Journal of Antivirals & Antiretrovirals
Open Access

Abstract

Therapies for Chronic Hepatitis B: Review of Indications, Outcomes and New Tools for Tailoring Treatments to Patients

Catherine M N Croagh, Sally J Bell and Paul V Desmond

Chronic Hepatitis B is a major cause worldwide of liver cirrhosis, hepatocellular carcinoma and liver related
mortality. The ultimate goals of treatment are to reduce the risk of these complications and the endpoints used in
clinical practice are viral suppression, ALT normalisation and histological regression of fibrosis as well as HBeAg
seroconversion in patients who are HBeAg positive. The indications for treatment differ slightly in different regions
however may still be conceptualised in terms of the phase of chronic hepatitis B Treatment options include a finite
course of Peg IFN which has immunomodulatory as well as antiviral effects although its use may be limited by
troublesome side effects and low efficacy in some patients. Recent advances in the use of quantitative HBsAg
and HBeAg levels during Peg IFN treatment has provided some predictors of response and therefore the ability to
individualise treatment courses to a degree, avoiding unnecessary prolongation of treatment where it is likely to be
futile. The oral nucleoside/nucleotide analogues now available have high potency and very low rates of resistance
however must be continued indefinitely in HBeAg negative patients and most HBeAg positive patients. Lifelong
treatment raises issues of side effects such as renal and bone disease, compliance, and management during
pregnancy. Research aimed at novel targets in the HBV life cycle or host immune response is ongoing. The ultimate
goal of therapies for CHB remains HBsAg clearance which at present still occurs only in a minority of cases.