Medscape www.medscape.com

Tables for:
New Developments in the Management of Hepatitis B Virus/HIV Coinfection

[Medscape General Medicine 4(3), 2002. © 2002 Medscape]


Table 1. Summary: Selected Antiviral Agents for the Treatment of Hepatitis B


Name

Activity

Key findings

FDA-Approved Anti-HBV Agents

Lamivudine

Inhibits HIV reverse transcriptase and HBV DNA polymerase

  • Monotherapy (100 mg/day) associated with HBV DNA clearance or reduction in nearly all patients
  • HBeAg seroconversion in only 17% at 1 year
  • YMDD mutants are lamivudine-resistant, but probably replication-impaired
  • Lamivudine withdrawal may result in severe hepatic flares
  • Interferon-alfa-2b

    Antiviral and immunomodulatory effects

  • Compared with lamivudine, comparable clinical response rates and higher HBeAg seroconversion and HBsAg clearance rates
  • Poor results in perinatally acquired disease and among Asian patients
  • High rates of adverse effects
  • Superior efficacy and reduced toxicity of pegylated forms of interferon
  • Investigational Anti-HBV Agents

    Adefovir dipivoxil

    Inhibits HIV reverse transcriptase (FDA approval was denied) and HBV DNA polymerase

  • Used at lower doses than were studied for HIV
  • Produced -4.80 log10 copies/mL reduction in HBV DNA (9/35 patients undetectable) at week 72 among lamivudine-resistant patients
  • 9% HBeAg seroconversion rate
  • Well tolerated
  • Tenofovir disoproxil fumarate

    Inhibits HIV reverse transcriptase (FDA-approved) and HBV DNA polymerase (investigational)

  • Active against HBV at doses used to treat HIV
  • Produced -3.94 log10 copies/mL reduction in HBV DNA at 48 weeks among 12 lamivudine-resistant patients
  • 1/12 HBeAg seroconversion
  • Emtricitabine

    Inhibits HIV reverse transcriptase and HBV DNA polymerase (both investigational)

  • 61% undetectable HBV DNA at 1 year at 200 mg/day, and 50% HBeAg seroconversion
  • L-dT

    Inhibits HBV DNA polymerase only (investigational)

  • Up to 3.6 log10 copies/mL reduction in HBV DNA at 4 weeks among patients with wild-type HBV