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February/March 2016 (vol. 12/5)
Hepatitis B treatment
A systematic review on treating adult patients with chronic hepatitis B virus (HBV) infection found moderate-quality evidence that antiviral therapy reduces the risks of cirrhosis, decompensated liver disease and hepatocellular carcinoma in those with immune-active infection. The 73 included studies variously compared treatment with lamivudine, entecavir, tenofovir or telbivudine against controls. A meta-analysis of 11 studies comparing two potent antivirals, entecavir or tenofovir (both of which have a low risk of antiviral drug resistance), found no statistical differences in renal safety or effect on bone mineral density, at least in the short term. There were no comparative studies examining continuing or discontinuing antiviral therapy in patients with immune-active HBeAg-negative chronic HBV, but uncontrolled studies suggest a high rate of viral relapse if treatment ceases. Uncontrolled studies suggest there is little or no benefit from adding either entecavir or tenofovir to the treatment regimes of patients who do not achieve undetectable levels of HBV DNA when using either drug on its own. In the UK, peginterferon alfa-2A is the usual first-line treatment for HBV; tenofovir or entecavir are prescribed as alternatives where clinically indicated.
Occupational Health at Work February/March 2016 (vol. 12/5) pp37