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Post Treatment Surveillance of Chronic HBV

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Dr VK Dixit    06 December 2018

  • Chronic hepatitis B (CHB) infection cannot be eradicated completely owing to the persistence of cccDNA in the nucleus of infected hepatocytes and integration of HBV genome with that of the host.
  • Goals of therapy of CHB include improvement of the QOL and survival of patients; these can be achieved by suppression of viral replication. The ultimate goal of HBV therapy should be aimed at global eradication of HBV infection through vaccination, prevention of transmission, and treatment.
  • A change in treatment approach for CHB should be considered in cases where a pharmaceutical agent has failed, drug resistance has developed or if the patient is unable to tolerate a treatment.
  • Management (12-week virologic response concept) – in the case of a primary response (HBV DNA) within 12 weeks of treatment initiation the intervention should be continued; in the case of primary treatment failure, non-adherent patients must be counseled and a more potent drug should be added for patients who are adherent to treatment.
  • Management (24-week virologic response concept) – in patients with primary response, early predictors of efficacy must be assessed at week-24. In those who exhibit a complete response, treatment should be continued with monitoring every six months. In those who show an inadequate response (HBV DNA higher than 2000 IU/mL) a more potent drug should be added and these patients must be monitored every 3 months. The common goal of treatment in both, HBeAg-positive and HBeAg-negative patients is long-term, profound viral suppression.

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