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BMC Medicine
Published in: BMC Medicine 1/2017

Open Access 01-12-2017 | Minireview

Elimination of Hepatitis B: Is It a Mission Possible?

Authors: Tai-Chung Tseng, Jia-Horng Kao

Published in: BMC Medicine | Issue 1/2017

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Abstract

Chronic hepatitis B virus (HBV) infection is a global public health issue. Although the disease cannot be cured effectively, disease management has been improved over the past decade. The introduction of potent nucleos(t)ide analogues (NAs) to suppress viral replication represented a giant leap in the control of this disease. It has been shown that tenofovir treatment, a potent NA, complements current immunoprophylaxis to diminish mother-to-infant transmission in pregnant women with a high viral load. For patients with chronic HBV infection, quantitative hepatitis B surface antigen is a useful tool to define inactive carriers and to guide antiviral therapy. Quantification of HBV mutants is also useful in predicting long-term outcomes more precisely than ever. The next challenge is how to achieve an HBV cure; although immunotherapy is a promising strategy, the current results from two clinical trials using therapeutic vaccines to induce HBV-specific immune response in patients with chronic HBV infection are disappointing. In the coming years, we are expecting to see a combination of therapeutic agents with various modes of action to complete the mission of HBV elimination.
Literature
1.
Schweitzer A, Horn J, Mikolajczyk RT, Krause G, Ott JJ. Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet. 2015;386:1546–55.CrossRefPubMed
2.
Lin CL, Kao JH. Perspectives and control of hepatitis B virus infection in Taiwan. J Formos Med Assoc. 2015;114:901–9.CrossRefPubMed
3.
Lin CL, Kao JH. Review article: novel therapies for hepatitis B virus cure - advances and perspectives. Aliment Pharmacol Ther. 2016;44:213–22.CrossRefPubMed
4.
Tseng TC, Kao JH. Clinical utility of quantitative HBsAg in natural history and nucleos(t)ide analogue treatment of chronic hepatitis B: new trick of old dog. J Gastroenterol. 2013;48:13–21.CrossRefPubMed
5.
Chen CJ, Yang HI, Su J, Jen CL, You SL, Lu SN, et al. Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. JAMA. 2006;295:65–73.CrossRefPubMed
6.
Tseng TC, Liu CJ, Yang HC, Su TH, Wang CC, Chen CL, et al. High levels of hepatitis B surface antigen increase risk of hepatocellular carcinoma in patients with low HBV load. Gastroenterology. 2012;142:1140–9.CrossRefPubMed
7.
Liu J, Yang HI, Lee MH, Jen CL, Batrla-Utermann R, Lu SN, et al. Serum levels of hepatitis B surface antigen and DNA Can predict inactive carriers with low risk of disease progression. Hepatology. 2016;64:381–9.CrossRefPubMed
8.
Brouwer WP, Chan HL, Brunetto MR, Martinot-Peignoux M, Arends P, Cornberg M, et al. Repeated measurements of hepatitis B surface antigen identify carriers of inactive HBV during long-term follow-up. Clin Gastroenterol Hepatol. 2016;14:1481–9. e5.CrossRefPubMed
9.
Brunetto MR, Oliveri F, Colombatto P, Moriconi F, Ciccorossi P, Coco B, et al. Hepatitis B surface antigen serum levels help to distinguish active from inactive hepatitis B virus genotype D carriers. Gastroenterology. 2010;139:483–90.CrossRefPubMed
10.
Tseng TC, Liu CJ, Yang WT, Chen CL, Yang HC, Su TH, et al. Hepatitis B surface antigen level complements viral load in predicting viral reactivation in spontaneous HBeAg seroconverters. J Gastroenterol Hepatol. 2014;29:1242–9.CrossRefPubMed
11.
Tseng TC, Liu CJ, Yang HC, Su TH, Wang CC, Chen CL, et al. Serum hepatitis B surface antigen levels help predict disease progression in patients with low hepatitis B virus loads. Hepatology. 2013;57:441–50.CrossRefPubMed
12.
Sonneveld MJ, Hansen BE, Piratvisuth T, Jia JD, Zeuzem S, Gane E, et al. Response-guided peginterferon therapy in hepatitis B e antigen-positive chronic hepatitis B using serum hepatitis B surface antigen levels. Hepatology. 2013;58:872–80.CrossRefPubMed
13.
Wang CC, Tseng KC, Hsieh TY, Tseng TC, Lin HH, Kao JH. Assessing the durability of entecavir-treated hepatitis B using quantitative HBsAg. Am J Gastroenterol. 2016;111:1286–94.CrossRefPubMed
14.
Hsu YC, Mo LR, Chang CY, Wu MS, Kao JH, Wang WL, et al. Association between serum level of hepatitis B surface antigen at end of entecavir therapy and risk of relapse in E antigen-negative patients. Clin Gastroenterol Hepatol. 2016;14:1490–8. e3.CrossRefPubMed
15.
Chen CH, Hung CH, Hu TH, Wang JH, Lu SN, Su PF, et al. Association between level of hepatitis B surface antigen and relapse after entecavir therapy for chronic hepatitis B virus infection. Clin Gastroenterol Hepatol. 2015;13:1984–92. e1.CrossRefPubMed
16.
Chotiyaputta W, Lok AS. Hepatitis B virus variants. Nat Rev Gastroenterol Hepatol. 2009;6:453–62.CrossRefPubMed
17.
Kao JH, Chen PJ, Lai MY, Chen DS. Basal core promoter mutations of hepatitis B virus increase the risk of hepatocellular carcinoma in hepatitis B carriers. Gastroenterology. 2003;124:327–34.CrossRefPubMed
18.
Yang HI, Yeh SH, Chen PJ, Iloeje UH, Jen CL, Su J, et al. Associations between hepatitis B virus genotype and mutants and the risk of hepatocellular carcinoma. J Natl Cancer Inst. 2008;100:1134–43.CrossRefPubMedPubMedCentral
19.
Nie H, Evans AA, London WT, Block TM, Ren XD. Quantitative dynamics of hepatitis B basal core promoter and precore mutants before and after HBeAg seroconversion. J Hepatol. 2012;56:795–802.CrossRefPubMed
20.
Yang HC, Chen CL, Shen YC, Peng CY, Liu CJ, Tseng TC, et al. Distinct evolution and predictive value of hepatitis B virus precore and basal core promoter mutations in interferon-induced hepatitis B e antigen seroconversion. Hepatology. 2013;57:934–43.CrossRefPubMed
21.
Tseng TC, Liu CJ, Yang HC, Chen CL, Yang WT, Tsai CS, et al. Higher proportion of viral basal core promoter mutant increases the risk of liver cirrhosis in hepatitis B carriers. Gut. 2015;64:292–302.CrossRefPubMed
22.
Bayliss J, Yuen L, Rosenberg G, Wong D, Littlejohn M, Jackson K. Deep sequencing shows that HBV basal core promoter and precore variants reduce the likelihood of HBsAg loss following tenofovir disoproxil fumarate therapy in HBeAg-positive chronic hepatitis B. Gut. 2016;doi:10.​1136/​gutjnl-2015-309300.
23.
Wen WH, Lai MW, Chang MH. A review of strategies to prevent mother-to-infant transmission of hepatitis B virus infection. Expert Rev Gastroenterol Hepatol. 2016;10:317–30.CrossRefPubMed
24.
Chen HL, Lee CN, Chang CH, Ni YH, Shyu MK, Chen SM, et al. Efficacy of maternal tenofovir disoproxil fumarate in interrupting mother-to-infant transmission of hepatitis B virus. Hepatology. 2015;62:375–86.CrossRefPubMed
25.
Pan CQ, Duan ZP, Dai EH, Zhang SQ, Han GR, Wang YM, et al. Tenofovir to prevent hepatitis B transmission in mothers with high viral load. New Engl J Med. 2016;374:2324–34.CrossRefPubMed
26.
27.
Yang HC, Kao JH. Viral hepatitis. HBV cure--can we pin our hopes on immunotherapy? Nat Rev Gastroenterol Hepatol. 2015;12:129–31.CrossRefPubMed
28.
Fontaine H, Kahi S, Chazallon C, Bourgine M, Varaut A, Buffet C, et al. Anti-HBV DNA vaccination does not prevent relapse after discontinuation of analogues in the treatment of chronic hepatitis B: a randomised trial--ANRS HB02 VAC-ADN. Gut. 2015;64:139–47.CrossRefPubMed
29.
Lok AS, Pan CQ, Han SH, Trinh HN, Fessel WJ, Rodell T, et al. Randomized phase II study of GS-4774 as a therapeutic vaccine in virally suppressed patients with chronic hepatitis B. J Hepatol. 2016;65:509–16.CrossRefPubMed
30.
Kennedy PT, Sandalova E, Jo J, Gill U, Ushiro-Lumb I, Tan AT, et al. Preserved T-cell function in children and young adults with immune-tolerant chronic hepatitis B. Gastroenterology. 2012;143:637–45.CrossRefPubMed
31.
Liu J, Zhang E, Ma Z, Wu W, Kosinska A, Zhang X, et al. Enhancing virus-specific immunity in vivo by combining therapeutic vaccination and PD-L1 blockade in chronic hepadnaviral infection. PLoS Pathog. 2014;10:e1003856.CrossRefPubMedPubMedCentral
32.
Su TH, Kao JH. Improving clinical outcomes of chronic hepatitis B virus infection. Expert Rev Gastroenterol Hepatol. 2015;9:141–54.CrossRefPubMed
33.
Hosaka T, Suzuki F, Kobayashi M, Seko Y, Kawamura Y, Sezaki H, et al. Long-term entecavir treatment reduces hepatocellular carcinoma incidence in patients with hepatitis B virus infection. Hepatology. 2013;58:98–107.CrossRefPubMed
34.
Wong GL, Chan HL, Mak CW, Lee SK, Ip ZM, Lam AT, et al. Entecavir treatment reduces hepatic events and deaths in chronic hepatitis B patients with liver cirrhosis. Hepatology. 2013;58:1537–47.CrossRefPubMed
35.
Su TH, Hu TH, Chen CY, Huang YH, Chuang WL, Lin CC, et al. Four-year entecavir therapy reduces hepatocellular carcinoma, cirrhotic events and mortality in chronic hepatitis B patients. Liver Int. 2016;36:1755–64.CrossRefPubMed
36.
Tseng TC, Liu CJ, Chen CL, Yang WT, Yang HC, Su TH, et al. Higher lifetime chance of spontaneous surface antigen loss in hepatitis B carriers with genotype C infection. Aliment Pharmacol Ther. 2015;41:949–60.CrossRefPubMed
37.
Mason WS, Gill US, Litwin S, Zhou Y, Peri S, Pop O, et al. HBV DNA integration and clonal hepatocyte expansion in chronic hepatitis B patients considered immune tolerant. Gastroenterology. 2016;151:986–98. e4.CrossRefPubMed
38.
Metadata
Title
Elimination of Hepatitis B: Is It a Mission Possible?
Authors
Tai-Chung Tseng
Jia-Horng Kao
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2017
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-017-0820-x

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