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World J Hepatol. Dec 27, 2011; 3(12): 292-299
Published online Dec 27, 2011. doi: 10.4254/wjh.v3.i12.292
Management of hepatitis B in developing countries
Zaigham Abbas, Adeel R Siddiqui
Zaigham Abbas, Adeel R Siddiqui, Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi 74200, Pakistan
Author contributions: Abbas Z designed the review; Abbas Z and Siddiqui AR drafted different parts of the review and approved the final review.
Correspondence to: Zaigham Abbas, FCPS, FRCP, Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi 74200, Pakistan.
Telephone: +92-21-35344651 Fax: +92-21-99215469
Received: February 28, 2011
Revised: September 26, 2011
Accepted: October 3, 2011
Published online: December 27, 2011

Hepatitis B is one of the leading causes of chronic hepatitis in developing countries, with 5% to 15% of the population carrying virus. The high prevalence is due to failure to adopt appropriate measure to confine the spread of infection. Most hepatitis B patients present with advanced diseases. Although perinatal transmission is believed to be an important mode, most infections in the developing world occur in childhood and early adulthood. Factors in developing countries associated with the progression of chronic hepatitis B (CHB) include co-infections with human immunodeficiency virus, delta hepatitis virus, hepatitis C virus, alcohol intake and aflatoxin. Treatment protocols extrapolated from developed countries may need modifications according to the resources available. There is some controversy as to when to start treatment, with what medication and for how long? There is now enough evidence to support that hepatitis B patients should be considered for treatment if they show persistently elevated abnormal aminotransferase levels in the last 6 mo, checked on at least three separate occasions, and a serum hepatitis B virus DNA level of > 2000 IU/mL. Therapeutic agents that were approved by Pure Food and Drug Administration are now available in many developing countries. These include standard interferon (INF)-α, pegylated INF-α, lamivudine, adefovir, entecavir and telbivudine. Drug resistance has emerged as a major challenge in the management of patients with CHB. The role of the universal vaccination program for effective control of hepatitis B cannot be emphasized enough.

Keywords: Hepatitis B, Management, Developing countries, Hepatitis B surface antigen, Hepatitis B virus DNA, Vaccination