What are the treatment options for chronic Hepatitis B (HBV) infection?

From the Guidelines

The primary treatment for chronic Hepatitis B (HBV) infection involves antiviral medications, with first-line options being entecavir or tenofovir, which have high barriers to resistance and are taken orally. The goal of treatment is to suppress viral replication, prevent liver damage, and ultimately improve survival and quality of life by preventing disease progression and hepatocellular carcinoma (HCC) development 1. Treatment decisions are based on several factors, including HBV DNA levels, ALT levels, HBeAg status, and evidence of liver damage.

Key Considerations

• The indication for treatment typically requires HBV DNA ≥ 2,000 IU/ml, elevated ALT, and/or at least moderate histological lesions, while all cirrhotic patients with detectable HBV DNA should be treated 1.
• The long-term administration of a potent nucleos(t)ide analogue with a high barrier to resistance, such as entecavir, tenofovir disoproxil, or tenofovir alafenamide, represents the treatment of choice 1.
• Pegylated interferon-alfa treatment can also be considered in mild to moderate chronic hepatitis B patients, but combination therapies are not generally recommended 1.
• Regular monitoring is essential, including liver function tests every 3-6 months and periodic assessment of viral load, as well as regular screening for hepatocellular carcinoma with ultrasound every 6 months, especially in those with cirrhosis or a family history of liver cancer.

Lifestyle Modifications

• Lifestyle modifications are also important, including avoiding alcohol, maintaining a healthy weight, and preventing transmission to others through vaccination of close contacts and safe practices.
• Patients should be educated on the importance of adherence to their treatment regimen and regular follow-up appointments to monitor their condition and adjust their treatment plan as needed.

Special Considerations

• Certain subgroups of patients with HBV infection, such as those with cirrhosis, require specific focus and may benefit from more aggressive treatment strategies 1.
• Future treatment strategies aim to achieve a "cure" of the disease, and new biomarkers are being explored to improve treatment outcomes 1.

From the FDA Drug Label

1 INDICATIONS AND USAGE Entecavir tablets are indicated for the treatment of chronic hepatitis B virus infection in adults with evidence of active viral replication and either evidence of persistent elevations in serum aminotransferases (ALT or AST) or histologically active disease

1 INDICATIONS AND USAGE Adefovir Dipivoxil Tablets are indicated for the treatment of chronic hepatitis B in patients 12 years of age and older with evidence of active viral replication and either evidence of persistent elevations in serum aminotransferases (ALT or AST) or histologically active disease

The treatment options for chronic Hepatitis B (HBV) infection include:

• Entecavir tablets: indicated for the treatment of chronic hepatitis B virus infection in adults with evidence of active viral replication and either evidence of persistent elevations in serum aminotransferases (ALT or AST) or histologically active disease 2
• Adefovir Dipivoxil Tablets: indicated for the treatment of chronic hepatitis B in patients 12 years of age and older with evidence of active viral replication and either evidence of persistent elevations in serum aminotransferases (ALT or AST) or histologically active disease 3

From the Research

Treatment Options for Chronic Hepatitis B (HBV) Infection

The treatment options for chronic HBV infection include:

• Antiviral therapy with the goal of suppressing HBV DNA replication to prevent disease progression and reduce the risk of cirrhosis and hepatocellular carcinoma 4, 5, 6, 7, 8
• Seven drugs are licensed for the treatment of chronic hepatitis B, including interferon alfa, pegylated interferon, lamivudine, adefovir dipivoxil, entecavir, telbivudine, and tenofovir 4, 5, 6
• The selection of a drug with high potency and low rate of resistance is essential to achieve rapid and long-term viral suppression 4
• The current treatment strategy of chronic hepatitis B is now standard: initial selection of entecavir, tenofovir, or peginterferon alfa-2a 4

Patient Selection for Treatment

The following patients are ideal candidates for treatment:

• Hepatitis B e antigen-positive patients with a prolonged phase of immune clearance and hepatitis B e antigen-negative patients with elevated levels of serum HBV DNA, abnormal alanine aminotransferase and histologic evidence of moderate or severe liver necroinflammation and/or fibrosis 5
• Patients with compensated or decompensated cirrhosis should be treated, even if alanine aminotransferase levels are normal and/or serum HBV DNA levels are low, in order to prevent disease flare and to improve liver function 5
• Patients in the immune clearance and reactivation phases, with elevated alanine aminotransferase (ALT) and HBV DNA levels, are candidates for antiviral therapy 6

Treatment Goals and Monitoring

The primary goal of therapy for chronic hepatitis B is suppression of viral replication, which has been shown to reduce hepatic necroinflammation and retard progression of hepatic fibrosis 6

• Long-term suppression of serum HBV DNA is likely to reduce progression to cirrhosis and hepatic decompensation and decrease the risk of hepatocellular carcinoma 6, 7
• Patients require monitoring every 3 to 6 months to ensure compliance and to test for the development of resistance if an oral agent is used 6