What is Chronic Hepatitis B (CHB)?

From the Guidelines

Chronic Hepatitis B (CHB) patients should be treated with either entecavir or tenofovir disoproxil fumarate as first-line medications, as they are potent antiviral drugs with high barriers to resistance, according to the most recent and highest quality study 1. The primary goal of CHB treatment is to eliminate or significantly suppress replication of HBV, thereby preventing progression of liver disease to cirrhosis, liver failure, or hepatocellular carcinoma (HCC) 1.

Key Considerations

• Treatment is recommended for patients with elevated liver enzymes, high viral load (HBV DNA ≥ 2,000 IU/ml), or evidence of liver damage 1.
• First-line medications include entecavir (0.5mg daily) or tenofovir disoproxil fumarate (300mg daily), which are potent antiviral drugs with high barriers to resistance 1.
• These medications suppress viral replication but rarely eliminate the virus completely, so treatment is typically long-term, often lifelong 1.
• Regular monitoring is essential, including liver function tests every 3-6 months, HBV DNA levels every 6-12 months, and periodic assessment for hepatocellular carcinoma with ultrasound and alpha-fetoprotein testing 1.
• Patients should avoid alcohol, maintain a healthy weight, and be vaccinated against hepatitis A 1.

Treatment Outcomes

• The induction of long-term suppression of HBV replication represents the main endpoint of current treatment strategies, while HBsAg loss is an optimal endpoint 1.
• Treatment works by inhibiting the viral DNA polymerase, preventing viral replication and reducing liver inflammation and damage 1.
• This approach helps prevent progression to cirrhosis, liver failure, and hepatocellular carcinoma, which are serious complications of untreated CHB 1.

From the Research

CHB Treatment Options

• Chronic hepatitis B (CHB) infection can be treated with various medications, including interferon alfa-2b, pegylated interferon alfa-2a, lamivudine, adefovir dipivoxil, and entecavir 2.
• Entecavir, a nucleoside analog, is a preferred first-line treatment option for patients with CHB who are nucleoside naïve, HBeAg positive or negative, and have compensated liver disease 2, 3.
• Other first-line treatment options for CHB include pegylated interferon, entecavir, or tenofovir, but the optimal treatment for an individual patient is controversial 4, 5.

Treatment Efficacy and Resistance

• Entecavir has been shown to be superior to lamivudine in clinical trials, with a higher efficacy and lower resistance rate 2, 3.
• The development of drug resistance mutations is a major drawback of nucleoside/nucleotide analogues (NAs) therapy, but newer and more potent NAs, such as entecavir and tenofovir, have very low resistance rates 6.
• Entecavir resistance has not occurred in nucleoside-naïve patients, but may develop in those who already possess lamivudine resistance mutations 2, 3.

Treatment Guidelines and Recommendations

• Current international guidelines recommend first-line treatment of CHB infection with pegylated interferon, entecavir, or tenofovir 4.
• 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 4, 5.
• Antiviral treatment should be initiated in patients with CHB who have a high risk of liver-related morbidity and who are likely to respond to treatment 5.