• In Chronic hepatitis B management, the decision on when to start, what to start and when to stop treatment is crucial.
• Rapid control of HBV DNA viral load to undetectable levels is the backbone of a successful anti-HBV treatment. This can be achieved only if a potent drug with high genetic barrier is used as firstline in treatment na ve patients.
• Tenofovir is the new preferred first-line drug based on its superior efficacy, tolerability, and favorable resistance profile of 0% even at the end of 3 years. It shows excellent renal safety in HBV patients.
• Tenofovir is the drug of choice in patients with prior lamivudine exposure or lamivudine resistance. Entecavir should be avoided in these patients due to a high risk of resistance as supported by data.
• As per guidelines, tenofovir can be an effective option in patients of telbivudine, entecavir or adefovir resistance where tenofovir can be added to existing treatment or combination of tenofovir and emtricitabine may be used.
• Multidrug resistant cases are difficult to treat hence a combination of drugs such as tenofovir + emtricitabine is suggested.
• Dr. Dietrich also emphasized that treatment with antivirals can reduce the incidence of liver cancer in patients with HBV-related liver cirrhosis and improve survival benefit; hence long term treatment with HBsAg loss should be targeted.
• Treatment of pregnant women with a high viral load (HBV DNA) in the 3rd trimester of pregnancy is recommended with a category B drug such as tenofovir or telbivudine. Also lamivudine serves as a safe option considering the many years of safety data in HIV infected women.
• Overall the treatment of HBV infection is closely analogous to HIV and with newer potent drugs being available it is only going to improve.

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