Author information

¹Clinical and Translational Hepatology, The Liver Institute, Rajagiri Hospital, Aluva, IND.

²Gastroenterology and Advanced Gastrointestinal Endoscopy, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Aluva, IND.

³Diagnostic and Interventional Radiology, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Aluva, IND.

Abstract

Chronic hepatitis B virus (HBV) infection is a global healthcare burden in the form of chronic liver disease, cirrhosis, liver failure and liver cancer. There is no definite cure for the virus and even though extensive vaccination programs have reduced the burden of liver disease in the future population, treatment options to eradicate the virus from the host are still lacking. In this review, we discuss in detail current updates on the structure and applied biology of the virus in the host, examine updates to current treatment and explore novel and state-of-the-art therapeutics in the pipeline for management of chronic HBV. Furthermore, we also specifically review clinical updates on HBV-related acute on chronic liver failure (ACLF). Current treatments for chronic HBV infection have seen important updates in the form of considerations for treating patients in the immune tolerant phase and some clarity on end points for treatment and decisions on finite therapy with nucleos(t)ide inhibitors. Ongoing cutting-edge research on HBV biology has helped us identify novel target areas in the life cycle of the virus for application of new therapeutics. Due to improvements in the area of genomics, the hope for therapeutic vaccines, vector-based treatments and focused management aimed at targeting host integration of the virus and thereby a total cure could become a reality in the near future. Newer clinical prognostic tools have improved our understanding of timing of specific treatment options for the catastrophic syndrome of ACLF secondary to reactivation of HBV. In this review, we discuss in detail pertinent updates regarding virus biology and novel therapeutic targets with special focus on the appraisal of prognostic scores and treatment options in HBV-related ACLF.

Annotation:

Jacobson, I. (2021) Philips CA, Ahamed R, Abduljaleel JD et al. Critical updates on chronic hepatitis B virus infection in 2021. Cereus 2021;DOI:10.7759/cereus.19152

In 15 pages (with thrifty pagination abetted by small font) and with 200 references, the authors of this remarkably comprehensive review cover the entire gamut of the hepatitis B field with an emphasis on recent developments.  There is rich material here for clinicians and scientists, whether their primary interests are in viral biology and life cycle, immunopathogenesis, diagnosis and evaluation including new markers like hepatitis B core related core antigen (HBcrAg), current treatment, or novel therapies under investigation.  Wherever one’s primary interest lies, the reader will be sure to find much of value and learn something new.  There are two excellent if busy figures depicting the viral life cycle and potential antiviral targets, and immunopathogenesis with corresponding targets for immunomodulatory therapies.  Highly recommended.