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Monitoring during and after antiviral therapy for hepatitis B
Author(s) -
Andersson Karin L.,
Chung Raymond T.
Publication year - 2009
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.22899
Subject(s) - hbsag , hbeag , medicine , seroconversion , hepatitis b virus , immunology , hepatitis b , viral load , virology , antibody , virus
Recent studies suggest that long‐term suppression of viral replication is critical to reducing the complications of chronic hepatitis B virus (HBV) infection. Monitoring for continued virological response during and after treatment is essential because current treatment options have limited success in achieving durable endpoints, and antiviral resistance may emerge during long‐term therapy. Methods of monitoring treatment response include tests for serum aminotransferase levels, HBV DNA level, hepatitis B e antigen (HBeAg) and antibody (anti‐HBe), hepatitis B surface antigen (HBsAg) or antibody (anti‐HBs), and liver histology. Virological suppression and loss of HBeAg or HBsAg with or without seroconversion play a prominent role in decision‐making regarding the success and duration of antiviral therapy. Guidelines recommend that testing for serum markers be repeated every 12‐24 weeks during antiviral therapy and every 6‐12 months afterward. Recent data also suggest that serum HBV DNA levels should be assessed at weeks 12 and 24 of therapy, because early viral response may predict the likelihood of sustained response and antiviral resistance. The use of serum HBV DNA levels for this purpose requires an assay with a wide range of quantification, such as real‐time polymerase chain reaction assays, which have a 7‐8 log 10 dynamic range. Newer, investigational methods for monitoring treatment response include quantitative measurement of HBsAg, HBeAg, and intrahepatic covalently closed circular DNA. Conclusions: Better methods for defining durable treatment endpoints are needed. Other areas requiring further research include the optimal treatment duration and the establishment of the optimal use of early viral kinetics for decision‐making during antiviral therapy. (H EPATOLOGY 2009;49:S166–S173.)