Assessment and management of chronic hepatitis B.

An understanding of the natural history of CHB is critical for the management of the liver disease. Three clinical patterns with different clinical outcomes are recognized: HBeAg-positive CHB, HBeAg-negative CHB,and inactive CHB. Patients with elevated aminotransferase levels and HBV DNA greater than 105 viral copies per mL in serum and with features of chronic hepatitis on liver biopsy are candidates for therapy regardless of HBeAg status. Multiple host and viral factors and safety profiles of current therapies need to be considered carefully before recommending therapy. There appears to be no role for HBV genotyping in the management of patients. Three antiviral agents are approved for use against CHB infection:IFN-a, lamivudine, and adefovir. Efficacy is moderate at best and is limited by the poor tolerability of IFN and the development of resistance, coupled with concerns regarding the long-term safety with nucleoside analogs. Several new nucleoside and nucleotide analogs and novel agents are at various stages of development as potential therapies for CHB. The ideal compound would be one that is active against all replicative intermediates of the virus and has a low toxicity profile. Despite current shortcomings, the future of therapy for HBV is promising, as newer therapeutic options are being developed based on an understanding of the HBV life cycle.