NCPA - National Center for Policy Analysis


March 29, 2006

Chronic infection of hepatitis B virus (HBV) accounts for an enormous burden of disease worldwide, including up to half of all cases of cirrhosis, end-stage liver disease and hepatocellular carcinoma (HCC). Entecavir is the newest of five antiviral agents approved for treatment of HBV.

With its excellent potency and low rate of resistance, entecavir treats chronic hepatitis B with much success, says Jay Hoofnagle. Consider the benefits of entecavir:

  • Long-term use of entecavir suppresses virus replication and decreases rates of HCC.
  • Trials in humans confirm few side effects and confirm potent activity against HBV.
  • After 48 weeks, 90 percent of those with high risks for end-stage liver disease and HCC had undetectable levels of HBV in their blood.

However, says Hoofnagle:

  • Experts still question who should be treated, with which antiviral agent, for how long, with what monitoring and with the use of which end points to measure the success or failure of treatment.
  • Entecavir, and the other four antiviral agents, do not eradicate HBV, nor cure the infection.
  • Once treatment with oral antiviral agents begins, stopping proves difficult.
  • The safety and efficacy of long-term therapy have yet to be proved.

Physicians should reserve therapy for patients with active disease, because basing therapy on HBV DNA levels alone is sometimes misleading. Indeed, HBV DNA levels can be high in people with mild or minimal disease, says Hoofnagle.

Source: Jay Hoofnagle, "Hepatitis B - Preventable and Now Treatable," New England Journal of Medicine, March 9, 2006.


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