Metabolism, interaction and use guidelines of anti-HBV and anti-HCV medications

Jinsheng Guo, Jian Wu

Research output: Chapter in Book/Report/Conference proceedingChapter


New nucleotide derivatives of anti-HBV medications have become the first-line treatment for naïve patients with high viral titers, lamivudine-resistant, abnormal or nearly normal alanine aminotransferase (ALT), yielded a convincing decrease of the viral load, improved HBeAg sero-conversion, and reduced drug resistance development. The treatment significantly minimizes the possibility of progression to end-stage liver disease, decompensated complications and the incidence of hepatocellular carcinoma (HCC). Monotherapy of anti-HBV nucleotides is often well-tolerated, and a combination of tenofovir or adefoviror with telbivudine or entecavir is suggested in rescue therapy for those who developed resistance to initial therapy. Thus, it is essential to understand the metabolism and drug interaction when more than one medication is given, especially when patients have existing conditions, such as organ transplantation, HIV co-infection, diabetes, hypertension or renal insufficiency. PEG-IFN plus ribavirin has been the standardized therapy for naïve and genome type I HCV infection with a moderate sustained viral response (SVR). Since adding a protease inhibitor (either boceprevir or telaprevir), the SVR has been elevated approximately 30% in naïve patients, even in those who failed to respond to the standardized regimen in their initial trial. However, both boceprevir and telaprevir are metabolized by cytochrome P450 (CYP) 3A, and the triple therapy regimen may enhance the severity of adverse effects caused by PEG-IFN and ribavirin, such as anemia, thyroid dysfunction, etc. due to drug interaction. When patients receiving the triple regimen have conditions mentioned above, the safe use of anti-HCV and other medications remains a critical issue in their clinical management. Understanding the principle of pharmacology, metabolism and interaction of all prescribed medications, as well as possible factors in potentiating adverse effects or toxicity would greatly improve the successful rate of selected regimens, limit adverse effects in a manageable scale, reduce the drop-out rate, and maintain patient compliance. This chapter will discuss the treatment regimens for HBV and HCV infection, recommended by internationally well-credited professional organizations (such as AASLD, EASL and APASL), provide the use guidelines for preventing possible drug interactions and severe adverse effects.

Original languageEnglish (US)
Title of host publicationCytochrome P450 Enzymes: Biochemistry, Pharmacology and Health Implications
PublisherNova Science Publishers, Inc.
Number of pages20
ISBN (Print)9781633216907, 9781619422094
StatePublished - Jan 1 2014
Externally publishedYes


  • Anti-hepatitis medication
  • Cytochrome P450
  • Direct-acting antiviral agents (DAAs)
  • Drug interaction
  • Drug metabolism

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)


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