A treatment algorithm for the management of chronic hepatitis B virus infection in the United States: 2008 update

Clin Gastroenterol Hepatol. 2008 Dec;6(12):1315-41; quiz 1286. doi: 10.1016/j.cgh.2008.08.021. Epub 2008 Aug 23.


Chronic HBV infection is an important public health problem worldwide and in the United States. A treatment algorithm for the management of this disease, published previously by a panel of U.S. hepatologists, has been revised on the basis of new developments in the understanding of the disorder, the availability of more sensitive molecular diagnostic tests, and the licensure of new therapies. In addition, a better understanding of the advantages and disadvantages of new treatments has led to the development of strategies for reducing the rate of resistance associated with oral agents and optimizing treatment outcomes. This updated algorithm was based primarily on available evidence by using a systematic review of the literature. Where data were lacking, the panel relied on clinical experience and consensus expert opinion. The primary aim of antiviral therapy is durable suppression of serum HBV DNA to low or undetectable levels. Assays can now detect serum HBV DNA at levels as low as 10 IU/mL and should be used to establish a baseline level, monitor response to antiviral therapy, and survey for the development of drug resistance. Interferon alfa-2b, lamivudine, adefovir, entecavir, peginterferon alfa-2a, telbivudine, and tenofovir are approved as initial therapy for chronic hepatitis B and have certain advantages and disadvantages. Although all of these agents can be used in selected patients, the preferred first-line treatment choices are entecavir, peginterferon alfa-2a, and tenofovir. Issues for consideration for therapy include efficacy, safety, rate of resistance, method of administration, and cost.

Publication types

  • Practice Guideline
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adenine / analogs & derivatives
  • Adenine / therapeutic use
  • Antiviral Agents / therapeutic use
  • Case Management / standards*
  • DNA, Viral / blood
  • Guanine / analogs & derivatives
  • Guanine / therapeutic use
  • Hepatitis B, Chronic / drug therapy*
  • Hepatitis B, Chronic / virology
  • Humans
  • Interferon alpha-2
  • Interferon-alpha / therapeutic use
  • Organophosphonates / therapeutic use
  • Polyethylene Glycols / therapeutic use
  • Recombinant Proteins
  • Tenofovir
  • Treatment Outcome
  • United States


  • Antiviral Agents
  • DNA, Viral
  • Interferon alpha-2
  • Interferon-alpha
  • Organophosphonates
  • Recombinant Proteins
  • Polyethylene Glycols
  • entecavir
  • Guanine
  • Tenofovir
  • Adenine
  • peginterferon alfa-2a