[Chronic. hepatitis. B]

ABSTRACT

Chronic hepatitis B is a major medical problem, distributing all over the world. Affecting more than 400 million people. In highly prevalence places, childhood transmission is the most common form but in low prevalence areas, injection, drug use and familial transmission are the main routes of acquisation of infection. Hepatocellular carcinoma and cirrhosis are significant problems of chronic hepatitis B. Exposure to HBV early in life may progress to hepatocellar carcinoma. The annual number of deaths from HBV infection and related diseases throughout the world is about 1.2 million. The goal of treatment of chronic hepatitis B with Lamivudin or INF-Alpha is sustained suppression of virus replication and liver disease remission. INF, Alpha and Lamivudin have similiar efficacy. The adventage of Lamivudin is that it is less expensive and is well tolerated and adventages of INF. Alpha are the short duration of treatment and absence of resistance but it is expensive and has many side effects. The response rate of INF. Alpha is better than Lamivudin but it is associated with a large number of side effects, sometimes we have to stop or decrease the dose of INF. Viral genotypes and other factors such as pretreatment viral load, fatty liver and liver histiology may alter the response rate. The long-term use of Lamivudin may be with the emergence of YMDD mutations. Treatment of YMDD form of chromic hepatitis B, with combination of Lamivudin and Adefovir dipivoxil, may improve liver function; and YMDD mutations may be over come. The emergence of YMDD mutations reduces the benefit of Lamivudin but does not negate it