Lamivudine, an oral nucleoside analogue, has demonstrated efficacy against the hepatitis B virus (HBV) in both HBeAg-positive and HBeAg-negative patients with chronic hepatitis B. Treatment with lamivudine is safe and well tolerated and induces a virological and biochemical response in most patients within a short time. Significant histological improvement was seen in clinical trials after 52 weeks of lamivudine treatment. However, durable posttreatment remission of chronic hepatitis B has not been shown to occur in a significant number of lamivudine-treated patients. To maintain the response to treatment, therefore, long-term therapy is required. Prolongation of therapy, however, is associated with the emergence of HBV resistance to lamivudine in most patients. This is accompanied by virological rebound and reversal of the initial therapeutic response, and sometimes by exacerbation of hepatitis. The need remains for effective, safe, and tolerable oral agents with durable activity against HBV.
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