Critical Issues in HBV: Considerations in Optimizing HBV Treatment

Issue: May 2015

ByTram T. Tran, MD

We have been very fortunate to have progressed from the discovery of the hepatitis B virus (HBV) to a highly effective vaccine in a relatively short period of time. Even with the vaccine availability, providing it universally to areas of high endemicity is still challenging. Unfortunately, for individuals chronically infected, approximately more than 400 million, risk for the end-stage manifestations of cirrhosis and liver cancer remain globally problematic. We now have efficacious, safe therapies that work to suppress viral replication, but challenges and areas of opportunity still exist in our management of patients infected with HBV.

In this monograph, the timing and treatment options for this disease are discussed, and the goals of determining true immunologic phenotypes based on more than ALT and HBV DNA, which is clinically important since many patients are in a gray zone that does not fit the current guidelines, are concisely summarized.

Monitoring and determining the endpoints of HBV therapy are addressed and a look at resistance, cross resistance, and strategies for salvage are detailed.

Also, the available data on long-term safety and options for therapeutic cessation is assessed. Ending therapy is an evolving area and it is clear that while HBsAg loss and seroconversion is the “holy grail” of hepatitis B, it is rare and may take several years to achieve.

In addition, immune tolerance, as well as the current status of treating young patients infected with the virus where the data are relatively lacking, is also reviewed.

Highlighted is the data presented at the recent EASL meeting in London, focusing on HBV reactivation. Many patients are not recognized until they are immunocompromised, at which time it may be too late. Recognizing the potential serious adverse outcomes of reactivation and the prevention by antiviral prophylaxis is an important message.

I think we are entering into a potentially exciting time in hepatitis B research where a better understanding of host immune responses may lead to the development of new therapies that will give us the elusive viral cure.

I would like to thank the faculty for their valuable contributions to this educational and informative monograph.

Click here to see Education Lab Activity.

Learning Objectives:

Upon completion of this activity, participants should be able to:

Develop individualized treatment strategies based on current best evidence for initiation of HBV treatment.
Implement appropriate serologic, nucleic acid, and laboratory tests to characterize HBV infection and treatment response.
Evaluate underlying causes of HBV treatment failure, considering adherence issues as well as the development of resistance.

Overview

Author(s)/Faculty: Tram T. Tran, MD; Walid S. Ayoub, MD; Robert G. Gish, MD; Harry Janssen, MD, PhD; Asad Javaid, MD; Daryl T-Y Lau, MD, MSc, MPH; Tanya M. Pavri, BA; K. Rajender Reddy, MD, FACP, FACG, FRCP; Robert J. Wong, MD, MS
Source: Healio Gastroenterology Education Lab
Type: Monograph
Articles/Items: 9
Release Date: 8/1/2014
Expiration Date: 8/1/2015
Credit Type: CME
Number of Credits: 1.5
Cost: Free
Provider: Vindico

CME Information

Provider Statement: This continuing medical education activity is provided by Vindico.
Support Statement: This activity is supported by an educational grant from Gilead Sciences Medical Affairs.
Target Audience: The intended audience for this activity is gastroenterologists and other health care professionals involved in the treatment of patients with hepatitis B virus.