Advancing the Clinical Treatment of Hepatitis B Virus

The care of patients with chronic hepatitis B virus (HBV) infection is a pressing public health issue in many parts of the world. Of the estimated 350 million carriers of this infection worldwide, 75% reside in the Asia-Pacific region, where prevalence rates for HBV infection may reach up to 15%. Perinatal transmission is the primary mode of acquisition in these areas, a route that is associated with a 90% likelihood of HBV infection becoming chronic. Mortality from chronic HBV infection is approximately 25%, attributed to complications such as cirrhosis with hepatic decompensation and hepatocellular carcinoma (HCC). These consequences make HBV infection the ninth leading cause of death worldwide, accounting for 1 million deaths each year. Although prevalence rates of HBV infection are far lower in developed countries, chronic hepatitis B is also a growing health concern in these nations, as changing immigration patterns introduce HBV carriers to many of their communities.

To reduce the impact of chronic hepatitis B on populations at risk clearly requires a global effort. One of the key elements in this effort is the dissemination of information, as it emerges, on advances in the diagnosis and treatment of HBV infection to physicians and other healthcare providers who influence patient care. Toward this objective, the Advancing Clinical Treatment of Hepatitis B Virus (ACT-HBV) Initiative was created. Guided by an Expert Council composed of internationally recognized leaders in the field, ACT-HBV provides timely educational programs and publications-such as this supplement-focused on communication of key issues such as case detection, accurate diagnostic categorization, screening for HCC, selection for antiviral therapy, and pros and cons of therapeutic options to appropriate audiences.

Each of the articles in this supplement presents the latest information from the author's area of expertise. Dr. Brian McMahon sets the stage for understanding the magnitude of the problem with his overview of the epidemiology and natural history of HBV infection, explaining the implications for clinicians. This is followed by Dr. Stephen Locarnini's synopsis of the molecular virology of HBV and the therapeutic significance of resistant mutations. Dr. Robert Perrillo discusses current treatment options in chronic HBV infection, identifying the advantages and limitations of each that need to be weighed in the treatment decision. Promising new therapies are now available, whether recently licensed or in clinical trials. Dr. Robert Gish reviews the data from several recently completed randomized, controlled trials and explains how these new therapies may become integrated into treatment guidelines. Dr. Yun-Fan Liaw addresses the prevention of HCC and discusses management strategies that may prolong survival in patients with chronic HBV infection. Finally, Dr. Kenneth Sherman and Norah Shire outline the management of HBV infection in patients who are also infected with human immunodeficiency virus, which is a growing clinical issue worldwide.

The ultimate goal of the ACT-HBV Initiative is to improve the quality and outcomes of care for patients with HBV infection. We hope this supplement will help fulfill that goal.

FINANCIAL DISCLOSURE Dr. Keeffe received honoraria for serving as speaker and on advisory boards for F. Hoffmann-La Roche Ltd., Bristol-Myers Squibb Co., Gilead Sciences, Inc., and Glaxo Smith Kline.