Current management strategies for hepatitis B in the elderly

Despite the availability of an efficient vaccine, chronic hepatitis B virus (HBV) infection remains a major public health problem worldwide. The World Health Organization estimates that there are still 350 million chronic car riers of the virus who are at risk of developing chronic hepatitis, liver c irrhosis and hepatocellular carcinoma (HCC). Antiviral therapy consists of the administration of either interferon-alpha (IFN alpha) or lamivudine. In the elderly, specific issues should be addre ssed. Because of the long duration of viral infection, screening for HCC is warranted in these patients, as new therapeutic options are being develope d. Antiviral treatment for chronic hepatitis B is indicated in patients wit h elevated transaminases. the presence of HBV replication, and inflammatory activity on liver histology analysis, providing the patient has no other s erious health problem impacting on life expectancy. Since IFN alpha therapy may cause many general adverse effects, lamivudine may be the best current treatment option in this patient population. The pharmacokinetics of lamiv udine in the elderly are slightly different from those in younger adults bu t this does not require dose adjustment, except in the presence of renal fu nction impairment. However, the beneficial effects of lamivudine therapy mu st be weighed against the selection of drug-resistant mutants. New therapeutic strategies are now under evaluation and may be available in the future for the elderly population. Besides mass HBV vaccination programmes, people sharing a house with patien ts infected with HBV should be vaccinated to prevent viral transmission.