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Trade off for HBV anti-viral therapy
Jan 25, 2009

Dr McGovern,

Thanks you very much for giving me medical advices. I would like to ask a question just to fulfill my curiosity. If you don't have spare time please ignore this question.

The recent drugs for treating HBV seem to have very low resistance rates. For example, entecavir has a 1.2% resistance rate after 5 years. These anti-viral oral agents suppresses HBV DNA to undetectable in 90% of patients. Moreover, there are minimal side effects for long-term use of these drugs.

I wonder why not just treat every Hepatitis B patients with HBeAb, whether they have inactive disease or HBeAg-negative chronic Hepatitis? I realize there is an economic aspect to this decision. But, from a medical viewpoint, what are the disadvantage of starting a life-long therapy? Is there any trade-off for such kind of preemptive treatments?

Response from Dr. McGovern

As with many drugs, we don't know the long term effect of chronic therapy for years and years. You always want to balance risk and benefit of every drug you use. If there is no detectable virus, there is no compelling reason to treat.

You would not want to treat patients with inactive disease since their immune system is keeping their infection in check. However, the treatment of HBeAg negative infection is important in those with active liver disease.



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