Lamivudine for hepatitis B in clinical practice

Lamivudine is a potent, once-daily, oral antiviral therapy that is effectiv e and well tolerated in most patient groups with chronic hepatitis B virus infection, including those with pre-core mutant infection. Studies to date show that lamivudine suppresses serum viral replication, causing reductions in serum hepatitis B virus (HBV) DNA and enhancing hepatitis B e antigen ( HBeAg) seroconversion (loss of HBeAg plus presence of antibodies to HBeAg [ anti-HBe]). Lamivudine also improves liver disease, as shown by normalisati on of alanine transaminase (ALT) levels and reduced progression to cirrhosi s. Lamivudine is effective in patients who are interferon (IFN) alpha naive and in those who have failed to respond to IFN alpha, and it suppresses HB V in decompensated liver disease and in liver transplantation. Variants wit h mutations in the YMDD (tyrosine-methionine-aspartate-aspartate) motif may emerge with prolonged lamivudine therapy, but most patients maintain clini cal control. Lamivudine has a safety profile similar to that of placebo and it is better tolerated than IFN alpha. In conclusion, lamivudine represent s a major advance in the therapeutic options available for the management o f patients with chronic hepatitis B and should now be considered the drug o f choice for most patients who require treatment. (C) 2000 Wiley-Liss, Inc.