Current approaches for treating chronic hepatitis B: when to start, what to start with, and when to stop

Abstract

The natural course of hepatitis B virus (HBV) infection is variable, and chronic hepatitis B (CHB) disease exhibits itself through a spectrum of clinical manifestations. These factors contribute to the challenges faced when managing patients who live with HBV infection. Furthermore, conventional treatment options (e.g., interferon alfa-2a, lamivudine, and adefovir) are moderately effective and can be associated with problems, such as poor tolerability (interferon alfa-2a) and the development of drug resistance (lamivudine). Over the last 5 years, several antiviral agents including entecavir, peginterferon alfa-2a, and telbivudine which are more efficacious and have improved tolerability over previous drugs have become available. The availability of novel antiviral agents and advances in understanding resistance patterns of antiviral agents has resulted in refinement of CHB treatment recommendations and guidelines. More recently, evidence from clinical trials suggests the central importance of virologic suppression as an indicator of treatment outcome and the predictive value of on-treatment HBV DNA levels in response to antiviral therapy. This review highlights the goals of therapy and clinical experience with therapies that are newly licensed or in the late stages of clinical development. Current approaches for treating CHB and new strategies for optimizing response to therapy are also discussed.

Characterization and assessment of HBV chronically infected patients: Identification of those eligible for treatment in the South West region of Cameroon

“…This further explains why treatment should be considered for people who fall in the immune clearance and immune escape phases as they are more at risk of developing cirrhosis and HCC [5,9,35]. Our study identified 22 and 30 participants in the immune clearance and immune escape phases respectively.…”

“…Our study showed that participants who were in the immune clearance and immune escape phases had a significantly higher APRI score (most likely to have fibrosis) than those in the other phases. This further explains why treatment should be considered for people who fall in the immune clearance and immune escape phases as they are more at risk of developing cirrhosis and HCC [ 5 , 9 , 35 ]. Our study identified 22 and 30 participants in the immune clearance and immune escape phases respectively.…”

Treatment of Chronic Hepatitis B in Asia-Pacific Countries: Is the Asia-Pacific Consensus Statement being followed?

“…This response implies that respondents would seek further clinical information before making a definitive decision and it might be speculated that because both patients were older (aged 45 and 55 years), physicians might seek further clarification regarding stage of liver disease (which might be more advanced in older patients). Indeed, liver biopsy is considered a useful element of pretreatment management among patients who do not clearly meet the criteria for starting therapy [25]. Guidelines from the American Association for Study of Liver Disease (AASLD; 2007) [24] recommend that liver histology be considered in patients older than 40 years who have fluctuating or minimally increasing ALT levels.…”

An overview of treatment response rates to various anti-viral drugs in Pakistani Hepatitis B Virus infected patients

“…Buster and Janssen [ 22 ] reported HBV treatment response of 19-35% by administration of peg-IFN. However, administration of pegylated interferon-α 2a for 4 months failed to treat the HBV, HDV and HCV co-infection in Pakistani population [ 20 ] and is associated with adverse effects like depression, flu-like symptoms, neuropsychiatric disorders and suppression of bone marrow [ 28 ].…”