From the Guidelines
The recommended first-line treatments for chronic hepatitis B virus (HBV) infection are entecavir, tenofovir disoproxil fumarate (TDF), or tenofovir alafenamide (TAF). These oral antiviral medications are typically taken once daily and are continued long-term, often for years or indefinitely in many patients. Entecavir is dosed at 0.5 mg daily for treatment-naïve patients and 1 mg daily for those with prior lamivudine resistance. TDF is given as 300 mg daily, while TAF is administered as 25 mg daily. These medications work by inhibiting HBV viral replication by targeting the viral DNA polymerase. They are highly effective at suppressing viral load, reducing liver inflammation, preventing progression to cirrhosis, and decreasing the risk of hepatocellular carcinoma.
Treatment decisions should be individualized based on factors such as:
- HBV DNA levels
- ALT levels
- HBeAg status
- Liver fibrosis stage
- Patient characteristics
TDF and TAF are preferred in patients with high viral loads or those requiring rapid viral suppression, while TAF may be preferred in patients with or at risk for renal or bone disease. Regular monitoring of liver function, renal function, and viral markers is essential during treatment, as indicated by studies such as 1.
The choice of treatment should prioritize the patient's quality of life, morbidity, and mortality, and should be guided by the most recent and highest-quality evidence, such as the 2017 EASL clinical practice guidelines on the management of hepatitis B virus infection 1.
Key considerations in treatment selection include:
- Efficacy
- Safety
- Resistance profile
- Method of administration
- Patient preferences and characteristics
By considering these factors and selecting the most appropriate treatment, healthcare providers can help improve outcomes and quality of life for patients with chronic HBV infection.
From the FDA Drug Label
1.2 Chronic Hepatitis B Tenofovir disoproxil fumarate is indicated for the treatment of chronic hepatitis B virus (HBV) in adults and pediatric patients 12 years of age and older.
The recommended dosage of tenofovir disoproxil fumarate tablets in adults and pediatric patients weighing at least 35 kg is one 300 mg tablet taken orally once daily without regard to food.
- First-line treatment: Tenofovir disoproxil fumarate is a recommended treatment for chronic hepatitis B virus (HBV) infection.
- Dosage: The recommended dosage is one 300 mg tablet taken orally once daily without regard to food for adults and pediatric patients weighing at least 35 kg.
- Key consideration: The dosage for tenofovir disoproxil fumarate is the same for both HIV and HBV indications 2.
1 INDICATIONS AND USAGE Entecavir tablets are indicated for the treatment of chronic hepatitis B virus infection in adults with evidence of active viral replication and either evidence of persistent elevations in serum aminotransferases (ALT or AST) or histologically active disease
- Alternative first-line treatment: Entecavir is also indicated for the treatment of chronic hepatitis B virus infection in adults with evidence of active viral replication.
- Dosage: The recommended dose of entecavir tablets for chronic hepatitis B virus infection in nucleoside-inhibitor-treatment-naïve adults is 0.5 mg once daily 3.
From the Research
HBV Treatment Overview
- The recommended first-line treatment for chronic hepatitis B virus (HBV) infection includes pegylated interferon, entecavir, or tenofovir, as stated in current international guidelines 4.
- These treatments have been shown to be effective in suppressing viral replication and reducing the risk of complications associated with HBV infection.
Treatment Options
- Pegylated-interferon is an immune-modulatory agent that works mainly by enhancing the innate immune response, while nucleos(t)ide analogues, such as lamivudine, adefovir, telbivudine, entecavir, and tenofovir, are oral drugs with direct inhibition of viral replication 5.
- Second-generation nucleos(t)ide analogues, such as entecavir and tenofovir, have both a high genetic barrier to resistance and potent antiviral action 5.
- Tenofovir disoproxil fumarate (TDF) is a first-line treatment for chronic hepatitis B and has been shown to be effective in achieving virological suppression and improving liver function 6, 7.
Efficacy and Safety
- TDF monotherapy has been shown to be effective in patients with HBV resistant to entecavir and/or adefovir, with a high proportion of patients achieving serum HBV DNA <15 IU/ml at week 240 8.
- However, TDF monotherapy has been associated with poor serological responses and decreasing renal function and bone mineral density 8.
- The safety profile of TDF is generally favorable, with few patients experiencing renal- or bone-related adverse events 6, 7.