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Lamivudine monotherapy for chronic hepatitis B virus infection

Anna SF Lok, MD
Section Editor
Rafael Esteban, MD
Deputy Editor
Jennifer Mitty, MD, MPH


The main aim of treatment for chronic hepatitis B is to suppress hepatitis B virus (HBV) replication before there is irreversible liver damage. Interferon alfa was the first treatment approved in most countries. It leads to a beneficial response in 30 to 40 percent of patients, but is expensive, and may be accompanied by unpleasant side effects. (See "Standard and pegylated interferon for chronic hepatitis B virus infection".)

Lamivudine (Epivir-HBV) was originally developed for the treatment of patients with human immunodeficiency virus infection (see "Selecting antiretroviral regimens for the treatment-naïve HIV-infected patient"). It was subsequently found to be effective in inhibiting HBV replication, and was the first oral antiviral therapy approved for treatment of hepatitis B.

Lamivudine (3TC) is the (-) enantiomer of 2', 3'-dideoxy 3'-thiacytidine. It is phosphorylated to the triphosphate (3TC-TP) which competes with dCTP for incorporation into growing DNA chains, causing chain termination. This may occur during reverse transcription of the first strand of HBV DNA, and during synthesis of the second strand of HBV DNA [1]. Lamivudine may also reverse the T cell hyporesponsiveness to hepatitis B viral antigens observed in patients who have chronic HBV infection, although this effect appears to be transient [2-4]. Lamivudine monotherapy is effective in suppressing HBV replication and in ameliorating liver disease in patients with HBeAg-positive as well as in patients with HBeAg-negative chronic hepatitis B.

This topic review will discuss the treatment of chronic hepatitis B with lamivudine. A general approach to patients with hepatitis B (including other treatment options) is presented separately. (See "Hepatitis B virus: Overview of management".)


A report from a National Institutes of Health (NIH) workshop on the management of hepatitis B proposes that responses to antiviral therapy of chronic hepatitis B should be categorized as biochemical, virological, or histological, and as on-therapy or sustained off-therapy [5]. These terms will be used throughout the subsequent discussion.

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Literature review current through: Nov 2017. | This topic last updated: Aug 24, 2016.
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