Topic Highlight
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2014; 20(33): 11595-11617
Published online Sep 7, 2014. doi: 10.3748/wjg.v20.i33.11595
Chronic hepatitis B in 2014: Great therapeutic progress, large diagnostic deficit
Claus Niederau
Claus Niederau, Katholisches Klinikum Oberhausen GmbH, St. Josef Hospital, Klinik für Innere Medizin, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, 46045 Oberhausen, Germany
Author contributions: Niederau C solely contributed to this paper.
Correspondence to: Claus Niederau, Professor, Katholisches Klinikum Oberhausen GmbH, St. Josef Hospital, Klinik für Innere Medizin, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Mülheimer Str. 83, 46045 Oberhausen, Germany. c.niederau@kk-ob.de
Telephone: + 49-208-8374501 Fax: +49-208-8374569
Received: September 16, 2013
Revised: January 3, 2014
Accepted: April 27, 2014
Published online: September 7, 2014
Processing time: 355 Days and 22.1 Hours
Abstract

This review analyzes progress and limitations of diagnosis, screening, and therapy of patients with chronic hepatitis B infection. A literature review was carried out by framing the study questions. Vaccination in early childhood has been introduced in most countries and reduces the infection rate. Treatment of chronic hepatitis B can control viral replication in most patients today. It reduces risks for progression and may reverse liver fibrosis. The treatment effect on development of hepatocellular carcinoma is less pronounced when cirrhosis is already present. Despite the success of vaccination and therapy chronic hepatitis B remains a problem since many infected patients do not know of their disease. Although all guidelines recommend screening in high risk groups such as migrants, these suggestions have not been implemented. In addition, the performance of hepatocellular cancer surveillance under real-life conditions is poor. The majority of people with chronic hepatitis B live in resource-constrained settings where effective drugs are not available. Despite the success of vaccination and therapy chronic hepatitis B infection remains a major problem since many patients do not know of their disease. The problems in diagnosis and screening may be overcome by raising awareness, promoting partnerships, and mobilizing resources.

Keywords: Chronic hepatitis B; HBsAg; Screening; Liver cirrhosis; Hepatocellular cancer; Entecavir; Tenofovi; Telbivudine; Adefovir; Lamivudine; Interferon

Core tip: This review analyzes progress and limitations of diagnosis, screening, and therapy of patients with chronic hepatitis B. Treatment can control viral replication in most patients today. It reduces risks for progression and may reverse fibrosis. However, screening recommendations have not been implemented, and the performance of hepatocellular carcinoma surveillance is poor. Many patients with chronic hepatitis B live in resource-constrained settings where effective drugs are not available. Despite the therapeutic progress, chronic hepatitis B remains a problem since many patients do not know of their disease. These problems may be overcome by raising awareness, promoting partnerships, and mobilizing resources.