Antiviral therapy in acute viral hepatitis B: why and when

Acute viral hepatitis B is cleared in more than 95% of patients, while the remainder ones may develop either chronic HBV infection or, rarely, fulminant hepatitis. Therefore there are elderly patients with severe acute HBV hepatitis caractherized by high serum bilirubin levels >15 mmole/dl, international normalized ratio (INR) with value more than 1.6; these patients are caractherized by a severe outcome of HBV infection. As known, outcome of infection and the pathogenesis of liver diseases are determined by viral and host factors, such as T reg lymphocytes. T regs may be associated with a negative immune response such as an inhibition of gamma- IFN secretion. The impact of viral load on antiviral T cell responses may play a critical role in thaese patients, influencing disease persistence and immune response. Antiviral drugs could be useful in these patients determing a possible down -regulation of T regs.