The availability of nucleoside analogues has broadened treatment options
for chronic hepatitis B virus (HBV ) infection. Registered treatment for
chronic hepatitis B currently consists of (pegylated) interferon,
lamivudine and adefovir, while entecavir is expected to be licensed in the
short term. Treatment is generally recommended for patients with high
serum HBV DNA and elevated ALAT, indicating the host's immune response
against HBV. Induction of an HBV -specific immune response seems crucial
for persistent control of HBV infection. Currently available treatment
strategies can be differentiated into those that provide sustained
off-treatment response and those that provide therapy maintained response.
A finite treatment course with immunomodulatory agents (interferon-based
therapy) results in sustained response in about one third of patients,
while nucleoside analogue treatment generally requires indefinite therapy
without a clear stopping point. Since nucleoside analogues are well
tolerated, prolonged therapy is feasible, but a major drawback is the
considerable risk of developing antiviral resistance, which occurs most
frequently in lamivudine treated patients and to a lesser extent during
adefovir or entecavir therapy. In our opinion, treatment with
peginterferon should therefore be considered first-line therapy in
eligible patients with a high likelihood of response based on serum HBV
DNA, ALAT and HBV genotype. Patients not responding to PEG-IF N therapy or
not eligible for peginterferon therapy should be treated with
nucleos(t)ide analogues