Journal
WORLD JOURNAL OF GASTROENTEROLOGY
Volume 20, Issue 20, Pages 6262-6278Publisher
BAISHIDENG PUBLISHING GROUP INC
DOI: 10.3748/wjg.v20.i20.6262
Keywords
Chronic hepatitis B virus infection; National institute for health and care excellence; Treatment guidelines; Interferon; Pegylated interferon; Nucleos(t)ide analogues; Antiviral resistance; Rescue therapy; Clinical trials
Categories
Funding
- Research Grant Council Hong Kong [CUHK3/CRF/12R, HKU3/CRF11R]
- National Basic Research Program of China, 973 Program [2013CB531401]
- CUHK Focused Investments Scheme B
- Hong Kong Research Grants Council [T12-403-11]
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Chronic hepatitis B (CHB) virus infection is a global public health problem, affecting more than 400 million people worldwide. The clinical spectrum is wide, ranging from a subclinical inactive carrier state, to progressive chronic hepatitis, cirrhosis, decompensation, and hepatocellular carcinoma. However, complications of hepatitis B virus (HBV)-related chronic liver disease may be reduced by viral suppression. Current international guidelines recommend first-line treatment of CHB infection with pegylated interferon, entecavir, or tenofovir, but the optimal treatment for an individual patient is controversial. The indications for treatment are contentious, and increasing evidence suggests that HBV genotyping, as well as serial on-treatment measurements of hepatitis B surface antigen and HBV DNA kinetics should be used to predict antiviral treatment response. The likelihood of achieving a sustained virological response is also increased by extending treatment duration, and using combination therapy. Hence the paradigm for treatment of CHB is constantly evolving. This article summarizes the different indications for treatment, and systematically reviews the evidence for the efficacy of various antiviral agents. It further discusses the shortcomings of current guidelines, use of rescue therapy in drug-resistant strains of HBV, and highlights the promising clinical trials for emerging therapies in the pipeline. This concise overview presents an updated practical approach to guide the clinical management of CHB. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.
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