Combination therapy of chronic hepatitis B

Česká verzia

Authors: V. Hejda
Authors place of work: Gastroenterologické a hepatologické oddělení, 1. interní klinika LF UK a FN Plzeň
Published in the journal: Gastroent Hepatol 2016; 70(1): 65-73
Category: Hepatology: Review article
doi: https://doi.org/10.14735/amgh201665

Summary

Chronic hepatitis B infection is still a major global medical problem because of the risk it poses for progression to liver cirrhosis and its associated complications (portal hypertension, liver failure, and hepatocellular carcinoma). However, a very effective therapy based on nucleos(t)ide analogues is now available. This therapy, which is associated with a very low risk of development of resistant mutations, is very effective for the suppression of hepatitis B virus DNA. However, it has a minimal effect on the intracellular reservoir of hepatitis B virus (covalently closed circular DNA) and has a no effect on HBsAg synthesis; thus, it does not provide a definitive cure. Medication must be taken long-term (eventually lifelong), because stopping treatment leads to the reemergence of viremia. Therapy with pegylated interferon is another treatment option. Interferon, with its antiviral and imunomodulatory properties, can lead to clearance of infected hepatocytes and therefore a decrease in the level of covalently closed circular DNA in the liver. This therapy is taken only for a limited duration (48 weeks) and, although it has more side effects than nucleos(t)ide analogue therapy, it is associated with a higher chance of eliminating HBsAg. This paper will review the feasibility of using combinatory therapy with nucleos(t)ide analogues and pegylated interferon to shorten of length of therapy and increase the chance of obtaining a definitive cure for HBV infection, i.e., HBsAg clearance.

Key words:
HBV – HBsAg – nucleos(t)ide analogue – PEG-IFN

The author declares he has no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
30. 10. 2015

Accepted:
1. 12. 2016

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