A durable suppression of viral replication in chronic HBV infection decreases the risk of liver disease progression. Treatment is recommended for patients in the immune-active phases of chronic HBV infection (HBeAg positive or HBeAg negative patients with serum HBV-DNA and elevated ALT). Licensed HBV therapies include interferon (sIFN, pegylated-IFN alfa-2a) and nucleoside/nucleotide analogues (lamivudine, adefovir, entecavir) allowing for two different treatment strategies: a finite treatment course of IFN that provides sustained off-treatment response in about one third of patients, or an indefinite treatment with nucleoside/nucleotide analogues that provides a therapy maintained response. IFN has the advantage of a defined treatment duration and of lacking resistance selection; disadvantages are the subcutaneous route of administration and poor tolerability. Nucleoside/nucleotide analogues are orally administered and well tolerated; their drawback is the risk of developing antiviral resistance which increases with duration of treatment. A finite course of IFN should be tried as first-line therapy; a long-term treatment with nucleoside/nucleotide analogues should be used for patients not responding or intolerant to interferon.
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