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 Table of Contents    
EDITORIAL  
Year : 2010  |  Volume : 7  |  Issue : 1  |  Page : 1-4
Editorial


Department of Gastroenterology, S.C.B. Medical College, Cuttack 753007, Orissa, India

Click here for correspondence address and email

Date of Web Publication4-Aug-2015
 

How to cite this article:
Singh SP. Editorial. Hep B Annual 2010;7:1-4

How to cite this URL:
Singh SP. Editorial. Hep B Annual [serial online] 2010 [cited 2020 Aug 5];7:1-4. Available from: http://www.hepatitisbannual.org/text.asp?2010/7/1/1/162100


This issue of hepatitis B annual is a compendium of articles based on key presentations made at the Asia-Pacific Regional Symposium on hepatitis B held in Mumbai on 31 January, 2010. Chronic hepatitis B (CHB) as a result of infection with hepatitis B virus (HBV) is a global health issue. HBV can establish chronic infection leading to progressive liver disease including cirrhosis and hepatocellular carcinoma (HCC). Clinical management of chronic HBV infections places a tremendous burden on healthcare resources and, most importantly, on the infected patients and their families. Clinicians and laboratory scientists have sought key epidemiological, pathological, and viral characteristics that may permit the safe and effective management of chronically infected individuals. The objective of this supplementary issue of the journal was to enhance awareness and familiarize health care providers with different clinical presentations of CHB to enable them to optimize care of their patients with CHB. The first essay "Screening for CHB" by Prof. K. T. Shenoy reviews the different aspects of screening for HBV infection including the special population groups who should be specifically targeted for screening and the requirements for an ideal screening test. Besides it also summarizes the recommendations and federal mandates related to routine testing for chronic HBV infection. The article lays special emphasis on patient participation in the screening decision, resolution of barriers that individual patients may face such as transportation need for dependent care and work schedules follow-up, and tracking of a patient's receipt of screening tests, and adherence to a negotiated screening strategy for a successful screening program.

Patients with CHB are at an increased risk of disease progression to cirrhosis, hepatic decompensation, and HCC. Effective therapy is necessary to reduce or prevent such disease progression. However, treatment of CHB continues to be a challenge for physicians due to the high burden of the disease and the limited efficacy of available therapy. The article "Goals of therapy in patients with CHB" by Dr. Ajay Duseja discusses the different goals of therapy including the biochemical and serological endpoints which have to be understood before one embarks upon the arduous task of elimination or suppression of the HBV and limiting progression of disease. This article also discusses the differing approaches to hepatitis B e-antigen (HBeAg)-positive and negative patient population, and the different treatment algorithms and guidelines proposed for managing CHB patients.

In CHB, the decision to commence treatment must balance the likelihood morbidity and mortality. Consideration of factors including age, concurrent illness, medication compliance, liver disease activity, likelihood of long-term benefit, and potential therapeutic risks such as side effects, must be included as part of a risk-benefit analysis. Besides, a large amount of new data accrued in recent years suggests that conventional criteria for treatment initiation based on existing disease progression do not necessarily correlate with the future risk of disease complications. Dr. R. K. Dhiman has in the article "Indications for treatment: Whom to treat and whom not to treat!" attempted to simplify decision making and answer the question: In whom is therapy indicated and in whom it is not? The next article "Selection of treatment options in management of CHB" by Dr. Deepak Amarapurkar highlights the different factors including patient characteristics which need to be taken into account before deciding on the agent used for treatment of CHB. These include antiviral potency and the genetic barrier to resistance.

In the next article "Treatment options for HBV with co-morbid conditions" Dr. A. K. Seth discusses the importance of testing for comorbidities. It should include a comprehensive medical history that focuses on cofactors associated with more progressive liver injury, and it should cover other viral liver diseases, tuberculosis pregnancy, etc. Co-infection can complicate treatment. The article discusses not only the propensity of people with liver damage due to chronic hepatitis to experience hepatotoxicity (liver toxicity) related to anti-HIV drugs, but also the potential of interaction between drugs used to treat HIV and hepatitis and how these can interact with exacerbation of side effects.

The article "HBV therapeutic end points" by Dr. Anil Arora discusses the different endpoints used in the treatment of CHB. Several virologic endpoints have been used to evaluate the efficacy of therapy including HBsAg loss, HBeAg seroconversion, and HBV DNA undetectability. Viral suppression induced by antiviral therapy is a major treatment endpoint because it is associated with an improvement in liver histology and clinical outcome and is now achievable in the majority of patients. The efficacy of antiviral treatment on the main clinical endpoints, such as survival and complications of the disease, has been demonstrated in patients with severe disease at baseline (cirrhosis with or without decompensation), but not yet in patients with minimal-to-moderate chronic hepatitis. Dr. Arora also discusses the evolving new end points for the treatment of chronic HBV infection in light of the development of more potent drugs and more sensitive assays with the quantification and kinetics of serum HBsAg, intrahepatic covalently closed circular-DNA and analysis of specific immunological responses. The last article by Dr. Gourdas Choudhuri dwells upon "Patient physician interaction" It has been shown that the way patients perceive their connection with their physician significantly influences their sense of satisfaction and level of concern about their health. Today, the fast-paced managed-care environment, relationship-building conversations has got lost, and the demands of keeping abreast of the latest medical treatment approaches can overshadow the need to practice and improve communication skills. This article stresses on how a good, effective, empathic physician-patient communication leads to improved patient compliance, better clinical outcomes and reduction in "doctor-shopping," and malpractice litigations.

This issue of hepatitis B annual should enhance awareness and familiarize health care providers with the different clinical presentations of CHB and enable them to provide better care to patients with hepatitis B viral infection.

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Correspondence Address:
Prof. Shivaram Prasad Singh
Department of Gastroenterology, S.C.B. Medical College, Cuttack - 7530070, Orissa
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-9747.162100

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