We have been very fortunate to have progressed from the discovery of the hepatitis B virus (HBV) to a highly effective vaccine in a relatively short period of time. Even with the vaccine availability, providing it universally to areas of high endemicity is still challenging.
Unfortunately, for individuals chronically infected, approximately more than 400 million, risk for the end-stage manifestations of cirrhosis and liver cancer remain globally problematic. We now have efﬁcacious, safe therapies that work to suppress viral replication, but challenges and areas of opportunity still exist in our management of patients infected with HBV.
In this monograph, the timing and treatment options for this disease are discussed, and the goals of determining true immuno-logic phenotypes based on more than ALT and HBV DNA, which is clinically important since many patients are in a gray zone that does not ﬁt the current guidelines, are concisely summarized. Monitoring and determining the end-points of HBV therapy are addressed and a look at resistance, cross resistance, and strategies for salvage are detailed. Also, the available data on long-term safety and options for therapeutic cessation is assessed. Ending therapy is an evolving area and it is clear that while HBsAg loss and sero-conversion is the “holy grail” of hepatitis B, it is rare and may take several years to achieve. ……..