Published online Jul 26, 2019. doi: 10.12998/wjcc.v7.i14.1784
Peer-review started: March 11, 2019
First decision: April 16, 2019
Revised: June 2, 2019
Accepted: June 26, 2019
Article in press: June 27, 2019
Published online: July 26, 2019
The goal of chronic hepatitis B (CHB) therapy is to improve the patient prognosis through the sustained inhibition of viral replication. However, due to the uncertainty and potentially unlimited duration of the treatment course, nucleus(t)ide analogue (NA) resistance and safety, financial costs and patient compliance, different endpoints of antiviral treatment have been proposed in CHB prevention and treatment guidelines. Different treatment endpoints are closely associated with the safety of drug withdrawal and improvements in prognosis. Antiviral treatment suppresses HBV DNA replication, drug withdrawal leads to relapse, and long-term treatment causes drug safety and resistance issues. Although hepatitis B e antigen seroconversion based on HBV DNA inhibition is considered as “a satisfactory endpoint”, drug withdrawal still leads to high relapse rates. Hepatitis B surface antigen (HBsAg) clearance is the “ideal endpoint” in terms of the safety of drug withdrawal and improvements in prognosis. However, the HBsAg clearance rate is low using the conventional single drug treatment and fixed course regimens. Recently, the application of an “optimized antiviral treatment strategy” has improved the HBsAg clearance rate, and make an “ideal endpoint” possible. This article reviews the different antiviral treatment endpoints in terms of the safety of drug withdrawal, improvements in prognosis and relevant advances.
Core tip: Different antiviral treatment endpoints have different degrees of improvement in disease prognosis. Hepatitis B surface antigen (HBsAg) clearance has been recommended as an optimal endpoint of antiviral treatment by the latest chronic hepatitis B management guidelines. It can not only lead to safer drug withdrawal but also significantly improves prognosis. However, HBsAg clearance rate is low using the conventional single drug treatment and fixed course regimens. So individualized treatment strategies should be implemented according to the specific conditions of patients. This article reviews the different antiviral treatment endpoints in terms of the safety of drug withdrawal, improvements in prognosis and how to improve HBsAg clearance.