Published online Aug 15, 2019. doi: 10.5495/wjcid.v9.i2.11
Peer-review started: May 7, 2019
First decision: June 18, 2019
Revised: June 22, 2019
Accepted: July 16, 2019
Article in press: July 17, 2019
Published online: August 15, 2019
Hepatitis B virus (HBV) is still a global health problem, mostly because of the intermediate/high rates of HBV chronic carriers living in most Asian, African and eastern European countries. The universal HBV vaccination of new-borns undertaken in most nations over the last 3 decades and effective HBV antiviral treatments (nucleos(t)ide analogue with high genetic barrier to viral resistance) introduced in the last decade have shown their beneficial effects in inducing a clear reduction of HBV endemicity in the countries where they have been extensively applied. Great hopes are now placed on new antiviral and immunotherapeutic drugs that are now at an advanced stage of study. It is in fact already conceivable that the synergistic use of new drugs targeting more than one HBV-lifecycle steps (covalent closed circular DNA destruction/silencing, HBV entry inhibitors, nucleocapsid assembly modulators targeting viral transcripts) and of some new immunotherapeutic agents might eliminate the intrahepatic covalent closed circular DNA and achieve the eradication of HBV infection. In spite of this, a strong effort should be given to extensive educational and screening programs for the at-risk population and to the implementation of HBV vaccination in developing countries.
Core tip: The spread of hepatitis B virus (HBV) infection has recently decreased in several countries due to the universal HBV vaccination of new-born babies and to the extended use of HBV nucleos(t)ide analogues with high genetic barrier to viral resistance. However, HBV vaccination and extensive educational and screening programs for at risk populations should be implemented predominantly in developing countries. New drugs targeting more than one HBV-lifecycle steps and of some new immunotherapeutic agents are under investigation with the aim of obtaining the clearance of hepatocytic covalent closed circular DNA through their synergistic action.