Q. Kindly guide me regarding the management of Hepatitis-B carriers in following respect: Is it possible to have HbeAg negative while HBV DNA positive or vice versa in same patient? Which one of these more sensitive? Is it possible to have very low AST/ALT in presence of marked HBV replication and hence high HBV DNA (When cell mediated immune response is poor)? Who are the ideal candidates among the carriers in terms of Viral markers and Liver function tests. Who should be given anti-viral? Inteferons vs. Lamivudine - Which is better for such patients? What should be the strategy to manage non-replicators in terms of Hepatocellular carcinoma?

A. Hepatitis B is an important problem worldwide due to the millions of people infected with the associated risk for chronic hepatitis and liver failure. In the U.S, there are an estimated 1,000,000 cases of chronic hepatitis due to the hepatitis B virus, and over 100,000 new cases yearly. Your questions concern evolving concepts of evaluation and treatment of the disease, so I will refer you to the following recent scientific references on the topic:

RECENT MEDICAL JOURNAL ARTICLES (available through hospital or medical school libraries):

Management of hepatitis b: 2000-summary of a workshop.
Gastroenterology 2001 Jun; 120: 1828-53
Lok AS Heathcote EJ Hoofnagle JH

The management of chronic hepatitis B infection.
Int J STD AIDS 2001 Jun; 12: 353-7
Matthews GV Nelson MR

HELPFUL WEBSITES:

http://www.cdc.gov/ncidod/diseases/hepatitis/index.htm

http://www.niddk.nih.gov/health/digest/pubs/hep/hepa-e/hepa-e.htm

Other Resource:

• More Questions on Hepatitis

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