Thoughts on expert opinion on expanding antiviral therapy for chronic hepatitis B

Zhihong LIU; Xieer LIANG; Jinlin HOU

doi:10.3969/j.issn.1001-5256.2023.01.002

Volume 39 Issue 1

Jan. 2023

Turn off MathJax

Article Contents

Article Navigation > Journal of Clinical Hepatology > 2023 > 39(1): 14-21

PDF( 1852 KB)

Thoughts on expert opinion on expanding antiviral therapy for chronic hepatitis B

DOI: 10.3969/j.issn.1001-5256.2023.01.002

Zhihong LIU^{1, 2},
Xieer LIANG^{1, 2},
Jinlin HOU^{1, 2
,
,}

1.
Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
2.
Institutes of Liver Diseases Research of Guangdong Province, Guangzhou 510515, China

More Information

Corresponding author: HOU Jinlin, jlhousmu@163.com (ORCID: 0000-0001-8230-8583)
Received Date: 2022-11-10
Published Date: 2023-01-20

Abstract

Abstract

Expanding antiviral therapy is currently the new trend for the diagnosis and treatment of chronic hepatitis B, and related research evidence should be studied and discussed. Reducing the threshold of alanine aminotransferase (ALT) for initiating antiviral therapy is one of the most important changes during the expansion of antiviral therapy. Chronic hepatitis B patients with a low-level increase in ALT or a high normal level of ALT still have a higher risk of liver cancer and thus require further intervention. At present, nucleos(t)ide analogues show a certain clinical effect in some patients in terms of virological inhibition and improvement in fibrosis, while reducing ALT threshold places higher requirements for biochemical response after treatment. In addition, although the mechanism and definition of low-level viremia (LLV) after treatment remain unclear, further intervention of LLV is an important strategy for optimizing patient management in clinical practice. Switch to another potent nucleos(t)ide analogue may improve the virologic response rate of patients with LLV, and nucleos(t)ide analogues combined with interferon or other new targeted drugs will be an important research direction for the treatment of LLV in the future.
- Hepatitis B, Chronic,
- Alanine Transaminase,
- Low Level Viremia

FullText(HTML)

References(39)

References

[1]	Chinese Society of Hepatology, Chinese Medical Association. Expert opinion on expanding anti-HBV treatment for chronic hepatitis B[J]. Chin J Hepatol, 2022, 30(2): 131-136. DOI: 10.3760/cma.j.cn501113-20220209-00060. 中华医学会肝病学分会. 扩大慢性乙型肝炎抗病毒治疗的专家意见[J]. 中华肝脏病杂志, 2022, 30(2): 131-136. DOI: 10.3760/cma.j.cn501113-20220209-00060.
[2]	Chinese Society of Infectious Diseases, Chinese Medical Association; Chinese Society of Hepatology, Chinese Medical Association. Guidelines for the prevention and treatment of chronic hepatitis B (version 2019)[J]. J Clin Hepatol, 2019, 35(12): 2648-2669. DOI: 10.3969/j.issn.1001-5256.2019.12.007. 中华医学会感染病学分会, 中华医学会肝病学分会. 慢性乙型肝炎防治指南(2019年版)[J]. 临床肝胆病杂志, 2019, 35(12): 2648-2669. DOI: 10.3969/j.issn.1001-5256.2019.12.007.
[3]	KWO PY, COHEN SM, LIM JK. ACG Clinical Guideline: evaluation of abnormal liver chemistries[J]. Am J Gastroenterol, 2017, 112(1): 18-35. DOI: 10.1038/ajg.2016.517.
[4]	LIU LZ, SUN J, HOU J, et al. Improvements in the management of chronic hepatitis B virus infection[J]. Expert Rev Gastroenterol Hepatol, 2018, 12(11): 1153-1166. DOI: 10.1080/17474124.2018.1530986.
[5]	European Association for the Study of the Liver. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection[J]. J Hepatol, 2017, 67(2): 370-398. DOI: 10.1016/j.jhep.2017.03.021.
[6]	TERRAULT NA, LOK A, MCMAHON BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance[J]. Hepatology, 2018, 67(4): 1560-1599. DOI: 10.1002/hep.29800.
[7]	SARIN SK, KUMAR M, LAU GK, et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update[J]. Hepatol Int, 2016, 10(1): 1-98. DOI: 10.1007/s12072-015-9675-4.
[8]	TERRAULT NA, BZOWEJ NH, CHANG KM, et al. AASLD guidelines for treatment of chronic hepatitis B[J]. Hepatology, 2016, 63(1): 261-283. DOI: 10.1002/hep.28156.
[9]	ZHUANG H. Should the threshold of alanine aminotransferase level for initiation of treatment for chronic hepatitis B be modified?[J]. Chin J Hepatol, 2021, 29(9): 878-881. DOI: 10.3760/cma.j.cn501113-20210823-00419. 庄辉. 慢性乙型肝炎启动治疗的ALT阈值应否修订?[J]. 中华肝脏病杂志, 2021, 29(9): 878-881. DOI: 10.3760/cma.j.cn501113-20210823-00419.
[10]	LIAW YF, SUNG JJ, CHOW WC, et al. Lamivudine for patients with chronic hepatitis B and advanced liver disease[J]. N Engl J Med, 2004, 351(15): 1521-1531. DOI: 10.1056/NEJMoa033364.
[11]	MARCELLIN P, CHANG TT, LIM SG, et al. Adefovir dipivoxil for the treatment of hepatitis B e antigen-positive chronic hepatitis B[J]. N Engl J Med, 2003, 348(9): 808-816. DOI: 10.1056/NEJMoa020681.
[12]	HADZIYANNIS SJ, TASSOPOULOS NC, HEATHCOTE EJ, et al. Adefovir dipivoxil for the treatment of hepatitis B e antigen-negative chronic hepatitis B[J]. N Engl J Med, 2003, 348(9): 800-807. DOI: 10.1056/NEJMoa021812.
[13]	CHANG TT, GISH RG, DE MAN R, et al. A comparison of entecavir and lamivudine for HBeAg-positive chronic hepatitis B[J]. N Engl J Med, 2006, 354(10): 1001-1010. DOI: 10.1056/NEJMoa051285.
[14]	MARCELLIN P, HEATHCOTE EJ, BUTI M, et al. Tenofovir disoproxil fumarate versus adefovir dipivoxil for chronic hepatitis B[J]. N Engl J Med, 2008, 359(23): 2442-2455. DOI: 10.1056/NEJMoa0802878.
[15]	HOU JL, GAO ZL, XIE Q, et al. Tenofovir disoproxil fumarate vs adefovir dipivoxil in Chinese patients with chronic hepatitis B after 48 weeks: a randomized controlled trial[J]. J Viral Hepat, 2015, 22(2): 85-93. DOI: 10.1111/jvh.12313.
[16]	BUTI M, GANE E, SETO WK, et al. Tenofovir alafenamide versus tenofovir disoproxil fumarate for the treatment of patients with HBeAg-negative chronic hepatitis B virus infection: a randomised, double-blind, phase 3, non-inferiority trial[J]. Lancet Gastroenterol Hepatol, 2016, 1(3): 196-206. DOI: 10.1016/S2468-1253(16)30107-8.
[17]	CHAN HL, FUNG S, SETO WK, et al. Tenofovir alafenamide versus tenofovir disoproxil fumarate for the treatment of HBeAg-positive chronic hepatitis B virus infection: a randomised, double-blind, phase 3, non-inferiority trial[J]. Lancet Gastroenterol Hepatol, 2016, 1(3): 185-195. DOI: 10.1016/S2468-1253(16)30024-3.
[18]	CHAN HL, CHAN CK, HUI AJ, et al. Effects of tenofovir disoproxil fumarate in hepatitis B e antigen-positive patients with normal levels of alanine aminotransferase and high levels of hepatitis B virus DNA[J]. Gastroenterology, 2014, 146(5): 1240-1248. DOI: 10.1053/j.gastro.2014.01.044.
[19]	HSU YC, CHEN CY, CHANG IW, et al. Once-daily tenofovir disoproxil fumarate in treatment-naive Taiwanese patients with chronic hepatitis B and minimally raised alanine aminotransferase (TORCH-B): a multicentre, double-blind, placebo-controlled, parallel-group, randomised trial[J]. Lancet Infect Dis, 2021, 21(6): 823-833. DOI: 10.1016/S1473-3099(20)30692-7.
[20]	CHAN HL. Debate settled for elevated alanine aminotransferase in hepatitis B?[J]. Lancet Infect Dis, 2021, 21(6): 750-751. DOI: 10.1016/S1473-3099(20)30682-4.
[21]	LIU Z, JIN Q, ZHANG Y, et al. Randomised clinical trial: 48 weeks of treatment with tenofovir amibufenamide versus tenofovir disoproxil fumarate for patients with chronic hepatitis B[J]. Aliment Pharmacol Ther, 2021, 54(9): 1134-1149. DOI: 10.1111/apt.16611.
[22]	AGARWAL K, BRUNETTO M, SETO WK, et al. 96 weeks treatment of tenofovir alafenamide vs. tenofovir disoproxil fumarate for hepatitis B virus infection[J]. J Hepatol, 2018, 68(4): 672-681. DOI: 10.1016/j.jhep.2017.11.039.
[23]	HOU J, NING Q, DUAN Z, et al. 3-year treatment of tenofovir alafenamide vs. tenofovir disoproxil fumarate for chronic HBV infection in China[J]. J Clin Transl Hepatol, 2021, 9(3): 324-334. DOI: 10.14218/JCTH.2020.00145.
[24]	LIU Z, JIN Q, ZHANG Y, et al. 96-week treatment of tenofovir amibufenamide and tenofovir disoproxil fumarate in chronic hepatitis B patients[J]. J Clin Transl Hepatol, 2022. DOI: 10.14218/jcth.2022.00058.[Online anead of print]
[25]	KIM JH, SINN DH, KANG W, et al. Low-level viremia and the increased risk of hepatocellular carcinoma in patients receiving entecavir treatment[J]. Hepatology, 2017, 66(2): 335-343. DOI: 10.1002/hep.28916.
[26]	LU FM, FENG B, ZHENG SJ, et al. Current status of the research on low-level viremia in chronic hepatitis B patients receiving nucleos(t)ide analogues[J]. J Clin Hepatol, 2021, 37(6): 1268-1274. DOI: 10.3969/j.issn.1001-5256.2021.06.007. 鲁凤民, 封波, 郑素军, 等. 核苷(酸)类似物经治的慢性乙型肝炎患者低病毒血症的研究现状[J]. 临床肝胆病杂志, 2021, 37(6): 1268-1274. DOI: 10.3969/j.issn.1001-5256.2021.06.007.
[27]	HOU JL, ZHAO W, LEE C, et al. Outcomes of long-term treatment of chronic HBV infection with entecavir or other agents from a randomized trial in 24 countries[J]. Clin Gastroenterol Hepatol, 2020, 18(2): 457-467. e21. DOI: 10.1016/j.cgh.2019.07.010.
[28]	ZIMMERMAN T. 3-year efficacy and safety of tenofovir alafenamide compared with tenofovir disoproxil fumarate in HBeAg-negative and -positive patients with chronic hepatitis B[G]. 2018: 1-3. E-poster on AASLD The liver meeting 2018.
[29]	ZHANG Q, PENG H, LIU X, et al. Chronic hepatitis B infection with low level viremia correlates with the progression of the liver disease[J]. J Clin Transl Hepatol, 2021, 9(6): 850-859. DOI: 10.14218/JCTH.2021.00046.
[30]	LEE SB, JEONG J, PARK JH, et al. Low-level viremia and cirrhotic complications in patients with chronic hepatitis B according to adherence to entecavir[J]. Clin Mol Hepatol, 2020, 26(3): 364-375. DOI: 10.3350/cmh.2020.0012.
[31]	LI ZB, LI L, NIU XX, et al. Switching from entecavir to tenofovir alafenamide for chronic hepatitis B patients with low-level viraemia[J]. Liver Int, 2021, 41(6): 1254-1264. DOI: 10.1111/liv.14786.
[32]	SUN Y, WU X, ZHOU J, et al. Persistent low level of hepatitis B virus promotes fibrosis progression during therapy[J]. Clin Gastroenterol Hepatol, 2020, 18(11): 2582-2591. e6. DOI: 10.1016/j.cgh.2020.03.001.
[33]	LU J, ZHANG C, HE P, et al. Risk factors for very low-level viremia in patients with chronic hepatitis B virus infection: A single-center retrospective study[J]. Liver Res, 2022, 6(1): 39-44. DOI: 10.1016/j.livres.2022.02.001.
[34]	CHEN H, FU JJ, LI L, et al. Influencing factors for low-level viremia in chronic hepatitis B patients treated with long-term entecavir antiviral therapy[J]. J Clin Hepatol, 2021, 37(3): 556-559. DOI: 10.3969/j.issn.1001-5256.2021.03.011. 陈贺, 傅涓涓, 李丽, 等. 长期恩替卡韦经治慢性乙型肝炎患者低病毒血症的相关影响因素[J]. 临床肝胆病杂志, 2021, 37(3): 556-559. DOI: 10.3969/j.issn.1001-5256.2021.03.011.
[35]	PALLIER C, RODRIGUEZ C, BRILLET R, et al. Complex dynamics of hepatitis B virus resistance to adefovir[J]. Hepatology, 2009, 49(1): 50-59. DOI: 10.1002/hep.22634.
[36]	ZHANG H, HU Y, WU M, et al. Randomised clinical trial: safety, efficacy and pharmacokinetics of HS-10234 versus tenofovir for the treatment of chronic hepatitis B infection[J]. Aliment Pharmacol Ther, 2021, 53(2): 243-252. DOI: 10.1111/apt.16196.
[37]	CHEN XY, REN S, LU J, et al. Combination therapy in HBeAg-negative chronic hepatitis B patients with low-level viremia to nucleos (tide) analogues[J]. J Hepatol, 2022, 77: S844. DOI: 10.1016/S0168-8278(22)01984-5.
[38]	SULKOWSKI MS, AGARWAL K, MA X, et al. Safety and efficacy of vebicorvir administered with entecavir in treatment-naïve patients with chronic hepatitis B virus infection[J]. J Hepatol, 2022, 77(5): 1265-1275. DOI: 10.1016/j.jhep.2022.05.027.
[39]	YUEN MF, AGARWAL K, MA X, et al. Safety and efficacy of vebicorvir in virologically suppressed patients with chronic hepatitis B virus infection[J]. J Hepatol, 2022, 77(3): 642-652. DOI: 10.1016/j.jhep.2022.04.005.

Relative Articles

Supplements(0)

Cited By

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Figures(1) / Tables(1)

Get Citation

PDF

XML

Article Metrics

Article views (2199) PDF downloads(281)

Thoughts on expert opinion on expanding antiviral therapy for chronic hepatitis B

DOI: 10.3969/j.issn.1001-5256.2023.01.002

Abstract

References

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

Thoughts on expert opinion on expanding antiviral therapy for chronic hepatitis B

DOI: 10.3969/j.issn.1001-5256.2023.01.002

Abstract

References

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

About Journal

Submission Guideline

Journal Online

Hepatobiliary College

Guidelines

Export File

Citation

Format

Content