Strategic use of lamivudine in the management of chronic hepatitis B

Lamivudine is no longer recommended as first-line therapy for chronic hepatitis B. The same advice has been made for adefovir and telbivudine, due to their relatively weak anti-viral activity and low resistance barrier, respectively. Instead, either tenofovir or entecavir is the currently preferred anti-HBV agent, given their potent anti-viral activity and high barrier to resistance. However, these drugs are expensive and their long-term use is often unaffordable for many individuals, including most patients in developing regions, where hepatitis B is generally much more prevalent. Herein, we argue that lack of universal access to the current best anti-viral drugs for hepatitis B should not imply a suboptimal management of chronic hepatitis B which denies therapy to persons who really need it. A wise and strategic use of lamivudine may provide an opportunity to bring the benefit of therapy to large HBV-infected populations, while reducing health care costs.