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Will we need novel combinations to cure HBV infection?
1Kings College Hospital, London, UK.
Chronic hepatitis B requires long-term nucleoside analogue therapy for cirrhosis and cancer risk reduction. Achieving a functional cure, defined by HBsAg loss off treatment, remains uncommon, necessitating new combination therapies.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- Chronic hepatitis B (CHB) is a major cause of liver cirrhosis and hepatocellular carcinoma.
- Current nucleoside analogue therapies require maintenance to suppress the virus, as functional cure (HBsAg loss) is rare.
Purpose of the Study:
- To review current and investigational strategies for achieving a functional cure for CHB.
- To explore the potential of combination therapies and immune modulation for HBV treatment.
Main Methods:
- Review of current literature on nucleoside analogue therapy for CHB.
- Analysis of ongoing clinical trials investigating novel antiviral agents and combination therapies.
- Discussion of mechanisms targeting HBV replication, cccDNA, and immune responses.
Main Results:
- Investigational agents aim to inhibit HBV replication, deplete cccDNA, or modulate the immune system.
- Combination therapies are being explored for synergistic effects to achieve HBsAg loss.
- Nucleoside analogue-suppressed patients are key participants in current trials.
Conclusions:
- Achieving a functional cure for CHB likely requires combination therapy with novel agents and immune modulators.
- Finite, safe, and highly effective treatments are needed to broaden treatment candidacy.
- Therapeutic withdrawal remains challenging due to risks of hepatitis flares and decompensation.
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