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Ideas and Opinions |3 July 2007

The Natural History and Treatment of Chronic Hepatitis B: A Critical Evaluation of Standard Treatment Criteria and End Points

Ching-Lung Lai, MD; Man-Fung Yuen, MD, PhD

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
  • From the University of Hong Kong, Hong Kong, China.

    Potential Financial Conflicts of Interest: Grants received: C.L. Lai (Bristol-Myers Squibb).

    Requests for Single Reprints: Ching-Lung Lai, MD, Department of Medicine, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China; e-mail, hrmelcl@hkucc.hku.hk.

    Current Author Addresses: Drs. Lai and Yuen: University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.

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Approximately 350 to 400 million people worldwide have chronic hepatitis B virus (HBV) infection, with roughly 1.25 million cases in the United States and 180 000 in Britain. More than 70% of all people with chronic HBV infection are Asian. Although white persons in the U.S. and British populations are usually infected in adolescence or adulthood (by means of sexual contact or sharing of intravenous needles), nearly every Asian person with this infection (whether born in or outside Asia) acquires it at birth from an infected mother or within 2 years of birth by means of close contact with infected relatives.
There are important differences between these 2 groups. Patients infected in adolescence or adulthood immediately enter an immune clearance phase; their disease is of short duration and tends to become quiescent after they seroconvert from hepatitis B e antigen (HBeAg) to antibodies against HBeAg (anti-HBe). Such patients have been termed “healthy” carriers (1). In contrast, patients infected early in life have a prolonged immune tolerance phase followed by a prolonged immune clearance phase before HBeAg seroconversion, and strong evidence indicates that their disease progresses after HBeAg seroconversion.
Guidelines for treatment and treatment end points from 3 regional liver associations (the American Association for the Study of Liver Diseases, the European Association for the Study of the Liver, and the Asian Pacific Association for the Study of the Liver) suggest that treatment should be initiated for patients who are HBeAg seropositive if their HBV DNA levels are 105...
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Lai C, Yuen M. The Natural History and Treatment of Chronic Hepatitis B: A Critical Evaluation of Standard Treatment Criteria and End Points. Ann Intern Med. 2007;147:58–61. doi: 10.7326/0003-4819-147-1-200707030-00010

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Published: Ann Intern Med. 2007;147(1):58-61.

DOI: 10.7326/0003-4819-147-1-200707030-00010

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2007 American College of Physicians
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