Do appropriate monotherapy or combination therapy paradigms exist for the treatment of chronic hepatitis B?
The efficacy and safety of several new antiviral agents for the treatment of patients infected with HBV have been demonstrated in clinical trials, but there is still an urgent need to develop an overall strategy for the treatment of these patients. Monotherapy may provide sustained reductions in viral load and sustained improvement in necroinflamation and fibrosis for some patients, but there is a need to identify those patients with a high probability of response. Several major predictive factors (eg, baseline serum ALT and baseline HBV DNA levels) have been identified, but standardized measures of response, including standard measures of HBV DNA, are required for accurate prediction and assessment of response. In principle, combination therapy may lead to rapid maximal viral suppression, but synergy with nucleoside/nucleotide combinations has not been observed, and the combination of peginterferon plus lamivudine does not appear superior to peginterferon alone. Variables such as vira
