D Yardeni et al. Gastroenterol 2023; 164: 42-60. Open Access! Current Best Practice in Hepatitis B Management and Understanding Long-term Prospects for Cure
This is a very helpful review. Table 1 lists treatment indications by group. For example, AASLD recommendations:
- Table 3 compares the effectiveness of current treatments
- Table 4 describes the large number (~50) of antiviral agents in development and their mechanism of action
- The authors recommend HCC surveillance in those with cirrhosis every 6 months with ultrasound with or without serum AFP
- “Although current therapy is associated with improved clinical outcome, it is not curative because of a lack of effect on cccDNA and integrated HBV DNA. Stopping therapy in the absence of HBsAg loss usually leads to relapse to active disease in most patients and thus treatment must be administered long term.”
- “Many challenges remain, the sheer breadth of therapeutic approaches in development holds great promise for curing and eliminating chronic HBV infection”
My take: While it is likely that newer medications will help many with chronic hepatitis B, the best hope for eliminating HBV continues to be with prevention and vaccination.
Related article: J-F Wu et al. Clin Gastroenterol Hepatol 2023; 21: 663-669. Baseline Hepatitis B Virus Surface Antigen Titers in Childhood Predict the Risk of Advanced Liver Fibrosis in Adulthood
Key finding: In this study with more than 30 years of prospective followup (n=214): n a multivariate analysis, both an HBsAg titer >4.44 log10 IU/mL at 15 years of age and HBV genotype C were predictors of advanced fibrosis (odds ratios, 15.43 and 4.77; P = .01 and P = .02, respectively).
Related blog posts:
- New Age for Hepatitis B Therapies
- What’s New in the Treatment of Hepatitis B
- Good News Story: The Remarkable Hepatitis B Vaccine Story
- Withdrawal of Chronic Hepatitis B Therapy
- Lessons Learned from Children In the Hepatitis B Virus Research Network
- Should All Pediatric Patients with Hepatitis B Undergo Routine Surveillance for Hepatocellular Carcinoma?
- Expanding Treatment Population in Chronic Hepatitis B?
- Ongoing Hepatitis B Susceptibility in U.S. Adults
- Comprehensive 2018 AASLD Guidance for Chronic Hepatitis B
- Why Fewer Children Have Immune-Tolerant Hepatitis B Infection Than Previously | gutsandgrowth
- Hep B-related Hepatocellular Carcinoma in Kids: 8 Needles in 4 Haystacks