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Optimal management of hepatitis B virus infection – EASL Special Conference

      Summary

      There have been great strides in the management of chronic hepatitis B virus (HBV) infection, but considerable challenges remain. The European Association for the Study of the Liver (EASL) convened a special conference focusing on all clinical aspects of the management of this disease.
      Immigration patterns are having a huge effect on the incidence, prevalence and genotype predominance of HBV in many European countries. In recent years there has been significant progress in our understanding of the virology and immunopathology of HBV, particularly the identification of the entry receptor for HBV conferring its hepatotropism, sodium taurocholate co-transporting polypeptide, and a better understanding of the regulation of the covalently closed circular DNA form of HBV – the major barrier to cure. However, more fundamental scientific research is needed.
      Serum biomarkers and transient elastography offer equivalent performance in the grading of disease stage and progression and monitoring of treatment. Occult HBV infection is often overlooked, but has many important implications for e.g., immuno-suppression, liver transplantation and the progression and severity of liver diseases from other causes.
      Hepatitis B e antigen positive immunotolerant patients, who are a significant source of horizontal and vertical transmission, are at risk for developing active chronic hepatitis B, but current treatment options are ineffective. Pegylated interferon therapy, given for a finite duration, offers sustained off-treatment responses in a minority of patients. Nucleos(t)ide analogues suppress the virus, improve liver histological lesions, reverse cirrhosis in the majority of cases, and improve survival, but ‘cure’ cannot be achieved. There is also a pressing need for novel HBV/hepatitis D virus co-infection therapies. Novel therapeutic strategies, e.g. immunomodulation, RNA interference and viral entry inhibition have demonstrated promising early results.

      Abbreviations:

      AASLD (American Association for the Study of Liver Diseases), ACLF (acute-on-chronic liver failure), AFP (alpha fetoprotein), ALT (alanine aminotransferase), anti-HBc (hepatitis B core antibody), anti-HBe (hepatitis B e antibody), anti-HBs (hepatitis B surface antibody), APASL (Asian Pacific Association for the Study of the Liver), BCP (basal core promoter), BEA (baseline-event-anticipation score), cccDNA (covalently closed circular DNA), CE-US (contrast-enhanced ultrasound), CHB (chronic hepatitis B), CTL (cytotoxic T cell), DCP (des-gamma-carboxyprothrombin), eGFR (estimated glomerular filtration rate), ELTR (European Liver Transplant Registry), ETV (entecavir), HBeAg (hepatitis B e antigen), HBIG (hepatitis B immune globulin), HBsAg (hepatitis B surface antigen), HBV (hepatitis B virus), HCC (hepatocellular carcinoma), HCV (hepatitis C virus), HDV (hepatitis D virus), HLA (human leukocyte antigen), HSPG (heparan sulfate proteoglycan), IFN (interferon), IFN-alpha (interferon-alpha), IL (interleukin), iMATEs (intrahepatic myeloid-cell aggregates for T cell population expansion), INR (international normalized ratio), LT (liver transplantation), PEG-IFN (pegylated interferon), miRNAs (micro-RNAs), MTCT (mother to child transmission), NA (nucleos(t)ide analogue), NTCP (Sodium taurocholate co-transporting polypeptide), OBI (occult HBV infection), PC (precore), PD-1 (programmed death receptor-1), PD-L1 (programmed death-ligand 1), SNPs (single nucleotide polymorphisms), TDF (tenofovir), TE (transient elastography), TLR (Toll-like receptor), TRAIL (tumor necrosis factor-related apoptosis-inducing ligand), ULN (upper limit of normal), US (ultrasound scan), WHV (woodchuck hepatitis virus)

      Keywords

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