Current and novel modalities for management of chronic hepatitis B infection.

Autor:	Salama II; Department of Community Medicine Research, National Research Centre, Giza 12411, Dokki, Egypt. salamaiman@yahoo.com., Sami SM; Department of Child Health, National Research Centre, Giza 12411, Dokki, Egypt., Salama SI; Department of Community Medicine Research, National Research Centre, Giza 12411, Dokki, Egypt., Abdel-Latif GA; Department of Community Medicine Research, National Research Centre, Giza 12411, Dokki, Egypt., Shaaban FA; Department of Child Health, National Research Centre, Giza 12411, Dokki, Egypt., Fouad WA; Department of Community Medicine Research, National Research Centre, Giza 12411, Dokki, Egypt., Abdelmohsen AM; Department of Community Medicine Research, National Research Centre, Giza 12411, Dokki, Egypt., Raslan HM; Department of Internal Medicine, National Research Centre, Giza 12411, Dokki, Egypt.
Jazyk:	angličtina
Zdroj:	World journal of hepatology [World J Hepatol] 2023 May 27; Vol. 15 (5), pp. 585-608.
DOI:	10.4254/wjh.v15.i5.585
Abstrakt:	Over 296 million people are estimated to have chronic hepatitis B viral infection (CHB), and it poses unique challenges for elimination. CHB is the result of hepatitis B virus (HBV)-specific immune tolerance and the presence of covalently closed circular DNA as mini chromosome inside the nucleus and the integrated HBV. Serum hepatitis B core-related antigen is the best surrogate marker for intrahepatic covalently closed circular DNA. Functional HBV "cure" is the durable loss of hepatitis B surface antigen (HBsAg), with or without HBsAg seroconversion and undetectable serum HBV DNA after completing a course of treatment. The currently approved therapies are nucleos(t)ide analogues, interferon-alpha, and pegylated-interferon. With these therapies, functional cure can be achieved in < 10% of CHB patients. Any variation to HBV or the host immune system that disrupts the interaction between them can lead to reactivation of HBV. Novel therapies may allow efficient control of CHB. They include direct acting antivirals and immunomodulators. Reduction of the viral antigen load is a crucial factor for success of immune-based therapies. Immunomodulatory therapy may lead to modulation of the host immune system. It may enhance/restore innate immunity against HBV (as toll-like-receptors and cytosolic retinoic acid inducible gene I agonist). Others may induce adaptive immunity as checkpoint inhibitors, therapeutic HBV vaccines including protein (HBsAg/preS and hepatitis B core antigen), monoclonal or bispecific antibodies and genetically engineered T cells to generate chimeric antigen receptor-T or T-cell receptor-T cells and HBV-specific T cells to restore T cell function to efficiently clear HBV. Combined therapy may successfully overcome immune tolerance and lead to HBV control and cure. Immunotherapeutic approaches carry the risk of overshooting immune responses causing uncontrolled liver damage. The safety of any new curative therapies should be measured in relation to the excellent safety of currently approved nucleos(t)ide analogues. Development of novel antiviral and immune modulatory therapies should be associated with new diagnostic assays used to evaluate the effectiveness or to predict response. Competing Interests: Conflict-of-interest statement: All authors report having no relevant conflicts of interest for this article. (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)
Databáze:	MEDLINE
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