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World J Hepatol. May 27, 2014; 6(5): 284-292
Published online May 27, 2014. doi: 10.4254/wjh.v6.i5.284
Chronic hepatitis B: Advances in treatment
Teresa Antonia Santantonio, Massimo Fasano
Teresa Antonia Santantonio, Massimo Fasano, Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy
Author contributions: Santantonio TA and Fasano M both contributed to this paper.
Correspondence to: Dr. Teresa Antonia Santantonio, Department of Clinical and Experimental Medicine, University of Foggia, Ospedali Riuniti, Viale Luigi Pinto 1, 71100 Foggia, Italy.
Telephone: +39-0881-732216 Fax: +39-0881-732215
Received: November 12, 2013
Revised: January 7, 2014
Accepted: March 13, 2014
Published online: May 27, 2014

Treatment of chronic hepatitis B (CHB) has markedly improved in the last 15 years due to the availability of direct antivirals which greatly increase therapeutic options. Currently, there are two classes of agents licensed for CHB treatment: standard or pegylated interferon alpha (IFN or Peg-IFN) and five nucleoside/nucleotide analogues (NAs). Long-term treatment with NAs is the treatment option most often used in the majority of CHB patients. Entecavir and tenofovir, the most potent NAs with high barrier to resistance, are recommended as first-line monotherapy by all major treatment guidelines and can lead to long-lasting virological suppression, resulting in histological improvement or reversal of advanced fibrosis and reduction in disease progression and liver-related complications. In this review, we focus on current treatment strategies of chronic hepatitis B and discuss the most recent efficacy and safety data from clinical trials and real life clinical practice. Recent findings of response-guided approaches are also discussed.

Keywords: Chronic hepatitis, Antiviral therapy, Peg-interferon, Nucleos(t)ide analogues, Antiviral resistance

Core tip: Patients with chronic hepatitis B are a heterogeneous population and require different management strategies. In clinical practice, several baseline factors, related to the patient, drug, stage of liver disease, comorbidities, lifestyle factors, coinfections and profile of hepatitis B virus infection, should be taken into consideration in order to individually optimize therapy. Surface antigen of the hepatitis B virus quantification is a potential new biomarker for treatment individualization and response-guided therapy. In the last two decades, the availability of potent oral antivirals changed the natural history of chronic hepatitis B; however, the risk of hepatocellular carcinoma (HCC) has not been abolished and thus regular HCC surveillance in high risk patients is required.