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Background: The hepatitis C pandemic has been systematically studied and characterized in North America and Europe, but this important public health problem has not received equivalent attention in other regions. Aim(s): The objective of this systematic review was to characterize hepatitis C virus (HCV) epidemiology in selected countries of Asia, Australia and Egypt, i.e. in a geographical area inhabited by over 40% of the global population. Methodology: Data references were identified through indexed journals and non-indexed sources. In this work, 7770 articles were reviewed and 690 were selected based on their relevance. Result(s): We estimated that 49.3-64.0 million adults in Asia, Australia and Egypt are anti-HCV positive. China alone has more HCV infections than all of Europe or the Americas. While most countries had prevalence rates from 1 to 2% we documented several with relatively high prevalence rates, including Egypt (15%), Pakistan (4.7%) and Taiwan (4.4%). Nosocomial infection, blood transfusion (before screening) and injection drug use were identified as common risk factors in the region. Genotype 1 was common in Australia, China, Taiwan and other countries in North Asia, while genotype 6 was found in Vietnam and other Southeast Asian countries. In India and Pakistan genotype 3 was predominant, while genotype 4 was found in Middle Eastern countries such as Egypt, Saudi Arabia and Syria. Conclusion(s): We recommend implementation of surveillance systems to guide effective public health policy that may lead to the eventual curtailment of the spread of this pandemic infection. © 2011 John Wiley & Sons A/S.

Background: Albinterferon-alfa-2b (albIFN) is a fusion protein of recombinant human albumin and rIFN-alpha2b with a half-life of 8 days. An active controlled study evaluated the safety and efficacy of albIFN q4w in treatment-naive patients with chronic HCV-2-3 hepatitis. Method(s): 391 patients were randomized 4:4:4:3 to one of 4 open-label treatment groups, in combination with oral ribavirin 800 mg/d: albIFN q4wks 900mug, 1200mug or 1500mug (6 injections) or PEG-IFNalpha2a 180mug q1wk (24 injections) for 24 weeks. An interim safety evaluation was conducted after all patients had completed the end of treatment while the interim efficacy endpoint was HCV RNA < LOD (20 IU/mL) at week 12 after end of treatment (SVR12). Patients were enrolled at 55 sites in Europe, Asia, Australia and Canada. Result(s): Rates of treatment discontinuation due to adverse events were 1.0%, 2.9%, 3.8%, and 1.3% in the alb- IFN 900mug, 1200mu g, 1500mug and PEG-IFNalpha2a groups respectively (p=NS). Serious AEs occurred in 4.9%, 2.9%, 2.9%, and 2.6% respectively (p=NS). No statistically significant increase in serious or severe respiratory events was noted in any albIFN arm as compared to PEG-IFNalpha2a. Rates of cough on albIFN were 21.6%, 21.4% and 26.7% respectively vs 19.2% on PEG-IFNalpha2a (p=NS). Rates of alopecia were 35.3%, 37.9%, 47.6% and 28.2% respectively (p=0.05). Overall, there were fewer hematology reductions on albIFN, leading to fewer IFN and ribavirin dose reductions. ANC reductions <750/mm3 were 5.0%, 13.7% and 8.6% for albIFN 900mug, 1200mug, 1500mug groups vs 17.9% on PEG-IFNalpha 2a (p=0.0279) while hemoglobin reductions <10g/dL were 11.9%, 18.4% 28.6% vs 25.6% respectively (p=0.0175). SVR 12 rates were 76%, 75%, 81% for albIFN 900mug, 1200mug and 1500mug, vs 82% for PEG-IFNalpha2a (intent to treat; p=NS). Corresponding rates of Rapid Virologic Response at week 4 (HCV RNA < 43 IU/mL) were respectively 49% (p<0.0001 vs PEG-IFNalpha2a) 60% (p=0.01), 71% (p=NS) vs 78% for

Quantitative HBsAg had been suggested to be helpful in management of HBV, but assays were cumbersome. The recent availability of commercial quantitative assays has restarted the interest in quantitative serum hepatitis B surface antigen (HBsAg) as a biomarker for prognosis and treatment response in chronic hepatitis B. HBsAg level reflects the transcriptional activity of cccDNA rather than the absolute amount of cccDNA copies. Serum HBsAg level tends to be higher in hepatitis B e antigen (HBeAg)-positive than HBeAg-negative patients. Among patients with a low HBV DNA (<2000IU/ml), HBsAg <1000IU/ml in genotype D HBV infection and HBsAg <100IU/ml in genotype B/C HBV infection is associated with inactive carrier state in HBeAg-negative patients. The HBsAg reduction by nucleos(t)ide analogues (NA) is not as pronounced as by interferon treatment. On peginterferon treatment, sustained responders tend to show greater HBsAg decline than the non-responders. The optimal on-treatment HBsAg cutoff to predict response needs further evaluation in HBeAg-positive patients, but an absence of HBsAg decline together with a <2 log reduction in HBV DNA at week 12 can serve as stopping rule in HBeAg-negative patients with genotype D HBV infection. A rapid serum HBsAg decline during NA therapy may identify patients who will clear HBsAg in the long-term. There are early reports among Asian patients that an HBsAg level of <100IU/ml might predict lower risk of relapse after stopping NA treatment. In clinical practice, serum HBsAg level should be used together with, but not as a substitute for, HBV DNA.

Large amounts of new data on the natural history and treatment of chronic hepatitis B virus (HBV) infection have become available since 2005. These include long-term follow-up studies in large community-based cohorts or asymptomatic subjects with chronic HBV infection, further studies on the role of HBV genotype/naturally occurring HBV mutations, treatment of drug resistance and new therapies. In addition, Pegylated interferon alpha2a, entecavir and telbivudine have been approved globally. To update HBV management guidelines, relevant new data were reviewed and assessed by experts from the region, and the significance of the reported findings were discussed and debated. The earlier "Asian-Pacific consensus statement on the management of chronic hepatitis B" was revised accordingly. The key terms used in the statement were also defined. The new guidelines include general management, special indications for liver biopsy in patients with persistently normal alanine aminotransferase, time to start or stop drug therapy, choice of drug to initiate therapy, when and how to monitor the patients during and after stopping drug therapy. Recommendations on the therapy of patients in special circumstances, including women in childbearing age, patients with antiviral drug resistance, concurrent viral infection, hepatic decompensation, patients receiving immune-suppressive medications or chemotherapy and patients in the setting of liver transplantation, are also included.