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REVIEW ARTICLE
Year : 2006  |  Volume : 3  |  Issue : 1  |  Page : 165-179

Controversies in the management of hepatitis B


Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow - 226 014, India

Correspondence Address:
Gourdas Choudhuri
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow 226014
India
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Source of Support: None, Conflict of Interest: None


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Hepatitis B is the leading cause of viral hepatitis in the developing world; at least 350 million people are infected with chronic hepatitis B worldwide. Although there are now 6 drugs approved by FDA for treatment of hepatitis B, treatment with nucleoside analogues are complicated by the need for long term therapy and the emergence of resistant strains. On the other hand, Interferon based treatment, though time bound, requires injections and is associated with significant side effects. Hence, optimal treatment of hepatitis B continues to remain the subject of many clinical trials. Management of nucleoside resistant mutants has become a major challenge in clinical practice today. Analogous to its use in HIV, the rationale behind the use of combination therapy is to improve the efficacy and decrease the risk of developing drug resistant strains. In treating HIV infection, combination therapy with agents acting through different mechanisms increases the genetic barrier for developing resistance. What is the current status of "combination therapy"? Is "combination therapy" the way forward? Other contentious issues in the field of Hepatitis B management include the relevance of Anti-HBc screening for blood donors, and the number of doses needed for Hepatitis B vaccine: two doses or three doses? Besides, should patients with normal ALT be treated? And is the presence of IgM anti-HBc diagnostic of acute hepatitis B? This review will discuss these different controversies that arise during care of patients with Hepatitis B.


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