Current and Emerging Therapeutic Strategies for Chronic Hepatitis B Virus Infection: A Review

The main objective in treating chronic hepatitis B (CHB) is to achieve sustained suppression of HBV DNA in order to slow or prevent the progression of liver disease. Interferon-alpha or nucleoside analog therapy aims to reduce HBV DNA levels to below 105 copies/mL in HBeAg-positive cases, and even lower in HBeAg-negative cases. HBeAg seroconversion and HBsAg loss are important markers of treatment success, though HBsAg loss remains infrequent. Interferon-based therapies have shown higher rates of HBsAg seroconversion compared to nucleoside analogs, which is likely due to their differing mechanisms of action. Treatment selection is based on patient-specific factors, including baseline HBV DNA and ALT levels, liver histology, and the patient’s ability to tolerate side effects. Global guidelines recommend initiating therapy for patients with elevated ALT and HBV DNA levels greater than 20,000 IU/mL, along with ongoing monitoring for resistance and treatment adherence. Recent advancements in antiviral agents, such as tenofovir and entecavir, have improved efficacy and reduced resistance compared to older treatments like lamivudine. Special considerations are necessary for populations such as pregnant women, individuals with cirrhosis, and those co-infected with HIV or HCV. While combination therapies may offer potential benefits, their optimal use still requires further research. Long-term monitoring is essential for achieving durable responses and improving outcomes in the management of CHB.