Write the first-line antivirus treatment regimen for the management of chronic hepatitis B along with the recommended monitoring strategy during therapy.
First-line Antiviral Therapy for Chronic Hepatitis B
Management of chronic hepatitis B (CHB) has advanced significantly with the availability of highly potent nucleos(t)ide analogues (NUCs). These agents are preferred because they achieve strong viral suppression, have extremely low resistance rates, and are generally safe for long-term use.
Preferred first-line agents include:
Entecavir (ETV): A nucleoside analogue given as 0.5 mg orally once daily for treatment-naïve patients. It has potent antiviral activity and a good safety profile.
Tenofovir Disoproxil Fumarate (TDF): A nucleotide analogue administered as 300 mg orally once daily. It is highly effective but may affect renal function and bone mineral density in some patients.
Tenofovir Alafenamide (TAF): A newer prodrug of tenofovir, prescribed as 25 mg orally once daily. TAF provides similar efficacy to TDF but with less renal and bone toxicity, making it suitable for patients with pre-existing kidney disease or osteoporosis.
Monitoring strategy during therapy:
Virological response: Quantitative HBV DNA every 3–6 months initially, then every 6–12 months when undetectable. In HBeAg-positive patients, HBeAg/anti-HBe monitored every 6–12 months to document seroconversion.
Biochemical response: ALT assessed every 3–6 months; normalization reflects reduced liver inflammation.
Safety monitoring: Renal function (creatinine, eGFR, phosphate) every 6–12 months, particularly with TDF. Bone health should be assessed by DEXA scans in at-risk patients. Periodic bilirubin, albumin, and INR should also be checked to evaluate liver function reserve.
HCC surveillance: All patients with cirrhosis, family history of hepatocellular carcinoma, or from high-risk regions require ultrasound and alpha-fetoprotein (AFP) testing every six months, even with viral suppression.
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