Hepatitis B

Hepatitis B virus (HBV) infection is a global health problem. Around 400 million people are chronically infected with HBV, which is a major cause of liver cirrhosis and liver failure. The interaction between the virus and host immune responses defines the clinical course of infection. The natural history of HBV is not linear and the clinical spectrum varies from an asymptomatic carrier state to fulminant hepatic failure. Immunization programmes have resulted in a dramatic decline in the incidence and prevalence of chronic hepatitis B infection in many countries. For those with infection, the timing of treatment and the choice of antiviral therapy depend on the patient profile. The main goal of antiviral therapy is to prevent liver cirrhosis. Antiviral treatment is with interferon or nucleoside analogues. Nucleoside analogues are potent oral antiviral drugs that can suppress viral replication to undetectable levels. However, the viral genome can persist in hepatocytes despite sustained and potent suppression. For selected patients with decompensated liver cirrhosis, liver transplantation may be appropriate.