Current treatment of chronic HBV infection

Chronic infection with the hepatitis B virus (HBV) is a major public health problem worldwide. Two of its complications, cirrhosis and hepatocellular carcinoma, result in the deaths of near one million people annually. In the past decades, a great deal has been learned about HBV replication, the natural history and the immunopathogenesis of chronic HBV infection. Additionally, the recent advent of potentially effective direct anti-viral agents such as nucleos(t)ide analogues and the accumulation of substantial experience in the use of these drugs have led to better therapeutic strategies for chronic HBV infection. The primary goal of treatment for chronic hepatitis B is to eliminate or permanently suppress HBV. The long-term goal is to prevent ALT flares that may lead to hepatic decompensation, to prevent progression to cirrhosis and/or HCC and ultimately prolong life. Currently, there are 2 interferon alpha (IFN) based therapy (conventional and pegylated IFN) and 5 nucleos(t)ide analogues (NUCs)approved therapies for HBV infection including lamivudine (LAM), adefovir (ADV), entecavir (ETV). telbivudine (Ldt) and tenofovir (TDF). The advantage and disadvantage between IFN-based therapy and NUCs has been reviewed in this article. The long-term efficacy of IFN and LAM in the prevention of disease progression and HCC is promising. However, the data is still lack in ADV, Ldt, ETV and TDF. The positive results of short-term response and the far less/delayed emergence of drug resistance of ADV, Ldt, ETV and TDF suggest that these antiviral agents have similar or even better long-term efficacy.