From the Guidelines
More than 95% of adults with acute HBV hepatitis do not require specific treatment, as they will fully recover spontaneously. The management of hepatitis B virus infection is primarily focused on preventing the risk of acute or subacute liver failure, improving quality of life, and lowering the risk of chronicity 1. In patients with acute hepatitis B, the main treatment goal is to prevent severe or fulminant acute hepatitis B, characterized by coagulopathy or a protracted course.
- Characteristics of severe acute hepatitis B include coagulopathy (defined as international normalized ratio [INR] ≥ 1.5) or a protracted course (persistent symptoms or marked jaundice for ≥ 4 weeks) 1.
- Only patients with severe acute hepatitis B should be treated with nucleos(t)ide analogs (NA) and considered for liver transplantation 1.
- In patients with chronic HBV infection, co-infection with HCV accelerates liver disease progression and increases the risk of hepatocellular carcinoma (HCC), highlighting the importance of screening for HCV and other blood-borne viruses 1.
- The use of direct-acting antivirals (DAAs) for HCV treatment has increased rapidly, with sustained virological response rates comparable to those in HCV mono-infected patients, but there is a potential risk of HBV reactivation during or after DAA therapy 1.
From the Research
Hepatitis Virus Treatment
- The treatment of hepatitis B virus (HBV) and hepatitis C virus (HCV) has been studied extensively, with various antiviral agents being compared for their efficacy [(2,3,4)].
- For HBV, tenofovir disoproxil fumarate (TDF) and entecavir (ETV) have been shown to be effective antivirals, with similar treatment responses and clinical outcomes in patients with severe acute exacerbation 2.
- A study comparing the efficacy of ETV, TDF, and tenofovir alafenamide (TAF) in treatment-naive HBV patients found that the outcomes of these antiviral agents were statistically similar in terms of the risk of hepatocellular carcinoma (HCC) and orthotopic liver transplantation (OLT) or mortality 3.
Hepatitis C Virus Treatment
- The treatment of HCV has also been studied, with direct-acting antiviral (DAA) therapies being shown to be effective in achieving sustained virologic response 5.
- However, the use of DAAs has also been associated with the risk of HBV reactivation in patients coinfected with HBV and HCV 6.
- A study evaluating the initial uptake, time to treatment, and real-world effectiveness of all-oral DAAs for HCV infection found that the estimated incidence of treatment initiation was 8.8% at the end of year 1 and 15.0% at the end of year 2, with a median time to initiating therapy of 300 days 5.
Comparison of Antiviral Agents
- A systematic review and Bayesian meta-analyses found that tenofovir and entecavir were the most effective antiviral agents for chronic hepatitis B, with tenofovir being most effective in inducing undetectable levels of HBV DNA and normalization of alanine aminotransferase (ALT) levels 4.
- Entecavir was found to be most effective in improving liver histology, and was second to tenofovir in inducing undetectable levels of HBV DNA and normalization of ALT levels 4.