Treatment of hepatitis B is recommended for people who are showing signs of an active infection and progressive liver damage. Current therapies can suppress viral load, improve liver inflammation and reduce the risk of developing cirrhosis and liver cancer. Unlike hepatitis C, hepatitis B cannot be cured with current treatments in the vast majority of cases. Instead, people with hepatitis B may need to take treatment with an antiviral drug for an indefinite period.
Tenofovir continues to suppress hepatitis B virus for eight years
At the recent American Association for the Study of Liver Diseases (AASLD) Liver Meeting, in Boston, researchers reported on the results of eight years of treatment with tenofovir, a nucleotide analogue. The study found that of those who joined the trial, 75% of HBeAg-negative participants and 58% of HBeAg-positive participants had viral suppression after eight years of follow-up, with no evidence of long-term side-effects.
Entecavir and tenofovir in drug-resistant hepatitis B virus
If the hepatitis B virus is not fully suppressed during antiviral treatment, it is prone to develop resistance to the antiviral drug being used, especially in the case of lamivudine. Since lamivudine is used frequently as the first-line treatment for hepatitis B in settings where resources are limited, it is important to have evidence of the effectiveness of second-line treatment. The ENTEBE trial evaluated the safety and efficacy of entecavir plus tenofovir combination therapy for 144 people with chronic hepatitis B who had experienced previous nucleoside/nucleotide treatment failure. The study found that 85% of those who joined the study had fully suppressed hepatitis B viral load after 96 weeks of treatment.
Adding pegylated interferon to tenofovir
The most favourable response to hepatitis B treatment is loss of hepatitis B surface antigen (HBsAg). Loss of HBsAg occurs in a very small proportion of people taking currently available treatment. The likelihood of antigen loss is improved by adding a course of treatment with pegylated interferon for people taking tenofovir. A 740-person study comparing various durations of additional treatment with pegylated interferon in people receiving standard treatment with tenofovir found that people who received a 48-week course of pegylated interferon and tenofovir were more likely to experience HBsAg loss after 72 weeks of follow-up. Nine per cent of patients in this arm of the study experienced HBsAg loss, compared to approximately 2% in those who received either 16 weeks of pegylated interferon plus tenofovir, or pegylated interferon alone.
In seven cases HBsAg reappeared after having been cleared, indicating that it may be premature to consider HBsAg loss as evidence of a ‘cure’ for hepatitis B without lengthy follow up. A cure is considered more likely when there is a full HBsAg seroconversion, with HBsAg loss and the development of protective anti-HBs antibodies.
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