درمان هپاتيت مزمن B

Treatment of chronic hepatitis B

Background and objectives:The primary goal of therapy in patients with chronic hepatitis B is durable suppression of HBV DNA to the lowest possible level. The threshold of HBV DNA level to initiate therapy is ≥ 105 copies /ml for patients with HBe antigen–positive and ≥ 104 copies /ml for patients with HBe antigen-negative chronic hepatitis B. Interferon α2b lamivudine and adefovir dipivoxil are FDA-approved and could all be used as an initial first-line therapy in chronic hepatitis B. It was shown that adding lamivudine to either conventional interferon or peg-interferon did not increase the efficacy of treatment. Also addition of lamivudine to adefovir had no additional effect in compensated patients. Response rate is about 30-40% with first-line drugs. Peg-interferon which recently received FDA approval was associated with an increased response rate. Further long-term studies are required in order to use Peg-interferon as a wide-scale first-line treatment. Treatment strategy is changing towards using prolonged combination therapy with evolving nucleoside analogues with or without an immunomodulatory agent aiming to eradicate cccDNA.