Is it possible to stop nucleos(t)ide analogue treatment in chronic hepatitis B patients?

Chronic hepatitis B (CHB) remains a challenging global health problem, with nearly one million related deaths per year. Nucleos(t)ide analogue (NA) treatment suppresses viral replication but does not provide complete cure of the hepatitis B virus (HBV) infection. The accepted endpoint for therapy is...

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Bibliographic Details
Published in:World journal of gastroenterology : WJG 2018-05, Vol.24 (17), p.1825-1838
Main Authors: Moreno-Cubero, Elia, Del Arco, Robert T Sánchez, Peña-Asensio, Julia, de Villalobos, Eduardo Sanz, Míquel, Joaquín, Larrubia, Juan Ramón
Format: Article
Language:English
Subjects:
Antiviral Agents - pharmacology
Antiviral Agents - therapeutic use
Hepatitis B Surface Antigens - immunology
Hepatitis B Surface Antigens - isolation & purification
Hepatitis B virus - immunology
Hepatitis B virus - physiology
Hepatitis B, Chronic - blood
Hepatitis B, Chronic - drug therapy
Hepatitis B, Chronic - virology
Humans
Nucleosides - pharmacology
Nucleosides - therapeutic use
Nucleotides - pharmacology
Nucleotides - therapeutic use
Patient Selection
Practice Guidelines as Topic
Review
Seroconversion - drug effects
Time Factors
Treatment Outcome
Virus Replication - drug effects
Withholding Treatment - standards
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Summary:Chronic hepatitis B (CHB) remains a challenging global health problem, with nearly one million related deaths per year. Nucleos(t)ide analogue (NA) treatment suppresses viral replication but does not provide complete cure of the hepatitis B virus (HBV) infection. The accepted endpoint for therapy is the loss of hepatitis B surface antigen (HBsAg), but this is hardly ever achieved. Therefore, indefinite treatment is usually required. Many different studies have evaluated NA therapy discontinuation after several years of NA treatment and before HBsAg loss. The results have indicated that the majority of patients can remain off therapy, with some even reaching HBsAg seroconversion. Fortunately, this strategy has proved to be safe, but it is essential to consider the risk of liver damage and other comorbidities and to ensure a close follow-up of the candidates before considering this strategy. Unanswered questions remain, namely in which patients could this strategy be effective and what is the optimal time point at which to perform it. To solve this enigma, we should keep in mind that the outcome will ultimately depend on the equilibrium between HBV and the host's immune system. Viral parameters that have been described as good predictors of response in HBeAg(+) cases, have proven useless in HBeAg(-) ones. Since antiviral immunity plays an essential role in the control of HBV infection, we sought to review and explain potential immunological biomarkers to predict safe NA discontinuation in both groups.
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v24.i17.1825