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Copyright ©2007 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2007; 13(18): 2554-2567
Published online May 14, 2007. doi: 10.3748/wjg.v13.i18.2554
Future prospectives for the management of chronic hepatitis B
WF Leemans, HLA Janssen, RA de Man
WF Leemans, HLA Janssen, RA de Man, Department of Gastroenterology & Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
Author contributions: All authors contributed equally to the work.
Correspondence to: RA de Man, MD, PhD, Department of Gastroenterology and Hepatology, Room H 437, Erasmus MC, University Medical Center Rotterdam’s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
Telephone: +31-104-635942 Fax: +31-104-365916
Received: December 15, 2006
Revised: December 18, 2006
Accepted: March 8, 2007
Published online: May 14, 2007

Chronic hepatitis B virus infection affects about 400 million people around the globe and causes approximately one million deaths a year. Since the discovery of interferon-α as a therapeutic option the treatment of hepatitis B has evolved fast and management has become increasingly complicated. The amount of viral replication reflected in the viral load (HBV-DNA) plays an important role in the development of cirrhosis and hepatocellular carcinoma. The current treatment modalities for chronic hepatitis B are immunomodulatory (interferons) and antiviral suppressants (nucleoside and nucleotide analogues) all with their own advantages and limitations. An overview of the treatment efficacy for both immunomodulatory as antiviral compounds is provided in order to provide the clinician insight into the factors influencing treatment outcome. With nucleoside or nucleotide analogues suppression of viral replication by 5-7 log10 is feasible, but not all patients respond to therapy. Known factors influencing treatment outcome are viral load, ALT levels and compliance. Many other factors which might influence treatment are scarcely investigated. Identifying the factors associated with response might result in stopping rules, so treatment could be adapted in an early stage to provide adequate treatment and avoid the development of resistance. The efficacy of compounds for the treatment of mutant virus and the cross-resistance is largely unknown. However, genotypic and phenotypic testing as well as small clinical trials provided some data on efficacy in this population. Discontinuation of nucleoside or nucleotide analogues frequently results in viral relapse; however, some patients have a sustained response. Data on the risk factors for relapse are necessary in order to determine when treatment can be discontinued safely. In conclusion: chronic hepatitis B has become a treatable disease; however, much research is needed to tailor therapy to an individual patient, to predict the sustainability of response and determine the best treatment for those failing treatment.

Keywords: Hepatitis B virus, Cirrhosis, Treatment, Interferon, Nucleoside analogues, Nucleotide analogues, Lamivudine, Adefovir, Entecavir, Telbivudine, Tenofovir, Resistance, Genotype