical trials with lower doses PEG IFN

alpha2a given in prolonged course as maintenance or intermittent treatment.

Serious new problems arose after the introduction of nucleoside/nucleotide

analogues in clinical practice. The most important ones are drug-resistance

and the high rates of relapse after treatment discontinuation. Therapy

should only be recommended if the expected benefit exceeds significantly the

abstain from treatment. The choice of therapy should take into account the

patient's age, co-morbidity, severity of liver disease and the risk of

drug-resistance. New antivirals significantly suppress HBV-replication, but

have no effect on cccDNA in hepatocytes, and after the treatment

discontinuation viral relapses occurs. At the present level of knowledge it

is impossible " to eradicate the virus " The realistic treatment goal is to

achieve durable response by clearance of HBeAg, sustained decrease of serum

HBV DNA levels, normalization of ALT, improvement of liver histology and

stopping of liver fibrogenesis. The competition between IFN based therapy

and nucleoside or nucleotide analogues still remains. IFN can cure the liver

disease while nucleotide analogues only suppress the viral replication

during therapy and can reduce the liver fibrosis. Treatment should be

prolonged for 24-mo or longer by using maintenance or intermittent treatment

course with the lowest effective IFN and PEG IFN doses.

Nucleoside/nucleotide analogues are a promising treatment option, but

additional data for treatment duration and long-term post-treatment outcome

are necessary.

http://www.wjgnet.com/1007-9327/abstract_en.asp?f=7081 & v=12

_________________________________________________________________

Fixing up the home? Live Search can help

http://imagine-windowslive.com/search/kits/default.aspx?kit=improve & locale=en-US\

& source=hmemailtaglinenov06 & FORM=WLMTAG