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Hepatitis B therapy

Nature Reviews Gastroenterology & Hepatology volume 8, pages 275–284 (2011)Cite this article

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Abstract

The goal of hepatitis B treatment is to prevent cirrhosis, liver decompensation and hepatocellular carcinoma. In clinical practice, treatment response is determined by suppression of serum HBV DNA levels, hepatitis B e antigen seroconversion to hepatitis B e antibody, hepatitis B surface antigen loss, normalization of alanine aminotransferase levels and improvement in liver histology. Patients with life-threatening liver disease, and those with high levels of HBV replication and active or advanced liver disease, should be treated. Other patients should be monitored so that treatment can be initiated when indicated. Currently, seven medications are approved for the treatment of hepatitis B: two formulations of interferon and five nucleos(t)ide analogues. Interferon is administered for a finite duration while nucleos(t)ide analogues are usually administered for many years. Antiviral drug resistance is a major limiting factor to the success of nucleos(t)ide analogue treatment; therefore, treatment should be initiated with drugs that have a high genetic barrier to resistance (that is, a low potential for drug resistance). In addition, treatment response should be closely monitored to detect virologic breakthroughs, and the importance of medication adherence should be emphasized. Management of patients with treatment failure should be tailored according to the type of treatment failure (lack of initial response versus virologic breakthrough), the treatment that the patient is receiving, history of prior treatment, and the pretreatment characteristics of both the patient and the disease.

Key Points

  • Indication for hepatitis B treatment is determined by HBV replication status and the activity and stage of liver disease

  • Patient age, hepatitis B e antigen status, and other circumstances—such as family history of HCC, occupational requirement, need for immunosuppressive or cancer chemotherapy, and pregnancy plans—should also be considered when deciding on treatment

  • Patients with chronic HBV infection need life-long monitoring because the status of the disease can change with time

  • There are seven approved treatments for hepatitis B: two formulations of interferon (conventional and pegylated), and five nucleos(t)ide analogues (lamivudine, entecavir, tenofovir disoproxil, adefovir dipivoxil and telbivudine)

  • PEG-IFN, entecavir and tenofovir disoproxil are the preferred first-line treatments for hepatitis B

  • Antiviral drug resistance is a major limiting factor to the success of nucleos(t)ide analogue therapy; treatment should be initiated with drugs that have a high genetic barrier to resistance and virologic response should be closely monitored

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Figure 1: Natural course of chronic HBV infection.
Figure 2: Mutations in the reverse transcriptase region of HBV polymerase that are associated with resistance to nucleos(t)ide analogue therapy.

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  1. Division of Gastroenterology and Hepatology, University of Michigan Health System, 1500 E. Medical Center Drive, 3912 Taubman Center, SPC 5362, Ann Arbor, 48109, MI, USA

    Hellan Kwon & Anna S. Lok

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H. Kwon contributed to the research, discussion and writing of this Review. A. S. Lok contributed to the research, discussion, writing and editing of this Review.

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Correspondence to Anna S. Lok.

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Anna S. Lok receives grant/research support from and is a consultant for Bristol-Myers Squibb, Gilead, GlaxoSmithKline, Roche/Genentech and Schering/Merck. She receives grant/research support from Innogenetics, and acts as a consultant for Abbot and Bayer. H. Kwon declares no competing interests.

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Kwon, H., Lok, A. Hepatitis B therapy. Nat Rev Gastroenterol Hepatol 8, 275–284 (2011). https://doi.org/10.1038/nrgastro.2011.33

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