The case for combination antiviral therapy for chronic hepatitis B virus infection

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THE LANCET INFECTIOUS DISEASES

Volume 8, Issue 7, July 2008, Pages 444-448

Personal View

The case for combination antiviral therapy for chronic hepatitis B virus

infection

Dr L Nash MRCPa, , and Graeme JM FRCPa

aDepartment of Hepatology, University Department of Medicine, Addenbrooke's

Hospital, Cambridge, UK

Available online 14 May 2008.

References and further reading may be available for this article. To view

references and further reading you must purchase this article.

Summary

The treatment of hepatitis B virus (HBV) infection has been revolutionised in

the past decade by the increased availability of effective antiviral agents.

Many studies have shown the benefits of single agent therapy, but there is an

alarming and rising rate of viral resistance, and clear evidence that viruses

that harbour resistant mutations can cause liver disease and death. Current

national guidelines for the treatment of HBV recommend a programme that starts

with monotherapy, followed by sequential monotherapy or add-on therapy for those

infections in which mutations have arisen. Very few studies starting with

combination therapy have been undertaken, so there is little evidence of the

clinical benefit of this approach to treatment. The studies that have been done

have been short term and have concentrated on clinical parameters rather than

virological resistance, which is likely to be the key determinant in the longer

term. We argue that we should not wait for the evidence to use combination

therapy for the treatment of HBV, since such trials may never be done and it

would take several years for a benefit to become apparent. In the meantime,

multidrug-resistant strains continue to hinder HBV control.

_________________________________________________________________

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24a511a1b60ca585d8ab221716023

THE LANCET INFECTIOUS DISEASES

Volume 8, Issue 7, July 2008, Pages 444-448

Personal View

The case for combination antiviral therapy for chronic hepatitis B virus

infection

Dr L Nash MRCPa, , and Graeme JM FRCPa

aDepartment of Hepatology, University Department of Medicine, Addenbrooke's

Hospital, Cambridge, UK

Available online 14 May 2008.

References and further reading may be available for this article. To view

references and further reading you must purchase this article.

Summary

The treatment of hepatitis B virus (HBV) infection has been revolutionised in

the past decade by the increased availability of effective antiviral agents.

Many studies have shown the benefits of single agent therapy, but there is an

alarming and rising rate of viral resistance, and clear evidence that viruses

that harbour resistant mutations can cause liver disease and death. Current

national guidelines for the treatment of HBV recommend a programme that starts

with monotherapy, followed by sequential monotherapy or add-on therapy for those

infections in which mutations have arisen. Very few studies starting with

combination therapy have been undertaken, so there is little evidence of the

clinical benefit of this approach to treatment. The studies that have been done

have been short term and have concentrated on clinical parameters rather than

virological resistance, which is likely to be the key determinant in the longer

term. We argue that we should not wait for the evidence to use combination

therapy for the treatment of HBV, since such trials may never be done and it

would take several years for a benefit to become apparent. In the meantime,

multidrug-resistant strains continue to hinder HBV control.

_________________________________________________________________

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back!

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