14. How do you determine which treatment should be used, and for how long?

When I try to look at it objectively, the first thing you have to do is weigh the side effects - interferon has more side effects, and lamivudine and adefovir are very patient-friendly. There are three prognostic markers for treatment with interferon: viral load (those with a lower load usually respond better), ALTs (those with higher levels usually respond better), and duration of the infection (those with shorter duration have a better response, usually). Most Asian patients do not meet these prognostic indicators for treatment with Interferon. Once again, I look at hepatitis from an infectious disease point of view - it is a chronic infection, and might need chronic suppression (long-term) just like HIV or diabetes.