Therapy of chronic type B hepatitis with adenine arabinoside and adenine arabinoside monophosphate

Hoofnagle, J.H.

Journal of Hepatology 3(Suppl 2): S73-S80


ISSN/ISBN: 0168-8278
PMID: 2439579
DOI: 10.1016/s0168-8278(86)80103-9
Accession: 029444958

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Adenine arabinoside (ARA-A) and its monophosphate (ARA-AMP) are potent inhibitors of hepatitis B virus, but they have not been shown to beneficially alter the natural history of chronic type B hepatitis. Analysis of responders to ARA-AMP therapy has shown that responses can be temporary and that truly long-term beneficial responses are rare. Most long-term responses occur in patients with marked elevations in serum aminotransferase activities and severe chronic active hepatitis. This group of patients, however, may also be the most likely to have a spontaneous improvement in chronic hepatitis. Analyses from England suggest that male homosexual patients have a lower response rate to ARA-AMP than heterosexual patients. This difference has not been shown in studies from the United States. The effect of HTLV-III infection on the course and outcome of hepatitis B virus infection and on clinical responses to antiviral therapy needs further evaluation. In view of the side-effects of ARA-AMP and its marginal efficacy, it is unlikely to play a role as a single agent in the therapy of this important chronic liver disease. However, the use of ARA-AMP after a short course of immunosuppressive therapy is an approach to therapy that deserves future investigation in prospective controlled trials.