34 Besides the inherent problems of the antiviral therapy, there

34 Besides the inherent problems of the antiviral therapy, there are specific problems in Asia–Pacific countries. First of all, most of the chronic HBV infection in this region is acquired perinatally or during early childhood, thus the patients usually have a long immune tolerance phase with minimal histological change and disease progression. Second,

the most prevalent HBV in this region is genotype C, which is associated with a more progressive disease course but is less responsive to IFN-based therapy. Also, there is more frequent relapse after stopping LAM therapy, especially if consolidation therapy after HBeAg seroconversion is too short. Third, and most importantly, most countries in this region have low-income economies, insufficient medical care systems, 5-Fluoracil lack of adequate postgraduate education, lack of awareness among health-care providers and low awareness of the disease among the general population and government officers. Lack of specialists, state-of-the-art laboratory

tests and adequate reimbursement is so common Ceritinib research buy in Asia that adequate drug therapy is restricted only to those who can afford it.35 NA are important agents for the management of HBV infection. Although they are potent viral suppressors, these agents alone are not able to permanently eradicate HBV. As these agents cannot completely suppress HBV replication, durability of response after stopping them is suboptimal. In order to improve the therapeutic efficacy, long-term maintenance therapy is required. However, prolonged treatment is frequently associated with the emergence of drug-resistant mutants. Before an ‘ideal’ drug(s) with high efficacy

and low incidence of drug resistance becomes available, the ‘road-map’ approach, using the on-treatment HBV DNA level as a predictor for drug resistance, may be useful. Cost-effectiveness is an important issue, too. While NA can be used for nucleoside naïve patients, the low rates of resistance with TDF and ETV have led to a more restricted pattern of use. Importantly, it can be used against ADV-resistant mutants. Ldt Leukocyte receptor tyrosine kinase is more expensive than LAM but is considerably less expensive than ADV, TDF, and ETV. Correspondingly, it may find more use when economic considerations are of major importance. Finally, the long-term efficacy of ADV, ETV and Ldt in the prevention of disease progression and HCC is still unknown. However, ADV, ETV and Ldt all have at least 1–5 years’ efficacy but reduced or delayed emergence of drug resistance and it is conceivable that their long-term efficacy on disease progression will be even better than that achieved by long-term LAM therapy. “
“We read with great interest the article recently published in this journal by Tarrats et al.1 In that study the authors investigated the role of tumor necrosis factor receptors (TNFRs) 1 and 2 in hepatic stellate cell (HSC) proliferation and activation.

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