The primary goal of therapy in patients with chronic hepatitis B is suppression and long-lasting maintenance of hepatitis B virus DNA to its lowest possible level. The threshold of hepatitis B virus DNA level for therapy is ≥105 copies/mL for HBeAg-positive patients and ≥104 for those with HBeAg-negative chronic hepatitis B. Interferon alpha-2b, lamivudine, and adefovir-dipivoxil are approved by FDA and could all be used as an initial first-line therapy in chronic hepatitis B. Adding lamivudine to either conventional interferon or peg-interferon did not increase the efficacy. Adding lamivudine to adefovir had also no additional effect in compensated patients. Response rate is about 30% - 40% with first-line drugs. Peg-interferon, which recently received the FDA approval, is associated with an increased response rate. Further long-term studies are required to use peg-interferon as a widespread first-line treatment. Treatment strategy is changing towards using prolonged combination therapy with evolving nucleoside analogues with or without an immunomodulatory agent, aiming at eradicating covalently closed circular DNA.
CITATION STYLE
Montazeri, G. (2006, January). Current treatment of chronic hepatitis B. Archives of Iranian Medicine.
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