Chronic Hepatitis B Infection: A Review

Area of Science:

• Hepatology
• Virology
• Infectious Diseases

Background:

• Chronic hepatitis B virus (HBV) infection impacts over 240 million people worldwide.
• Untreated chronic HBV can lead to cirrhosis, liver failure, and liver cancer in 15-40% of cases.

Purpose of the Study:

• To review the efficacy and limitations of current antiviral treatments for chronic HBV.
• To provide guidance on first-line therapy selection and long-term management strategies.

Main Methods:

• Review of pegylated interferon and various nucleos(t)ide analogues (lamivudine, adefovir, entecavir, tenofovir disoproxil, tenofovir alafenamide).
• Analysis of data on viral suppression, liver fibrosis regression, and rates of hepatitis B surface antigen loss.

Main Results:

• Antiviral therapies suppress HBV DNA replication and improve liver inflammation and fibrosis.
• Long-term viral suppression is linked to fibrosis regression and reduced hepatocellular carcinoma risk.
• Cure rates remain low (3-12%), necessitating indefinite treatment for most patients.

Conclusions:

• Antiviral treatment is recommended for chronic HBV patients with liver inflammation to prevent disease progression.
• Nucleos(t)ide analogues are preferred as first-line therapy due to better resistance profiles and tolerability compared to older agents.
• Given low cure rates, long-term or indefinite antiviral therapy is typically required for chronic HBV management.