Ronald L. Koretz, MD
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Koretz RL. Interferon for Chronic Hepatitis B. Ann Intern Med. 1996;124:276-277. doi: 10.7326/0003-4819-124-2-199601150-00026
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Published: Ann Intern Med. 1996;124(2):276-277.
TO THE EDITOR:
In a recent paper, Wong and colleagues  concluded that the use of interferon in HBeAg-positive patients with chronic hepatitis B was cost-effective. This conclusion was based on two observations: 1) that interferon is effective in producing HBeAg loss and 2) that the natural history of HBeAg-negative chronic hepatitis is less ominous than that of HBeAg-positive disease.
The authors assumed that the natural history of disease in patients who did or did not seroconvert from HBeAg positivity with interferon was the same as that in patients who did or did not spontaneously seroconvert. However, certain factors predict interferon responses. Some of these factors (higher aminotransferase levels, lower hepatitis B viral DNA levels, and female sex) are also associated with spontaneous HBeAg or hepatitis B surface antigen clearance. Nonresponders tend not to have these factors, and they probably have a worse prognosis than untreated HBeAg-positive patients. An untreated group would contain more patients likely to seroconvert in the future.
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