Management of chronic hepatitis B: an evolving issue

The highest concentration of persons chronically infected with the hepatitis B virus (HBV) occurs in Asia and countries of the Pacific Rim. Approximately 75% of the more than 400 million individuals with HBV infection worldwide live in these regions (1). China and India together account for more than 50% – China alone contributes more than one-third. Primarily, HBV is transmitted perinatally and in early childhood in countries where the infection is endemic (2). In contrast to adult-acquired infection, which is more common in developed countries where HBV infection spreads largely as a result of risk behaviors such as injection-drug use and sexual activity, this form of transmission is most likely to lead to chronic hepatitis B, exposing patients to an earlier lifetime risk of developing serious disease sequelae: cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC). Clearly, the healthcare implications of an infection of this nature are staggering. Many organizations around the world have embraced the mission of changing the course of HBV infection and reducing the burden of disease. Among these, the ACT-HBV Initiative (Advancing the Clinical Treatment of Hepatitis B Virus) was created to improve patients’ quality of care and health outcomes by enhancing the medical community’s understanding of HBV disease. Nowhere is this mission more critical than in the Asia-Pacific region. The ACT-HBV Initiative is led by a Steering Committee composed of some of the world’s leading experts in HBV infection. As Chairman of the Steering Committee for the Asia-Pacific region, I have worked with the Steering Committee to oversee the efforts of national ACT-HBV chapters in the Asia-Pacific region, addressing country-specific educational and informational needs. In March 2006, the Asia-Pacific ACT-HBV Steering Committee met together in Manila, in conjunction with the annual meeting of the Asian-Pacific Association for the Study of the Liver (APASL), to discuss key issues in hepatitis B, new and emerging clinical trial results, and diagnostic and treatment advances. This supplement presents the highlights of that meeting. Reflecting the combined expertise of a distinguished faculty, the papers presented here, collectively authored, discuss the epidemiology of hepatitis B in the Asia-Pacific region, HBV molecular virology, disease progression, new therapies for HBV infection, and the management of special patient populations. An important focus of the Steering Committee meeting was a critical review and update of current treatment recommendations for HBV infection, based on the emergence of new clinical data and licensing of new therapies. The first article by Professor Laurentius Lesmana and his colleagues reviews the burden of HBV infection in the Asia-Pacific region, citing the latest figures on its epidemiology and prevalence. Many barriers to effective prevention and treatment exist, including the high cost of diagnosis and treatment and a lack of medical professionals and facilities in many areas. Despite successful programs in some countries, healthcare systems in the Asia-Pacific region still struggle with the socioeconomic burden of a largely endemic HBV population. The next article is a cogent review of the molecular virology of HBV, by Professor Stephen Locarnini and Professor Masao Omata. These authors relate virologic mechanisms to the development of drugresistance mutations, reviewing the common mutants of HBV, especially those that affect antiviral drug sensitivity of the HBV polymerase. They explain the determinants selecting for these mutants and outline appropriate treatment strategies to overcome resistance. Professor Yun-Fan Liaw and Professor Jose Sollano present new insights into factors that accelerate disease progression from chronic infection to complications such as cirrhosis and HCC, drawing on data from recent studies exploring the correlations between viral load, aminotransferase levels, and these sequelae. Knowing that high HBV DNA concentrations are related to disease progression provides a rationale for adopting treatment strategies that will sustain viral suppression and reduce liver damage. The development of new drugs to accomplish this objective is of prime interest to clinicians. Professors TingTsung Chang, Jidong Jia, and Seung Kew Yoon review the latest clinical data on new therapies for Liver International 2006; 26: 1–2 r 2006 The Author Journal compilation r 2006 Blackwell Munksgaard