Recent progress and new trends in the treatment of hepatitis B

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Online ISSN: 1096-9071 Print ISSN: 0146-6615

Journal of Medical Virology

Volume 67, Issue 3, 2002. Pages: 458-462

Published Online: 24 May 2002

Copyright © 2002 Wiley-Liss, Inc

Recent progress and new trends in the treatment of hepatitis B

Alfredo Alberti 1, Maurizia Rossana Brunetto 2, Massimo Colombo 3,

Craxì 4 *

1Department of Internal Medicine, University of Padua, Padua, Italy

2GI Unit, Spedali Santa Chiara, Pisa, Italy

3GI Unit, University of Milan, Milan, Italy

4GI Unit, University of Palermo, Palermo, Italy

email: Craxì (craxanto@...)

*Correspondence to Craxì, UO Gastroenterologia, Clinica Medica,

Piazza delle Cliniche 2, 90127 Palermo, Italy.

ABSTRACT

The annual rate of progression to cirrhosis in patients with chronic HBV is

0.4 to 14.2% and that of death 4 to 10%. HCC risk increases in parallel with

the severity and duration of infection, with an annual incidence less than

0.5% in carriers and 6% in patients with cirrhosis. The main aim of

antiviral therapy for chronic wild-type HBV infection is to suppress viral

replication before cirrhosis and HCC develop. Two drugs are approved: IFN

alpha and lamivudine. IFN alpha is costly, has a narrow range of efficacy,

safety, and tolerability. Lamivudine is active, cheaper, and better

tolerated but has limited efficacy, being associated with increasing

resistance and loss of clinical response in the long term. IFN may be the

first choice treatment in HBeAg-positive patients with a favourable profile

and compensated liver disease. Patients with HBeAg-negative active disease

can benefit from 12-24 months IFN treatment if early response is observed.

Lamivudine should be started only after considering the uncertainties about

duration of therapy and risks of stopping it. In patients with slowly

progressive liver disease, treatment is better postponed until effective

combination regimens are available. Lamivudine is of paramount importance in

end-stage chronic liver disease to suppress HBV replication and allow

successful transplantation. The role of interferon in preventing HCC is

controversial. In two studies comparing the incidence of HCC in patients

with HBeAg-negative chronic hepatitis treated with IFN, HCC developed less

frequently in sustained responders than in non-responders in Greece (2 vs.

10%, P = 0.045), but not in Milan (7 vs. 10%, P = ns). J. Med. Virol.

67:458-462, 2002. © 2002 Wiley-Liss, Inc.

Accepted: 24 January 2002

10.1002/jmv.10097 DOI

[Guest guest]

Online ISSN: 1096-9071 Print ISSN: 0146-6615

Journal of Medical Virology

Volume 67, Issue 3, 2002. Pages: 458-462

Published Online: 24 May 2002

Copyright © 2002 Wiley-Liss, Inc

Recent progress and new trends in the treatment of hepatitis B

Alfredo Alberti 1, Maurizia Rossana Brunetto 2, Massimo Colombo 3,

Craxì 4 *

1Department of Internal Medicine, University of Padua, Padua, Italy

2GI Unit, Spedali Santa Chiara, Pisa, Italy

3GI Unit, University of Milan, Milan, Italy

4GI Unit, University of Palermo, Palermo, Italy

email: Craxì (craxanto@...)

*Correspondence to Craxì, UO Gastroenterologia, Clinica Medica,

Piazza delle Cliniche 2, 90127 Palermo, Italy.

ABSTRACT

The annual rate of progression to cirrhosis in patients with chronic HBV is

0.4 to 14.2% and that of death 4 to 10%. HCC risk increases in parallel with

the severity and duration of infection, with an annual incidence less than

0.5% in carriers and 6% in patients with cirrhosis. The main aim of

antiviral therapy for chronic wild-type HBV infection is to suppress viral

replication before cirrhosis and HCC develop. Two drugs are approved: IFN

alpha and lamivudine. IFN alpha is costly, has a narrow range of efficacy,

safety, and tolerability. Lamivudine is active, cheaper, and better

tolerated but has limited efficacy, being associated with increasing

resistance and loss of clinical response in the long term. IFN may be the

first choice treatment in HBeAg-positive patients with a favourable profile

and compensated liver disease. Patients with HBeAg-negative active disease

can benefit from 12-24 months IFN treatment if early response is observed.

Lamivudine should be started only after considering the uncertainties about

duration of therapy and risks of stopping it. In patients with slowly

progressive liver disease, treatment is better postponed until effective

combination regimens are available. Lamivudine is of paramount importance in

end-stage chronic liver disease to suppress HBV replication and allow

successful transplantation. The role of interferon in preventing HCC is

controversial. In two studies comparing the incidence of HCC in patients

with HBeAg-negative chronic hepatitis treated with IFN, HCC developed less

frequently in sustained responders than in non-responders in Greece (2 vs.

10%, P = 0.045), but not in Milan (7 vs. 10%, P = ns). J. Med. Virol.

67:458-462, 2002. © 2002 Wiley-Liss, Inc.

Accepted: 24 January 2002

10.1002/jmv.10097 DOI