Frontiers in Viral Hepatitis

Frontiers in Viral Hepatitis

2003, Pages 225-243
Frontiers in Viral Hepatitis

Chapter 20 - Novel approaches in the management of chronic HBV infection

https://doi.org/10.1016/B978-044450986-4/50071-0Get rights and content

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The treatment of chronic hepatitis B infection is restricted to alpha interferon (IFN-α) and a small number of nucleoside analogues with infrequent clearance of infection. The failure to eradicate chronic infection and the development of resistance may limit their usefulness in the long term. The main goals in the treatment of chronic hepatitis B are (1) prevention of liver fibrosis that requires long-term suppression of HBV replication and (2) prevention of hepatocellular carcinoma (HCC), where treatment needs to be initiated before HBV DNA integration into host cell DNA has occurred. Antiviral nucleoside analogues are effective and convenient therapeutic agents but do not eradicate chronic infection. The management of chronic hepatitis B should be based on an understanding of the pathogenesis of the disease. There are three key elements: virus, hepatocyte, and immune response. The best therapeutic approach is based on immune modulation with cytokines and therapeutic vaccines, blocking viral replication using antiviral agents and cytokines, and preventing re-infection by neutralizing antibodies. These in vitro and in vivo models provide invaluable information on combining nucleoside analogue therapy for chronic hepatitis B infection and help to guide future clinical trials of combinations of antiviral, antisense, and immune modulating therapeutics

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