than each drug (Lau et al 2004). An earlier study comparing LVD and ADV to LVD monotherapy showed no beneﬁt of combination (Sung et al 2003). Nevertheless, Yuen et al (2001) showed that if patient’s serum HBV DNA is 103 copies/ml at 6th month on LVD therapy, addition of adefovir could decrease the chance of LVD resistance which may occur in 64% of these patients at the end of the year. Summary-practice guideline for HBeAg positive and negative patients To date, several guidelines for the treatment CHB patients (AASLD (Lok and McMahon 2001 and 2004), EASL (The EASL Jury 2003), APASL (Liaw et al 2003) and others such as KASL guideline (Korean Association for the Study of Liver 2004), and Keeffe and his colleagues (Keeffe et al 2006) are presented. However, there are no uniform guide- lines globally for the usage of antivirals in the treatment CHB at present. Ultimately the ideal antiviral therapy would be tailored for individual patients. Physicians may need to examine the various guidelines and determine which recom- mendations are most appropriate for the locale, availability of the drugs, and economic situations in which they prac- tice. Keeffe et al recently suggested cut-off levels of HBV DNA as an indication of antiviral therapy of 20,000 IU/mL (100,000 copies/mL) for patients with HBeAg(+) CHB and 2,000 IU/mL (10,000 copies/mL) for HBeAg(–) CHB, both with abnormal ALT levels. The newly recommended upper normal level of ALT by Keeffe et al is 30 U/L for males and 19 U/L for females (Prati et al 2002). At present, LVD, ADV, ETV, LDT or PegIFN can be considered as the ﬁrst line option except the recent guideline proposed by Keeffe and his group in the US (Keeffe et al 2006). Despite issues with the development of resistance, LVD remains an affordable option for CHB therapy for patients with limited ﬁnancial means. Based on the experience by Chae and Hann (2006), patients with low baseline HBV DNA ( 6log10 copies/ml) may still beneﬁt from LVD as ﬁrst line therapy. The ultimate goal of antiviral therapy for CHB patients lies in halting the progression of liver disease to liver cirrhosis and its life threatening complications and in prevent- ing/reducing the development of HCC. We feel that this goal can be achieved with careful, well-informed decision making on antiviral therapy and close follow-up of CHB patients. Acknowledgment We thank Christine L. Hann, M.D., Ph.D. for her critical review and assistance with editing the manuscript. Supported by Chungbuk National University Grant in 2005 (HB.C.) Therapeutics and Clinical Risk Management 2007:3(4) Time for an active therapy for HBV Note Dr Hie-Won Hann is on the speaker’s bureau for Gilead, Bristol-Myers Squibb and receives clinical research support from Gilead, Bristol-Myers Squibb, and Idenix. 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