Role of antiviral therapy in the natural history of hepatitis B virus-related chronic liver disease

Abstract

interactions among HBV, hepatocytes, and the host immune system. Natural history studies of chronic hepatitis B (CHB) infection have shown an association between active viral replication and adverse clinical outcomes such as cirrhosis and hepatocellular carcinoma. The goal of therapy for CHB is to improve quality of life and survival by preventing progression of the disease to cirrhosis, decompensation, end-stage liver disease, hepatocellular carcinoma (HCC) and death. This goal can be achieved if HBV replication is suppressed in a sustained manner. The accompanying reduction in histological activity of CHB lessens the risk of cirrhosis and of HCC, particularly in non-cirrhotic patients. However, CHB infection cannot be completely eradicated, due to the persistence of covalently closed circular DNA in the nucleus of infected hepatocytes, which may explain HBV reactivation. Moreover, the integration of the HBV genome into the host genome may favour oncogenesis, development of HCC and may also contribute to HBV reactivation. Core tip: The goal of therapy for chronic hepatitis B is to improve quality of life and survival by preventing progression of the disease to cirrhosis, decompensation, end-stage liver disease, hepatocellular carcinoma and death. Current therapeutic options do not eradicate hepatitis B virus (HBV) infection, since HBV remains either integrated in the host genome or in the nuclei of hepatocytes as covalently closed circular DNA, a fact that may favour oncogenesis towards the development of hepatocellular carcinoma, and explains HBV reactivation. It is mandatory for clinicians to start viral suppression in patients with active chronic liver disease, particularly in

A novel diagnostic algorithm to predict significant liver inflammation in chronic hepatitis B virus infection patients with detectable HBV DNA and persistently normal alanine transaminase

“…In China, HBV infection is moderately endemic, and chronic hepatitis B (CHB) is the main cause of cirrhosis, liver de-compensation, and hepatocellular carcinoma (HCC) 2 . Among chronic HBV infection patients, those with significant liver inflammation have a much greater risk of cirrhosis, liver de-compensation, and HCC 3 . According to the guidelines for chronic HBV infection, it is critical to identify patients with significant liver inflammation, and treat them immediately 4 – 6 .…”

Development of algorithms based on serum markers and transient elastography for detecting significant fibrosis and cirrhosis in chronic hepatitis B patients: Significant reduction in liver biopsy

“…Hepatitis B viral (HBV) infection, a risk factor for chronic liver diseases including cirrhosis, hepatocellular carcinoma, and liver failure, remains a global health problem . Studies have indicated that effective antiviral therapy may reduce development of liver‐related complications, which is of great significance for the long‐term clinical prognosis for patients . Therefore, accurate and timely staging of liver fibrosis, especially significant fibrosis and cirrhosis, is important for the timing of antiviral therapy in chronic hepatitis B (CHB) patients in effort to maximize the benefit of antiviral therapy.…”

A pleasant dilemma to have: to treat the HCV patient on the waiting list or to treat post‐liver transplantation?

“…On the other hand, encouraging SVR12 statistics in patients with decompensated cirrhosis receiving Harvoni ® and ribavirin suggest that these patients will respond to the most recent wave of anti‐HCV medications . The fate of patients with advanced liver disease who achieve SVR is uncertain, but the liver transplant community remains optimistic that the efficacy of HCV antiviral therapy will parallel the successes seen with hepatitis B over the last 10–15 yr, in which antiviral treatment has appreciably decreased the need for LT for decompensated liver disease, with HCC being the primary complication for the majority of patients on treatment . Nevertheless, the treatment of HCV in cirrhotic patients should be carefully monitored at experienced LT centers, after thorough consideration of the risks and benefits.…”