Therapeutic strategies in the management of patients with chronic hepatitis B virus infection

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The Lancet Infectious Diseases 2008; 8:167-178

DOI:10.1016/S1473-3099(07)70264-5

Review

Therapeutic strategies in the management of patients with chronic hepatitis B

virus infection

Dr V Papatheodoridis MD a , Spilios Manolakopoulos MD a, Prof

Geoffrey Dusheiko MD b and Prof Athanasios J Archimandritis MD a

Summary

Currently available options for the treatment of chronic hepatitis B virus (HBV)

infection include standard and pegylated interferon alfa and four oral antiviral

agents (lamivudine, adefovir, entecavir, and telbivudine). These treatment

strategies are either therapies of finite duration that aim to achieve sustained

off-therapy responses, or long-term treatments that aim to maintain on-therapy

remission. Pegylated interferon alfa may offer higher sustained off-therapy

responses after 1 year, but most patients do not respond. Oral antivirals are

the only candidates for long-term treatment of patients with chronic HBV

infection. Viral suppression has favourable effects on patients' outcome and

modifies the natural history of the disease. Viral resistance is the main

drawback of long-term antiviral therapy. Lamivudine monotherapy is associated

with higher resistance (year 1, 10–27%; year 2, 37–48%; year 4, 60–65%) than

adefovir (year 1, 0%; year 2, 3%; year 5, 29%) or telbivudine (year 1, 3–4%;

year 2, 9–22%). Entecavir resistance is rare in naive individuals (year 4,

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