SPECIAL FEATURE Vol.6 No.2 (April 2001)

The Hong Kong Association for the Study of Liver Diseases Position Statement - Therapy for Chronic Hepatitis B
(November 2000)

Dr. Nancy Leung
Department of Medicine and Therapeutics, Prince of Wales Hospital,
The Chinese University of Hong Kong

Natural History of Chronic Hepatitis B Infection

Most Asians are infected at birth or early childhood. 3 stages are identified in the natural history. It is important to realize that patients proceed through them at different speed. Immune tolerance stage is followed by immune clearance state. Final quiescent stage may be reached with no hepatic injury if there is early HBeAg seroconversion with negative HBV-DNA and resolved inflammatory activity. On the other hand, prolonged immune clearance with fluctuating viral level and ALT elevation may lead to cirrhosis and increase risk for hepatocellular carcinoma. HBeAg negative viraemic patients with precore/core promotor mutant virus is recently recognized as another subgroup of chronic hepatitis.

Therapeutic Options for Chronic Hepatitis B Infection

Therapeutic agents act by direct antiviral action and/or immune modulation. Many potential agents are found in recent years and being assessed in clinical trials. At present, only interferon and lamivudine are registered in Hong Kong.

Key Points

Interferon Monotherapy

Lamivudine Monotherapy

Interferon and Lamivudine Combination

Clinical trials showed improved efficacy predominantly in those with ALT 2-5 x ULN. This needs to be confirmed with more large scale studies.

Future Perspectives

Though interferon and lamivudine monotherpay yielded significant response, this is still far from ideal. The strategy for therapy should be a combination of two and more effective agents that can rapidly and strongly suppress viral replication and eliminate infected hepatocytes that harbour HBV cccDNA. The potential candidate include nucleoside analogues (emtricitabine, adefovir dipivoxil, entecavir, FMAU), thymosin and therapeutic vaccines.