Update in the management of chronic hepatitis B.

Division of Digestive and Liver Disease, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8887, USA. Shannan.Tujios@UTSouthwestern.edu

Current opinion in gastroenterology 2013 May

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To review the recent developments in the management of chronic hepatitis B (CHB) based on the articles published between January 2012 and January 2013. International guidelines have been updated to include recent discoveries in the natural history of CHB, how to determine who should be treated, recommendations of management of special populations, and support of highly potent medications with high genetic barrier to resistance as the first-line therapy. Sustained response rates to interferon may be influenced by the IL28B genotype and can be predicted by on-treatment monitoring of hepatitis B surface antigen (HBsAg) and hepatitis B virus (HBV) DNA. Long-term viral suppression can be obtained by entecavir and tenofovir even in cases of multidrug resistance, leading to decreased rates of hepatocellular carcinoma and death. Current therapies suppress, but rarely eradicate hepatitis B. Drug resistance remains a barrier to success in the long-term treatment of CHB, especially in resource-poor areas and in previously treated patients. Quantitative hepatitis B surface antigen in addition to other clinical data may provide personalized treatment decisions based on risk and response. There remains a need for novel therapies targeting HBV replication and immune system for CHB cure.