From the Guidelines
Chronic hepatitis B is defined as a persistent hepatitis B virus (HBV) infection lasting more than six months, characterized by the presence of hepatitis B surface antigen (HBsAg) in the blood for at least that duration, and can be classified into five phases: (I) HBeAg-positive chronic infection, (II) HBeAg-positive chronic hepatitis, (III) HBeAg-negative chronic infection, (IV) HBeAg-negative chronic hepatitis and (V) HBsAg-negative phase, as outlined in the EASL 2017 clinical practice guidelines on the management of hepatitis B virus infection 1.
Key Characteristics
- Chronic HBV infection is a global public health problem with changing epidemiology due to several factors including vaccination policies and migration 1.
- All patients with chronic HBV infection are at increased risk of progression to cirrhosis and hepatocellular carcinoma (HCC), depending on host and viral factors 1.
- The main goal of therapy is to improve survival and quality of life by preventing disease progression, and consequently HCC development 1.
- 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.
Diagnosis and Classification
- The diagnosis is confirmed through blood tests showing persistent HBsAg positivity, along with other markers such as hepatitis B e-antigen (HBeAg), HBV DNA levels, and liver function tests.
- Chronic hepatitis B is further classified based on disease phases, which help guide treatment decisions 1.
- The typical indication for treatment 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.
Treatment and Management
- The long-term administration of a potent nucleos(t)ide analogue with high barrier to resistance, i.e., 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 1.
- Combination therapies are not generally recommended 1.
- All patients should be monitored for risk of disease progression and HCC, and treated patients should be monitored for therapy response and adherence 1.
From the Research
Definition of Chronic Hepatitis B
- Chronic hepatitis B is defined as the persistence of hepatitis B surface antigen for more than six months 2.
- This definition is based on the presence of hepatitis B surface antigen in the blood for an extended period, indicating a chronic infection.
- Chronic hepatitis B can lead to serious complications, such as hepatocellular carcinoma and cirrhosis, if left untreated or not properly managed 3.
Key Characteristics
- Chronic hepatitis B is characterized by the presence of hepatitis B surface antigen and hepatitis B virus (HBV) DNA in the blood 2.
- The infection can be asymptomatic, but it can also cause symptoms such as jaundice, fatigue, and abdominal pain.
- The risk of developing chronic hepatitis B is higher in individuals who are infected with HBV at a young age or who have a weakened immune system 4.
Diagnosis and Treatment
- Diagnosis of chronic hepatitis B is typically made through blood tests that detect the presence of hepatitis B surface antigen and HBV DNA 2.
- Treatment options for chronic hepatitis B include antiviral medications, such as entecavir and tenofovir, and pegylated interferon-α 2, 5.
- The goal of treatment is to suppress HBV replication, reduce liver inflammation and fibrosis, and prevent the development of complications such as hepatocellular carcinoma and cirrhosis 4, 6.