Hepatitis B Treatment (cont.)
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Treatment is usually considered when the risk of complications is high. This would include individuals who have a persistently high viral load, those who have HBeAg in their blood, and those who have signs or symptoms of liver dysfunction. There is no 'rule' for when to start treatment, and the decision is usually made jointly between the physician and the patient. If a decision is made not to treat, patients are monitored regularly to ensure that their disease is not progressing quickly and to evaluate their candidacy for new agents that might be available on the market.
The decision of whether to use nucleotide/nucleoside analogues or pegylated interferon is also individualized. Patients at high risk for neuropsychiatric side effects of pegylated interferon may choose to start with a nucleotide/nucleoside analogue. Nucleotide/nucleoside analogues, especially lamivudine, are more likely to induce resistance in the virus, rendering the drug ineffective after a few months or years.
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