I nterferon alfa (IFN), lamivudine, and adefovir dipivoxil are the only approved treatments for chronic hepatitis B. IFN treatment has a moderate efficacy and frequent side effects, and is associated with an inconvenient 3-timesweekly dosing regimen. Lamivudine and adefovir have significant antiviral activity, although viral rebound after cessation of therapy and development of resistance after long-term lamivudine therapy are major clinical limitations.The new pegylated forms of IFN (pegylated interferon alfa-2a or 2b) are currently being evaluated among chronic hepatitis B patients. The benefit of conjugation of IFN with polyethylene glycol is the improvement of delivery of IFN by significantly prolonging its plasma halflife and thereby providing protracted activity, which allows once-per-week dosing. Results from trials among hepatitis B e antigen (HBeAg) (ϩ) or HBeAg (Ϫ) chronic hepatitis B patients indicate that treatment with pegylated interferon alfa-2a is superior to conventional interferon alfa-2a or lamivudine monotherapy. 1-3 The combination of pegylated interferon alfa-2a or alfa-2b and lamivudine was not found to improve sustained response rates over pegylated interferon monotherapy in HBeAg (Ϫ) or HBeAg (ϩ) chronic hepatitis B patients, respectively. 3,4 Mathematical modeling of the dynamics of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection during antiviral therapy has provided useful insight into viral replication, host cell death rate, and treatment efficacy. [5][6][7] In the last years, similar studies have been Abbreviations: IFN, interferon alpha; HCV, hepatitis C virus; HBV, hepatitis B virus; ALT, alanine aminotransferase; LMV, lamivudine; QD, daily; QW, once weekly. From the

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Serum procalcitonin levels remain below the threshold of 0.5 ng/ml in all patients with uncomplicated cirrhosis, irrespective of the cause of the disease, while they are significantly elevated when bacterial infection complicates the course of the disease. A significant proportion of patients with acute alcoholic hepatitis on a cirrhotic background as well as of patients with acute on chronic viral hepatitis, without bacterial infection, exhibit serum procalcitonin levels above 0.5 ng/ml, suggesting that this cut-off value is probably not enough to discriminate between patients with or without bacterial infection within these subgroups of patients with liver disease.

The immunogenicity of HBV vaccine seems to be lower in CHC patients compared to healthy subjects. SVR following IFN plus RIB treatment does not affect the antibody response to HBV vaccine. Infection by genotype-1 seems to negatively influence the seroconversion rates. Vaccination against HBV during PEG plus RIB combination treatment is not beneficial in terms of anti-HBs seroconversion rates.