Management of hepatitis B

Treatment is not indicated in all patients of hepatitis B. It is reserved for patients who have elevated aminotransferase levels, clinical evidence of progressive disease, or biopsy evidence of chronic active hepatitis.

Oral antiviral drug entecavir is the first-line treatment. Entecavir is a nucleoside analogue and is the most potent antiviral drug currently available against hepatitis B. Resistance to entecavir is rare. Dose modification is necessary in patients with renal dysfunction. There have been no reported serious side effects.

Important note: Combination therapy has not been proven to be superior to monotherapy with entecavir.

Interferon alpha or pegylated interferon alpha was previously used as a first-line treatment.

It reduces viral replication in up to 30% of chronic carriers. A better response is predicted by being female, < 50 years old, low HBV DNA levels, non-Asian, HIV negative, high degree of inflammation on liver biopsy

This drug can increase aminotranseferase levels and is poorly tolerated. Initial few doses can cause an influenza-like syndrome. Other serious side effects that can develop later are fatigue, malaise, depression, bone marrow suppression and autoimmune disorders. It is not the most potent drug.

Lamivudine

Nucleoside reverse transcriptase inhibitors