Nucleos(t)ide analogues for hepatitis B virus: strategies for long-term success.
Studies in the past decades have shown that active hepatitis B virus (HBV) replication is the key driver of liver injury and disease progression, and thus sustained viral suppression is of paramount importance in the management of chronic HBV infection. The nucleos(t)ide analogues lamivudine, adefovir, entecavir, telbivudine and tenofovir are potent inhibitors of HBV polymerase/reverse transcriptase activity and are highly effective in the suppression of HBV replication, but rarely eliminate the virus. Long-term therapy is usually required to achieve sustained hepatitis B e antigen seroconversion, HBV DNA suppression, ALT normalization and fibrosis reversal. Maintained long-term therapy has been demonstrated to significantly lower the rate of hepatic decompensation and development of cirrhosis or hepatocellular carcinoma. However, drug resistance is a serious risk on prolonged nucleos(t)ide analogue therapy, and this poses a critical challenge. Prevention and proper management of drug resistance are crucial to ensure long-term success.
Chien
Rong-Nan
RN
Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.
Liaw
Yun-Fan
YF
D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000227:Adenine Nucleotides / Q000008:administration & dosage; D000410:Alanine Transaminase / Q000097:blood / Q000187:drug effects; D006528:Carcinoma, Hepatocellular / Q000517:prevention & control; D004279:DNA, Viral / Q000097:blood / Q000187:drug effects; D004334:Drug Administration Schedule; D024882:Drug Resistance, Viral / Q000187:drug effects; D004359:Drug Therapy, Combination; D006147:Guanine / Q000008:administration & dosage / Q000031:analogs & derivatives; D006513:Hepatitis B e Antigens / Q000097:blood / Q000187:drug effects; D006515:Hepatitis B virus / Q000187:drug effects*; D019694:Hepatitis B, Chronic / Q000097:blood / Q000188:drug therapy* / Q000821:virology*; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage; D008103:Liver Cirrhosis / Q000517:prevention & control; D008113:Liver Neoplasms / Q000517:prevention & control; D009705:Nucleosides / Q000008:administration & dosage; D063065:Organophosphonates / Q000008:administration & dosage; D011744:Pyrimidinones / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage*; D000077712:Telbivudine; D013936:Thymidine / Q000031:analogs & derivatives; D016896:Treatment Outcome; D014779:Virus Replication / Q000187:drug effects
D000227:Adenine Nucleotides; D004279:DNA, Viral; D006513:Hepatitis B e Antigens; D009705:Nucleosides; D063065:Organophosphonates; D011744:Pyrimidinones; D018894:Reverse Transcriptase Inhibitors; D000077712:Telbivudine; D019259:Lamivudine; C413685:entecavir; D006147:Guanine; C053001:adefovir; D000410:Alanine Transaminase; D000225:Adenine; D013936:Thymidine