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Chronic Hepatitis B with Spontaneous Severe Acute Exacerbation
Wei-Lun Tsai1,2, Wei-Chi Sun3,4, Jin-Shiung Cheng5,6
1Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan. tsaiwl@yahoo.com.tw.
International Journal of Molecular Sciences
|December 26, 2015
Summary
Chronic hepatitis B (CHB) can cause severe acute exacerbations (AE), potentially leading to liver failure. Early antiviral nucleos(t)ide analogue treatment may improve outcomes in CHB patients experiencing severe AE.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- Chronic hepatitis B virus (HBV) infection affects 400 million globally.
- Spontaneous acute exacerbations (AE) occur in 10-30% of chronic hepatitis B (CHB) patients annually.
- Severe AE can lead to hepatic decompensation and mortality.
Purpose of the Study:
- To review the natural history, pathogenesis, and treatment of severe acute exacerbations in chronic hepatitis B.
- To summarize current knowledge on therapeutic options for CHB with severe AE.
Main Methods:
- This is a review article.
- Literature search on CHB, acute exacerbations, and antiviral therapies.
- Synthesis of existing data on pathogenesis and treatment outcomes.
Main Results:
- Pathogenesis may involve cytotoxic T lymphocyte responses to HBV.
- An increase in HBV DNA often precedes elevated ALT and bilirubin.
- Early nucleos(t)ide analogue (NA) treatment appears beneficial for severe AE, though evidence is limited.
- No randomized trials compare different NAs for severe CHB AE.
Conclusions:
- Potent nucleos(t)ide analogues with favorable resistance profiles are recommended for CHB with severe AE.
- Further research, including randomized trials, is needed to guide NA selection in severe CHB AE.
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