What is the goal of antiviral treatment for hepatitis B (HBV) (Hep B)?

Updated: Jun 08, 2021
  • Author: Nikolaos T Pyrsopoulos, MD, PhD, MBA, FACP, AGAF; Chief Editor: BS Anand, MD  more...
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The aim of antiviral treatment is to lower the risk of associated liver-related complications of chronic HBV infection. Immunologic cure involves loss of hepatitis B surface antigen (HBsAg) and sustained suppression of HBV DNA. Virologic cure consists of viral eradication, including the covalently closed circular DNA (cccDNA form)—this type of cure is currently unattainable.

Antiviral therapy is indicated only for individuals with acute symptomatic hepatitis B and acute liver failure, or who have a protracted, severe disease course (total bilirubin >3 mg/dL or direct bilirubin >1.5 mg/dL; international normalize ratio [INR] >1.5; encephalopathy; or ascites). [48] Use the preferred agents (see 2016 and 2018 AASLD Guidelines), and continue treatment until confirmation of HBsAg clearance or indefinitely in liver transplant recipients. Peg-IFN is contraindicated. [48] Individuals with chronic hepatitis B who fail to clear HBsAg after 6-12 months of treatment should receive ongoing management based on guidelines for chronic hepatitis B.

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