ANNA SUK-FONG LOK
Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
Abstract The ultimate goal of hepatitis B treatment is to prevent cirrhosis, hepatic failure, and hepatocellular carcinoma (HCC). Because clinical outcomes arise only after decades of infection, surrogate end points are used to determine the success of hepatitis B treatment. Standardizeddefinitions of treatment response were discussed in detail at the 2006 National Institutes of Health Workshop on “Management of Hepatitis B.”Currently, there are 6 approved therapies for hepatitis B virus (HBV) infection including 2 formulations of interferon, standard interferon α-2b (IFN-α-2b) and pegylatedinterferonα-2a (pegIFN-α-2a), and 4 nucleos(t)ideanalogues, lamivudine (Epivir), adefovir (Hepsera), entecavir(Baraclude), and telbivudine (Tyzeka). Despite these advances, approved treatments for hepatitis B do not eradicate hepatitis B virus. Thus, clinical benefit is dependenton the ability to maintain sustained suppression of HBV replication. However, long-term treatment with nucleos(t)ide analogues is associated with increasing rates of drug resistance, and the safety and efficacy of these therapies beyond 1-5 years have not been established. This review aims to help the reader navigate the maze of hepatitis B treatments. New therapies and molecularmechanisms of antiviral resistance are discussed in an accompanying article by Ghany and Liang.
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