While there is no ‘cure’ for CHB at present, there is very effective antiviral therapy (AVT), which can reduce the complications of CHB, such as cirrhosis, end-stage liver disease and liver cancer (or hepatocellular carcinoma, HCC). The most commonly used antivirals are Tenofovir, Entecavir and Tenofovir Alafenamide (currently not available on the NHS) and these medications work by suppressing the virus, so the HBV DNA becomes undetectable. The effect of suppressing HBV to undetectable levels results in normalisation of the liver enzymes and thus reducing the risk of disease progression and the complications of CHB, such as cirrhosis and liver cancer.
HBV DNA>2,000IU/ml (antiviral therapy is indicated)
Treatment guidelines are changing and the threshold to start AVT is lower than ever before. Thus any person living with CHB can be considered for treatment and this is a discussion which should take place between treating clinician and patient. Even patients with low levels of HBV DNA (<2,000IU/ml) can be considered treatment candidates, but it is important that patients with this clinical profile understand the benefits and potential risks of long-term antiviral therapy. Conversely, if there is evidence of liver damage or established fibrosis, treatment is mandated, as the benefits of AVT clearly outweigh any risks.
Tenofovir and Entecavir are considered the first-line treatment by most treating clinicians; they are widely used in the management of CHB and generally are considered very safe medications. However, there are recognised limitations with these antiviral drugs, including adherence, cost, and potential side effects with long-term usage. For this reason, the HBV field continues to strive to develop finite treatment options and ‘functional cure’.