The decision about the kind of drugs in chronic HBV is not limited to the cost of drugs. The chance of development resistance to drugs is important too. In our country, Iran due to production of many anti-HBV drugs (Domestic products) the access to drugs such as IFN, Lamivudine, Adefovir and Tenofovir is very easy and cheaper than the imported ones. I think the WHO should support the low income countries in production of anti-HBV drugs in their country as they have been successful regarding HBV vaccine before. It will help the communities to be safer and more healthy, especially they do not have access to liver transplantation for all cases.
Article World Health Organization Department of Immunization, Vaccin...
Both AASLD and EASL consider Baraclude and Tenofovir the only two NUCs for the first line therapy. In clinical practice some prefer Baraclude in patients with renal problems since Viread has been reported to augment phosphate and calcium loss.
Tenefovir is available in Iran and we start this drug as first one in management of chronic HBV. in my experience in using Tenefovir for 3 years we had less than 1% risk of bone disorders. we give the calcuime and vitamin D supplements to patients especially old and women.
According to our experience Entecavir is very effective and safe(as first line) in treating patients with chronic active HBV infection but in some patients (eg:pregnant ladies) we prefer Tenfovir as the safety of Entecavir in pregnancy is not ensued. The only thing that we can not answer to our patients is when to stop these medications? as the majority of our patients are HBeAg -ve so treatment is lifelong.
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