Update on Hepatitis B Virus Infection: Focus on Treatment

Abstract

This review article is an update of the current treatment strategies available for chronic hepatitis B. In addition to achieving on-therapy clinical remission and suppression of HBV replication without resistance, the ultimate goal of therapy is the development of sustained remission and HBsAg loss after discontinuation of treatment. This is the closest possible to cure outcome for hepatitis B virus (HBV) infection. These goals can be achieved by response-guided courses of pegylated interferon (peg-IFN)-alpha at rates higher than 30%, both in hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients. Review of the data regarding discontinuation of long term NA treatment in HBeAg-negative patients revealed that stopping such therapy is safe with high rates of sustained off treatment responses that appear to be immunologically induced. Decreasing hepatitis B surface antigen (HBsAg) titers under therapy to <500, particularly <100 IU/mL, and adding a course of peg-IFN to ongoing long term nucleos(t)ide analogue (NA) therapy increase the percentage of sustained responses following discontinuation of NA treatment.

Keywords: Chronic hepatitis; HBV; Interferon; NA discontinuation; Treatment.

Fig. 1. Withdrawal of ADV treatment after 5 years in an HBeAg negative patient with CHB (first arrow in the left) followed by virological relapse and subsequent increase in ALT (clinical relapse).

The patient was no retreated and was monitored at 2 week intervals. Note the delay in spontaneous resolution of the relapse and that HBsAg was cleared later. HBV DNA was measured in copies/mL (From: Hadziyannis et al., 2014).,

Fig. 2. Low levels of HBsAg at the end of long term treatment (EOT) with NAs are associated with sustained off-treatment response and HBsAg loss.,.