Evaluating Efficacy of Treatment and the Endpoint of Viral Eradication during Chronic Hepatitis B Virus Infection Therapy

Abstract

Hepatitis B is a viral disease with a high incidence and prevalence worldwide. Hepatitis B can cause acute and
chronic liver disease. The clinical presentation ranges from subclinical hepatitis to symptomatic hepatitis and, in
rare instances, fulminant hepatitis. Long-term complications of hepatitis B include cirrhosis and hepatocellular
carcinoma(HCC). Perinatal or childhood infection is associated with few or no symptoms, but it has a high risk of
becoming chronic. A limited number of medications can be used to effectively treat chronic hepatitis B; a safe and
effective vaccine is available to prevent hepatitis B infection caused by the hepatitis B virus (HBV). HBV is a doublestranded DNA virus of the Hepadnaviridae family. HBV is a hepatotropic virus that replicates in the liver and causes
hepatic dysfunction. HBV is transmitted by percutaneous or permucosal exposure to infectious body fluids, by sexual
contact with an infected person, and by perinatal transmission from an infected mother to her infant.
Persons with chronic HBV infection are predisposed to chronic liver disease and have a greater then 200-fold
increased risk of hepatocellular carcinoma. Fulminant hepatic failure occurs in approximately 0.1-0.5% of patients
and is believed to be caused by massive immune-mediated lysis of infected hepatocytes. A variety of extrahepatic
manifestations, including urticarial rashes, arthralgia, and arthritis, are associated with acute clinical and subclinical
HBV infection, as well as multiple immune-complex disorders such as Gianotti-Crosti syndrome (papular
acrodermatitis), necrotizing vasculitis, and hypocomplementemic glomerulonephritis. HBV is associated with 20%
of the cases of membranous nephropathy in children. Essential mixed cryoglobulinemia, pulmonary hemorrhage
related to vasculitis, acute pericarditis, polyserositis, and Henoch-Schönlein purpura have been reported in association
with HBV infection. Hepatitis B virus (HBV) infection and its sequelae remain a major cause of chronic liver disease
worldwide, with nearly 400 million persons infected. Although the majority of individuals with HBV infection
will likely remain in an inactive phase associated with low viral replication and histologic remission, a significant
proportion will develop chronic hepatitis B.
In conclusion; given the low rate of spontaneous remission as well as the increased risk for progression to cirrhosis
and/or the development of hepatocellular carcinoma, there is a continued need for effective therapeutic intervention
in chronic hepatitis B