Treatment of hepatitis B: the next five years

Abstract

-The natural history of individuals chronically infected with hepatitis B typically fluctuates, with periods of active viral replication with or without an associated hepatitis and sometimes prolonged periods of spontaneous viral suppression and inactive liver disease. In the majority, this chronic infection is clinically silent unless either liver failure and/or hepatocellular carcinoma (HCC) supervenes. Thus proactive steps are needed to first identify those with hepatitis B infection and to then serially monitor those found to be chronically infected for both level of alanine aminotransferase (ALT) and hepatitis B virus DNA (HBV-DNA) (using sensitive polymerase chain reaction techniques. Antiviral therapy significantly reduces the risk of liver disease progression and HCC in those with ongoing viral replication >10 5 c/ml and advanced hepatic fibrosis. The decision of when to initiate (possibly lifelong) treatment has to be made judiciously. Before introducing therapy both patient and physician must recognise the need for compliance with both treatment and viral surveillance so as to minimise the development of drug resistance. Drug resistance needs to be identified prior to recurrence of hepatitis (rise in ALT) to prevent hepatic decompensation, this necessitates serial HBV-DNA testing.

Medication Nonadherence with Long-Term Management of Patients with Hepatitis B e antigen-Negative Chronic Hepatitis B

“…Failure to achieve early virologic response is often a predictor for future antiviral resistance with long-term therapy [5,9]. In addition, rates of adherence to usage of medications are usually lower in patients with chronic conditions such as CHB compared to those with acute conditions [10,11].…”

Preventative hepatology: minimising symptoms and optimising care

“…Compliance with prescribed medications contributes significantly to treatment responses, and patient education and support is paramount -in hepatitis B, resistance to antiviral agents is potentiated by poor compliance, while support from nurse specialists can improve compliance (and virological response) to often poorly tolerated interferon-based treatments c 2008 The Authors. Journal compilation c 2008 Blackwell Munksgaard (45,46), with their well-rehearsed side effects. Encouraging the wearing of a 'Medic Alert' bracelet and/ or carrying a list of prescribed medicines is equally useful for emergencies.…”