TREATMENT OF CHRONIC

Treatment is considered for patients with high HBV DNA, elevated ALT levels and evidence of inflammation or fibrosis on liver biopsy. Patients in the immune clearance and reactivation phases of infection, but not in the immune tolerance phase, are candidates for therapy. The primary goal of therapy is control of viral replication. In HBeAg-positive patients, HBe seroconversion is an endpoint of therapy. In HBeAg negative-patients, no therapeutic endpoint exists and therapy is usually indefinite. Direct antiviral agents can be chosen according to their potency, their side effects and the chance of resistance. For treatment-naïve patients, entecavir is the best currently available antiviral therapy. For lamivudine-resistant patients, adefovir added to lamivudine therapy is most effective. Long-term therapy is commonly required and resistance is likely, with all agents in current use. Pegylated interferon has comparable efficacy to antiviral agents, with the disadvantage of increased side effects and the advantage of a shorter, fixed duration therapy without drug resistance. Therapy should be individualised. Regular monitoring is required to identify resistance, hepatitis flares and response