HBeAg-positive chronic hepatitis B: Why do I treat my patients with Nucleos(t)ide Analogs?

The ultimate goal of therapy for hepatitis B virus (HBV) infection is to obtain a clinical benefit for the patient by reducing infection-related complications, including hepatocellular carcinoma (HCC). Two main types of antiviral agents have been approved to treat patients in the immune clearance phase: interferon (IFN) and nucleos(t)ide analogues (NAs). NAs are used in most HBeAg-positive chronic hepatitis B patients for several reasons. They are oral drugs that are taken once a day and can be prescribed to all chronic hepatitis B patients, even those with contraindications for IFN. The current first-line NA options, entecavir (ETV) and tenofovir (TDF), have minimal or no risk of long-term resistance, and the sustained virological response is achieved in almost 100% of adherent HBeAg-positive patients. Tolerance is excellent and the safety profile is good, whereas IFN can be associated with adverse events that affect the patients' quality of life. There is considerable evidence to show that NAs modify the natural history of chronic hepatitis B, and increasing evidence that they reduce the risk of developing HCC. The need for long-term, perhaps indefinite treatment in patients who do not achieve anti-HBe seroconversion is the main limitation of NAs, but this is offset by their excellent tolerance and safety profile.