Update on Hepatitis B Virus Infection: Focus on Treatment

Area of Science:

• Hepatology
• Virology
• Immunology

Background:

• Chronic hepatitis B virus (HBV) infection remains a significant global health challenge.
• Current treatment aims for viral suppression and clinical remission, with functional cure (HBsAg loss) as the ultimate goal.

Purpose of the Study:

• To review and update current treatment strategies for chronic hepatitis B.
• To evaluate methods for achieving sustained remission and HBsAg loss after treatment discontinuation.

Main Methods:

• Review of existing data on chronic hepatitis B treatment strategies.
• Analysis of response-guided pegylated interferon (peg-IFN)-alpha therapy outcomes.
• Evaluation of nucleos(t)ide analogue (NA) treatment discontinuation in HBeAg-negative patients.

Main Results:

• Pegylated interferon (peg-IFN)-alpha therapy achieves response-guided clinical remission and HBV replication suppression in over 30% of patients.
• Discontinuation of long-term NA treatment in HBeAg-negative patients is safe and associated with high rates of sustained off-treatment responses.
• Low hepatitis B surface antigen (HBsAg) titers (<500, especially <100 IU/mL) and adding peg-IFN to NA therapy enhance sustained off-treatment responses.

Conclusions:

• Achieving sustained remission and HBsAg loss, a functional cure, is attainable for chronic hepatitis B.
• Response-guided pegylated interferon (peg-IFN)-alpha therapy is effective in both HBeAg-positive and HBeAg-negative patients.
• Combining NA therapy with peg-IFN and monitoring HBsAg titers can optimize outcomes for sustained off-treatment responses.