Abstract
Interferon (IFN) alpha, lamivudine, and adefovir are the three antiviral therapies currently approved for the treatment of chronic hepatitis B virus (HBV). Initiation of treatment is indicated in patients with abnormal liver enzymes and markers of active viral replication (ie, HBV DNA positive). Hepatitis B early antigen seroconversion rates are higher and treatment duration is shorter with IFN than with lamivudine or adefovir. However, treatment results in frequent side effects and many patients have contraindications to therapy. Lamivudine and adefovir are better tolerated, but have lower seroconversion rates after 12 months of treatment. Resistance develops in 20% of lamivudine patients after 12 months; adefovir resistance has not been identified to date. Individualization of therapy, based on factors such as patient comorbidities, response to prior therapies, and stage of disease (ie, presence of cirrhosis), is recommended. All patients over the age of 40 or with advanced liver disease should be continually screened for hepatocellular carcinoma with serum alphafetoprotein and abdominal imaging every 6 months.
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