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Published on: September 25, 2019
Antiviral drugs for HBV liver disease
Mauro Viganò1, Pietro Lampertico
1Hepatology Unit, Ospedale San Giuseppe, Via San Vittore 12, Milan, Italy.
Insights
Chronic hepatitis B (CHB) management has advanced with pegylated interferon and nucleos(t)ide analogues (NUCs). While effective, long-term safety and resistance remain key challenges for CHB treatment.
Area of Science:
- Hepatology
- Virology
- Internal Medicine
Background:
- Chronic hepatitis B (CHB) affects 400 million globally, a leading cause of mortality.
- CHB management has rapidly evolved, offering new therapies to prevent disease progression and reduce morbidity/mortality.
Purpose of the Study:
- To summarize current CHB treatment modalities.
- To discuss recent advancements and guidelines in CHB management.
Main Methods:
- Review of current treatment options for CHB.
- Analysis of recent literature on pegylated interferon and nucleos(t)ide analogues (NUCs).
- Discussion of 2009 AASLD and EASL guidelines for CHB management.
Main Results:
- Pegylated interferon offers short-term sustained virological response in about one-third of patients.
- NUCs rapidly inhibit HBV replication in most patients with long-term suppressive therapy.
- Long-term safety and drug resistance are critical unresolved issues for NUC therapy.
Conclusions:
- Individualized treatment strategies are essential for CHB patients.
- Patient history, liver disease staging, and virological factors must guide treatment decisions.
- Careful evaluation is crucial for selecting the most appropriate CHB treatment.
Introduction:
Chronic hepatitis B (CHB) virus infection affects about 400 million people around the globe and is among the world's leading causes of death. The management of CHB has evolved rapidly, several therapeutic options are now available to prevent both progression of liver disease and anticipated liver morbidity and mortality.
Areas Covered:
Current treatment modalities for CHB patients, together with suggestions from our own experience are summarized. The most relevant works published in recent years on pegylated interferon, nucleos(t)ides analogues (NUC) and the 2009 update of the American Association for the Study of Liver Diseases Practice Guidelines and the 2009 European Association for the Study of the Liver (EASL) Clinical Practice Guidelines on the management of chronic hepatitis B are discussed.
Expert Opinion:
Pegylated interferon and NUC have advantages and limitations, as short-term interferon treatment induces a sustained virological response in a third of patients, whereas long-term suppressive therapy by NUC rapidly inhibits HBV replication in most patients but drug resistance and safety in the long-term will remain the most important unresolved questions. Careful evaluation of patient history, staging of liver disease and virological factors should guide the start of treatment and the choice to the most appropriate individualized treatment strategy in all CHB patients.
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