الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Hepatitis B viral infection (HBV) is one of the major public health problems allover the world. Chronic Hepatitis B (CHB) is defined as presence of Hepatitis B surface antigen (HBsAg) in serum for more than six months and it is presented either as HBeAg positive or HBeAg negative CHB. In Egypt about 80% of patients of CHB are HBeAg negative CHB.The indications of treatment in CHB including patients with HBV DNA level ≥ 20,000 IU/ ml in HBeAg positive patients or HBV DNA level ≥ 2000 IU/ ml in HBeAg negative patients with elevation of serum ALT level, if there is normal serum ALT level it is recommended to do liver biopsy. Currently, seven drugs are available for CHB including, interferon alfa (IFN), conventional or peglated interferon, and nucleoside analogs (NUCs) including, lamivudine, adefovir, telbivudine, entecavir, emtricitabine and tenofovir. Peg- IFN is beneficial for HBeAg positive patients and gives seroconversion rate about 35-40% of cases. It gives better results for patients with higher baseline ALT level and lower HBV DNA level (<107 copies/ml). The main advantages of NUCs over IFN therapy; they are given orally, less expensive, have negligible side effects and they can be used for patients with cirrhosis and after liver transplantation. The disadvantages of NUCs are; they may be given for indefinite period of treatment and the development of antiviral resistance. Tenofovir or entecavir can be used as first line monotherapy for most of patients. The role of combination therapy appeared in prevention and treatment of dug resistance so it is used in case of cirrhosis. Therapeutic vaccine is a novel approach for CHB management but it still under trials.