B Positive – all you wanted to know about - ASHM

e targeting different aspects of the disease
process such as: altered viral replication 4,5 antiinflammatory
actions 6 and chemoprevention
of malignant change. 7,8 if proven, these actions
would be useful adjuncts to the standard
antiviral therapies in chronic hepatitis b. these
agents are also used in symptom management
during antiviral treatment and more generally
to improve quality of life and wellbeing. 8
The pharmacological actions
of complementary medicines
traditional chinese medicine (tcM) and western
herbal medicine use a number of plant-based
chemicals with synergistic and overlapping
pharmacological actions. Herbal medicines
are chosen for their intrinsic characteristics to
treat diseases, regulate yin and yang and help
the body to re-establish normal physiological
function and restore health. 9–11
Studies demonstrating specific
activities relevant to HBV
management include:
Activity on viral replication
a flavonoid (wogonin) isolated from the
traditional chinese medicinal plant scutellaria
baicalensis (baical skullcap) suppressed
Hbsag production in a HbV transfected liver
cell line (Ms-G2) and inhibited duck HbV dna
polymerase in HbV infected ducks. 12
a study examining the effect of another
flavonoid (apigenin) isolated from ocium
basilicum (sweet basil) showed this agent had
the capacity to reduce the production and
release of Hb s and e antigens in HepG 2.2.15
cell lines using the Xtt assay. this effect was
more marked than that of lamivudine. the
significance of this finding in terms of sustained
viral suppression is unknown. 13
a multicentre study of chronic hepatitis b
patients found that two different oxymatrine
preparations administered for 24 weeks
improved HbV dna clearance compared to
placebo (p = 0.001). no follow-up period was
included in the study protocol or reported in
the research paper. 14
in a small study, patients receiving 400 mg a day
kurorinone (extracted from sophora flavescens)
intramuscularly (n=45) for three months or
3Miu interferon α 2a (n=49) daily for the first
month and on alternate days for the next
two months showed that aLt normalisation
was achieved in 50% of the kurorinone group
and in 61.3% in the interferon α 2a group
with loss of Hbeag or HbV dna. 15 the 12month
follow-up period showed a sustained
virological response (sVr) of 26.7–36.7% in the
kurorinone group compared to 44.4–46.7%
in the interferon group. 15 no further reports
have been published. no recommendations for
clinical use can be made from these studies.
Anti-inflammatory activity
tJ-9 (sho-saiko-to; Xiao-chai-Hu-tang) is
a Japanese and chinese herbal medicine
which has been widely investigated in both
animal and human studies of liver disease.
in the treatment of HbV it has been shown
to significantly reduce liver inflammation
as evidenced by reduced aLt levels 16 and
improved liver histology (the latter particularly
evident in animal studies). 17-19 the main
ingredients are bupleurum chinensis (chai Hu),
scutellaria baicalensis (baical skullcap; Huang
Qin) and Glycyrrhiza (liquorice; Gan cao) root:
all of these ingredients are regarded as potent
anti-inflammatory agents as well as having
other pharmacological actions. 16,20 However,
there have been about 10 case reports of
pneumonitis related to sho-saiko-to in the past
decade. 21-23 some of these case reports may be
related to interactions with interferon-based
therapy. 23
Antifibrotic activity
there are limited but interesting data on the
use of herbal preparations to modify fibrosis in
HbV.
in one study, a tcM formulation compound
861 (0.03 mg/mL) significantly inhibited
human hepatic stellate cell (LX-2) proliferation
compared to the control. in addition, LX-2
cells exposed to cpd 861 (0.01mg/mL) had
significantly lower alpha-smooth muscle actin
(α-sMa) expression (59% at 48 hours [p < 0.05])
and (60% at 72 hours [p < 0.01]) compared to
b Positive – all you wanted to know about hepatitis b: a guide for primary care providers 97