Current treatment of chronic hepatitis B

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 > or = 10(5) copies/mL for HBeAg-positive patients and > or = 10(4) 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.