title: Management of chronic hepatitis B infection: current treatment guidelines, challenges, and new developments.
abstract: 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.
authors.affiliation: Ceen-Ming Tang, Tung On Yau, Jun Yu, Institute of Digestive Disease and Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Ceen-Ming
authors.initials: CM
authors.lastname: Tang
authors.affiliation: Ceen-Ming Tang, Tung On Yau, Jun Yu, Institute of Digestive Disease and Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Tung On
authors.initials: TO
authors.lastname: Yau
authors.affiliation: Ceen-Ming Tang, Tung On Yau, Jun Yu, Institute of Digestive Disease and Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Yu
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use; D004279:DNA, Viral / Q000097:blood; D019468:Disease Management; D016503:Drug Delivery Systems; D024882:Drug Resistance, Viral; D005838:Genotype; D006147:Guanine / Q000031:analogs & derivatives / Q000627:therapeutic use; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D007372:Interferons / Q000627:therapeutic use; D063065:Organophosphonates / Q000627:therapeutic use; D011092:Polyethylene Glycols / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D000068698:Tenofovir; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D063065:Organophosphonates; D011092:Polyethylene Glycols; C413685:entecavir; D006147:Guanine; D007372:Interferons; D000068698:Tenofovir; D000225:Adenine
keywords: Antiviral resistance; Chronic hepatitis B virus infection; Clinical trials; Interferon; National institute for health and care excellence; Nucleos(t)ide analogues; Pegylated interferon; Rescue therapy; Treatment guidelines