Current Practice in Hepatitis B and Long-term Prospects

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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).

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