Hepatitis B flare: the good, the bad and the ugly

Therapies against chronic hepatitis B infections: The times they are a-changin’, but the changing is slow!

“…Induced death of infected cells, as a broad therapeutic concept, has to be handled with care as it is not clear how many hepatocytes are infected at a given stage of the natural history of HBV infections, and one want to avoid "bad ALT flares" that could lead to liver failure. Considerations on "bad versus good flares" (the latter being looked for to improve functional cure rate) can be found in other reviews (Ghany et al, 2020;Liaw, 2022); with our current understanding, it seems impossible to think that an increased rate of functional cure can be obtained in "short duration regimen" without "playing" somehow with good flare events. Looking for finite duration regimens to replace safe but almost long-life administration of NAs, has a cost!…”

“…Predictors (beyond HBsAg level and HBe-negative status) of HBsAg seroclearance are actively looked for, including immunological ones, in order to better identify CHB patients who would benefit the most from this strategy. More information of "stopping NA" strategy can be found in these reviews (Wong et al, 2022;Berg and Lampertico, 2021;Jeng et al, 2021;Papatheodoridi and Papatheodoridis, 2021), whereas the concept of good versus bad flares is discussed in these ones (Ghany et al, 2020;Liaw, 2022). Whether combinations of DAAs (e.g.…”