India has a hepatitis B virus carrier rate of about 2%, and about 37 million people are still known to be affected by the disease. Almost six decades have passed since the discovery of the hepatitis B virus or HBV, and scientists have been researching various aspects of the disease including epidemiology, pathogenesis, diagnostic methods, the natural course of the infection in humans, and the efficacy and management of each of its sequelae.
It was only in 1982 that scientists discovered the vaccine to cure the hepatitis B virus. Almost a decade later, in 1992, the first therapy interferon for HBV was introduced. Subsequently, till 2018, extensive research had been undertaken to provide nucleoside and nucleotide analogues, with the latest one being tenofovir alafenamide.
However, despite all the efforts being put into the research and innovation of relevant drugs to combat the hepatitis B virus, there are still some bottlenecks in the way of long-term treatment of HBV.
During the last two decades, the identification of fatty liver disease as well as alcoholic liver disease is on a rapid rise affecting almost one-third of the global population, which in turn, is gradually becoming the major cause of liver disease all over the world.
Hence, the next most important thing clinicians are facing all over the world, especially in India, is that the spectrum of liver diseases is changing.
What are the various issues faced by clinicians when it comes to long term treatment of the hepatitis B virus?
- Do all hepatitis B viruses present in a similar fashion?
- Out of them who need therapy and why they need therapy?
- Is there any benefit to treating them? Do we benefit them because the hepatitis B virus causes sinister sequelae like cirrhosis, liver cancer, liver failure, and death?
- Does it get prevented by treatment? If so, how do you treat them?
- And who doesn’t need treatment, yet needs monitoring, and why do you want to monitor?
- When you treat these patients for the virus, what are the goals?
- What we are trying to achieve should be clear in our mind and there are many therapies now, which therapy suits which category of patients, is important to decide and institute specific therapy?
- While you are treating the patient how do you follow up this patient and what do you look for, particularly monitoring during therapy?
- Are the therapeutic agents that you have used safe and can the drugs be effectively used in all populations?
It is evident that all hepatitis B virus patients need management and a strong host immune system. Interaction with the virus should be the major determinant of the progress. Therefore, when the immune system is right, and not completely developed, particularly in the pediatric age group, HBV infection causes chronicity and that is the major determinant of chronic HBV infection that would require long-term hepatitis B therapy and management.
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