Premium
Treatment options beyond IFN α and NUC s for chronic HBV infection: expectations for tomorrow
Author(s) -
Baltayiannis G.,
Karayiannis P.
Publication year - 2014
Publication title -
journal of viral hepatitis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.329
H-Index - 100
eISSN - 1365-2893
pISSN - 1352-0504
DOI - 10.1111/jvh.12307
Subject(s) - hepatocellular carcinoma , hepatitis b virus , medicine , cirrhosis , pegylated interferon , virology , seroconversion , hepatitis b , virus , viral replication , chronic hepatitis , immunology , cancer research , ribavirin
Summary Chronic hepatitis B virus ( HBV ) infection may progress to cirrhosis, hepatocellular carcinoma ( HCC ) and end‐stage liver failure with time. Interruption of this process can only be achieved through effective antiviral treatment. This approach has so far involved the use of immunomodulators such as pegylated interferon alpha ( P eg‐ IFN α ) for a finite period of up to a year and nucleos‐(t)ide analogues ( NUC s) for treatment over much longer periods of time. The latter act by suppressing HBV replication at the level of DNA synthesis by inhibiting the viral reverse transcriptase/ DNA polymerase and causing premature termination of DNA synthesis. The ideal treatment end point is loss of HB s A g in both HB e A g+ve and HB e A g−ve patients following monotherapy. This, however, is only achievable in a minority of patients. Secondary outcomes are durable HB e A g loss and seroconversion to anti‐ HB e, which occur in about 18–30% of HB e A g+ve patients depending on the antiviral used, and sustained suppression of HBV ‐ DNA accompanied by biochemical normalization and histological improvement in non‐ HB e A g+ve seroconverting and HB e A g−ve patients. There is therefore a need for additional direct‐acting antivirals ( DAA s) targeting different stages of the life cycle of the virus, as well as immunotherapeutic approaches. Such developments may pave the way for their use either alone or more likely in combination in the fight against chronic HBV infection. Such drugs or approaches, which are currently undergoing preclinical or clinical testing, are the subject of this review.