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Hepatitis B virus long‐term impact of antiviral therapy nucleot(s)ide analogues ( NUC s)
Author(s) -
Grossi Glenda,
Viganò Mauro,
Loglio Alessandro,
Lampertico Pietro
Publication year - 2017
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13291
Subject(s) - entecavir , medicine , cirrhosis , hepatocellular carcinoma , decompensation , hepatitis b , gastroenterology , hepatitis b virus , liver disease , clinical trial , immunology , virus , lamivudine
The goal of antiviral therapy is to improve the quality of life and survival of patients with chronic hepatitis B ( CHB ) by halting the progression to cirrhosis, end‐stage liver disease or hepatocellular carcinoma ( HCC ), thus preventing anticipated liver‐related death. Oral administration of potent and less resistance‐prone nucleot(s)ide analogues ( NUC s), such as entecavir ( ETV ) and tenofovir disoproxil fumarate ( TDF ) has become the most popular treatment strategy worldwide because of their excellent efficacy and safety profile as well as easy management confirmed in both registration trials and in clinical practice studies. Long‐term administration of ETV or TDF suppresses HBV replication in >95% of patients, resulting in biochemical remission, histological improvement including the regression of cirrhosis and prevention or reversal of clinical decompensation but not the development of HCC , particularly in patients with cirrhosis. Moreover, NUC s can be administered to all patients including those with severe liver disease, the elderly and in those who do not respond, are unwilling to take or have contraindications to interferon. The need for long‐term, perhaps indefinite, treatment is the main limitation of NUC s therapy with the associated costs, unknown long‐term safety and the low rates of hepatitis B surface antigen ( HB sAg) seroclearance, which is still the best stopping rule for NUC s‐treated patients with cirrhosis.