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Published on: September 25, 2019
Treatment of chronic hepatitis B: Evolution over two decades
Man-Fung Yuen1, Ching-Lung Lai
1Department of Medicine, the University of Hong Kong, Queen Mary Hospital, China. mfyuen@hkucc.hku.hk
New antiviral treatments for chronic hepatitis B (CHB) offer long-term HBV DNA suppression and reduced hepatocellular carcinoma risk. Potent agents like entecavir and tenofovir show low resistance rates, improving patient outcomes.
Area of Science:
- Hepatology
- Virology
- Pharmacology
Background:
- Chronic hepatitis B (CHB) treatment paradigms are shifting, with increasing recognition of Hepatitis B e antigen (HBeAg)-negative disease.
- Treatment aims for long-term HBV DNA suppression and ideally Hepatitis B surface antigen (HBsAg) seroconversion.
Purpose of the Study:
- To review the evolution and efficacy of antiviral treatments for CHB.
- To compare the effectiveness and resistance profiles of various antiviral agents.
Main Methods:
- Review of licensed antiviral agents for CHB, including interferons and nucleoside/nucleotide analogues.
- Analysis of treatment outcomes, focusing on HBV DNA suppression, HBeAg seroconversion, and drug resistance.
Main Results:
- Pegylated interferon-alpha achieves 33% HBeAg seroconversion.
- Nucleoside/nucleotide analogues show varying efficacy and resistance rates; entecavir and tenofovir demonstrate high potency and low resistance.
- Entecavir achieved undetectable HBV DNA in 94% of patients after 5 years with 1.2% resistance.
- Tenofovir shows high potency, less renal toxicity than adefovir, and no described resistance after 3 years.
Conclusions:
- Current potent antivirals like entecavir and tenofovir enable long-term HBV DNA suppression, potentially reversing cirrhosis.
- These agents are associated with a reduced risk of hepatocellular carcinoma development in CHB patients.
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