HBV therapeutic end points

Abstract

Chronic hepatitis B [CHB] is a major health problem especially in developing countries. Defining the end point of therapy is a key issue in management of CHB patients, since a judicious balance has to be maintained between containing the virus and its sequelae and futility of continuation of therapy beyond a point. The major goals of antiviral therapy are to prevent the complications of CHB such as the development of liver cirrhosis, liver failure, HCC and death. Major advances have been made in the treatment of chronic hepatitis B, which led to significant improvements in the management of the disease. Several virologic end points have been used to evaluate the efficacy of therapy, including HBsAg loss, HBeAg seroconversion and HBV DNA undetectability. It was shown that viral suppression induced by antiviral therapy is a major treatment end point because it is associated with an improvement in liver histology and clinical outcome, and is now achievable in the majority of patients. New end points for the treatment of chronic HBV infection are emerging in the light development of more potent drugs and availability of more sensitive assays with the quantification and kinetics of serum HBsAg, intrahepatic cccDNA and analysis of specific immunological responses. However, liver biopsy still remains the gold standard but is impractical due to invasive nature, sampling error, and the significantly delay it takes for changes to appear. There is no ideal endpoindr for evaluation of therapies for hepatitis B at the moment, and future research should be directed at development and validation of endpoints that could precisely foretell or reflect outcomes in patients with CHB.This review which discusses the various end points of treatment of CHB should be of immense benefit to the practicing clinicians.