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World J Gastroenterol. Oct 7, 2014; 20(37): 13293-13305
Published online Oct 7, 2014. doi: 10.3748/wjg.v20.i37.13293
Update on hepatitis B virus infection
Chan Ran You, Sung Won Lee, Jeong Won Jang, Seung Kew Yoon
Chan Ran You, Sung Won Lee, Jeong Won Jang, Seung Kew Yoon, Division of Hepatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 137-701, South Korea
Author contributions: Yoon SK conducted the review and wrote the manuscript; You CR, Lee SW and Jang JW revised the manuscript.
Correspondence to: Seung Kew Yoon, MD, PhD, Professor, Division of Hepatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, #505 Banpodong, Seocho-gu, Seoul 137-701, South Korea. yoonsk@catholic.ac.kr
Telephone: +82-2-22587534 Fax: +82-2-5369559
Received: November 29, 2013
Revised: March 18, 2014
Accepted: April 5, 2014
Published online: October 7, 2014
Processing time: 312 Days and 1.5 Hours
Abstract

Chronic infection with hepatitis B virus (HBV) leads to the development of hepatocellular carcinoma and/or chronic liver failure. Despite extensive research, the immunopathogenesis is not completely understood. Viral persistence and clinical outcomes following HBV infection depend on viral factors and host factors; including genetic factors that determine a host’s immune mechanisms. The primary goal of chronic hepatitis B (CHB) treatment is to eradicate HBV or to at least maintain suppression of HBV replication. Despite recent advances in anti-viral agents for chronic HBV infection, complete eradication of the virus has been difficult to achieve. Agents for the treatment of CHB are divided mainly into two groups: immunomodulating agents and antiviral nucleos(t)ide analogues (NAs). Although NAs are safe, effective and easily administered orally, their long-term use poses the risk of drug resistance. Currently, international evidence-based guidelines have been developed to support physicians in managing CHB patients. However, treatment of patients with drug resistance is still challenging, as only a few classes of anti-HBV drugs are available and cross-resistance between drugs can occur. In addition, as the currently available genotypic test for detection of drug resistance still has limitations in identifying the different substitutions present in the same viral genome, the development of a new virologic test to overcome this limitation is necessary. Among the predictive factors associated with response to pegylated interferon (PEG-IFN) therapy, hepatitis B surface antigen quantification is considered to be a surrogate marker for monitoring response to PEG-IFN. Current practice guidelines stress the importance of profound and durable HBV viral suppression in the treatment of CHB patients. To this end, it is essential to choose a potent antiviral drug with a low risk of resistance for initial treatment of CHB to achieve sustained virological response. This review highlights recent advances in the understanding of the immunopathogenesis of HBV and currently available and developing treatment strategies against HBV infection.

Keywords: Hepatitis B virus; Chronic hepatitis B; Nucleos(t)ide analogue; Pegylated interferon; Antiviral therapy

Core tip: The primary goal of chronic hepatitis B (CHB) treatment is to eradicate hepatitis B virus (HBV) or to at least maintain suppression of HBV replication. To this end, it is essential to better understand the immunopathogenesis of CHB, although it has yet to be further elucidated. More practically, it is of great importance to choose a potent antiviral drug with a low risk of resistance for initial treatment of CHB to achieve sustained virological response. This review highlights recent advances in the understanding of the immunopathogenesis of HBV and currently available and developing treatment strategies for HBV infection.