What has been revealed about the treatment of chronic hepatitis B

The guideline recommended treatment goals for chronic hepatitis B are to maximize long-term suppression of HBV replication, reduce hepatocellular inflammatory necrosis and liver fibrosis, and achieve delay and reduction of liver failure, cirrhosis loss, liver cancer and other complications, thereby improving quality of life and prolonging survival. This is largely consistent with the 2010 version of the guidelines, although the new guidelines specifically state that clinical cure of chronic hepatitis B, i.e., sustained virologic response after cessation of therapy, disappearance of HBsAg, accompanied by ALT normalization and improvement in liver histology, should be pursued as far as possible for some suitable patients during the course of treatment. This indicates that medical experts recognize that with advances in treatment, clinical cure is now a real and attainable goal for chronic hepatitis B and is no longer just an unrealistic “dream”. In addition, based on the goals of treatment, the new edition of the guidelines gives a very detailed, hierarchical presentation of the endpoints of treatment for slow hepatitis B: 1. Desirable endpoints, HBeAg-positive versus HBeAg-negative patients who obtain durable HBsAg disappearance with or without HBsAg serologic conversion after discontinuation of the drug. 2, Satisfactory endpoint, HBeAg-positive patients, obtaining sustained virological response and ALT normalization with HBeAg serological conversion after drug discontinuation; HBeAg-negative patients, obtaining sustained virological response and ALT normalization after drug discontinuation. 3. essential endpoints, such as failure to obtain sustained response after drug discontinuation and long-term maintenance of virologic response during antiviral therapy (undetectable HBV DNA). The results of several large-scale studies published in recent years have shown a lower incidence of adverse outcomes such as cirrhosis and hepatocellular carcinoma in patients with chronic hepatitis B with e antigen serologic conversion and surface antigen clearance compared to patients with viral conversion alone. This hierarchical recommendation of treatment endpoints reflects the results of these studies and makes the requirements for the treatment of slow hepatitis B clearer: for better clinical outcomes, higher goals should be pursued. In simple terms, the best treatment for slow hepatitis B is to achieve major triplet to minor triplet conversion and sustained response after drug discontinuation, and ideally to achieve disappearance of surface antigen, or “cap removal”. If these endpoints cannot be achieved, the second best option is to consider long-term medication to maintain virologic response during long-term treatment.