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JAC Advance Access originally published online on May 25, 2009
Journal of Antimicrobial Chemotherapy 2009 64(2):223-226; doi:10.1093/jac/dkp189
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Leading articles

Antiviral therapy for chronic hepatitis B: are we doing any good to patients?

Vincent Wai-Sun Wong1,2 and Joseph Jao-Yiu Sung1,2,*

1 Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong 2 Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong

* Corresponding author. Department of Medicine and Therapeutics, 9/F, Prince of Wales Hospital, 30–32 Ngan Shing Road, Shatin, Hong Kong. Tel: +852-26323132; Fax: +852-26373852; E-mail: joesung{at}cuhk.edu.hk

At the recent National Institutes of Health Consensus Development Conference, the value of antiviral therapy for chronic hepatitis B in improving clinical outcome was hotly debated. In patients with chronic hepatitis B, antiviral therapy has proved effective in viral load reduction, alanine aminotransferase normalization and histological improvements. However, its efficacy in reducing decompensated liver disease, hepatocellular carcinoma and liver-related death remains unclear. To date, animal studies and observational studies, but very few randomized controlled trials, have shown improved clinical outcomes after antiviral therapy. The difficulties of conducting clinical trials using clinical endpoints are highlighted. Before more clinical outcome data are available, it is important to validate the clinical implications of surrogate markers including biochemical, virological and histological responses.

Keywords: hepatocellular carcinoma , interferon alfa-2a , lamivudine , liver cirrhosis , viral DNA


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