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Current approaches for treating chronic hepatitis B: when to start, what to start with, and when to stop

Abstract

The natural course of hepatitis B virus (HBV) infection is variable, and chronic hepatitis B (CHB) disease exhibits itself through a spectrum of clinical manifestations. These factors contribute to the challenges faced when managing patients who live with HBV infection. Furthermore, conventional treatment options (e.g., interferon alfa-2a, lamivudine, and adefovir) are moderately effective and can be associated with problems, such as poor tolerability (interferon alfa-2a) and the development of drug resistance (lamivudine). Over the last 5 years, several antiviral agents including entecavir, peginterferon alfa-2a, and telbivudine which are more efficacious and have improved tolerability over previous drugs have become available. The availability of novel antiviral agents and advances in understanding resistance patterns of antiviral agents has resulted in refinement of CHB treatment recommendations and guidelines. More recently, evidence from clinical trials suggests the central importance of virologic suppression as an indicator of treatment outcome and the predictive value of on-treatment HBV DNA levels in response to antiviral therapy. This review highlights the goals of therapy and clinical experience with therapies that are newly licensed or in the late stages of clinical development. Current approaches for treating CHB and new strategies for optimizing response to therapy are also discussed.

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Fig. 1

Abbreviations

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

CHB:

Chronic hepatitis B

HBeAg:

Hepatitis B e antigen

HBsAg:

Hepatitis B surface antigen

HBV:

Hepatitis B virus

HIV:

Human immunodeficiency virus

PCR:

Polymerase chain reaction

PEG:

Polyethylene glycol

NA:

Nucleoside or nucleotide analog

ULN:

Upper limit of normal

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Chang, TT., Suh, D.J. Current approaches for treating chronic hepatitis B: when to start, what to start with, and when to stop. Hepatol Int 2, 19–27 (2008). https://doi.org/10.1007/s12072-008-9059-0

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Keywords

  • Chronic hepatitis B
  • Human immunodeficiency virus
  • Hepatitis B e antigen