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   2010| January-December  | Volume 7 | Issue 1  
    Online since August 4, 2015

 
 
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REVIEW ARTICLES
Goals of therapy in patients with CHB
Ajay Duseja
January-December 2010, 7(1):16-27
DOI:10.4103/0972-9747.162109  
Despite the development of a number of antiviral agents for treatment of Chronic Hepatitis B, the treatment of chronic hepatitis B continues to be a challenge for physicians due to the high burden of the disease and the limited efficacy of available therapy. The primary goal of treatment is to eliminate or suppress HBV in order to decrease pathogenicity and infectivity, and reduce hepatic necroinflammation. Clinically, the short-term goal of treatment is to reduce hepatic activity, to prevent the development of hepatic decompensation, to ensure loss of HBeAg (with seroconversion to anti-HBe) and/or HBV-DNA with alanine aminotransferase (ALT) normalization at the end or 6-12 months after the end of treatment. The long-term goals are eradication of infection, prevent progression to cirrhosis, prevent development of HCC, and ultimately prolong survival. This review discusses the goals of therapy in patients with chronic hepatitis B.
  5,687 201 -
Indications for treatment: Whom to treat and whom not to treat!
RK Dhiman
January-December 2010, 7(1):28-44
DOI:10.4103/0972-9747.162121  
Despite the development of an effective vaccine, Hepatitis B virus (HBV) infection remains a major public health problem worldwide with a significant proportion of chronic HBV infected patients developing liver cirrhosis, liver failure, and primary hepatocellular carcinoma (HCC). Chronic hepatitis B is one of the 10 major causes of death worldwide. Although a number of antiviral agents against HBV are now available, proper selection of patients who would be ideal candidates for therapy is essential. The rationale for treatment is to reduce the risk of progressive chronic liver disease, transmission to others, and other long-term complications from chronic HBV such as hepatocellular carcinoma. The decision to commence treatment must balance the likelihood of a sustained treatment response, with the future risk of liver-related morbidity and mortality. Consideration of further factors, including patient 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. A large amount of new data have become available in recent years, suggesting that conventional criteria for treatment initiation based on existing disease progression do not necessarily correlate with the future risk of disease complications. This review summarizes the various factors which have to be considered before selecting the patient for treatment.
  4,975 182 -
Screening for chronic Hepatitis B
KT Shenoy
January-December 2010, 7(1):5-15
DOI:10.4103/0972-9747.162105  
Hepatitis B virus (HBV) infection is a major public health problem worldwide. More than 2 billion people have been infected; more than 350 million present with chronic HBV infection. A significant proportion (15-40%) of chronic HBV infected patients develop liver cirrhosis, liver failure, and primary hepatocellular carcinoma (HCC), making chronic hepatitis B one of the 10 major causes of death worldwide. The practice of preventive medicine involves three primary tasks: Screening, counseling, and immunization or chemoprophylaxis. Screening healthy individuals incurs an ethical obligation on the clinician. Persons who are most likely to be actively infected with HBV should be tested for chronic HBV infection. Testing should include a serologic assay for HBsAg offered as a part of routine care and be accompanied by appropriate counseling and referral for recommended clinical evaluation and care. To determine susceptibility among persons who are at ongoing risk for infection and recommended for vaccination, total anti-HBc or anti-HBs also should be tested at the time of serologic testing for chronic HBV infection. Recommendations related to screening for chronic HBV infection have been summarized in this article.
  3,356 232 -
EDITORIAL
Editorial
Shivaram Prasad Singh
January-December 2010, 7(1):1-4
DOI:10.4103/0972-9747.162100  
  2,018 114 -
REVIEW ARTICLES
Selection of treatment options in the management of chronic Hepatitis B
Deepak Amarapurkar
January-December 2010, 7(1):45-56
DOI:10.4103/0972-9747.162125  
There has been considerable progress in the treatment of hepatitis B in the past two decades. However, currently approved treatments have significant limitations, and the long-term management of patients with chronic HBV infection is as much an art as a science. Selection of the optimal treatment option is very important in the treatment of chronic hepatitis B. In this review, the focus is on current treatment strategies of chronic hepatitis B
  2,024 98 -
HBV therapeutic end points
Anil Arora
January-December 2010, 7(1):73-85
DOI:10.4103/0972-9747.162150  
Chronic hepatitis B [CHB] is a major health problem especially in developing countries. Defining the end point of therapy is a key issue in management of CHB patients, since a judicious balance has to be maintained between containing the virus and its sequelae and futility of continuation of therapy beyond a point. The major goals of antiviral therapy are to prevent the complications of CHB such as the development of liver cirrhosis, liver failure, HCC and death. Major advances have been made in the treatment of chronic hepatitis B, which led to significant improvements in the management of the disease. Several virologic end points have been used to evaluate the efficacy of therapy, including HBsAg loss, HBeAg seroconversion and HBV DNA undetectability. It was shown that viral suppression induced by antiviral therapy is a major treatment end point because it is associated with an improvement in liver histology and clinical outcome, and is now achievable in the majority of patients. New end points for the treatment of chronic HBV infection are emerging in the light development of more potent drugs and availability of more sensitive assays with the quantification and kinetics of serum HBsAg, intrahepatic cccDNA and analysis of specific immunological responses. However, liver biopsy still remains the gold standard but is impractical due to invasive nature, sampling error, and the significantly delay it takes for changes to appear. There is no ideal endpoindr for evaluation of therapies for hepatitis B at the moment, and future research should be directed at development and validation of endpoints that could precisely foretell or reflect outcomes in patients with CHB.This review which discusses the various end points of treatment of CHB should be of immense benefit to the practicing clinicians.
  1,961 75 -
Patient physician interaction
Gourdas Choudhuri
January-December 2010, 7(1):86-93
DOI:10.4103/0972-9747.162158  
Effective interaction and communication between doctor and patient is a central clinical function that cannot be delegated. Besides, the information and evidence which is generated by a proper interaction and communication, to individualize and tailor the treatment for each patient of Hepatitis B, the way patients' perceive their connection with their physician significantly influences their sense of satisfaction and level of concern about their health. A good effective, empathic physician-patient communication leads to improved patient compliance, better clinical outcomes and reduction in "doctor-shopping" and malpractice litigations. It has now been established that problems in doctor-patient interaction and communication are extremely common and adversely affect patient management. It has been repeatedly shown that the clinical skills needed to improve these problems can be taught and that the subsequent benefits to medical practice are demonstrable, feasible on a routine basis, and enduring. Improvement in the care of hepatitis B patients, it is essential that patient physician interaction is optimal in view of the prolonged duration of therapy and uncertainty of outcome of therapy in these cases. This unique essay sheds light on the strategies which the physicians need to adopt to improve patient physician interaction.
  1,766 54 -
Treatment options for HBV with co-morbid conditions
AK Seth
January-December 2010, 7(1):57-72
DOI:10.4103/0972-9747.162141  
The treatment for Hepatitis B viral infection without any co-morbidities is relatively simpler, although the outcome remains suboptimal. However in a large number of these patients, the matter is complicated by co-morbid conditions which exist in these patients and the treatment in such patients has to be tailored to individual settings and demands. All patients of chronic hepatitis B [CHB] must be evaluated for co-morbidities especially those which can complicate treatment. This overview attempts to provide clinicians with guidance for treatment of CHB patients who have coexisting co-morbidities.
  1,703 61 -
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