Customizing the Management of Chronic Hepatitis B Virus Infection

Robert G. Gish; Robert P. Perrillo; Ira M. Jacobson

doi:10.1055/s-2007-984695

Seminars in Liver Disease, Table of Contents

Semin Liver Dis 2007; 27: 009-017
DOI: 10.1055/s-2007-984695

Customizing the Management of Chronic Hepatitis B Virus Infection

Robert G. Gish¹ , Robert P. Perrillo² , Ira M. Jacobson³

¹Division of Hepatology and Complex GI, Physicians Foundation, California Pacific Medical Center, San Francisco, California
²Hepatology Division, Baylor University Medical Center, Dallas, Texas
³Division of Gastroenterology and Hepatology, Weill Medical College of Cornell University, New York, New York

Abstract

ABSTRACT

As of October 2006, 6 medications are approved in the United States for the management of chronic hepatitis B virus (HBV) infection: 2 formulations of interferon and 4 oral nucleos(t)ide analogues. For the treating practitioner, tailoring the pharmaceutical regimen according to patient features and clinical circumstances can be a challenge. First-line therapeutic regimens for the management of HBV infection include monotherapy with a U.S. Food and Drug Administration-approved agent that has potent on-treatment viral response and low rates of resistance; in the future, these regimens may include a combination of more than one nucleos(t)ide analogue or a combination of a nucleos(t)ide analogue and pegylated interferon. The oral nucleos(t)ide analogues are generally better tolerated than interferon; however, they can be expensive when administered for lengthy periods and can also lead to medication resistance. Lamivudine, the first approved nucleoside analogue for the treatment of HBV infection, has a very high resistance profile; in fact, lamivudine exposure increases viral resistance to other commercially available nucleos(t)ide analogues: entecavir, telbivudine, and adefovir. For these reasons, the 2007 American Association for the Study of Liver Diseases (AASLD) guidelines no longer recommend lamivudine as first-line therapy for the management of HBV infection. A satellite symposium conducted during the 57th Annual Meeting of the AASLD in Boston, Massachusetts, presented approaches to customizing the management of chronic HBV infection. The presentation highlighted recent findings suggesting that early, profound, and sustained viral suppression improves the probability of sustained virologic response and reduces the likelihood of nucleos(t)ide resistance.

KEYWORDS

Hepatitis B - antiviral therapy - nucleoside and nucleotide inhibitors - interferon - antiviral resistance - HBV DNA

Full Text

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Robert G GishM.D.

California Pacific Medical Center

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