Antiviral treatment for chronic hepatitis B: Safety, effectiveness, and prognosis.

The goal of chronic hepatitis B (CHB) therapy is to improve the patient prognosis through the sustained inhibition of viral replication. However, due to the uncertainty and potentially unlimited duration of the treatment course, nucleus(t)ide analogue (NA) resistance and safety, financial costs and patient compliance, different endpoints of antiviral treatment have been proposed in CHB prevention and treatment guidelines. Different treatment endpoints are closely associated with the safety of drug withdrawal and improvements in prognosis. Antiviral treatment suppresses HBV DNA replication, drug withdrawal leads to relapse, and long-term treatment causes drug safety and resistance issues. Although hepatitis B e antigen seroconversion based on HBV DNA inhibition is considered as "a satisfactory endpoint", drug withdrawal still leads to high relapse rates. Hepatitis B surface antigen (HBsAg) clearance is the "ideal endpoint" in terms of the safety of drug withdrawal and improvements in prognosis. However, the HBsAg clearance rate is low using the conventional single drug treatment and fixed course regimens. Recently, the application of an "optimized antiviral treatment strategy" has improved the HBsAg clearance rate, and make an "ideal endpoint" possible. This article reviews the different antiviral treatment endpoints in terms of the safety of drug withdrawal, improvements in prognosis and relevant advances.

[Genetic polymorphisms of MxA protein and eIF-2a-reg2 and their responses to interferon treatment in patients with chronic hepatitis B].

OBJECTIVES: To identify the host single nucleotide polymorphisms (SNP) of myxovirus resistance A (MxA) protein and eukaryote initiation factor 2alfa regulatory region 2(eIF-2a-reg2) and to predict interferon (IFN) treatment responses in patients with chronic hepatitis B. METHODS: Two hundred sixty-two patients with chronic hepatitis B (CHB) were treated with interferon alfa (IFN ) for 12 months. Six months later the therapeutic effectiveness was evaluated. All the patients had signed a formal consent form. The patients were grouped into a sustained response (SR) group and a non-sustained response (NSR) group according to their responses to the IFNa treatment. Single nucleotide polymorphisms of the antiviral protein MxA promoter -88,-123 and protein kinase(PKR) activated eIF-2a-reg2 sites were examined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and were compared with the responsiveness to IFN treatment of these CHB patients. RESULTS: Among the 262 patients, 212 (80.9%) were non-sustained responders to IFNa and 50 (19.1%) were sustained responders. The rate of sustained responders with GT heterozygote at MxA promoter -88 was higher than that of the GG genotype (OR: 5.3, 95% CI: 2.46-11.43, P less than 0.01) and also higher than that of the TT genotype (OR: 4.1, 95% CI: 1.86-9.09, P less than 0.01). There were no statistically significant differences in IFN therapeutic effectiveness among the patients with different genotypes at MxA promoter -123, eIF-2a-reg2 and haplotypes made by MxA promoter -88 G/T, and -123 C/A alleles (P more than 0.05). CONCLUSION: Patients with GT genotype at MxA promoter -88 responded well to IFN treatment. SNP as a potential marker could be used to predict IFN treatment responses of patients with chronic hepatitis B.

[Efficacy, influencing factors and safety of PEG-INF alpha-2a (PEG-INF-2a) in the treatment of chronic hepatitis C: analysis of 89 patients].

BACKGROUND: To investigate the efficacy, influencing factors and safety of PEG-INF alpha-2a (PEG-INF-2a) in the treatment of hepatitis C. METHODS: Totally 89 patients with hepatitis C were included in this study and 46 patients were treated with PEG-INF-2a (180 microg or 135 microg/week) and RBV 900 mg/d, 43 patients were treated with IFNalpha-2a (5 MIU/qod) and RBV 900 mg/d. The time of treatment was 48 weeks, and all the patients were visited 24 weeks after treatment. There were no significant differences between the two groups in pretreatment HCV-RNA, HCV genotype and other clinical data. The main parameters to evaluate the efficacy were virological and biochemical responses. The side effects were intensively observed. RESULTS: Sustained virological response (SVR) rate in PEG-IFNalpha-2a group was significantly higher than that in IFNalpha-2a group (56.5% and 19.5% respectively, P<0.001). As the patients were divided according to HCV genotype 1 and high virus load, the SVR rate of PEG-INF alpha-2a group was higher than IFNalpha-2a group (P<0.001). However, there was no significant difference between two groups in the patients with non-genotype 1 and low viral load (P=0.664, 0.116). Similar side-effects were observed in PEG-IFNalpha-2a group and IFNalpha-2a group, but the rate of weight decline and the degree of leukocyte decrease were more significant in PEG-INF alpha-2a group than in IFNalpha-2a group (P=0.001). CONCLUSION: The efficacy of PEG-INF alpha-2a in the treatment of chronic hepatitis C is superior to that of conventional IFNalpha-2a, PEG-INF alpha-2a had good tolerance and safety profiles.