Interferon for HBV infection: Plain or Pegylated? Alone or in combination? Concurrent or sequential?

Hepatitis B Virus (HBV) infection is a significant global public health problem. Treatment options that have evolved rapidly over the last two decades have proven to be effective, but clear recommendations regarding the choice of first-line therapy are lacking. With the emergence of pegylated interferon (PEG IFN), conventional interferon has been relegated into the background and has a very limited role in the treatment of chronic Hepatitis B. Pegylated interferon α2a / 2b treatment has been documented to successfully achieve normalization of alanine aminotransferase (ALT) and viral suppression in nearly half of the patients. However, HBsAg loss can be achieved only rarely. Combination therapy, comprising of pegylated interferon plus nucleos(t)ide analogs theoretically appear attractive because of the synergistic anti-viral and immunomodulatory actions, but the available present literature does not provide sufficient evidence to recommend the combination therapy. Patient selection is important for tailoring the therapy for patients with chronic hepatitis B. Pegylated interferon seems suitable for young patients with raised ALTs, moderately high viral load, and having Genotype A / B; the advantage being finite duration of therapy and no risk of emergence of drug resistance.