Current Best Practice in Hepatitis B Management and Understanding Long-term Prospects for Cure

The hepatitis B virus (HBV) is a major cause of cirrhosis and hepatocellular carcinoma worldwide. Despite an effective vaccine, the prevalence of chronic infection remains high. Current therapy is effective at achieving on-treatment, but not off-treatment, viral suppression. Loss of hepatitis B surface antigen, the best surrogate marker of off-treatment viral suppression, is associated with improved clinical outcomes. Unfortunately, this end point is rarely achieved with current therapy because of their lack of effect on covalently closed circular DNA, the template of viral transcription and genome replication. Major advancements in our understanding of HBV virology along with better understanding of immunopathogenesis have led to the development of a multitude of novel therapeutic approaches with the prospect of achieving functional cure (hepatitis B surface antigen loss) and perhaps complete cure (clearance of covalently closed circular DNA and integrated HBV DNA). This review will cover current best practice for managing chronicHBV infection and emerging novel therapies for HBV infection and their prospect for cure.

Automated summary

Hepatitis B virus is a major cause of cirrhosis and hepatocellular carcinoma, and despite the availability of an effective vaccine, chronic infection continues to be prevalent. Current therapies are effective at suppressing the virus during treatment, but do not provide long-term viral suppression. There is a need for novel therapies that can achieve functional or complete cure by targeting key components of the virus. This review discusses current best practices for managing chronic HBV infection and new emerging therapies with the potential for a cure.