The light of day for patients with chronic hepatitis B – some slow hepatitis B can be clinically cured

  On October 25, 2015, the Chinese Hepatitis Prevention and Control Foundation, the Chinese Medical Association Liver Disease Branch and the Chinese Medical Association Infectious Diseases Branch jointly released the 2015 Guidelines for the Prevention and Treatment of Chronic Hepatitis B in Beijing. The new version of the Guidelines identifies the therapeutic goals of maximizing long-term suppression of HBV replication, reducing inflammatory necrosis of hepatocytes and liver fibrosis, and achieving delay and reduction of liver failure, cirrhosis decompensation, HCC and other complications, thus improving the quality of life and prolonging survival time. In the course of treatment, clinical cure of chronic hepatitis B, i.e., sustained virological response after cessation of therapy, disappearance of HBsAg with ALT normalization and improvement of liver histology, should be pursued as much as possible for some suitable patients.  The Guidelines clearly state that the total course of nucleoside and nucleotide analogues is recommended for at least 4 years, and that after reaching a hepatitis B virus DNA test below the lower limit, normalization of glutamic aminotransferase, and seroconversion of hepatitis B e antigen, and then consolidation of therapy for at least 3 years (reviewed every 6 months) that remains unchanged, discontinuation may be considered, but an extended course of therapy may reduce relapse.  In addition, the Guidelines set three major treatment endpoints, as follows: 1. Desirable endpoint: HBeAg-positive and HBeAg-negative patients who obtain durable HBsAg disappearance with or without HBsAg seroconversion after drug discontinuation.  2. Satisfactory endpoints: HBeAg-positive patients with sustained virological response and ALT normalization with HBeAg serological conversion after discontinuation; HBeAg-negative patients with sustained virological response and ALT normalization after discontinuation.  3. Essential endpoints: long-term maintenance of virologic response (undetectable HBV DNA) during antiviral therapy if sustained response after drug discontinuation cannot be obtained.  It is clearly stated that tenofovir disoproxil and entecavir, the representative drugs of potent low resistance, are the preferred oral agents for patients with primary treatment of chronic hepatitis B, while highly resistant drugs are not recommended.