Hydroxyurea: A useful adjunct to the standard antiviral therapy in chronic hepatitis B

I read with interest the article by Kashani et al, on the use of hydroxyurea (HU) in the treatment of chronic hepatitis B published in Hepatitis Monthly (1). In their article, the authors performed a limited pilot study and concluded that HU effectively blocks HBV replication. Favorable dosing schedule, safety profile, and cost make HU a very attractive adjunct to the therapeutic armamentarium in a wide range of diseases including sickle cell anemia, thalassemia intermedia and human immunodeficiency virus (HIV) infection (2, 3). The potential role of HU in the treatment of HIV infection was supported first by in vitro experiments and then by controlled clinical trials (4). Indeed, an activated cellular environment is crucial for the initial phase of the HIV-1 life cycle that involves reverse transcription of the viral RNA, the establishment of the HIV-1 provirus within host chromosomes, and the subsequent production of virions. The arrest of the cell cycle in the G1 phase by HU reduces cellular activation and thus should decrease viral production and overall viral burden (5). In all controlled trials assessing treatment of HIV, addition of HU to the standard antiretroviral therapy (ART) has been compared to ART with or without placebo (4). Herein, I would like to mention a couple of drawbacks in the study design of this article: First of all, for ethical concerns, it was better if the authors would have used HU or placebo with standard antiviral therapy among patients and control c 2011 Kowsar M.P.Co. All rights reserved. Please cite this paper as: Alavi-Moghaddam M. Hydroxyurea: A useful adjunct to the standard antiviral therapy in chronic hepatitis B. Hepat Mon. 2011;11(3):210.