Table 1.

Approved Antiviral Therapies in Adults and Children

Drug	Dose in Adults1	Use in Children1	Pregnancy Category2	Potential Side Effects2	Monitoring on Treatment3
Preferred
Peg-IFN-α-2a (adult) IFN-α-2b (children)	180 mcg weekly	≥1 year dose: 6 million IU/m2 three times weekly4	C	Flu-like symptoms, fatigue, mood disturbances, cytopenia, autoimmune disorders in adults, anorexia and weight loss in children	Complete blood count (monthly to every 3 months) TSH (every 3 months) Clinical monitoring for autoimmune, ischemic, neuropsychiatric, and infectious complications
Entecavir	0.5 mg daily5	≥2 years dose: weight-based to 10–30 kg; above 30 kg: 0.5 mg daily5	C	Lactic acidosis (decompensated cirrhosis only)	Lactic acid levels if there is clinical concern Test for HIV prior to treatment initiation
Tenofovir dipovoxil fumarate	300 mg daily	≥12 years	B	Nephropathy, Fanconi syndrome, osteomalacia, lactic acidosis	Creatinine clearance at baseline If at risk for renal impairment, creatinine clearance, serum phosphate, urine glucose and protein at least annually Consider bone density study at baseline and during treatment in patients with history of fracture or risks for osteopenia Lactic acid levels if there is clinical concern Test for HIV prior to treatment initiation
Tenofovir alafenamide	25 mg daily	--	There are insufficient human data on use during pregnancy to inform a drug-associated risk of birth defects and miscarriage	Lactic acidosis	Lactic acid levels if clinical concern Assess serum creatinine, serum phosphorus, creatinine clearance, urine glucose, and urine protein prior to initiating and during therapy in all patients as clinically appropriate Test for HIV prior to treatment initiation
Non-Preferred
Lamivudine	100 mg daily	≥2 years dose: 3 mg/kg daily to max 100 mg	C	Pancreatitis Lactic acidosis	Amylase if symptoms are present Lactic acid levels if there is clinical concern Test for HIV prior to treatment initiation
Adefovir	10 mg daily	≥12 years	C	Acute renal failure Fanconi syndrome Lactic acidosis	Creatinine clearance at baseline If at risk for renal impairment, creatinine clearance, serum phosphate, urine glucose, and urine protein at least annually Consider bone density study at baseline and during treatment in patients with history of fracture or risks for osteopenia Lactic acid levels if clinical concern
Telbivudine	600 mg daily	--	B	Creatine kinase elevations and myopathy Peripheral neuropathy Lactic acidosis	Creatine kinase if symptoms are present Clinical evaluation if symptoms are present Lactic acid levels if there is clinical concern

¹Dose adjustments are needed in patients with renal dysfunction.

²In 2015, the US Food and Drug Administration replaced the pregnancy risk designation by letters A, B, C, D, and X with more specific language on pregnancy and lactation. This new labeling is being phased in gradually, and to date only TAF includes these additional data.

³Per package insert.

⁴Peg-IFN-α-2a is not approved for children with chronic hepatitis B but is approved for treatment of chronic hepatitis C. Providers may consider using this drug for children with chronic HBV. The duration of treatment indicated in adults is 48 weeks.

⁵Entecavir dose is 1 mg daily if the patient is lamivudine experienced or if they have decompensated cirrhosis.