Chronic Hepatitis B: An Update, An Issue of Clinics in Liver Disease

A recent Institute of Medicine report has concluded that 'there is a lack of knowledge and awareness about chronic viral hepatitis on the part of health-care and social-service providers, as well as among at-risk populations, members of the public, and policy-makers. Due to the insufficient understanding about the extent and seriousness of this public-health problem, inadequate public resources are being allocated to prevention, control, and surveillance programs'. It is with these concerns in mind that Dr. Tsai assembled a group of experts in this field to present their expertise in such a level, where the practicing clinicians who deal with this disease in their daily practice can understand thereby implement this knowledge into their own practice. Dr. Brian McMahon discusses the natural history of chronic hepatitis B with his vast knowledge and experience working with the high endemic population of Inuit in Alaska. Drs. Marc Ghany and Ed provide a very easy-to-understand description of HBV virology. Dr. Kyon-Mi Chang contributes an article on HBV immunology, which is the least understood area of this disease but has the most potential to improve our knowledge in the management of chronic hepatitis B. Dr. Anna Lok provides an authoritative review on the current issues and controversies of treatment of chronic hepatitis B. Dr. Stephen Locarnini, who has extensive experience in anti-viral resistance and its management, presents important issues in the usage of currently available anti-viral oral agents. Dr. Myron Tong discusses the current understanding of HBV carcinogenesis and updates HCC surveillance and treatment - the most dreadful outcome of this disease. Dr. Paul Martin discusses management of end- stage chronic hepatitis B - anti-viral therapy, montherapy vs combo therapy, choice of agent, when to start therapy and post-transplant patients including duration of HBIG therapy, HBcAb(+)only recipient) and Occult HBV infection. Dr. Tram Tran discusses the treatment in reproductive women, during pregnancy, and prevention of vertical transmission in third trimester with antiviral agents - an area with significant lack of good clinical evidence. Dr. Steve Han discusses management of patients with acute hepatitis B, co-infection with HDV/HCV/HIV, pre-immuno-suppressive therapy, and management of renal and heart transplant patients with HBV infection. Dr. Mei Huei Chang discusses Taiwanese success in implementing universal vaccination leading to a remarkable reduction in both prevalence of chronic hepatitis B and incidence of hepatocellular carcinoma. Finally Drs. Michelle Lai and Yun Fan Liaw provide a rundown of what we have accomplished and the hope for the future in our fight to control this disease.