s95
Possible prevention of chronic hepatitis B by early interferon therapy
A study is currently uttde?way to investigate the efficacy of interferon therapy in p&nts dtb prolonged (310 weeks but that of sy+aatic therapy of ?rlute hepatitis c~scs, sine acute caSeS are 20 times more common and 95% of these patients will recuver completely. It should be emphasized. however, that cams ia which the virus is still repli’ sting more than 10 weeks after disease omt are rarer tbPn previousIy believed in symp tomatic acute hepatitis B. It is likely that these patients will be missed unless doctors begin screening for HBV infections with minimal tiigns, particularly in high risk groups. Specific programmes should be planned in different settings.
fat. The pattern of response suggests that IJ?N may ha;.re triggered a more intense cellular immune attack against infected hepatocytes containing repiicatin? virus and expressing virzJ antigen on their surface, By increasing HLA class 1 antigen on the surface of the liver cell, IFN may have helped immune lysis by enhancing recognition of target hepatocytes by specific T cells. An increase in natural killer cell activity may also have contributed, This
If confirmed, our results should trigger a new strategy with far more vigilant screening for .aised serum transaminase and HBV markers, in order to identify at an early stage thm patients who are likely to progress to chronic hepatitis. Progammes such as this may providepatients with a maximum chance of cure with the minimum inconvenience, The cost effectiveness of this stategy will aIs have to be carefully evaluated.
References
1Tr+o C, OuzanI), Fontanges T, et al. Therapeutic activity of vidarabinein symptomaGc chronic activehepatitis related IOHBV. J HepatoI 1986,3 (supppl2):S9i-105. 2 Oman D, Tr&paC. GntroHed study of prednisone withdrawal followed by vidarabin monophosphate in the treatment of chronic active hepatitis associated with HEW replication but without cirrhosis. J Hepstol 1983;94: 137.
3 Mamllin P, Own D, Degos F, et al. Random&d wntrollcd trial of denine arabinoside Y-monophosphate [ARA-AMP) in chrok active hepatitis B: comparisonof tit ef&cy in heterosexual and homosexuat patients. Hepatology 1990, in press. 4 Davis GL. Hoofnaglc IH. Interferon in viral hepatitis. Hepatology 1986;6: 1038-41. 5 Thomas HC, Scully W. Antiviral therapy in chronic hepatitis B virus infection. Br Med Bull 1986; 41: 374-80. 6 Tassopoulos NC, Hadziyannis SJ. Wright GE. A randomized
SW
ckmble-blind ptaeeLmxomrolle~! trial of a-interferon in acute type B hepatitis. Hcpatoiogy t9s9; IO: 576 (Abstmct). 7 Wit MA, Zoutim F, Captl F, Dubattchet S, Dauguet C, Tr&o C. Variable expression of pre-SI antigen during chrwric hepatitis B virus WV) infection: an accurate marker for the level of HBV repliatiiaa. Hepatology 199J; in prt#. !3 Cova L, Iamberr V, Cbevalicr A, er al. Evidence for the p’lesens OI Duck Hepatitis B virus in wild migrating ducks. J Gen virOI 1986; 67: 53747. 9 Maoiatis T, Fritsch EF, Sambrook . Molecular Cloning: A Uboratoq Manual. #Id Spring Harbor: Cold Spring Harbor taba ratory. 1W2.
J
ID Rigby PWJ. Dicckmann AI, Rhodes C, Berg P. Labelling deoxyribonucleic acid to high mfic activity in vitro by nick translation with DNA polymcrax I. J MoI Biol lm, 113: 23741. 11 Saiki R, Scharf S. Ftia F, et al. Enzymatic amplification of figIobin genomic sequtnuzs and restsite analysis for diagnw sis of tickle cell anemia. Sckncc 19%; 230: 1350-4. 12 HartC,SpiraT.MooreJ,etal.~detecti~ofHTV~Aexpression in ~~ropositive subject% L~WXC1988; ii: 5969. 13 Muller R, E&i12 H. Wdci I. et al. A&viral treament in chronic hepatitis B . Data of 5 prospectively controlled randomized trials. J Heptot 1986;3 isup@ 2): 5217-B
Possible prevention of chronic hepatitis B by early interferon therapy
A study is currently uttde?way to investigate the efficacy of interferon therapy in p&nts dtb prolonged (310 weeks but that of sy+aatic therapy of ?rlute hepatitis c~scs, sine acute caSeS are 20 times more common and 95% of these patients will recuver completely. It should be emphasized. however, that cams ia which the virus is still repli’ sting more than 10 weeks after disease omt are rarer tbPn previousIy believed in symp tomatic acute hepatitis B. It is likely that these patients will be missed unless doctors begin screening for HBV infections with minimal tiigns, particularly in high risk groups. Specific programmes should be planned in different settings.
fat. The pattern of response suggests that IJ?N may ha;.re triggered a more intense cellular immune attack against infected hepatocytes containing repiicatin? virus and expressing virzJ antigen on their surface, By increasing HLA class 1 antigen on the surface of the liver cell, IFN may have helped immune lysis by enhancing recognition of target hepatocytes by specific T cells. An increase in natural killer cell activity may also have contributed, This
If confirmed, our results should trigger a new strategy with far more vigilant screening for .aised serum transaminase and HBV markers, in order to identify at an early stage thm patients who are likely to progress to chronic hepatitis. Progammes such as this may providepatients with a maximum chance of cure with the minimum inconvenience, The cost effectiveness of this stategy will aIs have to be carefully evaluated.
References
1Tr+o C, OuzanI), Fontanges T, et al. Therapeutic activity of vidarabinein symptomaGc chronic activehepatitis related IOHBV. J HepatoI 1986,3 (supppl2):S9i-105. 2 Oman D, Tr&paC. GntroHed study of prednisone withdrawal followed by vidarabin monophosphate in the treatment of chronic active hepatitis associated with HEW replication but without cirrhosis. J Hepstol 1983;94: 137.
3 Mamllin P, Own D, Degos F, et al. Random&d wntrollcd trial of denine arabinoside Y-monophosphate [ARA-AMP) in chrok active hepatitis B: comparisonof tit ef&cy in heterosexual and homosexuat patients. Hepatology 1990, in press. 4 Davis GL. Hoofnaglc IH. Interferon in viral hepatitis. Hepatology 1986;6: 1038-41. 5 Thomas HC, Scully W. Antiviral therapy in chronic hepatitis B virus infection. Br Med Bull 1986; 41: 374-80. 6 Tassopoulos NC, Hadziyannis SJ. Wright GE. A randomized
SW
ckmble-blind ptaeeLmxomrolle~! trial of a-interferon in acute type B hepatitis. Hcpatoiogy t9s9; IO: 576 (Abstmct). 7 Wit MA, Zoutim F, Captl F, Dubattchet S, Dauguet C, Tr&o C. Variable expression of pre-SI antigen during chrwric hepatitis B virus WV) infection: an accurate marker for the level of HBV repliatiiaa. Hepatology 199J; in prt#. !3 Cova L, Iamberr V, Cbevalicr A, er al. Evidence for the p’lesens OI Duck Hepatitis B virus in wild migrating ducks. J Gen virOI 1986; 67: 53747. 9 Maoiatis T, Fritsch EF, Sambrook . Molecular Cloning: A Uboratoq Manual. #Id Spring Harbor: Cold Spring Harbor taba ratory. 1W2.
J
ID Rigby PWJ. Dicckmann AI, Rhodes C, Berg P. Labelling deoxyribonucleic acid to high mfic activity in vitro by nick translation with DNA polymcrax I. J MoI Biol lm, 113: 23741. 11 Saiki R, Scharf S. Ftia F, et al. Enzymatic amplification of figIobin genomic sequtnuzs and restsite analysis for diagnw sis of tickle cell anemia. Sckncc 19%; 230: 1350-4. 12 HartC,SpiraT.MooreJ,etal.~detecti~ofHTV~Aexpression in ~~ropositive subject% L~WXC1988; ii: 5969. 13 Muller R, E&i12 H. Wdci I. et al. A&viral treament in chronic hepatitis B . Data of 5 prospectively controlled randomized trials. J Heptot 1986;3 isup@ 2): 5217-B
