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Oral nucleos(t)ide agents are used to prevent major complications of chronic hepatitis B infection, such as the development of cirrhosis, hepatic decompensation, hepatocellular carcinoma, and death. To achieve benefit, long-term, and potentially, life-long, antiviral therapy is needed to maintain adequately suppressed hepatitis B viral loads, and therefore, medication adherence is essential. However, long-term therapy may also be complicated by virological breakthrough and the development of antiviral resistance. This will be a brief review of the several recent studies that have examined how patient adherence affects virological outcomes, as well as the potential factors that can affect adherence to antiviral therapy for hepatitis B. infection. [ABSTRACT FROM AUTHOR]

A major goal of antiviral therapy in patients with chronic hepatitis B (CHB) is to achieve durable suppression of viral replication. By maintaining undetectable serum HBV DNA levels, one hopes to improve the clinical outcome of these CHB patients. Recent studies have demonstrated that prolonged viral suppression using first-line antiviral medications such as entecavir or tenofovir is associated with a significant reduction in necroinflammation, fibrosis, and even reversal of cirrhosis. Thus, durable suppression of viral replication might decrease the rates of developing cirrhosis, hepatocellular carcinoma, and most importantly, the mortality from complications associated with HBV-related liver diseases. The first-line medications, entecavir, tenofovir and pegylated interferon α-2a, may help to achieve such outcome with potency and lack or minimal chance of developing antiviral resistance to them. Achieving HBeAg loss and seroconversion in patients with HBeAg-positive CHB is another major goal of antiviral therapy. However, the possibility of HBsAg loss and seroconversion albeit uncommon, represents the holy grail of successful HBV treatment and remains the best predictor of durable viral suppression in patients with CHB. [ABSTRACT FROM AUTHOR]

Despite the introduction of new nucleos(t)ide analogues in recent years, peginterferon is still recommended as a potential first-line treatment option by current practice guidelines for the management of chronic hepatitis B. Peginterferon offers the advantage of higher sustained off-treatment response rates compared to nucleos(t)ide analogues because of its immunomodulatory effects. Sustained transition to the inactive hepatitis B surface antigen (HBsAg) carrier state can be achieved in about 30% of hepatitis B e antigen (HBeAg)-positive patients and 20% of HBeAg-negative patients. Recent studies have focused on identification of pretreatment and on-treatment factors that allow the selection of patients who are likely to achieve a sustained response to peginterferon therapy in order to avoid the side-effects and costs associated with unnecessary treatment. Future studies need to address whether specific virologic benchmarks can guide individualized decisions concerning therapy continuation and whether peginterferon combined with new potent nucleos(t)ide analogues improves treatment outcomes. [ABSTRACT FROM AUTHOR]

The epidemics of hepatitis C virus (HCV) and HIV are major causes of morbidity and mortality worldwide; the 33 million individuals who are coinfected with HCV and HIV face an increased risk of complications and death from liver disease in light of the accelerated progression of hepatitis C to fibrosis and cirrhosis in HIV coinfection. The mechanisms by which HIV accelerates the progression of HCV are thought to be related to alterations in the immunologic milieu, which collectively act to promote fibrogenesis. The progression of liver disease is in large part related to immunodeficiency, and, as with monoinfected individuals, optimal management of HIV infection with HAART may be important for prevention of hepatic morbidity. Treatment of HCV with pegylated interferon and ribavirin should be considered in eligible coinfected persons. Clinical trials in this population demonstrate sustained virologic response rates ranging from 17% to 35% in genotypes 1 and 4 and 44% to 73% in genotypes 2 and 3. However, given these limited response rates and high rates of intolerability, the impending introduction of directly acting antivirals against HCV holds particular promise for interruption of the insidious natural history of liver disease in HIV coinfected persons. [ABSTRACT FROM AUTHOR]