title: A treatment algorithm for the management of chronic hepatitis B virus infection in the United States.
abstract: OBJECTIVE
  Chronic hepatitis B is an important public health problem worldwide and in the United States. A treatment algorithm for chronic hepatitis B virus (HBV) infection was developed by a panel of US hepatologists based on new developments in the understanding of the virology of HBV, availability of more sensitive molecular diagnostic testing, and advantages and disadvantages of currently approved therapies.
  
  
  METHODS
  This algorithm is based on available evidence, but where data are lacking, the panel relied on clinical experience and consensus expert opinion.
  
  
  RESULTS
  Serum HBV DNA can be detected at levels as low as 100-1000 copies/mL by using molecular assays and should be determined to establish a baseline level before treatment, monitor response to antiviral therapy, and survey for the development of drug resistance. The primary aim of antiviral therapy is durable suppression of serum HBV DNA to the lowest level possible. The threshold level of HBV DNA for determination of candidacy for therapy is >/=10(5) copies/mL for patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B. A lower serum HBV DNA threshold is appropriate for patients with HBeAg-negative chronic hepatitis B and those with decompensated cirrhosis, and the panel recommends thresholds of 10(4) copies/mL and 10(3) copies/mL, respectively.
  
  
  CONCLUSIONS
  Interferon alfa-2b, lamivudine, and adefovir dipivoxil are all approved as initial therapy for chronic hepatitis B and have certain advantages and disadvantages. Issues for consideration include efficacy, safety, incidence of resistance, method of administration, and cost. Studies are under way to explore the safety and efficacy of combination therapy, which may prove to be more effective than monotherapy in suppressing viral replication and may decrease or delay the incidence of drug resistance.
authors.affiliation: Stanford University Medical Center, 750 Welch Road, Suite 210, Palo Alto, California 94304-1509, USA. ekeeffe@stanford.edu
authors.forename: Emmet B
authors.initials: EB
authors.lastname: Keeffe
authors.forename: Douglas T
authors.initials: DT
authors.lastname: Dieterich
authors.forename: Steve-Huy B
authors.initials: SH
authors.lastname: Han
authors.forename: Ira M
authors.initials: IM
authors.lastname: Jacobson
authors.forename: Paul
authors.initials: P
authors.lastname: Martin
authors.forename: Eugene R
authors.initials: ER
authors.lastname: Schiff
authors.forename: Hillel
authors.initials: H
authors.lastname: Tobias
authors.forename: Teresa L
authors.initials: TL
authors.lastname: Wright
mesh_terms: D000465:Algorithms; D000998:Antiviral Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D004279:DNA, Viral / Q000097:blood; D006515:Hepatitis B virus / Q000187:drug effects / Q000502:physiology; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome; D014481:United States
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral