The management of chronic hepatitis B infection

Chronic hepatitis B infection is frequently diagnosed within the genitourin ary clinic setting with sexual transmission the commonest route of acquisit ion in the United Kingdom. Only 3-5% of adults who contract acute hepatitis B will progress to chronic infection, and these individuals can be identif ied by the presence of hepatitis B surface antigen (HBsAg) in the bloodstre am 6 months after infection. Individuals at highest risk of long-term compl ications such as cirrhosis and hepatocellular carcinoma, carry HBeAg and ha ve high levels of circulating hepatitis B virus (HBV) deoxyribonucleic acid (DNA). Therapy should be targeted towards this group of patients. Two form s of therapy are now licensed for use in chronic hepatitis B infection: int erferon-alpha and lamivudine. Seroconversion occurs in 30-40% of patients t reated with interferon and treatment is often limited by toxicity. Lamivudi ne is well tolerated with seroconversion rates of 15-20% at one year, risin g with increasing duration of therapy. Long-term monotherapy is limited how ever by the development of resistance mutations and combination nucleoside therapy is likely to become the treatment of choice in the future. Patients with chronic hepatitis B should be counselled regarding transmission, part ner vaccination and alcohol intake and co-infection with other hepatitis vi ruses should be excluded.