Hepatitis B : Latest treatment guidelines

Patients with chronic hepatitis B who are candidates for treatment include those in the immune clearance phase (positive for hepatitis B e antigen [HBeAg], elevated olanine aminotransferase level, moderate to severe inflammation on liver biopsy, and evidence of viremia) and those in the reactivation phase (negative for HBeAg, documented viremia, active liver disease, or moderate to severe inflammation on liver biopsy). Monitor infected patients in whom liver enzyme levels are normal or slightly elevated or in whom biopsy shows minimal or mild inflammation. The long-term goals of treatment are sustained viral suppression, biochemical remission of liver disease, and prevention of decompensated cirrhosis and hepatocellular carcinoma. FDA-approved treatment options include interferon alfa, lamivudine, and adefovir. Virologic and biologic responses at the end of treatment appear fairly comparable for the 3 therapies; a sustained response is slightly more likely in interferon responders. Interferon therapy is associated with significant side effects and at times is contraindicated in patients with drrhosis.