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Clinical management of chronic hepatitis B: A concise overview
Arno Furquim d'Almeida1,2, Erwin Ho1,2, Stijn Van Hees1,2
1Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium.
Insights
Chronic hepatitis B virus (HBV) infection affects millions globally, increasing liver disease risk. Stopping nucleos(t)ide analogue therapy may be viable for some patients, but better biomarkers are needed for safe NA withdrawal.
Area of Science:
- Hepatology
- Virology
- Infectious Diseases
Background:
- Chronic hepatitis B virus (HBV) infection impacts over 250 million people worldwide.
- HBV infection significantly elevates the risk of severe liver complications like cirrhosis and hepatocellular carcinoma.
- Many HBV infections are asymptomatic, highlighting the critical need for screening and timely medical care.
Observation:
- Nucleos(t)ide analogue (NA) therapy offers excellent clinical outcomes but often requires lifelong treatment due to the absence of a functional cure.
- Emerging research indicates that discontinuing NA therapy after achieving long-term viral suppression may be a beneficial strategy for select patients.
- The current lack of reliable biomarkers hinders the identification of patients suitable for NA withdrawal.
Findings:
- Long-term viral suppression through NA therapy may allow for treatment discontinuation in some chronic hepatitis B patients.
- Identifying patients who can safely stop NA therapy requires further research into predictive biomarkers.
- Improving screening and care linkage are essential for optimizing the management of chronic HBV.
Implications:
- Developing reliable biomarkers is crucial for enabling safe and effective nucleos(t)ide analogue withdrawal in chronic hepatitis B patients.
- Novel strategies for hepatitis B virus screening and linkage to care are needed to improve patient outcomes.
- Optimizing treatment protocols, including potential NA discontinuation, can enhance the long-term management of chronic hepatitis B.
Abstract:
Worldwide, over 250 million people are chronically infected with the hepatitis B virus (HBV). Infected patients have an up to 100-fold increased risk for liver-related complications, including cirrhosis, hepatic decompensation and hepatocellular carcinoma. Nonetheless, the majority of the infections remains asymptomatic, stressing the importance of HBV screening and linkage to care. Excellent clinical outcomes are seen during nucleos(t)ide analogue (NA) therapy, which often is continued indefinitively due to a lack of functional cure. Increasing evidence suggests that NA discontinuation following long-term treatment induced viral suppression in patients without a functional cure may be a favourable option. Reliable biomarkers are, however, urgently needed to select the patients that would benefit from NA withdrawal. In addition, renewed and novel approaches to improve screening and linkage to care are other fundamental factors in the optimisation of the clinical management of chronic hepatitis B.
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