Step-down affordable treatment for chronic hepatitis B infection in Africa and India Acronym - STEP-HEP

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Chronic infection with the hepatitis B virus is common in the developing world. Without therapy a large proportion of those who are infected will develop liver disease (cirrhosis and liver cancer) that will lead to premature death. Effective treatments for hepatitis B are available but they are too costly for wide spread use in the developing world.We plan to investigate a new approach to treating chronic hepatitis B. We will initiate therapy with an expensive, but very powerful, drug - tenofovir - and, when the hepatitis B is controlled, we will step down to a weaker, but much cheaper drug - lamivudine. We will ensure that this approach is safe by checking that anyone who does not respond to lamivudine can be effectively treated by the re-introduction of tenofovir. The best way to monitor treatment in people with chronic hepatitis B is to measure the amount of virus in the blood using very sophisticated, expensive test. These tests are often not available in the developing world and we will therefore determine whether or not we can use simple, cheap tests of liver inflammation to monitor patients receiving treatment for hepatitis B.