Clinical update: hepatitis B

Chronic hepatitis B (CHB) remains a global health problem, with disproportionately high prevalence rates approaching 10-15% in the Asian population worldwide and in Asian immigrants in the United States. Chronic infection complications, including cirrhosis and hepatocellular carcinoma, occur in 1 5-40% of infected individuals, and important recent data from the REVEAL study have suggested that, independent of other factors, high viral replication may impact long-term disease outcomes. More recent recognition of parameters for defining normal transaminases may also affect decision-making for therapy initiation. Recently, new treatment options have been effective at viral suppression, with lower rates of viral resistance compared to lamivudine. Currently, therapies for hepatitis B treatment include interferon, lamivudine, adefovir, entecavir, and telbivudine. Treatment considerations need to take into account therapy duration and risks, specifically the development of viral resistance. Recently updated guidelines and algorithms use viral replication, alanine aminotransferase levels, and severity of histologic disease as the determining factors for treatment. Therapy length is dependent on hepatitis B e antigen (HBeAg) seroconversion in HBeAg-positive CHB patients. In patients with the precore/basal core promoter HBeAg-negative CHB, the treatment goal is continued viral suppression. Future options, including new oral agents, therapeutic vaccines, and combination therapies, require further study.