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[Chronic hepatitis B. Recent advances in diagnosis and treatment]
Mauro Bernardi1, Maurizio Biselli, Annagiulia Gramenzi
1Servizio di Semeiotica Medica, Dipartimento di Medicina Interna, Cardioangiologia ed Epatologia, Alma Mater Studiorum Università di Bologna. bernardi@med.unibo.it
Insights
Chronic hepatitis B (CHB) is a global health issue. HBeAg-negative CHB presents unique challenges, with limited treatment options like interferon and lamivudine showing modest efficacy, necessitating new antiviral strategies.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- Chronic hepatitis B (CHB) is a significant worldwide health concern.
- HBeAg-negative CHB, characterized by viral replication despite anti-HBe positivity, presents a distinct clinical course.
- This form of CHB often shows intermittent disease activity with fluctuating ALT and HBV-DNA levels.
Purpose of the Study:
- To review the characteristics and challenges of HBeAg-negative CHB.
- To evaluate the efficacy of current treatment strategies, including interferon and nucleoside analogues.
- To highlight the need for novel antiviral agents and combination therapies.
Main Methods:
- Literature review of studies on HBeAg-negative CHB.
- Analysis of diagnostic criteria for CHB.
- Assessment of treatment responses to interferon and lamivudine.
Main Results:
- Interferon therapy shows disappointing response rates in HBeAg-negative CHB.
- Lamivudine demonstrates antiviral effects and good tolerance but often leads to viral control rather than eradication and can select for resistant mutants.
- Diagnosis relies on HBsAg positivity, HBV replication markers (HBV-DNA), and elevated ALT levels.
Conclusions:
- HBeAg-negative CHB requires specific management approaches.
- Current therapies have limitations, underscoring the need for improved treatment options.
- Development of new antiviral agents and combination strategies is crucial for effective CHB management.
Abstract:
Chronic hepatitis B (CHB) remains a major public health problem worldwide. In the early 1980's patients from the Mediterranean area, although negative for HBeAg and positive for antibodies to HBeAg (anti-HBe), were reported to have CHB with replicating hepatitis B virus (HBV). The typical course of HBeAg-negative CHB was characterized by an intermittent pattern of disease activity with elevations of alanine aminotransferase (ALT) values preceded, in most instances, by increase in HBV-DNA levels. The response to interferon (IFN) treatment in HBeAg-negative CHB is disappointing. The diagnosis of CHB is based on HBsAg positivity for more than six months associated with HBV replication documented by either HBeAg positivity and/or HBV-DNA in the serum, and increased ALT levels, either persistent or intermittent. The main strategies to combat chronic HBV infection rely on the stimulation of the specific antiviral immune response and on the inhibition of viral replication. The IFN therapy is only moderately effective and often limited by dose-dependent side effects. Recently, new nucleoside analogues, such as lamivudine, have shown very promising results in terms of antiviral effect and tolerance. The prolonged administration of lamivudine is most often associated with a control of viral replication rather than eradication, and may select for resistant mutants. The search for new antiviral agents is therefore mandatory to design combination strategies.