Materiały źródłowe

• #1 Hepatitis B Treatment & Management: Approach Considerations, Pharmacologic Management, Surgical Intervention

  https://emedicine.medscape.com/article/177632-treatment

  Please note that guidelines for the current diagnostic workup and management of hepatitis B virus (HBV) infection continue to evolve. Clinicians are advised to refer frequently to the most recent recommendations of the American Association for the Study of Liver Diseases (AASLD). […] The primary treatment goals for patients with hepatitis B (HBV) infection are to prevent progression of the disease, particularly to cirrhosis, liver failure, and hepatocellular carcinoma (HCC). […] A synergistic approach of suppressing viral load and boosting the patients immune response with immunotherapeutic interventions is needed for the best prognosis. […] The prevention of HCC often includes the use of antiviral treatment using pegylated interferon (PEG-IFN) or nucleos(t)ide analogues. […] Therapy is currently recommended for patients with evidence of chronic active hepatitis B disease (ie, abnormal aminotransferase levels, positive HBV DNA findings, positive or negative hepatitis B e antigen [HBeAg]).

• #1 Hepatitis B Basics | Hepatitis B | CDC

  https://www.cdc.gov/hepatitis-b/about/index.html

  If you are diagnosed with acute or chronic hepatitis B, find a doctor who specializes in infectious, digestive, or liver diseases. They will need to do regular tests to monitor how your liver is working. […] For people with acute hepatitis B and experiencing mild symptoms, health care providers usually recommend rest, adequate nutrition, and fluids. There are no medications for acute hepatitis B. There are some medications for chronic hepatitis B; they aren’t a cure and are only helpful for some people with chronic hepatitis B. Learn more about treatment options for hepatitis B.

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  https://www.aurorahealthcare.org/services/gastroenterology-colorectal-surgery/hepatitis-b

  Many adults who have the hep B virus can recover fully from it, usually within 6 months. This is known as acute hepatitis B infection. […] However, some people have the infection for a longer period of time this is known as chronic hepatitis B infection. It can last an entire lifetime and lead to liver scarring, liver failure, and liver cancer. […] Its important to seek treatment early if youre exposed to the hepatitis B virus to increase your chances of a smooth recovery. […] HBV treatment can be given within 24 hours of exposure to the virus, which may reduce the risk of infection. […] If you have chronic hepatitis B, youll be treated with antiviral medication. […] Since there is no cure for hepatitis B, prevention is important.

• #1 Hepatitis B – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hepatitis-b/diagnosis-treatment/drc-20366821

  Treatment to prevent HBV infection after exposure […] Medicine called immunoglobulin may help protect you from getting sick with hepatitis B. You need to receive a shot of the medicine within 24 hours of exposure to the hepatitis B virus. This treatment only provides short-term protection. So you also should get the hepatitis B vaccine at the same time if you never received it. […] Treatment for acute HBV infection […] If your symptoms are severe, you may need antiviral medicines or a hospital stay to prevent complications. […] Treatment for chronic HBV infection […] Most people with chronic hepatitis B virus infection need treatment for the rest of their lives. The decision to start treatment depends on many factors, including whether: […] Treatment helps lower the risk of liver disease and prevents you from passing the infection to others.

• #1 Hepatitis B Treatment & Management: Approach Considerations, Pharmacologic Management, Surgical Intervention

  https://emedicine.medscape.com/article/177632-treatment

  Antiviral therapy is not recommended for HBeAg-positive children aged 2 years up to 18 years who have persistently normal ALT, regardless of the HBV DNA level. […] In individuals with HBV/human immunodeficiency virus (HIV) coinfection, the AASLD recommends initiating ART in all those with evidence of severe chronic liver disease, regardless of CD4 count, as well as those with a CD4 count of 500 cells/mm3 or below, regardless of their liver disease stage. […] Patients with hepatitis B disease and fulminant hepatic failure should be hospitalized in the intensive care unit (ICU) and be considered for liver transplantation in the event that they do not recover. […] Currently, pegylated interferon alfa (PEG-IFN-a), entecavir (ETV), and tenofovir disoproxil fumarate (TDF) are the FDA-approved agents in the treatment of hepatitis B disease.

• #1 Hepatitis B Foundation: Treatment Options

  https://www.hepb.org/treatment-and-management/treatment/

  People living with chronic hepatitis B infection should expect to live a long and healthy life. There are also approved drugs for both adults and children that control the hepatitis B virus, which helps reduce the risk of developing more serious liver disease, but there is still no complete cure. […] Current treatments for hepatitis B fall into two general categories: Immune modulator Drugs These are interferon-type drugs that boost the immune system to help get rid of the hepatitis B virus. Antiviral Drugs These are drugs that stop or slow down the hepatitis B virus from reproducing, which reduces the inflammation and damage of your liver. […] It is important to know that not everyone with chronic hepatitis B infection needs to be treated. Current treatments, however, are generally found to be most effective in those who show signs of active liver disease (e.g. through a physical exam, blood tests and imaging studies such as an ultrasound).

• #1 Treatment of chronic hepatitis B virus infection – B Positive

  https://hepatitisb.org.au/treatment-of-chronic-hepatitis-b-virus-infection/

  Primary goals of treatment are to improve both quality of life and survival of people with HBV infection via: Normalise alanine aminotransferase (ALT) levels; Achieve HBeAg loss in HBe Ag-positive patients; Achieve sustained suppression of HBV viral replication; Achieve HBsAg loss with or without anti HBs seroconversion; Reduce risk of progression to cirrhosis and hepatocellular carcinoma. […] The decision to commence antiviral therapy is based on a number of factors, including the patient’s age, serum HBV DNA levels, extent of hepatic fibrosis, ALT levels, hepatitis B e antigen (HBeAg) status and the risk of HCC. […] A liver biopsy is no longer mandatory for reimbursement; however, in some settings, it may still have a role in decision making. Non-invasive techniques to indirectly measure the extent of liver fibrosis should be used to assist decision making in preference to liver biopsy.

• #1 Hepatitis B Treatment & Management: Approach Considerations, Pharmacologic Management, Surgical Intervention

  https://emedicine.medscape.com/article/177632-treatment

  The National Institutes of Health (NIH) recommends nucleos(t)ide therapy for the treatment of patients with acute liver failure, as well as cirrhotic patients who are HBV DNA positive and those with clinical complications, cirrhosis or advanced fibrosis with positive serum HBV DNA, or reactivation of chronic HBV during or after chemotherapy or immunosuppression. […] In general, for hepatitis B e antigen (HBeAg)-positive patients with evidence of chronic HBV disease, treatment is advised when the HBV DNA level is at or above 20,000 IU/mL (105 copies/mL) and when serum ALT is elevated for 3-6 months. […] For HBeAg-negative patients with chronic hepatitis B disease, treatment can be administered when the HBV DNA is at or above 2,000 IU/mL (104 copies/mL) and the serum ALT is elevated (ALT levels 20 U/L for females; 30 U/L for males) for 3-6 months.

• #1 Treatment of Hepatitis B | Hepatitis B | CDC

  https://www.cdc.gov/hepatitis-b/treatment/index.html

  People with hepatitis B can live healthy and normal lives; it is important to see a doctor to optimize your care. […] There are medications available for chronic hepatitis B called antivirals, but not everyone needs them. […] If you are diagnosed with hepatitis B, see your doctor to determine the best treatment for you. […] The treatment your doctor will recommend depends on whether you have acute or chronic hepatitis B. […] There are several medications approved to treat people who have chronic hepatitis B, and new drugs are in development. […] For some people with hepatitis B, these medications can prevent severe liver disease. […] However, not every person with chronic hepatitis B needs medication, and the drugs may cause side effects in some people. […] People who start hepatitis B treatment may need to take medication for the rest of their lives because these medications do not lead to a cure.

• #1 Hepatitis B Foundation: Treatment Options

  https://www.hepb.org/treatment-and-management/treatment/

  Whether you start treatment or not, it is very important to be regularly seen by a liver specialist or a health care provider who is knowledgeable about hepatitis B. […] The Hepatitis B Foundation created the HBF Drug Watch to keep track of approved and promising new treatments. There are now 7 approved drugs for hepatitis B in the United States — 2 types of injectable interferons and 5 oral antivirals that control the hepatitis B virus. A cure, however, may be in the near future because there is exciting research being done today to generate promising new drugs.

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• #1 Review of Current and Potential Treatments for Chronic Hepatitis B Virus Infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8475260/

  Current treatments are associated with improved liver-related outcomes but relatively low rates of sustained hepatitis B surface antigen (HBsAg) seroconversion. Novel and potentially promising therapeutic strategies are in development and may result in more durable and complete responses. […] To date, there are 2 classes of drugs approved by the US Food and Drug Administration (FDA) for the treatment of HBV: interferon (IFN) and nucleos(t)ide analogues (NAs). […] Standard IFN was approved as the first agent for the treatment of HBV infection 40 years ago. IFNs are cytokines with potent antiviral, antiproliferative, and immunomodulatory properties. […] In 2005, pegylated (PEG)-IFN largely replaced standard IFN as first-line treatment for chronic HBV infection owing to its improved pharmacokinetics and prolonged half-life.

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• #1 Treatment of chronic hepatitis B virus infection – B Positive

  https://hepatitisb.org.au/treatment-of-chronic-hepatitis-b-virus-infection/

  Women with CHB interested in starting a family should consider the safety profile of various treatment options, and restricted access to treatment under PBS Section 100 criteria. […] There are two main treatment options for treatment. The first-line treatments are nucleoside analogues (NAs) with a high barrier to resistance: tenofovir and entecavir. An alternative option in highly selected patients is PEG-IFN. […] The use of conventional IFN has been supplanted by the use of PEG-IFN, which has the advantage of weekly dosing and (probably) of improved efficacy. […] The main advantage of PEG-IFN is the fixed duration of therapy (which is particularly attractive to younger patients), and the chance for HBsAg seroconversion. […] Long-lasting, treatment-maintained suppression of HBV DNA without resistance is achievable in most patients with entecavir or tenofovir.

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• #1 HBV: Treatment Goals and Medications – Viral Hepatitis and Liver Disease

  https://www.hepatitis.va.gov/hbv/treatment/medications.asp

  Hepatitis B […] General goals of HBV treatment: To suppress HBV DNA and normalize ALT. To achieve loss of HBeAg (if initially HBeAg positive). To achieve loss of HBsAg (this occurs rarely). To reduce the likelihood of cirrhosis and HCC. To decrease the morbidity and mortality related to HBV. […] In general, patients with active HBV (HBV DNA 2,000 IU/mL if HBeAg-negative and HBV DNA 20,000 IU/mL if HBeAg-positive, and high ALT or evidence of advanced fibrosis) should be considered for HBV antiviral treatment. […] There are 6 medications approved for HBV in the United States: 1 is pegylated interferon (subcutaneous injection) and 5 are nucleos(t)ide analogs (oral). […] First line (low resistance potential): Tenofovir alafenamide (TAF, Vemlidy), Tenofovir disoproxil fumarate (TDF, Viread), Entecavir (ETV, Baraclude), Peginterferon (PEG, Pegasys) – in select patients. […] Second line (high resistance potential): Lamivudine (3TC, Epivir-HBV), Adefovir (ADV, Hepsera).

• #1

  https://journals.lww.com/hep/fulltext/2016/01000/aasld_guidelines_for_treatment_of_chronic.32.aspx

  Side effects are more frequent with interferon (IFN) therapy than with nucleos(t)ide analogs (NAs) therapy. […] Overall, all NAs have an excellent safety profile across a wide spectrum of persons with CHB, including those with decompensated cirrhosis and transplant recipients. […] The AASLD recommends antiviral therapy for adults with immuneactive CHB (HBeAg negative or HBeAg positive) to decrease the risk of liverrelated complications. […] The AASLD recommends PegIFN, entecavir, or tenofovir as preferred initial therapy for adults with immuneactive CHB. […] The AASLD recommends against antiviral therapy for adults with immunetolerant CHB. […] The AASLD suggests that ALT levels be tested at least every 6 months for adults with immunetolerant CHB to monitor for potential transition to immuneactive or inactive CHB.

• #1 Review of Current and Potential Treatments for Chronic Hepatitis B Virus Infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8475260/

  The current recommended first-line agents for immune-active chronic HBV infection are PEG-IFN, ETV, or tenofovir (TDF or TAF). […] The advantages of chronic HBV treatment with PEG-IFN include finite treatment duration and the absence of drug resistance. […] However, treatment with PEG-IFN has severe limitations, including frequent AEs such as thrombocytopenia and leukopenia, which require dose adjustment or even medication discontinuation. […] Patients generally have better adherence to oral NAs compared with subcutaneously injected PEG-IFN. Newer NAs are preferred over PEG-IFN because of their potent antiviral activity, high barrier to antiviral resistance, and more favorable safety profile. […] The availability of a simple, safe, and highly effective cure for hepatitis C virus infection has reignited the search for a cure for HBV infection. The limited efficacy of currently approved treatments for chronic HBV infection underscores the urgent need for more effective agents that not only suppress viral replication, but also completely eradicate HBV infection. Several novel approaches are currently in preclinical or early clinical development.

• #1 Hepatitis B – Wikipedia

  https://en.wikipedia.org/wiki/Hepatitis_B

  Treatment Antiviral medication (tenofovir, interferon), liver transplantation. […] Although none of the available medications can clear the infection, they can stop the virus from replicating, thus minimizing liver damage. […] As of 2024, there are seven medications licensed for the treatment of hepatitis B infection in the United States. […] Treatment lasts from six months to a year, depending on medication and genotype. […] Those with current cirrhosis are in most need of treatment. […] The use of interferon, which requires injections daily or thrice weekly, has been supplanted by long-acting PEGylated interferon, which is injected only once weekly. […] However, it seems unlikely that the disease will be eliminated by 2030, the goal set in 2016 by WHO. However, progress is being made in developing therapeutic treatments.

• #1 Hepatitis B Virus: Advances in Prevention, Diagnosis, and Therapy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7048015/

  Treatment guidelines are regularly updated to incorporate the new developments in the field. […] The key features of the treatment recommendations from major guidelines available worldwide are found in Table 5. […] Current therapies for the management of CHB include peginterferon (PEG-IFN) and orally administered nucleos(t)ide analogs (NAs). […] For NAs, all regional associations agree that first-line therapy should be with an oral antiviral with a strong barrier to resistance: either entecavir, TDF, or TAF. […] Short-term treatment with NAs is feasible for those HBeAg-positive patients who experience seroconversion to anti-HBe during treatment. […] After HBeAg seroconversion occurs, treatment should continue for at least 1 year and, it is hoped, an additional 3 years in order to achieve a long-lasting response once therapy is discontinued.

• #1 Treatment of chronic hepatitis B virus infection – B Positive

  https://hepatitisb.org.au/treatment-of-chronic-hepatitis-b-virus-infection/

  Entecavir, a purine-derived nucleoside analogue, is a highly effective inhibitor of viral replication. Long-term (at least 3 years) entecavir therapy appears to result in the reversal of fibrosis and cirrhosis, and continued improvement in liver histology. […] Tenofovir disoproxil fumarate (TDF) is an acyclic adenine nucleotide with potent activity against HBV. […] In summary, both nucleos(t)ide analogues and PEG-IFN can be prescribed as first-line treatment options for CHB. However, PEG-IFN should only be considered for patients with a high chance of response based on pre-treatment and on-treatment factors. […] In patients on antiviral agents, a rising ALT or HBV DNA level may indicate viral resistance or non-adherence. […] While on therapy, patients should be monitored regularly to document virological response to treatment, detect adverse events early in their evolution, identify the emergence of viral resistance and encourage adherence.

• #1 Hepatitis B Treatment & Management: Approach Considerations, Pharmacologic Management, Surgical Intervention

  https://emedicine.medscape.com/article/177632-treatment

  The 2015 WHO guidelines for the prevention, care, and treatment of persons with chronic hepatitis B infection indicate treatment priority for individuals of all ages who have chronic hepatitis B infection and clinical evidence of compensated/decompensated cirrhosis. […] Treatment is recommended for adults with chronic hepatitis B infection without clinical evidence of cirrhosis, but who have all of the following features, and regardless of HBeAg status: Are older than 30 years, Have persistently abnormal ALT levels, Have evidence of high-level HBV replication (HBV DNA 20,000 IU/mL). […] The AASLD does not recommend antiviral therapy in individuals with all of the following, regardless of HBeAg status or age: No clinical evidence of cirrhosis, Persistently normal ALT levels, Low levels of HBV DNA replication (HBV DNA 2,000 IU/mL).

• #1 Hepatitis B: Screening, Prevention, Diagnosis, and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0301/p314.html

  Treating pregnant women who are HBsAg positive reduces perinatal transmission rates. […] Individuals with decompensated cirrhosis and chronic hepatitis B should be treated with a nucleoside/nucleotide analogue and assessed for liver transplantation eligibility. […] There is strong evidence that antiviral therapy improves liver function, increases survival, and avoids the need for liver transplantation when anti-HBV treatment is initiated early in decompensated cirrhosis.

• #1 Hepatitis B Treatment & Management: Approach Considerations, Pharmacologic Management, Surgical Intervention

  https://emedicine.medscape.com/article/177632-treatment

  The following are medications approved for the treatment of chronic hepatitis B in adult and/or pediatric patients: Preferred agents include Pegylated interferon (PEG-IFN)-alpha-2a, Entecavir, Tenofovir disoproxil fumarate (DF), Tenofovir alafenamide (AF). […] The 2016 AASLD guidelines for the treatment of chronic hepatitis B as well as select recommendations from the 2018 AASLD guidance update on the prevention, diagnosis, and treatment of chronic hepatitis B are outlined below. […] Orthotopic liver transplantation (OLT) is the treatment of choice for patients with fulminant hepatic failure who do not recover and for patients with end-stage liver disease due to hepatitis B disease.

• #1 Hepatitis B | UC San Diego Health

  https://health.ucsd.edu/care/liver-disease/hepatitis-b/

  You may receive antiviral medications if: The level of hepatitis B virus in your blood is high. You’re showing signs of long-term liver damage. […] A liver transplant does not cure a hepatitis B infection. However, thanks to improved prevention and medication control, hepatitis B reinfection occurs in only a very small percentage of people. […] All patients who undergo transplantation and have had hepatitis B will require lifelong treatment with hepatitis B medication to prevent the reactivation of the virus.

• #1 Hepatitis B Virus Infection: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/hepatitis-b-virus

  All people with HIV/HBV coinfection (HBsAg positive), regardless of CD4 count and HBV DNA level, should be treated with an ART regimen that includes drugs active against both HIV and HBV infections. […] Some experts recommend that people with isolated anti-HBc positivity receive an ART regimen that includes drugs active against HBV and HIV. […] The ART regimen should include two drugs active against HBV, preferably with TAF (10 or 25 mg) plus FTC 200 mg or TAF 25 mg plus 3TC 300 mg PO once daily, or TDF 300 mg plus (FTC 200 mg or 3TC 300 mg) once daily. […] People on treatment for HBV and HIV should receive therapy indefinitely. […] HBV DNA should be monitored at 6-month intervals. […] HBsAg should be monitored yearly. […] Anti-HBV therapy (TDF, TAF, or entecavir) must be given if there is a switch to a nucleos(t)ide-sparing ARV regimen.

• #1 Hepatitis B Virus/HIV Coinfection | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/hepatitis-b-virus-hiv-coinfection

  Hepatitis A, B, and C virus serologies should be performed for all people with HIV (AIII). […] Before initiating or switching antiretroviral therapy (ART), all people who test positive for hepatitis B surface antigen (HBsAg) should be tested for hepatitis B virus (HBV) DNA using a quantitative assay to determine the level of HBV replication (AIII). […] Because tenofovir alafenamide (TAF), tenofovir disoproxil fumarate (TDF), emtricitabine (FTC), and lamivudine (3TC) are active against both HIV and HBV, an antiretroviral (ARV) regimen for people with both HIV and HBV should include (TAF or TDF) plus (3TC or FTC) as the nucleoside reverse transcriptase inhibitor (NRTI) backbone of a fully suppressive ARV regimen (AI). […] In people with HBV/HIV coinfection, using 3TC or FTC as the only drug in a regimen with HBV activity is not recommended (AII), because HBV resistance to these drugs can emerge.

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  https://journals.lww.com/hep/fulltext/2016/01000/aasld_guidelines_for_treatment_of_chronic.32.aspx

  The AASLD suggests antiviral therapy to reduce the risk of perinatal transmission of hepatitis B in HBsAgpositive pregnant women with an HBV DNA level 200,000 IU/mL. […] The AASLD recommends against the use of antiviral therapy to reduce the risk of perinatal transmission of hepatitis B in the HBsAgpositive pregnant woman with an HBV DNA 200,000 IU/mL. […] The AASLD suggests antiviral therapy in HBeAgpositive children (ages 2 to 18 years) with both elevated ALT and measurable HBV DNA levels, with the goal of achieving sustained HBeAg seroconversion. […] The AASLD recommends against use of antiviral therapy in HBeAgpositive children (ages 2 to 18 years) with persistently normal ALT, regardless of HBV DNA level.

• #1 Chronic HBV Treatment Guidelines | HCP Site

  https://www.vemlidyhcp.com/treatment-guidelines/

  VEMLIDY is a preferred first-line therapy for adults with chronic hepatitis B, as recommended by 5 treatment guidelines/algorithms. […] Chronic hepatitis B patients with compensated cirrhosis (HBeAg+/-) and detectable HBV DNA should be treated, regardless of ALT levels. […] VEMLIDY has not been tested for use during pregnancy. Both AASLD and EASL guidelines recommend TDF for use during pregnancy. […] VEMLIDY is not recommended in patients with end stage renal disease (ESRD; estimated creatinine clearance [eCrCl] 15 mL/min) who are not receiving chronic hemodialysis; in patients on chronic hemodialysis, on hemodialysis days, administer VEMLIDY after completion of hemodialysis treatment. […] VEMLIDY is indicated for the treatment of chronic hepatitis B virus (HBV) infection in adults with compensated liver disease.

• #1 Hepatitis B – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hepatitis-b/symptoms-causes/syc-20366802

  Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV). […] For those who get infected, treatment depends on whether the infection is acute or chronic. Some people need medicine. Others with serious liver damage from a chronic infection need a liver transplant. […] If the virus starts to quickly make copies of itself, tests may spot this rise or find the virus. This is called reactivation of the virus. It can lead to liver damage or even liver failure. […] Before taking these medicines, you should be tested for hepatitis B. If testing shows that you have hepatitis B, see a liver specialist called a hepatologist before you start these medicines. […] The hepatitis B vaccine is the main way to prevent infection with HBV. The vaccine is given as two shots one month apart, or three or four shots over six months. How many shots you get depends on the type of hepatitis B vaccine that you’re given. You can’t get hepatitis B from the vaccine.

• #1 Hepatitis B virus prophylaxis in immunocompromised adults

  https://www.eviq.org.au/clinical-resources/side-effect-and-toxicity-management/prophylaxis-and-treatment/1382-hepatitis-b-virus-prophylaxis-in-immunocompro

  Antiviral prophylaxis with a potent, high barrier to resistance nucleoside/nucleotide analogues (i.e. entecavir or tenofovir) is recommended over lamivudine. […] Antiviral prophylaxis is recommended for all HBsAg positive patients with haematological malignancy or solid tumour undergoing therapy. […] Antiviral prophylaxis is recommended to prevent the reactivation of hepatitis B in patients who are: HBsAg positive with haematological or solid tumour malignancy undergoing anti-cancer therapy; HBsAg negative and anti-HBc positive and undergoing higher risk anti-cancer therapy. […] Entecavir or tenofovir is recommended as first-line antiviral therapy and should be initiated as soon as possible relative to the start of anti-cancer therapy. […] These third generation nucleotide analogues have low rates of viral resistance and studies have demonstrated superiority over lamivudine.

• #1 Treatment for hepatitis B in patients with drug resistance

  https://atm.amegroups.org/article/view/11714/html

  Persistent hepatitis B virus (HBV) infections affect about 240 million patients worldwide that are at risk of developing liver cirrhosis or hepatocellular carcinoma. […] Nucleoside and nucleotide analogues like lamivudine (LMV), entecavir (ETV), telbivudine (LdT), adefovir dipivoxil (ADV) and tenofovir (TDF) are used to achieve long-term suppression of viral replication. […] From a clinical point of view, patients undergoing antiviral therapy require regular testing for HBV DNA (every 36 months). […] If drug resistance is suspected or even molecularly confirmed, rescue therapy strategies exist, usually switching to a noncross-resistant antiviral drug. […] Complex treatment histories with many antivirals may sometimes necessitate the combination of highly effective antivirals like ETV and TDF.

• #1 Hepatitis B: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0415/p965.html

  Several medications are approved in the United States for the treatment of HBV infection. […] Although interferon is approved for treatment, pegylated interferon alfa-2a has higher effectiveness, with a similar adverse effect profile, and is preferred over interferon. […] During the active phase of chronic HBV infection, ALT levels are elevated and HBV DNA levels exceed 20,000 IU per mL. Patients in the active phase of chronic HBV infection should be offered treatment. […] During the inactive phase of chronic HBV infection, ALT levels are normal and HBV DNA levels are low (less than 20,000 IU per mL). Treatment and liver biopsy are not indicated in patients with inactive HBV infection. […] The primary limitation of all oral antiviral agents is development of viral resistance because of mutations in the viral DNA during replication. […] If resistance develops to one agent, the effectiveness of a second agent with the same site of action is reduced. […] The risk of resistance increases whenever patients have persistent detectable HBV DNA levels.

• #1 Treatment for hepatitis B in patients with drug resistance

  https://atm.amegroups.org/article/view/11714/html

  The main treatment goal for chronic hepatitis B is to suppress viral replication and consequently to prevent progression to liver fibrosis and cirrhosis, liver failure and development of hepatocellular carcinoma. […] In order to reduce the risk of drug resistance, all guidelines now recommend the use of newer, highly potent antivirals with a high barrier to resistance such as ETV or TDF. […] Most guidelines recommend testing HBV-DNA serum levels every 3 months during the first year of treatment and at least every 6 months thereafter. […] In cases of a confirmed virological breakthrough and exclusion of non-adherence, the patient should be either switched to another antiviral monotherapy with a high genetic barrier to resistance (ETV or TDF) or a second antiviral drug with a complementary resistance profile should be added.

• #1 Hepatitis B Virus: Advances in Prevention, Diagnosis, and Therapy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7048015/

  Therefore, new therapies for HBV that can achieve sustained suppression and HBsAg loss after a limited course of therapy are of high interest. […] Such therapies will permit the discontinuation of NAs after short periods of therapy and provide a so-called HBV cure. […] The goal of HBV therapy will always remain complete cure. […] Functional cure may be attained within the next 5 to 10 years through the use of newly developed antivirals and immunomodulatory agents that will reduce the HBV viral load and build the hosts own immune response against disease. […] Complete cure will require gene editing approaches which are some years away from human trials.

• #1 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20250317/Researchers-move-closer-to-a-functional-cure-for-chronic-hepatitis-B.aspx

  Hepatitis B virus infection remains one of the leading causes of liver disease, including cirrhosis and hepatocellular carcinoma. […] Current therapies, such as nucleos(t)ide analogues and interferons, fail to eliminate cccDNA, allowing the virus to rebound after treatment is stopped. […] The study examines the molecular mechanisms governing cccDNA activity and explores potential therapeutic approaches to silence its transcription. […] The review highlights the complex biology of cccDNA, which forms minichromosomes in the infected liver cell nucleus. […] Key epigenetic mechanisms such as DNA methylation, histone modifications, and the involvement of noncoding RNAs regulate cccDNA activity. […] One of the most compelling findings is the role of the HBV protein HBx in maintaining cccDNA transcriptional activity.

• #1 New treatment for Chronic Hepatitis B | Clinic FEHV

  https://fehv.org/en/new-treatment-chronic-hepatitis-b/

  Chronic hepatitis B virus infection is a global health problem. […] There are drugs against hepatitis B (entecavir, tenofovir) that are very effective in inhibiting the replication of the virus but that do not achieve its complete elimination, that is, the loss of the surface antigen of the hepatitis B virus (HBsAg). […] A study has been published in the New England Journal of Medicine in which patients with chronic hepatitis B have been treated with a new drug that is an antisense probe (Bepirovirsen) that can effectively inhibit the multiplication of the B virus. […] It was shown that between 9-10% of the patients treated with 300 mg of the drug presented a complete response (maintained loss of HBsAg and B virus DNA), that is, a cure. […] In summary, Bepirovirsen is a drug with very promising results for the cure of chronic hepatitis B and studies are being carried out combining Bepirovirsen with other therapies (pegylated interferon, vaccine, PAPD5 and PAPD7 enzyme inhibitors) to increase the efficacy of the drug treatment. Therefore, the future for the complete cure of chronic hepatitis B with new drugs is very hopeful.

• #1 Imdusiran for Chronic Hepatitis B Achieves Functional Cure in 50% of Patients

  https://www.contagionlive.com/view/imdusiran-for-chronic-hepatitis-b-achieves-functional-cure-in-50-of-patients

  Arbutus CEO Michael McElhaugh discussed trial results showing that a combination of imdusiran, an RNAi therapeutic, and pegylated interferon alfa-2 can achieve a functional cure in chronic hepatitis B patients. […] The data, showing up to 50% of patients achieving a functional cure, will be presented at The Liver Meeting 2024, hosted by the American Association for the Study of Liver Diseases (AASLD) on November 18. […] The data from this study reveal significant long-term potential for imdusiran in combination with interferon as a pathway toward a functional cure for cHBV, McElhaugh said. This combination has the potential to change the treatment landscape for Hepatitis B. […] Results revealed that 50% (3/6) of patients with baseline hepatitis B surface antigen (HBsAg) levels less than 1000 IU/mL achieved a functional cure, defined as sustained HBsAg loss and undetectable HBV DNA for 24 weeks after stopping all treatments. Overall, 25% (3/12) of patients across the cohort achieved a functional cure.

• #1 Hepatitis B Virus: Advances in Prevention, Diagnosis, and Therapy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7048015/

  The recommended therapy cutoff criteria for NAs in HBeAg-negative patients vary by region. […] In contrast to NA therapy, the use of peginterferon as primary therapy in patients with CHB has been limited by its poor efficacy and tolerability. […] However, unlike NA therapy, PEG-IFN has a finite duration. […] Combinations of peginterferon with NAs or add-on or sequential therapy with NAs followed by peginterferon treatment have been demonstrated to be safe and to have improved seroconversion rates compared to those of single therapies. […] It should be noted that peginterferon should not be used in patients with decompensation, but it can be used with caution in patients with compensated cirrhosis. […] In contrast, oral NA therapy improves and restores function even in patients with severe decompensated liver disease.

• #1 Hepatitis B: Symptoms, Causes, and Treatment

  https://www.webmd.com/hepatitis/digestive-diseases-hepatitis-b

  Lifestyle changes recommended for people with chronic hepatitis B […] Whether or not you are taking medicine, your doctor will likely recommend you make a few changes to protect your liver, such as: […] Avoid alcohol. […] Eat a healthy, balanced diet. […] Limit how much fat and sugar you eat and drink. […] Check with your doctor before taking other drugs, herbs, or supplements because some can damage your liver.

• #1 Hepatitis B Treatment: A Complete Guide

  https://www.everydayhealth.com/hepatitis-b/guide/treatment/

  Lifestyle changes can help you better manage hepatitis B and keep your liver as healthy as possible. People with hepatitis B need to avoid substances that increase the risk of liver damage: Alcohol, Certain medications that are processed in the liver, Herbal medications, Herbal supplements. If you have hepatitis B, be sure to check with your doctor before taking any supplements, vitamins, or over-the-counter medications. For your best health, you should also adhere to these recommendations: Follow a nutritious diet […] Get vaccinated against hepatitis A […] Get screened for hepatitis C […] Stay physically active […] Maintain a body weight that’s healthy for you. […] Hepatitis B is a potentially severe disease that stems from infection with the hepatitis B virus. An acute infection often goes away with time, but many people who experience chronic hepatitis B will need long-term treatment with antiviral medications or immune modulators. Healthy lifestyle choices like avoiding alcohol can help keep your liver healthy if you have hepatitis B.

• #1 Treatment for hepatitis B – British Liver Trust

  https://britishlivertrust.org.uk/information-and-support/liver-conditions/hepatitis-b/treatment/

  Interferon helps your immune system get the virus under control. If it works for you, it can be effective at controlling the virus in the long-term. […] Interferon can have a number of side effects. Common ones include: Flu-like symptoms; Muscle pains; Headaches; Feeling tired; Weight loss; Depression; Hair loss; Rashes or soreness from injections. […] Treatment usually lasts for a year. During this time you will have regular check-ups and tests. […] If you are not having treatment for chronic hepatitis B you will have regular check-ups. It is very important to go to all your check-ups. […] People with hepatitis B should have their ALT levels monitored with blood tests. ALT is a sign of liver damage. An ALT flare is when ALT levels rapidly rise to at least 5 times the normal amount. […] A flare can be a good sign, because it means your immune system is attacking the virus. […] The British Liver trust is here to support anyone with a liver condition.

• #1 Core Concepts – When to Initiate HBV Treatment – Treatment of HBV – Hepatitis B Online

  https://www.hepatitisb.uw.edu/go/hbv/initial-treatment/core-concept/all

  Because of the dynamic nature of HBV infection, our inability to eradicate HBV, and the potentially long, if not indefinite, duration of therapy, treatment is not universally indicated for everyone with chronic HBV, but rather reserved for those who are thought most likely to benefit from the standpoint of disease modification. […] There is now consensus among the major hepatitis treatment guidelines that the presence of at least moderate liver necroinflammation or fibrosis warrants initiation of HBV treatment. […] The presence of cirrhosis is generally considered a strong indicator that favors initiating HBV treatment. […] The evidence base for the beneficial impact of HBV-active antiviral therapy on reducing the risk of adverse clinical outcomes, such as hepatic decompensation or hepatocellular carcinoma (HCC), is particularly compelling for patients with cirrhosis.

• #1 Chronic HBV Treatment Guidelines | HCP Site

  https://www.vemlidyhcp.com/treatment-guidelines/

  VEMLIDY is recommended as a first-line hepatitis B therapy by the Simplified Approach to Hepatitis B Algorithm, and by the guidelines from the American Association for the Study of Liver Diseases, the US Treatment Algorithm, the Asian American Treatment Algorithm, and the guidelines from the European Association for the Study of the Liver. […] The guidelines and algorithms recommend VEMLIDY as a first-line therapy because it has proven efficacy, 0 resistance, and demonstrated reduced impact on long-term renal and bone safety parameters. […] VEMLIDY can be considered in patients with, or at risk for, renal dysfunction and bone disease. […] VEMLIDY is not indicated for patients with decompensated (Child-Pugh B or C) hepatic impairment and has not been tested in this population. […] VEMLIDY can be considered in patients with, or at risk for, renal dysfunction and bone disease.

• #2

  https://journals.lww.com/hep/fulltext/2016/01000/aasld_guidelines_for_treatment_of_chronic.32.aspx

  This document presents official recommendations of the American Association for the Study of Liver Diseases (AASLD) on the treatment of chronic hepatitis B (CHB) virus (HBV) infection in adults and children. […] This guideline focuses on using antiviral therapy in chronic HBV infection and does not address other related and important issues, such as screening, prevention, and surveillance. […] The goals of antiviral treatment are to decrease the morbidity and mortality related to CHB. […] The achievement of a sustained suppression of HBV replication has been associated with normalization of serum ALT, loss of HBeAg with or without detection of (antiHBe), and improvement in liver histology. […] There are six therapeutic agents approved for the treatment of adults with CHB in the United States and five therapeutic agents approved for the treatment of children with CHB.

• #2 Hepatitis B | HBV | MedlinePlus

  https://medlineplus.gov/hepatitisb.html

  Hepatitis B is a type of viral hepatitis. It can cause an acute (short-term) or chronic (long-term) infection. […] Some people with chronic hepatitis B will need treatment. […] If you have a chronic infection and blood tests show that hepatitis B could be damaging your liver, you may need to take antiviral medicines. […] If you have acute hepatitis B, you probably don’t need treatment. Some people with chronic hepatitis B don’t need treatment.

• #2 Hepatitis B: Symptoms, Causes, and Treatment

  https://www.webmd.com/hepatitis/digestive-diseases-hepatitis-b

  Hepatitis B Treatment […] Treatment for preventing HBV infection after you’ve been exposed […] If you think you’ve been exposed to the virus, get to a doctor as soon as possible. Your doctor may recommend you get preventive treatment so you don’t get an infection, such as: […] An immediate dose (preferably within 24 hours of your exposure) of the hepatitis B vaccine […] Hepatitis B immune globulin (HBIG), which is made from antibodies against HBV from human blood […] Treatment for acute hepatitis B […] You likely won’t need specific treatment for acute hepatitis B, because if you got infected as an adult, you will recover on your own. If you have serious symptoms, your doctor may offer you the following to make you feel better: […] Pain medicines […] IV fluids […] IV nutrition

• #2 Review of Current and Potential Treatments for Chronic Hepatitis B Virus Infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8475260/

  Current treatments are associated with improved liver-related outcomes but relatively low rates of sustained hepatitis B surface antigen (HBsAg) seroconversion. Novel and potentially promising therapeutic strategies are in development and may result in more durable and complete responses. […] To date, there are 2 classes of drugs approved by the US Food and Drug Administration (FDA) for the treatment of HBV: interferon (IFN) and nucleos(t)ide analogues (NAs). […] Standard IFN was approved as the first agent for the treatment of HBV infection 40 years ago. IFNs are cytokines with potent antiviral, antiproliferative, and immunomodulatory properties. […] In 2005, pegylated (PEG)-IFN largely replaced standard IFN as first-line treatment for chronic HBV infection owing to its improved pharmacokinetics and prolonged half-life.

• #2 Hepatitis B Treatment & Management: Approach Considerations, Pharmacologic Management, Surgical Intervention

  https://emedicine.medscape.com/article/177632-treatment

  The National Institutes of Health (NIH) recommends nucleos(t)ide therapy for the treatment of patients with acute liver failure, as well as cirrhotic patients who are HBV DNA positive and those with clinical complications, cirrhosis or advanced fibrosis with positive serum HBV DNA, or reactivation of chronic HBV during or after chemotherapy or immunosuppression. […] In general, for hepatitis B e antigen (HBeAg)-positive patients with evidence of chronic HBV disease, treatment is advised when the HBV DNA level is at or above 20,000 IU/mL (105 copies/mL) and when serum ALT is elevated for 3-6 months. […] For HBeAg-negative patients with chronic hepatitis B disease, treatment can be administered when the HBV DNA is at or above 2,000 IU/mL (104 copies/mL) and the serum ALT is elevated (ALT levels 20 U/L for females; 30 U/L for males) for 3-6 months.

• #2 Hepatitis B Treatment & Management: Approach Considerations, Pharmacologic Management, Surgical Intervention

  https://emedicine.medscape.com/article/177632-treatment

  The 2015 WHO guidelines for the prevention, care, and treatment of persons with chronic hepatitis B infection indicate treatment priority for individuals of all ages who have chronic hepatitis B infection and clinical evidence of compensated/decompensated cirrhosis. […] Treatment is recommended for adults with chronic hepatitis B infection without clinical evidence of cirrhosis, but who have all of the following features, and regardless of HBeAg status: Are older than 30 years, Have persistently abnormal ALT levels, Have evidence of high-level HBV replication (HBV DNA 20,000 IU/mL). […] The AASLD does not recommend antiviral therapy in individuals with all of the following, regardless of HBeAg status or age: No clinical evidence of cirrhosis, Persistently normal ALT levels, Low levels of HBV DNA replication (HBV DNA 2,000 IU/mL).

• #2

  https://www.hepatitisaustralia.com/hepatitis-b-treatment

  Getting medicine for chronic hepatitis B helps you keep healthy. But it can’t get rid of the virus. […] Not all people with hepatitis B will need to take medicines. […] Getting liver check-ups helps to work out if you need medicine for hepatitis B. […] Medicines for hepatitis B help you live well with the virus. They are not a cure. But they will make you much less likely to get liver disease or liver cancer. […] If you have signs of liver damage you should think about taking medicines for hepatitis B. […] There are a few options for medicines that treat chronic hepatitis B. […] The most common medicines for hepatitis B are antiviral tablets. […] Both are very good at treating hepatitis B. […] A less common option is pegylated interferon (PEG-IFN). […] Not everyone who has hepatitis B needs to take medicine.

• #2 Hepatitis B therapy | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/nrgastro.2011.33

  The goal of hepatitis B treatment is to prevent cirrhosis, liver decompensation and hepatocellular carcinoma. […] Currently, seven medications are approved for the treatment of hepatitis B: two formulations of interferon and five nucleos(t)ide analogues. […] Antiviral drug resistance is a major limiting factor to the success of nucleos(t)ide analogue treatment; therefore, treatment should be initiated with drugs that have a high genetic barrier to resistance (that is, a low potential for drug resistance). […] There are seven approved treatments for hepatitis B: two formulations of interferon (conventional and pegylated), and five nucleos(t)ide analogues (lamivudine, entecavir, tenofovir disoproxil, adefovir dipivoxil and telbivudine). […] PEG-IFN, entecavir and tenofovir disoproxil are the preferred first-line treatments for hepatitis B. […] Antiviral drug resistance is a major limiting factor to the success of nucleos(t)ide analogue therapy; treatment should be initiated with drugs that have a high genetic barrier to resistance and virologic response should be closely monitored.

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• #2 Hepatitis B: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0415/p965.html

  Several medications are approved in the United States for the treatment of HBV infection. […] Although interferon is approved for treatment, pegylated interferon alfa-2a has higher effectiveness, with a similar adverse effect profile, and is preferred over interferon. […] During the active phase of chronic HBV infection, ALT levels are elevated and HBV DNA levels exceed 20,000 IU per mL. Patients in the active phase of chronic HBV infection should be offered treatment. […] During the inactive phase of chronic HBV infection, ALT levels are normal and HBV DNA levels are low (less than 20,000 IU per mL). Treatment and liver biopsy are not indicated in patients with inactive HBV infection. […] The primary limitation of all oral antiviral agents is development of viral resistance because of mutations in the viral DNA during replication. […] If resistance develops to one agent, the effectiveness of a second agent with the same site of action is reduced. […] The risk of resistance increases whenever patients have persistent detectable HBV DNA levels.

• #2 Hepatitis B Virus: Advances in Prevention, Diagnosis, and Therapy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7048015/

  Treatment guidelines are regularly updated to incorporate the new developments in the field. […] The key features of the treatment recommendations from major guidelines available worldwide are found in Table 5. […] Current therapies for the management of CHB include peginterferon (PEG-IFN) and orally administered nucleos(t)ide analogs (NAs). […] For NAs, all regional associations agree that first-line therapy should be with an oral antiviral with a strong barrier to resistance: either entecavir, TDF, or TAF. […] Short-term treatment with NAs is feasible for those HBeAg-positive patients who experience seroconversion to anti-HBe during treatment. […] After HBeAg seroconversion occurs, treatment should continue for at least 1 year and, it is hoped, an additional 3 years in order to achieve a long-lasting response once therapy is discontinued.

• #2

  https://www.who.int/news-room/fact-sheets/detail/hepatitis-b

  There is no specific treatment for acute hepatitis B. Chronic hepatitis B can be treated with medicines. […] Chronic hepatitis B infection can be treated with oral medicines, including tenofovir or entecavir. […] Treatment can slow the advance of cirrhosis, reduce cases of liver cancer, improve long term survival. […] Most people who start hepatitis B treatment must continue it for life. […] With the updated Hepatitis B Guidelines, it is estimated that more than 50% of people with chronic hepatitis B infection will require treatment, depending on setting and eligibility criteria. […] In low-income settings, most people with liver cancer present late in the course of the disease and die within months of diagnosis. In high-income countries, patients present to hospital earlier in the course of the disease and have access to surgery and chemotherapy, which can prolong life for several months to a few years. Liver transplantation is sometimes used in people with cirrhosis or liver cancer in technologically advanced countries, with varying success.

• #2 Hepatitis B Virus: Advances in Prevention, Diagnosis, and Therapy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7048015/

  The recommended therapy cutoff criteria for NAs in HBeAg-negative patients vary by region. […] In contrast to NA therapy, the use of peginterferon as primary therapy in patients with CHB has been limited by its poor efficacy and tolerability. […] However, unlike NA therapy, PEG-IFN has a finite duration. […] Combinations of peginterferon with NAs or add-on or sequential therapy with NAs followed by peginterferon treatment have been demonstrated to be safe and to have improved seroconversion rates compared to those of single therapies. […] It should be noted that peginterferon should not be used in patients with decompensation, but it can be used with caution in patients with compensated cirrhosis. […] In contrast, oral NA therapy improves and restores function even in patients with severe decompensated liver disease.

• #2 Hepatitis B Treatment – Viral Hepatitis and Liver Disease

  https://www.hepatitis.va.gov/hbv/patient/treat.asp

  Injections: Interferon and pegylated interferon […] Pegylated interferon is given as an injection once per week. It can be used alone or with an oral hepatitis B medication. Patients with both chronic hepatitis B and hepatitis D infection may need pegylated interferon alone or combined with an oral hepatitis B pill. […] Pegylated interferon therapy is usually given for 48 weeks. […] Pegylated interferon may cause many side effects, such as flu-like symptoms, rashes, irritability, and depression. […] Side effects to interferon require close monitoring with routine blood tests. […] What will I need to do if I am on hepatitis B medications? […] Take oral medications every day to avoid developing resistance. […] See your provider on a regular basis […] Have periodic laboratory tests to monitor HBV viral load and liver enzymes to monitor disease activity and response to medications.

• #2 Treatment for hepatitis B – British Liver Trust

  https://britishlivertrust.org.uk/information-and-support/liver-conditions/hepatitis-b/treatment/

  Interferon helps your immune system get the virus under control. If it works for you, it can be effective at controlling the virus in the long-term. […] Interferon can have a number of side effects. Common ones include: Flu-like symptoms; Muscle pains; Headaches; Feeling tired; Weight loss; Depression; Hair loss; Rashes or soreness from injections. […] Treatment usually lasts for a year. During this time you will have regular check-ups and tests. […] If you are not having treatment for chronic hepatitis B you will have regular check-ups. It is very important to go to all your check-ups. […] People with hepatitis B should have their ALT levels monitored with blood tests. ALT is a sign of liver damage. An ALT flare is when ALT levels rapidly rise to at least 5 times the normal amount. […] A flare can be a good sign, because it means your immune system is attacking the virus. […] The British Liver trust is here to support anyone with a liver condition.

• #2 Treatment of chronic hepatitis B virus infection – B Positive

  https://hepatitisb.org.au/treatment-of-chronic-hepatitis-b-virus-infection/

  Primary goals of treatment are to improve both quality of life and survival of people with HBV infection via: Normalise alanine aminotransferase (ALT) levels; Achieve HBeAg loss in HBe Ag-positive patients; Achieve sustained suppression of HBV viral replication; Achieve HBsAg loss with or without anti HBs seroconversion; Reduce risk of progression to cirrhosis and hepatocellular carcinoma. […] The decision to commence antiviral therapy is based on a number of factors, including the patient’s age, serum HBV DNA levels, extent of hepatic fibrosis, ALT levels, hepatitis B e antigen (HBeAg) status and the risk of HCC. […] A liver biopsy is no longer mandatory for reimbursement; however, in some settings, it may still have a role in decision making. Non-invasive techniques to indirectly measure the extent of liver fibrosis should be used to assist decision making in preference to liver biopsy.

• #2

  https://journals.lww.com/hep/fulltext/2016/01000/aasld_guidelines_for_treatment_of_chronic.32.aspx

  The AASLD suggests antiviral therapy in the select group of adults 40 years of age with normal ALT and elevated HBV DNA (1,000,000 IU/mL) and liver biopsy showing significant necroinflammation or fibrosis. […] The AASLD suggests indefinite antiviral therapy for adults with HBeAgnegative immuneactive CHB, unless there is a competing rationale for treatment discontinuation. […] The AASLD suggests that adults with compensated cirrhosis and low levels of viremia (2,000 IU/mL) be treated with antiviral therapy to reduce the risk of decompensation, regardless of ALT level. […] The AASLD recommends that HBsAgpositive adults with decompensated cirrhosis be treated with antiviral therapy indefinitely regardless of HBV DNA level, HBeAg status, or ALT level to decrease risk of worsening liverrelated complications.

• #2 Hepatitis B Virus Infection: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/hepatitis-b-virus

  All people with HIV/HBV coinfection (HBsAg positive), regardless of CD4 count and HBV DNA level, should be treated with an ART regimen that includes drugs active against both HIV and HBV infections. […] Some experts recommend that people with isolated anti-HBc positivity receive an ART regimen that includes drugs active against HBV and HIV. […] The ART regimen should include two drugs active against HBV, preferably with TAF (10 or 25 mg) plus FTC 200 mg or TAF 25 mg plus 3TC 300 mg PO once daily, or TDF 300 mg plus (FTC 200 mg or 3TC 300 mg) once daily. […] People on treatment for HBV and HIV should receive therapy indefinitely. […] HBV DNA should be monitored at 6-month intervals. […] HBsAg should be monitored yearly. […] Anti-HBV therapy (TDF, TAF, or entecavir) must be given if there is a switch to a nucleos(t)ide-sparing ARV regimen.

• #2 Recommendations | Hepatitis B (chronic): diagnosis and management | Guidance | NICE

  https://www.nice.org.uk/guidance/cg165/chapter/recommendations

  Offer tenofovir disoproxil as second-line treatment to people who do not undergo HBeAg seroconversion or who relapse (revert to being HBeAg positive following seroconversion) after first-line treatment with peginterferon alfa-2a. […] Offer entecavir as an alternative second-line treatment to people who cannot tolerate tenofovir disoproxil or if it is contraindicated. […] Offer entecavir as first-line treatment in people with decompensated liver disease if there is no history of lamivudine resistance. […] Offer tenofovir disoproxil to people with a history of lamivudine resistance. […] Discuss with pregnant women the benefits and risks of antiviral treatment for them and their baby. […] Offer tenofovir disoproxil to women with HBV DNA greater than 107 IU/ml in the third trimester to reduce the risk of transmission of HBV to the baby. […] Advise women that there is no risk of transmitting HBV to their babies through breastfeeding if guidance on hepatitis B immunisation has been followed, and that they may continue antiviral treatment while they are breastfeeding.

• #2 Prevention and management of hepatitis B virus reactivation in patients with hematological malignancies in the targeted therapy era

  https://www.wjgnet.com/1007-9327/full/v29/i33/4942.htm

  Hepatitis due to hepatitis B virus (HBV) reactivation can be serious and potentially fatal, but is preventable. HBV reactivation is most commonly reported in patients receiving chemotherapy, especially rituximab-containing therapy for hematological malignancies and those receiving stem cell transplantation. […] Thus, all patients with hematological malignancies receiving anticancer therapy should be screened for active or resolved HBV infection by blood tests for hepatitis B surface antigen (HBsAg) and antibody to hepatitis B core antigen. Patients found to be positive for HBsAg should be given prophylactic antiviral therapy. For patients with resolved HBV infection, there are two approaches. The first is pre-emptive therapy guided by serial HBV DNA monitoring, and treatment with antiviral therapy as soon as HBV DNA becomes detectable. The second approach is prophylactic antiviral therapy, particularly for patients receiving high-risk therapy, especially anti-CD20 monoclonal antibody or hematopoietic stem cell transplantation. Entecavir and tenofovir are the preferred antiviral choices.

• #2 Hepatitis B virus prophylaxis in immunocompromised adults

  https://www.eviq.org.au/clinical-resources/side-effect-and-toxicity-management/prophylaxis-and-treatment/1382-hepatitis-b-virus-prophylaxis-in-immunocompro

  Recommendations on the duration of antiviral prophylaxis differ across international guidelines, ranging from 6 to 12 months after the cessation of chemotherapy, and for 12 to 24 months after the cessation of anti-CD20 monoclonal antibodies or BMT to reduce the risk of HBV reactivation which may occur after the withdrawal of antiviral therapy.

• #2 Treatment for hepatitis B in patients with drug resistance

  https://atm.amegroups.org/article/view/11714/html

  Patients with resistance to LMV or LdT should be immediately switched to TDF monotherapy. […] In case of ETV resistance, one can either add TDF or switch to TDF monotherapy, as no cross-resistance can be expected. […] ETV has no cross-resistance with ADV and is therefore effective in patients with ADV-resistant HBV mutants. […] Although there is no signature mutation pattern conferring TDF resistance, cases of insufficient responses to TDF have been reported. […] Current antiviral therapies for hepatitis B aim at stably suppressing viral replication in order to prevent HBV-related complications such as hepatic decompensation, liver cirrhosis and hepatocellular carcinoma. […] In cases of treatment failure and drug resistance, switching to a noncross-resistant antiviral or adding a second highly effective antiviral drug represent recommended rescue strategies.

• #2 Toward a Functional Cure for Hepatitis B

  https://www.gutnliver.org/journal/view.html?pn=mostread&uid=2175&vmd=Full

  Current treatment of chronic hepatitis B virus (HBV) infection, pegylated interferon- (pegIFN-) and nucleos(t)ide analogue (NA), can suppress HBV replication, reverse liver inflammation and fibrosis, and decrease risks of cirrhosis and hepatocellular carcinoma, but hepatitis B surface antigen (HBsAg) loss is rare. […] Current treatment of chronic hepatitis B virus (HBV) infection comprises pegylated interferon- (pegIFN-) or nucleos(t)ide analogues (NAs), used as monotherapy. Both pegIFN- and NA can suppress HBV DNA replication, decrease liver inflammation, reverse liver fibrosis, and decrease risk of cirrhosis, hepatocellular carcinoma, and liver-related deaths. However, HBV remains in the liver and hepatitis B surface antigen (HBsAg) remains in the circulation even after HBV DNA has been undetectable in serum for many years, and virological relapse is universal when treatment is stopped.

• #2 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20250317/Researchers-move-closer-to-a-functional-cure-for-chronic-hepatitis-B.aspx

  The study also explores emerging therapeutic strategies, including targeting HBx, utilizing epigenetic modifiers, and employing gene-editing technologies like CRISPR/Cas9 to disrupt cccDNA. […] These innovative approaches offer the potential to permanently silence cccDNA, paving the way for a functional cure. […] By targeting these pathways, we can develop therapies that not only suppress viral replication but also offer a functional cure for chronic hepatitis B. […] Epigenetic modifiers, such as histone deacetylase inhibitors and DNA methyltransferase inhibitors, could be repurposed or newly designed to specifically target cccDNA. […] Furthermore, CRISPR/Cas9 technology offers a precise method for disrupting cccDNA, potentially leading to a permanent cure. […] By combining these strategies with current antiviral treatments, researchers could significantly enhance their effectiveness, bringing us closer to a functional cure for chronic hepatitis B.

• #2 GSK receives US FDA Fast Track designation for bepirovirsen in chronic hepatitis B | GSK

  https://www.gsk.com/en-gb/media/press-releases/gsk-receives-us-fda-fast-track-designation-for-bepirovirsen-in-chronic-hepatitis-b/

  GSK plc (LSE/NYSE: GSK) announced today that the US Food and Drug Administration (FDA) has granted Fast Track designation for bepirovirsen, an investigational antisense oligonucleotide (ASO) for the treatment of chronic hepatitis B (CHB). […] The designation was requested based on the potential for bepirovirsen to address an unmet medical need for CHB, a serious and life-threatening condition. […] Bepirovirsen is the only single agent in phase III development that has shown the potential to achieve clinically meaningful functional cure response when combined with oral nucleoside/nucleotide analogues (NAs). […] Bepirovirsen is also being investigated as a potential backbone therapy in future sequential regimens to pursue functional cure in a broader population of patients with CHB. […] Bepirovirsen is a triple action investigational antisense oligonucleotide (ASO), currently being evaluated in the B-Well phase III clinical trial programme for the treatment of CHB. […] Bepirovirsen inhibits the replication of viral DNA in the body, suppresses the level of hepatitis B surface antigen (HBsAg) in the blood, and stimulates the immune system to increase the chances of a durable and sustained response.

• #2 Imdusiran for Chronic Hepatitis B Achieves Functional Cure in 50% of Patients

  https://www.contagionlive.com/view/imdusiran-for-chronic-hepatitis-b-achieves-functional-cure-in-50-of-patients

  The primary goal of this trial was to reduce surface antigen levels with imdusiran, McElhaugh explained. After the interferon phase, we paused all treatments and monitored patients for 24 weeks without therapy, which is the regulatory definition of a functional cure. This means Hepatitis B DNA is undetectable, and surface antigen is lost or reduced to below the limit of quantification. […] In this cohort, 25% of patients achieved a functional cure, a result McElhaugh calls one of the best seen in the field. Even more notable was the response rate in patients with baseline surface antigen levels below 1,000 IU/mL, where 50% of patients achieved a functional cure. […] Achieving a functional cure in half of these patients is a very promising result. […] Patients with surface antigen levels below 1000 IU/mL had a markedly higher chance of success compared to those with higher levels.

• #2 Toward a Functional Cure for Hepatitis B

  https://www.gutnliver.org/journal/view.html?pn=mostread&uid=2175&vmd=Full

  New drugs are needed to achieve HBV cure. They include direct-acting antivirals targeting different steps in the HBV lifecycle and immune modulators aimed to stimulate HBV-specific immune response or to remove immune blockade. […] To date, functional cure is mainly observed in combination therapies of direct-acting antivirals with immune modulatory therapies particularly pegIFN-, but all trials involved small numbers of patients with responses mainly in those with low baseline HBsAg levels and uncertain long-term durability.

• #2 Hepatitis B: Symptoms, Causes, and Treatment

  https://www.webmd.com/hepatitis/digestive-diseases-hepatitis-b

  Lifestyle changes recommended for people with chronic hepatitis B […] Whether or not you are taking medicine, your doctor will likely recommend you make a few changes to protect your liver, such as: […] Avoid alcohol. […] Eat a healthy, balanced diet. […] Limit how much fat and sugar you eat and drink. […] Check with your doctor before taking other drugs, herbs, or supplements because some can damage your liver.

• #2 Hepatitis B Treatment: A Complete Guide

  https://www.everydayhealth.com/hepatitis-b/guide/treatment/

  Lifestyle changes can help you better manage hepatitis B and keep your liver as healthy as possible. People with hepatitis B need to avoid substances that increase the risk of liver damage: Alcohol, Certain medications that are processed in the liver, Herbal medications, Herbal supplements. If you have hepatitis B, be sure to check with your doctor before taking any supplements, vitamins, or over-the-counter medications. For your best health, you should also adhere to these recommendations: Follow a nutritious diet […] Get vaccinated against hepatitis A […] Get screened for hepatitis C […] Stay physically active […] Maintain a body weight that’s healthy for you. […] Hepatitis B is a potentially severe disease that stems from infection with the hepatitis B virus. An acute infection often goes away with time, but many people who experience chronic hepatitis B will need long-term treatment with antiviral medications or immune modulators. Healthy lifestyle choices like avoiding alcohol can help keep your liver healthy if you have hepatitis B.

• #2 Review of Current and Potential Treatments for Chronic Hepatitis B Virus Infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8475260/

  Chronic hepatitis B virus (HBV) infection remains a major global health burden. Millions of people are at risk for complications of chronic HBV infection, despite the widespread availability of an effective prophylactic vaccine. The current available treatments for HBV infection—interferon and nucleos(t)ide analogues—are effective at suppressing viral replication and decreasing the risk of cirrhosis. However, these treatments have a number of limitations, creating the need for alternative therapeutic agents. Recent advances in drug therapy have heralded a new horizon of novel therapeutic approaches for chronic HBV infection, with several promising antiviral and immunomodulatory agents currently in preclinical or clinical testing. This article reviews the current landscape of HBV treatments and highlights the most recent therapeutic strategies designed to directly target HBV or to improve immune response during chronic infection.

• #2 Therapeutic vaccine for chronic hepatitis B enters clinical trial | German Center for Infection Research

  https://www.dzif.de/en/therapeutic-vaccine-chronic-hepatitis-b-enters-clinical-trial

  TherVacB, a novel therapeutic vaccine to combat chronic hepatitis B, entered the first clinical trial. The first clinical trial in patients with chronic hepatitis B is being prepared and scheduled to start in 2024. Current treatment options involve antiviral medications that help reduce the virus load and liver inflammation but do not provide a curative solution. Consequently, there is an urgent need for curative treatment. This is a phase Ia, open-label, escalating dose study to evaluate the safety and immunogenicity of TherVacB in 24 healthy participants aged 18 to 65 years. Simultaneously, preparations are underway for applying for the first-in-patient phase Ib/IIa trial, aiming to assess the safety and efficacy in patients with chronic hepatitis B. Therapeutic vaccines aim to cure an existing disease, such as a chronic infection. Over the past two decades, numerous attempts have been made to develop effective therapeutic hepatitis B vaccines, but none have been successful so far. Building upon these discoveries, scientists at Helmholtz Munich have developed a novel therapeutic approach to activate these immune cells by therapeutic vaccination to cure chronic HBV infection. Our approach is designed to induce exactly the type of immunity required and cover a broad spectrum of over 95% of HBV strains worldwide. Phase Ia clinical trial results are expected to be public by the end of 2024. […] Around 300 million people are living with a chronic hepatitis B virus (HBV) infection and currently there is no cure for the disease.

• #3 Hepatitis B Virus: Advances in Prevention, Diagnosis, and Therapy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7048015/

  Currently, despite the use of a preventive vaccine for several decades as well as the use of effective and well-tolerated viral suppressive medications since 1998, approximately 250 million people remain infected with the virus that causes hepatitis B worldwide. […] In the last 5 years, more attention has been focused on the important topics of HBV screening, diagnosis of HBV infection, and appropriate linkage to care. […] There have also been rapid clinical developments toward a functional cure of HBV infection, with novel compounds currently being in various phases of progress. […] Thus, to fill these gaps and provide a more comprehensive and relevant document to regions worldwide, we have taken a global approach by using the findings of global experts on HBV as well as citing major guidelines and their various approaches to addressing HBV and its disease burden.

• #3 Hepatitis B: Symptoms, Causes, and Treatment

  https://www.webmd.com/hepatitis/digestive-diseases-hepatitis-b

  Hepatitis B Treatment […] Treatment for preventing HBV infection after you’ve been exposed […] If you think you’ve been exposed to the virus, get to a doctor as soon as possible. Your doctor may recommend you get preventive treatment so you don’t get an infection, such as: […] An immediate dose (preferably within 24 hours of your exposure) of the hepatitis B vaccine […] Hepatitis B immune globulin (HBIG), which is made from antibodies against HBV from human blood […] Treatment for acute hepatitis B […] You likely won’t need specific treatment for acute hepatitis B, because if you got infected as an adult, you will recover on your own. If you have serious symptoms, your doctor may offer you the following to make you feel better: […] Pain medicines […] IV fluids […] IV nutrition

• #3 Hepatitis B Treatment & Management: Approach Considerations, Pharmacologic Management, Surgical Intervention

  https://emedicine.medscape.com/article/177632-treatment

  Adults with immune-active chronic hepatitis B infection (ie, ALT 2 times the upper limit of normal [ULN] or significant histologic disease and HBeAg negative [HBV DNA 2,000 IU/mL] or HBeAg positive [HBV DNA 20,000 IU/mL]) should be administered antiviral therapy to lower the risk of morbidity and mortality associated with chronic hepatitis B infection. […] The recommended initial agent for adults is PEG-IFN, entecavir, or tenofovir. […] Antiviral therapy is not recommended for noncirrhotic individuals who are HBeAg negative and who have normal ALT activity and low-level viremia ( 2,000 U/mL; inactive chronic hepatitis B). […] For HBeAg-positive children aged 2 years up to 18 years who have both elevated ALT and detectable HBV DNA levels, the AASLD suggests antiviral therapy (IFN-alpha-2b: age 1 year; lamivudine, entecavir: age 2 year), with the goal of achieving sustained HBeAg seroconversion.

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• #3 Hepatitis B therapy | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/nrgastro.2011.33

  The goal of hepatitis B treatment is to prevent cirrhosis, liver decompensation and hepatocellular carcinoma. […] Currently, seven medications are approved for the treatment of hepatitis B: two formulations of interferon and five nucleos(t)ide analogues. […] Antiviral drug resistance is a major limiting factor to the success of nucleos(t)ide analogue treatment; therefore, treatment should be initiated with drugs that have a high genetic barrier to resistance (that is, a low potential for drug resistance). […] There are seven approved treatments for hepatitis B: two formulations of interferon (conventional and pegylated), and five nucleos(t)ide analogues (lamivudine, entecavir, tenofovir disoproxil, adefovir dipivoxil and telbivudine). […] PEG-IFN, entecavir and tenofovir disoproxil are the preferred first-line treatments for hepatitis B. […] Antiviral drug resistance is a major limiting factor to the success of nucleos(t)ide analogue therapy; treatment should be initiated with drugs that have a high genetic barrier to resistance and virologic response should be closely monitored.

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• #3 Is Hepatitis B Curable? Treatments for Different Types

  https://www.healthline.com/health/is-hepatitis-b-curable

  Like acute hepatitis B, chronic hepatitis B may not require medical treatment to avoid permanent liver damage. For some people, monitoring their symptoms and getting regular liver tests is an appropriate care regimen. […] Treatment generally involves antiviral medications, such as peginterferon alfa-2a injections and antiviral tablets, such as tenofovir or entecavir. […] Antiviral medications can help to reduce your symptoms and prevent liver damage, but they rarely completely get rid of the hepatitis B virus. Instead, the goal of treatment is for you to have the lowest viral load possible. […] If you have chronic hepatitis B, youll likely need to follow up with a doctor every 6 months for a blood test to determine your viral load and liver health. Based on your results, a doctor may alter your medication dosage. Some people with severe chronic hepatitis B may eventually need a liver transplant. […] Theres no cure for hepatitis B, but there are several treatments that can help you with managing your symptoms and lowering your risk of long-term health problems, such as cirrhosis.

• #3 Medical Treatment for Hepatitis | NYU Langone Health

  https://nyulangone.org/conditions/hepatitis/treatments/medical-treatment-for-hepatitis

  Antiviral medications prevent the virus from replicating, which means creating copies of itself. They prevent and can even reverse liver damage. Current antiviral medications are safe, highly effective, and can treat hepatitis B with a low risk of serious side effects. These medications, which are taken by mouth, are usually required for years or even indefinitely. […] NYU Langone hepatologists and infectious disease specialists prescribe medication when they have determined that without treatment, the hepatitis B virus poses a risk of damaging the liver over time. […] If your doctor prescribes antiviral medication, you take it by mouth once daily. Your doctor monitors the effectiveness of medication using blood tests and imaging tests during follow-up visits. […] Doctors recommend avoiding alcoholic beverages and high doses of acetaminophen throughout treatment, because these substances can lead to liver damage.

• #3 Treatment for hepatitis B in patients with drug resistance

  https://atm.amegroups.org/article/view/11714/html

  The main treatment goal for chronic hepatitis B is to suppress viral replication and consequently to prevent progression to liver fibrosis and cirrhosis, liver failure and development of hepatocellular carcinoma. […] In order to reduce the risk of drug resistance, all guidelines now recommend the use of newer, highly potent antivirals with a high barrier to resistance such as ETV or TDF. […] Most guidelines recommend testing HBV-DNA serum levels every 3 months during the first year of treatment and at least every 6 months thereafter. […] In cases of a confirmed virological breakthrough and exclusion of non-adherence, the patient should be either switched to another antiviral monotherapy with a high genetic barrier to resistance (ETV or TDF) or a second antiviral drug with a complementary resistance profile should be added.

• #3 Chronic Hepatitis B Infection: New Approaches towards Cure

  https://www.mdpi.com/2218-273X/13/8/1208

  The development of LAI for chronic viral infections beyond HIV, including HBV, is gaining traction due to its potential to simplify regimens and treatment outcomes. […] The use of ultra-long-acting antivirals for the prevention of certain viral illnesses, halting either contagions or reactivations under immunosuppression would fill an immediate need in providing protection when classic vaccines do not exist, responses are suboptimal, escape mutants emerge or immunity wanes. […] The achievement of HBV functional cure focuses on eliminating HBsAg and suppression/elimination of cccDNA.

• #3 IDCM — Infectious Diseases and Clinical Microbiology

  https://www.idcmjournal.org/new-treatment-options-in-chronic-hepatitis-b

  In the treatment of hepatitis B, a functional cure cannot be achieved with current treatment options. […] The most important obstacle to functional cure is the presence of cccDNA. For this reason, direct intervention in the life cycle of the virus with direct-acting antiviral therapies targeting cccDNA becomes important for a permanent response. […] Another treatment option is immunomodulatory therapies, which allow the restoration of the immune response and provide viral clearance. […] The combination of both treatment options currently shows promise in the treatment of chronic hepatitis B. […] The current approach in the treatment of chronic HBV infection is to use more than one drug combination. Decreased HBsAg load with antiviral treatments targeting the viral life cycle also provides an opportunity for immune restructuring and can help to eliminate T-cell depletion. As new DAA and immunomodulatory therapies continue to emerge and evolve, a functional cure in HBV treatment may be an achievable goal.

• #3 Hepatitis B: Symptoms, Causes, and Treatment

  https://www.webmd.com/hepatitis/digestive-diseases-hepatitis-b

  Lifestyle changes recommended for people with chronic hepatitis B […] Whether or not you are taking medicine, your doctor will likely recommend you make a few changes to protect your liver, such as: […] Avoid alcohol. […] Eat a healthy, balanced diet. […] Limit how much fat and sugar you eat and drink. […] Check with your doctor before taking other drugs, herbs, or supplements because some can damage your liver.

• #4 Hepatitis B | HBV | MedlinePlus

  https://medlineplus.gov/hepatitisb.html

  Hepatitis B is a type of viral hepatitis. It can cause an acute (short-term) or chronic (long-term) infection. […] Some people with chronic hepatitis B will need treatment. […] If you have a chronic infection and blood tests show that hepatitis B could be damaging your liver, you may need to take antiviral medicines. […] If you have acute hepatitis B, you probably don’t need treatment. Some people with chronic hepatitis B don’t need treatment.

• #4 Hepatitis B Treatment – Viral Hepatitis and Liver Disease

  https://www.hepatitis.va.gov/hbv/patient/treat.asp

  Injections: Interferon and pegylated interferon […] Pegylated interferon is given as an injection once per week. It can be used alone or with an oral hepatitis B medication. Patients with both chronic hepatitis B and hepatitis D infection may need pegylated interferon alone or combined with an oral hepatitis B pill. […] Pegylated interferon therapy is usually given for 48 weeks. […] Pegylated interferon may cause many side effects, such as flu-like symptoms, rashes, irritability, and depression. […] Side effects to interferon require close monitoring with routine blood tests. […] What will I need to do if I am on hepatitis B medications? […] Take oral medications every day to avoid developing resistance. […] See your provider on a regular basis […] Have periodic laboratory tests to monitor HBV viral load and liver enzymes to monitor disease activity and response to medications.

• #4 Hepatitis B: Symptoms, Causes, and Treatment

  https://www.webmd.com/hepatitis/digestive-diseases-hepatitis-b

  Lifestyle changes recommended for people with chronic hepatitis B […] Whether or not you are taking medicine, your doctor will likely recommend you make a few changes to protect your liver, such as: […] Avoid alcohol. […] Eat a healthy, balanced diet. […] Limit how much fat and sugar you eat and drink. […] Check with your doctor before taking other drugs, herbs, or supplements because some can damage your liver.

• #5 Hepatitis B Symptoms, Diagnosis, Treatment, & Prevention | UPMC

  https://www.upmc.com/services/digestive-disorders-center/services/liver-diseases/conditions/chronic-liver-conditions/viral-hepatitis/hepatitis-b

  Antiviral drugs attack the virus, reducing its ability to attack the liver. […] In some people, drugs don’t work to control their chronic hep B infection. You may qualify for a liver transplant if the disease causes advanced liver damage. […] People with a chronic hepatitis B infection should avoid anything that can further damage the liver. […] Before taking any herb or drug, check with your doctor to make sure it will not hurt your liver.

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