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Should Treatment Indications for Chronic Hepatitis B Be Expanded?
1Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou branch, Taiwan; Chang Gung University College of Medicine, Taiwan.
Current antiviral therapy for chronic hepatitis B virus (HBV) infection improves outcomes but doesn't eradicate the virus. Expanding treatment to specific patient groups may be beneficial, but evidence is lacking for others.
Area of Science:
- Hepatology
- Virology
- Internal Medicine
Background:
- Antiviral therapy has significantly improved outcomes for patients with chronic hepatitis B virus (HBV) infection, active liver disease, or advanced fibrosis/cirrhosis.
- Current treatments do not eradicate HBV, necessitating long-term therapy for sustained clinical benefit.
- Professional guidelines currently do not recommend treating all patients with chronic HBV infection.
Purpose of the Study:
- To review evidence supporting and opposing the expansion of antiviral treatment for chronic HBV infection.
- To evaluate treatment recommendations for patients not currently meeting guideline criteria.
Main Methods:
- Literature review of available data on HBV treatment expansion.
- Analysis of evidence for and against treating specific patient subgroups.
Main Results:
- Evidence supports expanding treatment to immune-tolerant patients and those in 'grey zones' with active/advanced liver disease.
- Treatment expansion is supported for immune-tolerant patients over 40 and those with biopsy/non-invasive test-confirmed liver disease.
- Insufficient evidence exists to support treatment expansion for confirmed inactive carriers and other immune-tolerant patients.
Conclusions:
- Current HBV treatment indications may become more liberal with the advent of new therapies.
- Emerging therapies aim for safe and effective HBsAg loss in a high percentage of patients after a finite treatment course.
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