Reviews for APASL guidelines: immunomodulator therapy of chronic hepatitis B

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Abstract
The primary aim of immunomodulator therapy is to help the natural human immune system to mount a defense against hepatitis B virus. IFN-α has been used for the treatment of HBeAg-positive and HBeAg-negative chronic hepatitis B for over two decades and has been shown to be effective in suppressing HBV replication and in inducing serological response leading to long-term clinical benefits. IFN-α has been used in patients with well-compensated cirrhosis with comparable or better response to that in non-cirrhotic patients. IFN-α therapy in patients with cirrhosis has a similar side effect profile as in those without cirrhosis. However, IFN-α is contraindicated in patients with overt or decompensated cirrhosis. Pegylated IFN-α has been shown to be effective in treatment of chronic hepatitis B with sustained response rate in about one-third of the treated patients. Peg IFN-α treatment in non-responders to lamivudine or adefovir dipivoxil showed similar response rate to that seen in naïve patients. Thymosin α1 is effective in treatment of HBeAg-positive and HBeAg-negative chronic hepatitis B with a significantly increasing virological response over time after therapy.