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Current management of chronic hepatitis B
Author(s) -
Papatheodoridis G. V.,
Hadziyannis S. J.
Publication year - 2004
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1046/j.1365-2036.2003.01810.x
Subject(s) - adefovir , medicine , lamivudine , hbeag , seroconversion , hepatitis b , gastroenterology , hepatitis b virus , immunology , liver biopsy , virology , virus , hbsag , biopsy
Summary Chronic hepatitis B can be diagnosed in patients with increased aminotransferases, hepatitis B virus viraemia and necroinflammation with fibrosis on liver biopsy. Although, ideally, all patients with chronic hepatitis B should be treated, therapeutic intervention is currently recommended for cases with a relatively satisfactory likelihood of response and/or advanced disease. A realistic therapeutic approach aims to sustain hepatitis B e antigen (HBeAg) loss and hepatitis B e antibody (anti‐HBe) seroconversion in HBeAg‐positive chronic hepatitis B and to sustain biochemical and virological remission in HBeAg‐negative chronic hepatitis B. Currently, three drugs are licensed for chronic hepatitis B: interferon‐alpha, lamivudine and adefovir dipivoxil. In patients with HBeAg‐positive chronic hepatitis B, all of these drugs achieve HBeAg loss (24–33%) and anti‐HBe seroconversion (12–30%) rates significantly superior to those observed in untreated placebo controls. In patients with HBeAg‐negative chronic hepatitis B, the sustained off‐therapy response rate is 20–25% after a ≥ 12‐month course of interferon‐alpha and minimal (< 10%), if any, after a 12‐month course of lamivudine or adefovir. Long‐term lamivudine induces an initial response in 70–90% of patients, but only 30–40% of patients remain in remission after the third year due to progressively increasing viral resistance. Long‐term adefovir achieves a response in approximately 70% of patients at 12 months, which is maintained at 24 months with rare (< 2%) drug resistance. Adefovir is also effective against lamivudine‐resistant strains. Many other anti‐viral agents, immunomodulatory approaches and combination therapies are currently being evaluated in chronic hepatitis B.