title: Nucleoside/nucleotide analogues in the treatment of chronic hepatitis B.
abstract: The current available agents for the treatment of chronic hepatitis B (CHB) include immunomodulatory agents, such as interferon-α and pegylated interferon-α, and oral nucleoside/nucleotide analogues (NAs), including lamivudine, adefovir, telbivudine, entecavir and tenofovir. The NAs work mainly by inhibiting hepatitis B virus (HBV) DNA polymerase activity and thus suppress HBV replication. Oral NAs have become the mainstay of CHB treatment, mainly due to their profound viral suppressive effects and also due in part to the ease of single daily dosing and lack of significant side effects. One major drawback of NA therapy is the development of drug resistance mutations with long-term treatment. Lamivudine, the first oral NA approved for CHB patients, is associated with high rates of drug resistance, with resultant virological relapse and biochemical flare. Fortunately, newer and more potent NAs, such as entecavir and tenofovir, have very low resistance rates, with potent and durable viral suppression. This review is aimed at the current developments in NAs for CHB treatment, detailing the mechanisms of antiviral activity of the different agents, the efficacy of viral suppression, the achievement of treatment endpoints, the development of drug resistance and the optimal strategies for using these drugs.
authors.affiliation: Department of Medicine,  University of Hong Kong, Queen Mary Hospital, Hong Kong SAR.
authors.forename: James
authors.initials: J
authors.lastname: Fung
authors.forename: Ching-Lung
authors.initials: CL
authors.lastname: Lai
authors.forename: Wai-Kay
authors.initials: WK
authors.lastname: Seto
authors.forename: Man-Fung
authors.initials: MF
authors.lastname: Yuen
mesh_terms: D000284:Administration, Oral; D000998:Antiviral Agents / Q000627:therapeutic use*; D024882:Drug Resistance, Viral; D019694:Hepatitis B, Chronic / Q000188:drug therapy*; D006801:Humans; D009705:Nucleosides / Q000627:therapeutic use*; D009711:Nucleotides / Q000627:therapeutic use*; D012008:Recurrence; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D009705:Nucleosides; D009711:Nucleotides