REVIEW - PRESENT AND FUTURE-DIRECTIONS IN THE TREATMENT OF CHRONIC HEPATITIS-B INFECTION

The last decade has witnessed substantial progress in the development of chemotherapeutic agents for chronic hepatitis B. However, the only currently licensed treatment in Australia, interferon-alpha, has low i nitial response rates and the adverse effects are often unacceptable. Of the newer agents in the class of nucleoside analogues, famciclovir and lamivudine are in phase III clinical trials with encouraging preli minary results, while other agents, such as bis-POM PMEA (Adefovir), a re at phase I/II development. Future approaches to therapy will be gov erned by an understanding of the effects of nucleoside analogues on th e natural history of the disease as well as on the hepatitis B virus-h epatocyte interaction. Combination antiviral therapy should theoretica lly offer improved response rates, decrease the development of viral r esistance, and provide the greatest reduction in viral load, but it ha s not yet been widely examined in the clinical setting. In this articl e, we review the currently available strategies, discuss potential pro blem areas, and speculate on promising approaches with combination che motherapy and the features of agents soon to be trialed.