[Hepatitis B: who should be treated?].

Area of Science:

• Hepatology
• Virology
• Internal Medicine

Context:

• Current therapies for hepatitis B virus (HBV) infection demonstrate limited efficacy in achieving viral eradication.
• Recent advancements in hepatitis B treatment over the past five years have not substantially improved eradication rates.
• Existing treatment guidelines require updates to reflect current understanding and therapeutic outcomes.

Purpose:

• To review and update therapeutic indications for both acute and chronic hepatitis B.
• To provide a framework for classifying patients based on the need for immediate, potential, or no routine therapy.
• To align treatment strategies with recent consensus statements from major international liver associations.

Summary:

• The effectiveness of current hepatitis B therapies is limited, with rare instances of complete viral eradication (normal ALT, undetectable HBV DNA, HBsAg seroconversion).
• Progress in hepatitis B treatment over the last five years has not significantly impacted eradication success.
• New therapeutic indications for acute and chronic hepatitis B are proposed, categorizing patients into three groups: therapy indicated, therapy may be indicated, and immediate therapy not routinely indicated.

Impact:

• Provides updated guidance for clinicians managing hepatitis B patients.
• Facilitates more precise patient stratification for hepatitis B treatment initiation.
• Aims to improve therapeutic outcomes and patient management in chronic hepatitis B.