Overview
Hepatitis B virus (HBV) reactivation is a significant clinical concern, particularly in immunocompromised individuals or those undergoing immunosuppressive therapy. Understanding the mechanisms of viral replication and host immune response is crucial for effective management and prevention 1.Diagnosis
Hepatitis B surface antigen (HBsAg) levels can be monitored to assess viral activity 2.
Hepatitis B surface antigen immunocomplexes (HBsAg ICs) may decline during effective therapy and follow-up 2.
Circulating HBV RNA and hepatitis B core-related antigen (HBcrAg) are markers that decline during antiviral therapy 2.Management
Nucleic acid polymers (NAPs), tenofovir disoproxil fumarate (TDF), and pegylated interferon (pegIFN) are used in the management of chronic hepatitis B 2.
These therapies can lead to high rates of HBsAg loss/seroconversion and functional cure 2.
HBsAg ICs may increase or flare during therapy with NAPs and pegIFN, but these increases are not always correlated with HBsAg decline or alanine aminotransferase levels 2.
Universal declines in HBV RNA and HBcrAg are observed during TDF monotherapy and continue with NAP + pegIFN 2.
The post-transcriptional regulatory element (PRE) of HBV is a potential therapeutic target 1.Key Recommendations
Therapies including nucleic acid polymers (NAPs), tenofovir disoproxil fumarate (TDF), and pegylated interferon (pegIFN) can achieve high rates of HBsAg loss/seroconversion and functional cure in chronic hepatitis B 2. (Evidence: Moderate)
Monitoring of HBsAg, HBsAg ICs, HBV RNA, and HBcrAg can be used to assess response to therapy and viral activity 2. (Evidence: Moderate)
The post-transcriptional regulatory element (PRE) of HBV is a target for antiviral development 1. (Evidence: Moderate)References
1 Mouzannar K, Schauer A, Liang TJ. The Post-Transcriptional Regulatory Element of Hepatitis B Virus: From Discovery to Therapy. Viruses 2024. link
2 Bazinet M, Anderson M, Pântea V, Placinta G, Moscalu I, Cebotarescu V et al.. Analysis of HBsAg Immunocomplexes and cccDNA Activity During and Persisting After NAP-Based Therapy. Hepatology communications 2021. link