Current treatment of chronic HBV infection: An Asian-Pacific perspective

Chronic hepatitis B virus (HBV) infection is a major global health problem with potential adverse sequelae including liver cirrhosis and hepatocellular carcinoma. Of more than 350 million chronic HBV carriers, 75% reside in the Asian-Pacific region, where most countries have low-income economies. Better understanding of the natural history and immunopathogenesis of chronic HBV infection and the invention of powerful antiviral agents have improved the therapeutic strategy. Guidelines issued by major liver associations are basically similar. However, each country in the Asian-Pacific region has specific problems. Because cost is a main concern, drugs with low genetic barrier to resistance are still widely used in these countries. Modifications needed to accommodate specific situations and problems include more stringent indications for drug therapy, starting therapy with the least expensive drug, and defining stopping rules even for hepatitis B e antigen-negative patients.