Hepatitis B treatment

Lamivudine (Epivir / Zeffix) is licensed as a treatment for hepatitis B in an increasing number of countries. It may be prescribed to people with chronic hepatitis B virus (HBV) infection with liver damage, liver inflammation or fibrosis. The standard dose for hepatitis B infection is 100mg once daily. Lamivudine can also improve liver function in people with HIV co-infection.1

A number of trials have found that lamivudine normalises liver function in the majority of people with hepatitis B. Clinical trials have found improved liver function in more people taking lamivudine than placebo, and less progression to fibrosis and liver cancer.2 3 However, some experts have questioned the appropriateness of once-daily, single drug therapy due to the likelihood of people with hepatitis B developing drug resistance in the long term.

Resistance to lamivudine in HBV usually occurs in the YMDD domain.4 Resistance emerges more slowly in HBV than in HIV. Lamivudine resistance appears to emerge more quickly in individuals with a higher body mass index, suggesting that resistance to lamivudine may develop if the dose of lamivudine used is not large enough.

The inclusion of lamivudine in antiretroviral therapy regimens for people with co-infection has also been questioned, since this would lead to lamivudine monotherapy for hepatitis B and the possibility of resistance developing.5 6 Combination approaches to hepatitis B treatment are being explored, using adefovir (Hepsera), tenofovir (Viread), interferon alfa (Roferon-A / Viraferon) or famciclovir (Famvir) alongside lamivudine.

People with HBV may experience a flare-up of hepatitis B when they stop lamivudine treatment.7 Additionally, cases of hepatitis B flare-up in people with HIV co-infection receiving lamivudine have been reported in the absence of any evidence of lamivudine resistance. This is probably caused by the reconstitution of the immune system before the lamivudine has time to control the HBV.8 9 A possible way to avoid this is to combine lamivudine with tenofovir in people with co-infection, to delay the addition of other anti-HIV drugs until the HBV is controlled, or to assess the extent of liver damage before initiation of antiretroviral therapy.


  1. Dore GJ et al. Dual efficacy of lamivudine treatment in HIV / hepatitis B virus coinfected persons in a randomized, controlled study (CAESAR). J Infect Dis 180: 607-613, 1999
  2. Dienstag JL et al. Lamivudine as initial treatment for chronic hepatitis B in the United States. N Engl J Med 341: 1256-1263, 1999
  3. Lai CL et al. A one-year trial of lamivudine for chronic hepatitis B. N Engl J Med 339: 61-68, 1999
  4. Bourne NE et al. Prolonged lamivudine therapy for chronic hepatitis B: safety, efficacy on HBV, variant emergence, and seroconversion. 12th International Conference on Antiviral Research, Jerusalem, abstract S74, 1999
  5. Hoff J et al. Evaluation of chronic hepatitis B virus (HBV) infection in coinfected patients receiving lamivudine as a component of anti-human immunodeficiency virus regimens. Clin Infect Dis 32: 963-969, 2001
  6. Neau D et al. Hepatitis B exacerbation with a precore mutant virus following withdrawal of lamivudine in a human immunodeficiency virus-infected patient. J Infect 41: 192-194, 2000
  7. Bessesen M et al. Chronic active hepatitis B exacerbations in human immunodeficiency virus-infected patients following development of resistance to or withdrawal of lamivudine. Clin Infect Dis 28: 1032-1035, 1999
  8. Drake A et al. Immune reconstitution hepatitis in HIV and hepatitis B coinfection, despite lamivudine therapy as part of HAART. Clin Infect Dis 39: 129-132, 2004
  9. Bellini C et al. Frequent liver dysfunction after lamivudine withdrawal in HIV-hepatitis B coinfection. Antivir Ther 8: S464, 2003
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.