The evolving treatment of chronic hepatitis B: A clinical update

The primary goal of therapy for chronic hepatitis B virus (HBV) infection is long-term suppression of serum HBV DNA, which will likely reduce the risk of progression to cirrhosis and hepatocellular carcinoma. Patients who are in the immune clearance or reactivation phases, which are characterized by elevated serum HBV DNA and alanine aminotransferase levels and/or by evidence of significant necroinflammation on liver biopsy, are potential candidates for therapy. The preferred treatment options are adefovir, entecavir, peginterferon alfa-2a and, potentially, telbivudine (if serum HBV DNA is undetectable after 24 weeks of therapy). Although data are limited, there are increasing trends for the use of combination nucleoside/nucleotide agents in patients who have antiviral drug resistance, in those with cirrhosis, and in patients who have undergone liver transplantation for HBV infection.