JAC Advance Access published online on March 13, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkg163
© 2003 by The British Society for Antimicrobial Chemotherapy
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Review
1 Department of Medicine A, Faculty of Medicine, Imperial
College of Science, Technology and Medicine,
St Mary's Campus, South Wharf Road, London W2 1NY, UK
* Corresponding author. E-mail: p.karayiannis{at}ic.ac.uk.
Patients chronically infected with hepatitis B virus
(HBV) run the risk of developing cirrhosis and hepatocellular carcinoma
in later life. Antiviral treatment offers the only means of preventing such
an undesirable outcome. To date, interferon-
Keywords: HBV, antivirals
Hepatitis B virus: old, new and future approaches
to antiviral treatment
(IFN-), an immunomodulator, and two synthetic
nucleoside analogues, lamivudine and adefovir dipivoxil, are the
only licensed antiviral agents for the treatment of chronic HBV
infection. However, the standard treatment endpoints of loss of
HBeAg with or without seroconversion to anti-HBe, normalization
of serum transaminase levels, loss of HBV-DNA and improvement in
liver histology following monotherapy with either types of agent
are only achievable in 
20-30% of
those treated. Long-term treatment with lamivudine is effective
in suppressing viral replication, but drug-resistant mutants arise
with increased length of treatment. Nevertheless, such mutants appear
to be susceptible to adefovir and other nucleoside analogues that
are undergoing Phase II/III clinical trials at the moment. Therapeutic vaccination
and other molecular approaches such as antisense oligonucleotides,
ribozymes, DNA vaccines, dominant-negative proteins and aptamers
are possible future antiviral therapies, which will supplement our
armamentarium against chronic HBV infection. It seems certain that combination
therapies involving two or more nucleoside analogues, immunomodulators
or gene therapies will be the future treatment regimens for chronic
HBV infection.
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