Hepatitis B: An assessment of current and future treatment options

Despite dramatic reductions in the incidence of new hepatitis B virus (HBV) infections in the past decade, about 1.25 million Americans have chronic HBV infection, putting them at increased risk for developing complications of chronic liver disease and hepatocellular carcinoma. Candidates for antiviral therapy include individuals with chronic active (replicative) HBV infection. Currently available options for treating chronic HBV infection are interferon alfa-2b and the oral nucleoside analog lamivudine. While interferon alfa can be effective in terminating viral replication and eradicating the carrier state in patients positive for HBeAg, it does not yield a sustained response in 60% to 70% of patients and is associated with significant adverse effects. Lamivudine is a potent suppressor of HBV replication and is effective initially in the large majority of treatment-naïve patients. However, prolonged lamivudine therapy is associated with frequent development of viral resistance. Hepatitis B immune globulin products are available for passive immunization in individuals exposed to HBV and are increasingly used as immunoprophylaxis against recurrence of HBV after liver transplantation. This article reviews and assesses current evidence on the use of these agents as well as five experimental therapies for chronic HBV infection.