Nucleoside Reverse Transcriptase Inhibitors (NRTIs) for Chronic Hepatitis B

Treatment for HBV infection is considered successful if blood tests show that the virus is no longer multiplying in the body, if liver enzyme levels return to normal, and if liver damage (such as Reference inflammation Opens New Window and scarring) improves. NRTIs work in most of the people who take them, but Reference relapse Opens New Window (the virus starts to multiply again) is common after a medicine is stopped, so you may have to take the medicine for a long time.^{Reference 1, Reference 2}

Some studies of entecavir show that it works better than lamivudine or adefovir.^{Reference 3, Reference 4, Reference 5}

Adefovir is effective against HBV infections that have become resistant to lamivudine.^{Reference 1} A study showed that treatment with adefovir worked better for some people with chronic hepatitis B if the medicine was taken for 144 weeks than if it was taken for only 48 weeks.^{Reference 6}

Tenofovir is effective at reducing the amount of hepatitis B virus in the body.^{Reference 7}

The hepatitis B virus may develop Reference resistance Opens New Window to some of the NRTIs:^{Reference 1}

• After 1 year of treatment with lamivudine, up to one-third of hepatitis B viruses may be resistant to the medicine. After 5 years of treatment, up to 70% of HBV may be resistant to lamivudine.
• Resistance is less of a problem with telbivudine than with lamivudine. But resistance to telbivudine goes up greatly after one year of treatment.
• Resistance is less of a problem with adefovir. After 5 years of adefovir treatment, about one-fifth (20%) of HBV was resistant to the medicine.
• Resistance is rare with entecavir, especially when it is used as the first medicine to treat hepatitis B. It is more common when entecavir is used after lamivudine treatment.
• Tenofovir works better than adefovir against hepatitis B virus that is resistant to lamivudine.^{Reference 8}
• Not many studies about resistance to tenofovir have been reported..

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