Experts: Do Not Treat Patients in the Immune-Tolerant Stage of Infection

— Christine M. Kukka, Project Manager, HBV Advocate

Experts, who studied recent studies and clinical trials, have concluded that patients in the immune tolerant stage of hepatitis B should not be treated, according to a report published in the November issue of the Journal of Viral Hepatology.

Patients in the immune-tolerant stage–which often includes children and young adults–are HBeAg-positive, have high viral loads, and normal ALT levels that appear to indicate there is no liver damage occurring.

However, many doctors are concerned that the high rates of viral replication may be setting the stage for future liver damage and cancer. Many doctors want to know if they should use antivirals in this younger patient population to knock down viral load to jumpstart the immune system, which appears unaware of the HBV infection, into action.

"Previous studies showed that HBeAg-positive patients with normal or near-normal ALT levels, who are assumed to be in the immune tolerance phase, have a lower HBeAg seroconversion rate (when they receive) ... either pegylated interferon or antiviral treatment," the scientists wrote.

Additionally, recent clinical trials that used the potent antiviral tenofovir in immune-tolerant patients produced poor results. "The HBeAg seroconversion rates are less than 5% (after) four years of treatment," they wrote.  Considering the minimal risk of disease progression and low treatment response rates in immune-tolerant patients, current antiviral therapy should not be recommended unless the patients have advanced liver fibrosis."

The researchers called for more innovative therapies that target HBV in different ways in order to treat this group of patients.

Source: www.ncbi.nlm.nih.gov/pubmed/25424771

http://www.hbvadvocate.org/news/HBJ11.12.htm

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