Korean J Gastroenterol.  2003 May;41(5):327-334.

Unresolved Problems on Current Antiviral Treatment for Chronic Hepatitis B in Korea

• Lee CH

Abstract

The prevalence of positive hepatitis B surface antigen (HBsAg) is approximately 70% in patients with chronic hepatitis in Korea, and up to 50% of these will eventually develop cirrhosis. At present, only two agents, interferon (IFN) alfa and lamivudine, are available in Korea for the treatment of chronic hepatitis B. However, both of these are associated with serious limitations in efficacy. Durable post-treatment remission after HBeAg seroconversion has not been shown in 60-70% of the patients treated with lamivudine. There is no defined consensus on the endpoint of the treatment in HBeAg-negative patients. Furthermore, the efficacy of the lamivudine has been compromised by the development of viral resistance in most of the patients. Elevation of ALT appears in 89% of the patients with viral breakthrough (V-BT: HBV DNA>10(5) copies/mL) following mutant development, and 10% of them fall into decompensation. The rescue therapy such as adefovir is necessary, in earlier time before V-BT because this therapy cannot turn the decompensation to the pretreatment state, if the therapy starts late. Such limitation will not be resolved easily with the nucleoside (nucleotide) analogs that are currently available and under development. In conclusion, the combination therapies using two or more nucleoside analogues or other antiviral drug(s) will be the future treatment regimens.

Keyword

Nucleosides; Nucleotides; Lamivudine; Viral breakthrough; Resistant mutant