What is the first-line treatment for chronic Hepatitis B virus infection in patients with elevated ALT?

The first-line treatment for chronic Hepatitis B virus infection in patients with elevated ALT is lamivudine. This antiviral medication is an effective nucleoside analog that helps to suppress the replication of the Hepatitis B virus, leading to improved liver function and a reduction in viral load. Lamivudine is particularly beneficial for patients with active inflammation as indicated by elevated ALT levels, as it can help to mitigate the risk of progressive liver disease, cirrhosis, and hepatocellular carcinoma.

Lamivudine is generally well tolerated and has a favorable safety profile, making it a common choice in clinical practice, especially for patients without advanced liver disease. The goal of therapy is to achieve viral suppression, which can lead to seroconversion in some cases, reducing the long-term complications associated with chronic Hepatitis B infection.

While other treatments such as interferon alpha and adefovir are available and can also be effective, they may come with more side effects or specific indications that make lamivudine a more favorable first-line option in many cases.