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.
16. What should a community hepatitis B program look like?
18. What drug therapies are currently in development for treatment of HBV?