Today, there is a wealth of antivirals—nucleoside and nucleotide analogues— capable of effectively controlling the replication of hepatitis B virus (HBV), with a consequent, significant impact on its liver disease expression. Consequently, the European Association for the Study of the Liver has recently issued very detailed guidelines for the management of hepatitis B infection [1]. Currently licensed drugs are both effective and well tolerated, and this has allowed the treatment of hepatitis B, once exclusively prescribed by selected specialists, to become popular with general practitioners. Although the hepatitis B surface antigen loss is still a rare event—occasionally observed only in a minority of patients treated with pegylated interferon alpha—the prolonged suppression of HBV replication is now a realistic goal.
Two drugs in particular, entecavir and tenofovir disoproxil fumarate, are not only very efficient in abating viremia, but are also characterized by a positive safety profile and a very low rate of selection of HBV-resistant strains. The focus of clinical investigators is now on refining current regimens, for example, by analyzing predictive factors of response. Thus, the kinetics of HBV deoxyribonucleic acid and antigens can be monitored before and during the administration of antivirals, and algorithms can then be evaluated that are of both diagnostic and prognostic significance. In addition, the role of HBV genotypes in predicting response—essentially to interferon-alpha—is being defined, and new tests are gradually being introduced to assess viral resistance to drugs.
The current issue of Hot Topics in Viral Hepatitis is devoted to HBV and its management. Two chapters analyze, respectively, the new diagnostic markers and their applications to the most recent results of clinical trials. In addition, Dr. Di Marco’s article focuses on the natural history of hepatitis B and provides critical insight into the use of serology to better characterize patients in everyday clinical practice, while Drs. Kula and Dieterich briefly discuss the potential interest of novel approaches in the treatment of HBV infection that may complement existing regimens. I am confident that this information will help you in the decision-making process when attending patients with chronic hepatitis B.
 

REFERENCE

1. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: management of chronic hepatitis B. J Hepatol 2009;50:227-242.