Approaches to the treatment of chronic hepatitis B viral infection.

In HBeAg positive patients with a high level of viral replication, antiviral therapy is the treatment of choice. The most promising agents at the moment are ARA-AMP and Interferon and both are being assessed in controlled clinical trials. In the anti-HBe positive patients in whom continued HBs antigenaemia is due to the presence of clones of cells containing integrated virus, some form of immune manipulation may be necessary. In rare cases in whom continuing inflammatory activity is related to an autoimmune reaction, low dose prednisolone may be beneficial. Treatment for delta infection has yet to be evaluated but antiviral agents such as interferon which inhibit both DNA and RNA viruses may prove effective. Although these forms of therapy are currently experimental, some are now entering phase III clinical trials. It seems probable that the ultimate regimen will include antiviral drugs and immune manipulation to adequately eliminate hepatocytes containing replicating and integrated virus. The latter is essential if we are to deal with the problem of neoplasia as well as infectivity and inflammatory liver disease.