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Should Treatment Indications for Chronic Hepatitis B Be Expanded?

Wen-Juei Jeng1, Anna S Lok2

  • 1Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou branch, Taiwan; Chang Gung University College of Medicine, Taiwan.

Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association
|May 21, 2020
PubMed

Insights

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.
Abstract

Keywords:
Antiviral TherapyGuidelinesImmune TolerantInactive Carrier

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