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World J Gastroenterol. May 28, 2014; 20(20): 6262-6278
Published online May 28, 2014. doi: 10.3748/wjg.v20.i20.6262
Management of chronic hepatitis B infection: Current treatment guidelines, challenges, and new developments
Ceen-Ming Tang, Tung On Yau, Jun Yu
Ceen-Ming Tang, Tung On Yau, Jun Yu, Institute of Digestive Disease and Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
Tung On Yau, Jun Yu, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen 518057, Guangdong Province, China
Ceen-Ming Tang, Department of Pharmacology, University of Oxford, Mansfield Road, Oxford OX1 3QT, United Kingdom
Author contributions: Tang CM wrote this review; Yau TO revised the article; and Yu J revised the article and supervised the work.
Supported by Collaborative Research Fund (CUHK3/CRF/12R; HKU3/CRF11R) of the Research Grant Council Hong Kong; National Basic Research Program of China, 973 Program, No. 2013CB531401; CUHK Focused Investments Scheme B to HY Lan; and Theme-based Research Scheme of the Hong Kong Research Grants Council, No. T12-403-11
Correspondence to: Jun Yu, MD, PhD, Professor, Institute of Digestive Disease and Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China. junyu@cuhk.edu.hk
Telephone: +852-3-7636099 Fax: +852-2-1445330
Received: October 21, 2013
Revised: November 24, 2013
Accepted: January 19, 2014
Published online: May 28, 2014
Processing time: 218 Days and 12.9 Hours
Abstract

Chronic hepatitis B (CHB) virus infection is a global public health problem, affecting more than 400 million people worldwide. The clinical spectrum is wide, ranging from a subclinical inactive carrier state, to progressive chronic hepatitis, cirrhosis, decompensation, and hepatocellular carcinoma. However, complications of hepatitis B virus (HBV)-related chronic liver disease may be reduced by viral suppression. Current international guidelines recommend first-line treatment of CHB infection with pegylated interferon, entecavir, or tenofovir, but the optimal treatment for an individual patient is controversial. 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. The likelihood of achieving a sustained virological response is also increased by extending treatment duration, and using combination therapy. Hence the paradigm for treatment of CHB is constantly evolving. This article summarizes the different indications for treatment, and systematically reviews the evidence for the efficacy of various antiviral agents. It further discusses the shortcomings of current guidelines, use of rescue therapy in drug-resistant strains of HBV, and highlights the promising clinical trials for emerging therapies in the pipeline. This concise overview presents an updated practical approach to guide the clinical management of CHB.

Keywords: Chronic hepatitis B virus infection; National institute for health and care excellence; Treatment guidelines; Interferon; Pegylated interferon; Nucleos(t)ide analogues; Antiviral resistance; Rescue therapy; Clinical trials

Core tip: This article summarizes the different indications for treatment, and systematically reviews the evidence for the efficacy of various antiviral agents. It further discusses the shortcomings of current guidelines, use of rescue therapy in drug-resistant strains of hepatitis B virus, and highlights the promising clinical trials for emerging therapies in the pipeline. This concise overview presents an updated practical approach to guide the clinical management of chronic hepatitis B.