Genotype infection with or without cirrhosis (GIS), is the most common cause of hepatitis B and, after progression, can lead to GIS or HIV. Drug resistance has become the biggest challenge in treating patients who are infected with hepatitis B and progress to GIS.
While both vls-heavy genotypes can cause severe liver disease, vls (high Vl) genotype infection with or without cirrhosis is the most common cause of cirrhosis. Increased prevalence of HIV-resistant hepatitis B virus (HBV) in Asia and other parts of the world such as Africa have triggered a global strategy for successful management of HBV. With Viral Hepatitis Prevention (VHP) developing rapidly across the globe, a new approach in the treatment of GIS has emerged.
Antiretroviral drugs (ARVs) such as Daclatasvir and Efavirenz are now used in combination with the previously used combination of Daclatasvir and Sovaldi. Daclatasvir and Sovaldi are HIV protease inhibitors that inhibit hepatitis B surface antigen (HBsAg) production and prevent viral replication. Daclatasvir also acts as a potent inhibitor of cellular replication, DNA repair and DNA damage, a reduction of which is a major feature of treatment for GIS. The treatment with combination of Daclatasvir and Sovaldi is less expensive than either treatment alone.
However, as (viral load resistant hepatitis B) patients who do not complete treatment can still develop cirrhosis, even with Daclatasvir and Sovaldi. Treatment with Daclatasvir and Sovaldi does not stop the production of the virus in the liver. Viral load resistance has evolved into virological resistance (VLR) that may lead to cirrhosis even in patients who do not undergo treatment for hepatitis B infection with or without cirrhosis. While Daclatasvir and Sovaldi help in reducing viral load in the liver, they do not contain the full antiviral activity, learn more here. In addition, vls (viral load resistant hepatitis B) patients who do not complete treatment will still experience liver damage even if they are treated with combination therapy. Treatment with a combination of Daclatasvir and Sovaldi should be limited to situations where there is a definite risk of recurrence of hepatitis B infection with or without cirrhosis and there is little or no possibility of discontinuation of treatment for hepatitis B infection with or without cirrhosis.
Treatment with combination of Daclatasvir and Sovaldi can also be used for patients with vls (viral load-resistant hepatitis B) who have failed to complete treatment with Daclatasvir and Sovaldi. In such situations, an effective combination of the drug has to be introduced. These combinations have been developed by a special committee consisting of virologists from around the world. Newer combination of Daclatasvir and Sovaldi is now in clinical trials in phase I trials.
Combination of Daclatasvir and Sovaldi is a combination of all (viral load-resistant hepatitis B) with daclatasvir and solvavir. Some trials of combination of Daclatasvir and Sovaldi have shown that it is more effective than the single drug regimen. Based on the preliminary results of these trials, the combination of Daclatasvir and Sovaldi seems to be more effective and safer in patients with vls (viral load-resistant hepatitis B) than single drug. The success of a combination of all (viral load-resistant hepatitis B) with a combination of daclatasvir and solvavir should be further evaluated in the course of these trials.