Recombinant interferon alfa-2b (Intron A)
Recommended dosage: adults—5 million IU SC per day, or 10 million IU SC three times per week; children—3 million IU per m2 SC three times in the first week, 6 million IU per m2 SC three times per week after that (not recommended for children younger than one year)
Recommended duration of therapy: HBeAg-positive patients—16 weeks; HBeAg-negative patients—one year
Cost for 16 weeks of therapy: $5,600*
Cautions: Interferon alfa-2b may cause or aggravate fatal or life-threatening neuropsychiatric, autoimmune, ischemic, or infectious disorders. Patients should be monitored closely with periodic clinical and laboratory evaluations.
Lamivudine (Epivir)
Recommended dosage: adults—100 mg orally per day; children—3 mg per kg orally per day (maximum: 100 mg per day)
Recommended duration of therapy: HBeAg-positive patients—one year but may be longer in those with HBeAg seroconversion; HBeAg-negative patients with chronic HBV infection—longer than one year, although duration has not been established
Cost for one month of therapy: $156
Cautions: Lactic acidosis and severe, possibly fatal, hepatomegaly have been reported. If lamivudine is prescribed for patients with unrecognized or untreated HIV infection, rapid emergence of HIV resistance is likely.
Adefovir dipivoxil (Hepsera)
Recommended dosage: adults—10 mg orally per day
Recommended duration of therapy: one year
Cost for one month of therapy: $528 [ corrected]
Cautions: Discontinuation of adefovir dipivoxil therapy may result in severe acute exacerbation. Chronic use may result in nephrotoxicity in patients at high risk for underlying renal dysfunction. Lactic acidosis and severe hepatosplenomegaly with steatosis have been reported. Rapid emergence of HIV resistance may occur in patients with unrecognized or untreated HIV infection. This drug is not FDA-approved for use in children.