Treatment of chronic hepatitis B virus infection: An Asia-Pacific perspective

Chronic hepatitis B infection is a serious health threat in the Asia-Pacifi c area. A consensus meeting on the treatment of chronic hepatitis B infecti on was conducted in Hong Kong, in August 1997. It was generally agreed that treatment of chronic hepatitis B infection should be based on the understa nding of the natural history of chronic hepatitis B infection. To date, int erferon a is the only Food and Drug Administration (FDA)-approved form of t herapy for chronic hepatitis B infection. The overall response in Asian pat ients is unsatisfactory: approximately 15-20% will clear hepatitis B e anti gen, but less than 5% will clear hepatitis B surface antigen. Newer immunom odulatory therapies are under trial. In contrast, nucleoside analogues, suc h as lamivudine (pending FDA approval) and famciclovir, have been shown to be potent. suppressors of hepatitis B viral replication; however, their rol e as monotherapy in the treatment of chronic hepatitis B infection remains to be defined. Also, the issues of resistance to nucleoside analogues and w ithdrawal rebound need to be carefully studied. The future direction of the rapy in chronic hepatitis B infection is probably a combination of nucleosi de analogues or nucleoside analogues with immunomodulatory therapy.