Chronic hepatitis B requires long-term antiviral management to suppress viral replication, prevent progressive liver injury, and achieve durable virological and biochemical endpoints. First-line treatment is based on a preferred class of oral antiviral agents, with agent selection guided by individual patient factors.
First-line therapy involves long-term oral antiviral treatment with a preferred nucleos(t)ide analogue — the specific agent chosen depends on renal function, bone disease, pregnancy, HIV coinfection status, and prior antiviral exposure.
Key targets are undetectable HBV DNA by PCR-based assay, HBeAg loss and seroconversion, HBsAg loss and seroconversion, and normalisation of serum ALT.
DOI: 10.1097/HEP.0000000000001549
There are three NAs that are preferred for treatment of CHB: entecavir (ETV), tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide (TAF).
All 3 drugs provide high efficacy in achieving HBV DNA suppression, have low rates of antiviral resistance, and are well tolerated and broadly applicable (including for persons with decompensated cirrhosis and immunocompromised states).
TAF is not recommended if creatinine clearance is less than 15mL/min and not yet on dialysis.
Therefore, surrogate virological (HBV DNA undetectable by a PCR-based assay, HBeAg loss and seroconversion, HBsAg loss and seroconversion), biochemical (serum ALT normal) and infrequently, histological (improvement in necroinflammation by ≥ 2 points with no worsening of fibrosis) endpoints are used as measures of treatment efficacy.
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