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World J Clin Cases. Jul 26, 2019; 7(14): 1784-1794
Published online Jul 26, 2019. doi: 10.12998/wjcc.v7.i14.1784
Antiviral treatment for chronic hepatitis B: Safety, effectiveness, and prognosis
Ya-Li Wu, Cheng-Li Shen, Xin-Yue Chen
Ya-Li Wu, Xin-Yue Chen, International Medical Department, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
Cheng-Li Shen, Division of Surgical Oncology, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Author contributions: Wu YL drafted the article, Shen CL and Chen XY critically revised and prepared the manuscript. All authors read and approved the submitted version of the manuscript.
Supported by the Thirteenth Five-Year Major Science and Technology Projects, No. 2017ZX10202201 and No. 2017ZX10201021-001-008; the Capital Characteristic Clinical Application Research and Extension of Achievements, No. Z151100004015181 and No. Z161100000516018; the Capital Health Research and Development Projects, No. 2016-1-2183; Special Fund for Clinical Medical Research of the Chinese Medical Association, No. 15030270615.
Conflict-of-interest statement: The authors declare that they have no actual or potential competing interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xin-Yue Chen, MD, Professor, International Medical Department, Beijing Youan Hospital, Capital Medical University, No. 8 of Xitoutiao Outside Youanmen, Fengtai District, Beijing 100069, China. chen1204doc@ccmu.edu.cn
Telephone: +86-10-83997159
Received: March 11, 2019
Peer-review started: March 11, 2019
First decision: April 16, 2019
Revised: June 2, 2019
Accepted: June 26, 2019
Article in press: June 27, 2019
Published online: July 26, 2019
Processing time: 139 Days and 8.2 Hours
Abstract

The goal of chronic hepatitis B (CHB) therapy is to improve the patient prognosis through the sustained inhibition of viral replication. However, due to the uncertainty and potentially unlimited duration of the treatment course, nucleus(t)ide analogue (NA) resistance and safety, financial costs and patient compliance, different endpoints of antiviral treatment have been proposed in CHB prevention and treatment guidelines. Different treatment endpoints are closely associated with the safety of drug withdrawal and improvements in prognosis. Antiviral treatment suppresses HBV DNA replication, drug withdrawal leads to relapse, and long-term treatment causes drug safety and resistance issues. Although hepatitis B e antigen seroconversion based on HBV DNA inhibition is considered as “a satisfactory endpoint”, drug withdrawal still leads to high relapse rates. Hepatitis B surface antigen (HBsAg) clearance is the “ideal endpoint” in terms of the safety of drug withdrawal and improvements in prognosis. However, the HBsAg clearance rate is low using the conventional single drug treatment and fixed course regimens. Recently, the application of an “optimized antiviral treatment strategy” has improved the HBsAg clearance rate, and make an “ideal endpoint” possible. This article reviews the different antiviral treatment endpoints in terms of the safety of drug withdrawal, improvements in prognosis and relevant advances.

Keywords: Chronic hepatitis B; Antiviral treatment endpoint; Safety; Prognosis improvement; Hepatitis B surface antigen clearance

Core tip: Different antiviral treatment endpoints have different degrees of improvement in disease prognosis. Hepatitis B surface antigen (HBsAg) clearance has been recommended as an optimal endpoint of antiviral treatment by the latest chronic hepatitis B management guidelines. It can not only lead to safer drug withdrawal but also significantly improves prognosis. However, HBsAg clearance rate is low using the conventional single drug treatment and fixed course regimens. So individualized treatment strategies should be implemented according to the specific conditions of patients. This article reviews the different antiviral treatment endpoints in terms of the safety of drug withdrawal, improvements in prognosis and how to improve HBsAg clearance.