Year : 2005 | Volume
: 2 | Issue : 1 | Page : 11--13
Management of chronic hepatitis B infection: Miles to go…….
Shivaram Prasad Singh
Dept of Gastroenterology, SCB Medical College, Cuttack 753007, India
Shivaram Prasad Singh
Dept of Gastroenterology, SCB Medical College, Cuttack 753007
|How to cite this article:|
Singh SP. Management of chronic hepatitis B infection: Miles to go……. Hep B Annual 2005;2:11-13
|How to cite this URL:|
Singh SP. Management of chronic hepatitis B infection: Miles to go……. Hep B Annual [serial online] 2005 [cited 2020 Feb 19 ];2:11-13
Available from: http://www.hepatitisbannual.org/text.asp?2005/2/1/11/29372
In the first issue of Hepatitis B Annual, the articles were standard review articles on common issues relating to epidemiology, treatment and prophylaxis of hepatitis B. The present issue focuses on very specific and complex aspects of hepatitis B viral infection. The first article by Dr. JP Allain deals with Occult hepatitis B infection. Although, occult hepatitis B infection has been recognized for nearly two decades, with the improvements in sensitivity of serological assays, the attention given to this nearly silent form of the infection has been growing. Molecular data regarding this entity are scarce, and since most of the patients who are affected are asymptomatic, very little clinical data, especially histological is available. In this article, Dr. Allain reviews the biological background, and diagnostic and clinical significance of this not so rare condition.
The second article by Dr. Onji and Dr. Akbar from Japan deals with the role of vaccine therapy in the management of chronic hepatitis B. They discuss not only the development of more potent prophylactic vaccines against HBV but also better regimens of therapeutic vaccines for patients with chronic hepatitis B in view of recent developments in the relevant field. This form of therapy assumes importance due to the high cost of alternative treatment including Interferon and newer oral agents. This holds promise particularly for the less affluent patients in the emerging economies.
Currently, booster vaccination is generally not recommended for immunocompetent subjects up to 15 years after neonatal vaccination. Nonetheless, several countries and individuals currently have a policy of administering booster doses to certain risk groups. The real duration of protection conferred by HBV vaccination remains uncertain. The necessity of booster vaccination for HBV has been a subject of much debate. The next article by Dr. MH Chang and Dr. CY Lu address the contentious issue of hepatitis B booster vaccination.
Although, prospects for control of chronic HBV infection have never been better, given the development of more sensitive and sophisticated diagnostic tests and the development of newer anti-viral agents, control of HBV mutants will require new drugs, vaccines, and treatment strategies, and will become the next major challenge on the path to eventual elimination of HBV infection. An understanding of the molecular biology of HBV and knowledge of its life cycle should provide the necessary insight to appreciate the clinical and public health significance of these recently identified variants/mutants of HBV. The third article by Dr. Peter Revill and Dr. Stephen Locarnini deals with the important issue of the clinical significance and public health implications of HBV mutants.
The next two articles deal with management of chronic hepatitis B infection. Nucleoside analogues are creating waves in the treatment of chronic hepatitis B. Lamivudine and adefovir dipivoxil are both licensed and available in many countries for the treatment of chronic hepatitis B. Dr. Nancy Leung compares the efficacy and limitations of these two important therapeutic agents in the management of chronic hepatitis B. A comparison of their efficacy in the treatment of various subgroups of chronic hepatitis B patients would facilitate management decision and the choice between these two agents.
In the next article, Dr. Anna Lok discusses the approach to a patient with chronic hepatitis B infection. At the outset, she stresses how an understanding of the natural history of chronic HBV infection, and the safety and efficacy of currently available treatments is critical in the long-term management of patients with chronic HBV infection. Subsequently she meticulously discusses not only who should be treated, and when should hepatitis B treatment be initiated, but also stresses upon counselling of carriers to decrease disease progression and transmission of infection. In a stepwise manner, the article first outlines initial evaluation of patients with chronic hepatitis B, and then goes on to delineate monitoring of patients receiving treatment - for treatment response, drug resistance and side effects, and finally monitoring of patients who have completed treatment for post-treatment relapse.
Primary liver cancers are the third most common cause of cancer deaths among men, and sixth most common cause of cancer deaths among women. About 80% of HCCs and the resulting deaths occur in the developing countries of Asia and Africa, and HBV infections account for 75 to 80% of these virus-associated HCCs. In the article on pathogenesis, prevention and treatment of hepatitis B associated hepatocellular carcinoma, the team of Dr. WT London, Dr. WS Mason and Dr. M Nguyen from Fox Chase Cancer Center describe what is known and what is hypothesized about the pathogenesis of HBV associated HCC, and how to accomplish primary prevention of HBV associated HCC by vaccination against HBV. They also discuss briefly how treatment of chronic hepatitis B may reduce the risk of HCC. However, for prevention, they emphasize screening for early detection of HCC and chemoprevention. With respect to treatment of HCC, they focus on surgical resection, ablation procedures, and transplantation.
In the last article, Dr. MJ Alter discusses the important issue of epidemiology of hepatitis B virus infection in healthcare workers in the West and Asia. From the view of public health importance, this is a subject which is paradoxically utterly neglected in the developing countries where the issue deserves greater attention. This is in contrast to the situation in the developed countries where regulations and recommendations are in vogue to tackle this problem. It is time the developing countries woke up and take steps in this field, and frame regulations and guidelines suitable for their regions.
It is hoped that this issue will on one hand provide researchers some direction and impetus to strive to make greater inroads in the field of management of chronic hepatitis B, and on the other hand provide the clinicians guidance in treating their patients with chronic hepatitis B more judiciously. It is also hoped that the hepatologists and health planners of the developing countries would give some time and thought to the contentious issues of hepatitis B immunization booster and hepatitis B infection in healthcare workers.