Complications of chronic HBV include:

	Cirrhosis
	Renal failure
	Ascites
	Hepatocellular Carcinoma
	Esophageal Variceal Hemorrhage

Because of these potential complications, therapy for chronic HBV has been sought. Treatment of Chronic Hepatitis B includes interferon and lamuvidine. Treatment of hepatitis B with alpha interferon has been associated with a 30 to 35 percent conversion from chronic hepatitis B to immunity. Optimal patients are those who have moderately high serum aminotransferases levels (AST and ALT) with low circulating titers of the hepatitis B virus. HBV can be measured in the blood stream with a PCR (polymerase chain reaction test) so that actual amount of virus circulating in the blood stream can be determined (in many cases, this type of test is not required.) Some patients with chronic HBV may benefit from pretreatment with steroids.

During treatment with interferon, a spike in aminotransferases levels may occur at approximately 8 weeks. This flare in serum ALT levels indicates the clearance of the infected Hepatitis B hepatocytes. This is a positive event in patients being treated with interferon.

Positive predictors of response to alpha-interferon for chronic hepatitis B are:

	Adult acquisition of hepatitis B
	ALT > 100 IU/ liter
	Hepatitis B DNA titers (via PCR) < 100 pg/ml
	Female sex
	Active hepatic inflammation assessed by liver biopsy.

Negative predictors of response to alpha interferon include:

	Early acquisition of Hepatitis B
	ALT < 100 IU/ l
	Serum Hepatitis B DNA concentrations > 200 pg/ml
	Positive HIV status.
	Coexistent Hepatitis D infection
	Minimal histologic inflammation on liver biopsy.

A vaccination for hepatitis B is now available. This should be administered to:

	Health-care workers who are potentially exposed to infectious body fluids
	Patients with chronic renal failure on hemodialysis
	Male homosexuals or promiscuous heterosexuals
	All workers and clients of institutions for the developmentally disabled
	Adolescents: Due to the high rate of sexual transmission associated with hepatitis B, vaccination has been recommended by pediatricians and hepatologists alike.

Approximately 10 percent patients treated with the current vaccine will fail to develop immunity.

Vaccination of adolescents will help to break the cycle of sexual transmission associated with HBV. By reducing the transmission rate in this group of patient, infection of the fetus from unplanned childbirth will be reduced.

Hepatitis B Page 1

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