17. What is needed to manage hepatitis B worldwide?

Any patient with evidence of ongoing active hepatitis B viral replication as shown by significant elevations in their viral level in their blood should be treated to suppress the replication. Any patient with evidence of ongoing chronic hepatitis or cirrhosis secondary to hepatitis B certainly needs to be treated. The key is an antiviral therapy can prevent progression of disease and transmission to others. All patients with chronic hepatitis B infections should be monitored for cirrhosis developing, liver cell cancer developing. So you really have to monitor these patients, which is a major public expense. For example, our project in Chinatown is a large reservoir of people who come from rural areas of China recently; are basically below economic strata; and are unfamiliar with Western medicine or afraid of actually confiding in any public hospital or public health facility. So this is a problem here in the United States and its even more of a problem in underdeveloped areas around the world because all of these patients have to be monitored for development of liver cancer. As Dr. London pointed out, in New York if you develop liver cancer, you’ve got a fighting chance because we have a great program for it at NYU and there are various ways of treating it and it’s a manageable condition, but that’s not adaptable to mass populations. If you have liver cancer in rural China or in Africa and all those other places where hepatitis B is rampant, that’s it. There’s really not any effective therapy.