Source：International Liver DiseaseAuthor：Published：2009-8-28Read：78Article Introduction：Interferon is currently one of the two pillars of antiviral therapy for chronic hepatitis B. A report by Prof. Hakan Senturk of Istanbul University Faculty of Medicine describes the non-response to interferon therapy. Long-term follow-up of patients with HBeAg serologic conversion revealed HBSAg clearance rates of 52% to 71%. Yuerong Li, Department of Infectious Diseases, Zhangqiu People’s Hospital Interferon is currently one of the two pillars of antiviral therapy for chronic hepatitis B. A report by Prof. Hakan Senturk, Istanbul University Faculty of Medicine, describes the non-response to interferon therapy. Long-term follow-up of patients with HBeAg serologic conversion revealed HBSAg clearance rates of 52% to 71%. End-of-treatment response rates and sustained response rates to interferon therapy varied significantly between genotypes. The latest EASL guidelines suggest that HBeAg-positive and negative patients with serum ALT levels three times above the upper limit of normal and HBV DNA levels less than 2×106 IU/mL are indications for interferon-based therapy. However, in fact this patient group represents at most 10% of all chronic hepatitis B patients, and there is a high rate of spontaneous seroconversion in HBeAg(+) patients in this disease state. Patients with genotypes A and B have better treatment outcomes than those with genotypes C and D. The guidelines also suggest that early response at 12 weeks has a high predictive value, and that if HBV DNA remains above 20,000/mL, primary non-response should be considered and the drug should be discontinued. However, this is not absolute. On the one hand, the sustained response rate of patients who meet the early response is only 50%, on the other hand, the titer and change of HBeAg and HBsAg are predictive of the outcome of the treatment.HBeAg seroconversion is a very important step in the treatment of chronic hepatitis B, which implies a significant reduction in the incidence of long term complications such as hepatocellular carcinoma and decompensated liver disease. IFN treatment is very effective in chronic hepatitis B patients with genotype A HBeAg (+), with high rates of serologic conversion and sustained response after discontinuation of the drug, and many of these patients end up clearing their HBsAg.Response to IFN is also good in genotype B patients. Patients with chronic hepatitis B in Turkey are almost exclusively genotype D, which is the group with the poorest response effect. In patients with HBeAg(+), the HBeAg seroconversion rate after IFN treatment was comparable to that of nucleoside (acid) analogs, whereas the proportion of HBV DNA conversions and histologic improvement was significantly lower than that of nucleoside (acid) analogs. In contrast, there is not much experience with IFN in HBeAg(-) patients. Finally, Prof. Senturk concluded that interferon is an option for a small proportion of patients with genotypes A and B, but cannot change the natural course of the disease in patients with genotypes C and D.