The optimal dose and duration of interferon for hepatitis B is somewhat contentious, but most clinicians use 8-10 million units three times a week for four to six months. Few patients lose all markers of infection with hepatitis B, and surface antigen usually remains in the serum. Successful treatment with interferon produces a sustained improvement in liver histology and reduces the risk of developing end stage liver disease. The risk of hepatocellular carcinoma is also probably reduced but is not abolished in those who remain positive for hepatitis B surface antigen. Depression can be a serious problem, and both suicide and admissions with acute psychosis are well described.
Viral clearance occurs through induction of immune mediated killing of infected hepatocytes.
Transient hepatitis can therefore occasionally cause severe decompensation requiring liver transplantation. Lamivudine is a nucleoside analogue that is a potent inhibitor of hepatitis B viral DNA replication. It has a good safety profile and has been widely tested in patients with chronic hepatitis B virus infection, mainly in the Far East. There was an associated improvement of inflammation and a reduction in progression of fibrosis on liver biopsy. Side effects are generally mild.