Hepatitis b

MINERVA MED 2009;100:447-58

M C IN O E P R Y V R A IG M H E T ® DI C A
Treatment of chronic hepatitis B has shown a rapid development in the last years leading to a shift of treatment strategiesfrom interferon to hepatitis B virus (HBV)-polymerase inhibitors. In particular, treatment with HBV-polymerase inhibitors has changed the indication on how to treat a patient and when to stop therapy.Long-term treatment with HBV-polymerase inhibitors may often be required, even if it raises the possibility of resistance and subsequent treatment failure. This review provides a strategy on how tomanage HBV therapy with the currently available treatment options. Key words: Hepatitis B, therapy - Interferons Drug resistance.

Therapy of chronic hepatitis B: new goals and new treatments
S.MAUSS

Center for HIV and Hepatogastroenterology Duesseldorf, Germany

Treatment options for HBV

I

nterferon monotherapy has been the standard of care for chronic hepatitis B until the mid1990s. Primary resistance against interferon exists as HBe- or HBs-antigen loss or seroconversion is less frequently reported for HBV-genotypes B, C and D compared to hepatitis B virus (HBV)-genotype A.1,2 However, the development of resistance to interferon under therapy has not been reported so far. An HBe-antigen seroconversion rate of about 30% can be expected after 12 months
Correspondingauthor: S. Mauss, MD, Center for HIV and Hepatogastroenterology, Grafenberger Allee 128a, 40237 Duesseldorf, Germany. E-mail: stefan.mauss@center-duesseldorf.de

of therapy with pegylated interferonalfa-2a. The situation in HBe-antigen negative patients is more complex with a negligible HBs-antigen seroconversion rate of usually less than 2% after one year of therapy which may increase to up to 4%five years after treatment discontinuation. HBs-antigen loss is more frequent with 5% and 12% respectively.3 However, since the introduction of lamivudine, treatment of chronic hepatitis B has...