Antiviral agents in HBeAg-negative liver disease0

Hepatitis B e antigen (HBeAg)-negative chronic hepatitis is characterized by persistent or intermittent hepatitis B virus (HBV) replication with a high lifetime incidence of cirrhosis and hepatocellular carcinoma. Antiviral therapy, which aims to suppress viral replication, may be achieved in as many as 70% to 90% of patients treated with 1 year of lamivudine and 51% to 74% of patients treated with 1 year of adefovir dipivoxil (ADV). However, the short-term therapeutic advantage of lamivudine is offset by the high incidence of drug-resistant mutations, which approaches 60% at 48 months. Both lamivudine and ADV have been associated with a high rate of virologic relapse following drug withdrawal and a low rate of hepatitis B surface antigen (HBsAg) clearance. Although interferon alpha is associated with HBsAg loss in up to 10% of treated patients, its side-effect profile precludes its use in patients with advanced liver disease. Thus, selection of antiviral therapy for patients with HBeAg-negative liver disease requires individualization based on disease severity, drug efficacy, and resistance profile.