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Chronic Hepatitis B

Chronic hepatitis B is an important preventable cause of cirrhosis and liver failure. It is estimated that 90-160,000 people in Australia have chronic hepatitis B. HBV-related hepatocellular carcinoma (HCC) is rising in frequency and is the third most common cause of cancer death in the Asia-Pacific region. Hepatitis B vaccination is the most important strategy to prevent chronic hepatitis B.

With the introduction of potent HBV antivirals, treatment of HBV is entering a new era. Orally administered drugs such as adefovir, entecavir, tenofovir, telbivudine and clevudine have equal or better antiviral efficacy to lamivudine and significantly lower rates of antiviral drug resistance. Furthermore, several of these agents are effective against lamivudine-resistant HBV. Pegylatedinterferon (peginterferon) has been shown to be superior to conventional interferon for obtaining sustained viral suppression, without drug resistance.

Management of patients with chronic hepatitis B includes prevention of HBV transmission (vaccination of sexual and household contacts), prevention and management of co-morbidities (excessive alcohol, obesity, type 2 diabetes, metabolic syndrome), and consideration of antiviral therapy. Appropriate measures should be taken to prevent hepatitis A (HAV vaccination) and hepatitis C and D virus co-infections (usually prevention of percutaneous exposure).