Semin Liver Dis 2004; 24: 71-76
DOI: 10.1055/s-2004-828681
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Practical Management of Chronic Hepatitis B Infection

Naoky C. S. Tsai1
  • 1Professor of Medicine, Chief, Section of Hepatobiliary Disease, Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
Further Information

Publication History

Publication Date:
11 June 2004 (online)

Chronic hepatitis B virus (HBV) infection is a complex disease. In recent years, there has been a marked increase in new knowledge regarding its virology, epidemiology, and natural history. In addition, more sensitive molecular diagnostic tests and relatively effective therapies for many individuals with chronic HBV infection have been developed and are available to practicing physicians. On the other hand, the influx of new immigrants from HBV hyperendemic areas such as the Asia-Pacific region, Indochina, and Eastern Europe has increased the demand for management of HBV infection in these populations. Physicians thus need to be able to identify persons at risk for hepatitis B and to evaluate and monitor them appropriately. Counseling on precautions to prevent transmission of HBV is also important for patients, as is education regarding the natural course of HBV infection and patient prognosis. Clinicians need to balance the treatment options carefully for their patients. This article provides up-to-date information on management of HBV infection for practicing physicians.

REFERENCES

  • 1 Lee W M. Hepatitis B virus infection.  N Engl J Med. 1997;  337 1733-1745
  • 2 McQuillan G M, Townsend T R, Fields H A et al.. Seroepidemiology of hepatitis B virus infection in the United States. 1976 to 1980.  Am J Med. 1989;  87(Suppl 3A) 5S-10S
  • 3 Centers for Disease Control and Prevention . Hepatitis B virus: a comprehensive strategy for limiting transmission in the United States through universal childhood vaccinations. Recommendations of the Advisory Committee on Immunization Practice (ACIP).  MMWR Morb Mortal Wkly Rep. 1991;  40(RR-13) 1-19
  • 4 McMahon B J. Hepatocellular carcinoma and viral hepatitis. In: Wilson RA Viral Hepatitis. New York; Marcel Dekker 1997: 315-330
  • 5 Tong M J, Hwang S J. Hepatitis B virus infection in Asian Americans.  Gastroenterol Clin North Am. 1994;  23 523-536
  • 6 Barnes S J, Bennett C. The Asian population 2000: Census 2000 Brief. February 2002 U.S. Department of Commerce http://www.census.gov/prod/2002pubs/c2kbr01-16.pdf
  • 7 Lok A SF, McMahon B J. Chronic hepatitis B AASLD practice guideline.  Hepatology. 2001;  34 1225-1241
  • 8 Villa E, Rubbiani L, Barchi T et al.. Susceptibility of chronic symptomless HBsAg carriers to ethanol-induced hepatic damage.  Lancet. 1982;  2 1243-1245
  • 9 Kim Y I, Heathcote J, Wanless I F. The hepatitis B carrier state-a follow-up study of 100 consecutive cases.  Clin Invest Med. 1987;  10 383-387
  • 10 Chevillotte G, Durbec J P, Gerolami A et al.. Interaction between hepatitis B virus and alcohol consumption in liver cirrhosis: an epidemiologic study.  Gastroenterology. 1983;  85 141-145
  • 11 Imanishi T, Morikawa S, Ohmagari K et al.. The effect of habitual alcohol drinking on the development of type B chronic hepatitis, liver cirrhosis and hepatocellular carcinoma.  Nippon Shokakibyo Gakkai Zasshi. 1988;  85 692-698
  • 12 Chung H T, Lai C L, Wu P C, Lok A SF. Synergism of chronic alcoholism and hepatitis B infection in liver disease.  J Gastroenterol Hepatol. 1989;  4 11-16
  • 13 Centers for Disease Control and Prevention . Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP).  MMWR Morbid Mortal Wkly Rep. 1996;  45(RR-15) 1-30
  • 14 Conjeevaram H S, Lok A SF. Management of chronic hepatitis B.  J Hepatol. 2003;  38 S90-S103
  • 15 Perrillo R P, Schiff E R, Davis G L et al.. A randomized, controlled trial of interferon alpha-2b alone and after prednisone withdrawal for the treatment of chronic hepatitis B.  N Engl J Med. 1990;  323 295-301
  • 16 Yao F Y, Terrault N A, Freis C et al.. Lamivudine treatment is beneficial in patients with severely decompensated cirrhosis and actively replicating hepatitis B infection awaiting liver transplantation: a comparative study using a matched, untreated cohort.  Hepatology. 2001;  34 411-416
  • 17 Perrillo R P, Lai C-L, Liaw Y-F et al.. Predictors of HBeAg loss after lamivudine treatment for chronic hepatitis B.  Hepatology. 2002;  36 186-194
  • 18 Chien R N, Liaw Y F, Atkins M. Pretherapy alanine transaminase level s a determinant for hepatitis B e antigen seroconversion during lamivudine therapy in patients with chronic hepatitis B. Asian Hepatitis Lamivudine Trial Group.  Hepatology. 1999;  30 770-774
  • 19 Hom X, Little N R, Jonas M M et al.. Predictors of virologic response after lamivudine treatment in children with chronic hepatitis B.  Gastroenterology. 2003;  124(Suppl 1) 338A
  • 20 Guan R, Lai C L, Liaw Y F et al.. Efficacy and safety of 5 years lamivudine treatment of Chinese patients with chronic hepatitis B.  Gastroenterol Hepatol. 2001;  16(Suppl 1) A60
  • 21 Chang T T, Lai C L, Liaw Y F et al.. Incremental increase in HBeAg seroconversion and continued ALT normalization in Asian chronic HBV (CHB) patients treated with lamivudine for four years.  Antiviral Ther. 2000;  5(Suppl 1) 44
  • 22 Leung N WY, Lai C L, Chang T T et al.. Extended lamivudine therapy in patients with chronic hepatitis B enhances hepatitis B e antigen seroconversion rates: results after 3 years of therapy.  Hepatology. 2001;  33 1527-1532
  • 23 Liaw Y F. Results of lamivudine trials in Asian.  J Hepatol. 2003;  39(Suppl 1) S111-S115
  • 24 Papatheoridis G V, Dimou E, Laras A et al.. Course of virologic breakthrough under long-term lamivudine in HBeAg-negative precore mutant HBV liver disease.  Hepatology. 2002;  36 219-226
  • 25 Cooper D, Cheng A, Coakly D F et al.. Anti-hepatitis B virus (HBV) activity of tenofovir disoproxil fumarate (TDF) in lamivudine (LAM)-experienced HIV/HBV co-infected patients. Program and Abstracts of the XIV International AIDS Conference July 7-12, 2002 Barcelona, Spain; Abstract #6015
  • 26 van Bommel F, Wunsche T, Schurmann D et al.. Tenofovir effectively inhibits viral replication in different patient groups with lamivudine resistance.  J Hepatol. 2003;  38(Suppl 2) 351A

Naoky C S TsaiM.D. 

2228 Liliha Street, #306

Honolulu, HI 96817

Email: naoky@hawaii.edu

    >