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More than 240 million individuals worldwide are infected with chronic hepatitis B virus (HBV). Among individuals with chronic HBV infection who are untreated, 15% to 40% progress to cirrhosis, which may lead to liver failure and liver cancer. Dr Lydia Tang and colleagues reviewed treatments for chronic HBV infection. Pegylated interferon and nucleotide analogues suppress HBV DNA replication and improve liver inflammation and fibrosis. Long-term viral suppression is associated with regression of liver fibrosis and reduced risk of hepatocellular carcinoma in cohort studies.
| | Nucleotide analogues should be considered as first-line therapy | | Alimentary Pharmacology & Therapeutics |
The cure rates after treatment remain low. Pegylated interferon therapy can be completed in 48 weeks and is not associated with the development of resistance. However, its use is limited by poor tolerability and adverse effects such as bone marrow suppression and exacerbation of existing neuropsychiatric symptoms such as depression. Newer agents may be associated with a significantly reduced risk of drug resistance compared with older agents, and should be considered as the first-line treatment. Dr Tang's team concludes, "Antiviral treatment with either pegylated interferon or a nucleotide analogue should be offered to patients with chronic HBV infection and liver inflammation in an effort to reduce progression of liver disease." "Nucleotide analogues should be considered as first-line therapy." "Because cure rates are low, most patients will require therapy indefinitely."
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