Hepatitis B: epidemiology, natural history, laboratory findings, and treatment monitoring.

Hepatitis B virus (HBV) infection is a worldwide public health problem. In France, 150 000 individuals are infected with the KBV. Although many are as ymptomatic carriers, about 30% have chronic hepatitis, a condition associat ed with a risk of cirrhosis and hepatocellular carcinoma. Antiviral treatme nts, most notably interferon alpha, probably modify the natural history of hepatitis B, decreasing the risk of hepatocellular carcinoma and increasing survival. Nucleoside analogs, particularly lamivudine, have also demonstra ted potent antiviral activity, which should however be weighed against the increasing risk over time of mutation development in the YMDD region of the DNA polymerase reverse transcriptase. Antiviral therapy monitoring should include clinical safety evaluations and periodic laboratory tests including blood cell counts, transaminase activities, and serum DNA levels. The impr oving results provided by antiviral drugs should not deflect attention away from the importance of large-scale hepatitis B immunization of neonates, w hich has been shown to decrease the incidence of hepatocellular carcinoma i n areas with high levels of hepatitis B endemicity.