The First-line Antiviral Medications for Chronic Hepatitis B Treatment

When it comes to managing chronic hepatitis B, antiviral therapy plays a crucial role in controlling the virus and preventing long-term liver complications. There are two main categories of antiviral medications: oral nucleoside analogs and injectable interferons. The most commonly prescribed oral medications include entecavir, tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide (TAF). The choice between these medications should be based on individual patient factors such as kidney function, age, and overall health status, and must be made under the supervision of a specialist.

Interferon therapy, on the other hand, offers additional benefits beyond viral suppression. It not only helps fight the hepatitis B virus but also has anti-fibrotic properties and may reduce the risk of liver cancer. This makes it a particularly attractive option for younger patients with a family history of liver cancer or cirrhosis. However, it is important to note that interferon is not recommended for patients with decompensated cirrhosis. For those with early-stage cirrhosis, interferon can still be considered, but treatment must be closely monitored by a liver disease specialist.

Before initiating any antiviral therapy, a comprehensive evaluation is essential to determine whether treatment is necessary. This includes blood tests such as hepatitis B surface antigen (HBsAg), HBV-DNA levels, liver function tests, complete blood count, alpha-fetoprotein (AFP), and kidney function tests. Imaging studies like liver, gallbladder, and spleen ultrasound are also important. These diagnostic tools help assess the level of viral activity and the extent of liver damage, including inflammation and fibrosis.

In some cases, more advanced diagnostic methods may be needed. For example, liver stiffness measurement using transient elastography can provide valuable insights into the degree of fibrosis. If necessary, a liver biopsy may also be performed. Treatment should be initiated when there is clear evidence of active viral replication and significant liver damage, such as grade 2 or higher inflammation or stage 2 or higher fibrosis. Patients with a family history of liver cancer or signs of extrahepatic manifestations of hepatitis B should also be considered for antiviral therapy.

In conclusion, selecting the appropriate first-line medication for chronic hepatitis B requires a personalized approach based on thorough medical evaluation and ongoing specialist guidance. Timely and effective antiviral treatment can significantly reduce the risk of serious liver complications and improve long-term outcomes.