Qom University of Medical Sciences Journal

Background and objectives:The primary goal of therapy in patients with chronic hepatitis B is
durable suppression of HBV DNA to the lowest possible level. The threshold of HBV DNA level to
initiate therapy is ≥ 105 copies /ml for patients with HBe antigen–positive and ≥ 104 copies /ml for
patients with HBe antigen-negative chronic hepatitis B. Interferon α2b, lamivudine and adefovir
dipivoxil are FDA-approved and could all be used as an initial first-line therapy in chronic hepatitis
B. It was shown that adding lamivudine to either conventional interferon or peg-interferon did not
increase the efficacy of treatment. Also, addition of lamivudine to adefovir had no additional effect in
compensated patients. Response rate is about 30-40% with first-line drugs. Peg-interferon, which
recently received FDA approval, was associated with an increased response rate. Further long-term
studies are required in order to use Peg-interferon as a wide-scale first-line treatment. Treatment
strategy is changing towards using prolonged combination therapy with evolving nucleoside
analogues with or without an immunomodulatory agent, aiming to eradicat CCCDNA.