Antiviral therapy and resistance with hepatitis B virus infection

Table 1 Indication for observing and treating HBV

	HBV-DNAlevels	ALT status	Therapy/Observation
HBeAg +	> 105	Normal	Observe
HBeAg +	> 105	Elevated	Yes	IFN, Antivirals
HBeAg +	> 104	Normal	Observe
HBeAg -	> 104	Elevated	Yes	Antivirals, IFN
HBeAg -	> 104	Normal	Observe
Pregnancy	> 109 geq/mL	Irrelevant	Yes	Antivirals
HBsAg + chemotherapy	Irrelevant	Irrelevant	Yes	Antivirals
HBsAg -
Anti-HBc + chemotherapy	Positive	Irrelevant	Observe, treat in case of HBs-Ag appearance	Antivirals
Advanced fibrosis	irrelevant	Elevated	Always	Antivirals
Transplanted patients	> 104		Consider Treatment	Antivirals
Asian male	> 105/6	Irrelevant	Yes	Antivirals

Table 2 Treatment options for chronic hepatitis B and their profile

	Standard Interferon PegIFN	Lamivudine	Adefovir	Entecavir
Viral suppression	4.5 log10 copies/mL	5-6 log10 copies/mL	3-4 log10 copies/mL	6-7 log10 copies/mL
Long term therapy	(6 to) 12 mo in HBe pos. Patients 24 mo in HBeAg neg. patients	+ (continuous)	+ (continuous)	+ (continuous)
Side effects	+	- to very low	- to very low	- to very low
HBe seroconversion	30%	15%-20% at 1 yr, 25%-30% at 2 yr	10%-15% at 1 yr	20% at 1 yr, 30% at 2 yr
Predictive factors for seroconversion	High ALT, low HBV DNA levels	High ALT	High ALT	?
Clearance of HBsAg	+	-	-	?
Cost	++ per months	+	++	(++)
Sustained response	< 30% HBeAg - ca. 30% in HBeAg +	Maintained response 30%-35% (3 yr)	Maintained response ≥ 70% (5 yr)	Maintained response?
Maintained response	Not applicable	Maintained response 30%-35% (3 yr)	Maintained response ≥ 70% (5 yr)	Maintained response?
Clearance of HBsAg	+ (Genotype dependent)	low	low	low
Resistance	No resistance but non-response	20% per year	0% at 1 yr up to 29% at yr 5	0% at 1 & 2 yr (2% at 1 and 10% at 2 yr in lam resistant patients)