7.3. Phyllanthus in HCV and HBV Infection. P. amarus extract was used, in 1988, in a preliminary study involving 37 patients with chronic hepatitis B. 22 of 37 treated patients had cleared the virus 2-3 weeks after the end of the treatment period and only one of 23 placebo treated became HBsAg negative [137] . The mechanism of action appears to be related to the suppressive effect of Phyllanthus extract on HBsAg secretion and HBsAg mRNA expression [138] and the inhibition of hepatitis B virus polymerase activity [139] . A recent study isolated a polyphenolic compound, 1,2,4,6tetra-O-galloyl-β-D-glucose (1246TGG), from P. emblica, and found that treatment with 1246TGG (6.25 μg/mL, 3.13 μg/mL), reduced both HBsAg and HBeAg levels in culture supernatant of HepG2.2.15 cells [140] . The role of Phyllanthus spp. in the treatment of chronic hepatitis B was studied in several reports that were evaluated in a recent Cochrane review. The authors included a total of 16 randomized trials but only one compared Phyllanthus with placebo and found no significant difference in HBeAg seroconversion after the end of treatment or followup. Fifteen trials compared Phyllanthus plus an antiviral drug like interferon alpha, lamivudine, adefovir dipivoxil, thymosin, vidarabine, or conventional treatment with the same antiviral drug alone and found that the combined treatment affect serum HBV DNA, serum HBeAg, and HBeAg seroconversion. The authors conclude that Phyllanthus in combination with an antiviral drug may be better than the same antiviral drug alone but clinical trials with large sample size and low risk of bias are needed to confirm these findings [141] .