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Optimal therapy of chronic hepatitis B: how do I treat HBeAg‐positive patients?
Author(s) -
Vlachogiannakos Jiannis,
Papatheodoridis George V.
Publication year - 2015
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12719
Subject(s) - entecavir , medicine , hbeag , hbsag , tolerability , pegylated interferon , gastroenterology , lamivudine , tenofovir , hepatitis b , chronic hepatitis , seroconversion , immunology , hepatitis b virus , adverse effect , virus , human immunodeficiency virus (hiv) , ribavirin
Current agents for the treatment of chronic hepatitis B ( CHB ) can be classified into interferon‐α (standard or pegylated) ( IFN ) and nucleos(t)ide analogues ( NA s). IFN therapy has the advantage of a finite duration (48 weeks) with a chance for durable sustained off‐treatment response in HB eAg positive CHB patients. However, these benefits are limited to approximately 30% of HB eAg positive patients, while parenteral administration and potential side effects are common patient concerns. Thus, patients who can benefit from IFN therapy must be carefully selected and monitored. Recently, stopping rules for IFN non‐responders were developed based on 12‐week HB sAg levels. NA s are currently used in most CHB patients. They are administered in one tablet daily and can be used in all patients with excellent tolerability and a good safety profile. The current first‐line options, entecavir ( ETV ) and tenofovir ( TDF ), are highly potent with a minimal risk of resistance during long‐term monotherapy. Prolongation of entecavir or tenofovir maintains the initially high virological remission rates in adherent HB eAg positive patients and modifies the long‐term outcomes. The need for a long‐term, perhaps indefinite, treatment duration is the main limitation of ETV or TDF , which may sometimes be safely discontinued in HB eAg positive patients who achieve stable HB eAg seroconversion. Since there will always be safety concerns and family planning issues with long‐term therapy, NA s should be used carefully particularly in young HB eAg positive patients with minimal‐mild liver disease.