How to achieve immune control in chronic hepatitis B?
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Chronic hepatitis B infection remains a major global health problem despite the existence of an effective vaccine. The current treatment options are either nucleos(t)ide analog therapy, which inhibits viral replication, or peginterferon-α, which has mainly immunomodulatory effects. However, treatment-induced HBeAg seroconversion with suppressed viral replication is mostly not sustainable, and loss of HBsAg is a rarely achieved endpoint. In addition, the hepatitis B virus persists in hepatocytes even after HBsAg clearance as covalently closed circular DNA is not eliminated from the hepatocytes. Because the course of chronic hepatitis B is determined by an ongoing interaction between the virus and the host immune system, immunomodulation may be the most logical approach in attempting to accomplish control or even cure of chronic hepatitis B. In the last years, methods for measuring the degree of immune control have been a major area of interest, with an important role for monitoring of HBsAg levels. In addition, new immunomodulatory agents are being developed and tested, providing promising options for future treatment.
KeywordsChronic hepatitis B infection Immune control Hepatitis B surface antigen Covalently closed circular DNA Immune modulation
Covalently closed circular DNA
Chronic hepatitis B
Hepatitis B surface antigen
Hepatitis B virus
- IA phase
- IT phase
Natural killer cell
Tenofovir disoproxil fumarate
Toll-like receptor 7
Prof.Dr. H.L.A. Janssen received grants from and is a consultant for Bristol Myers Squibb, Gilead Sciences, Novartis, Roche, Merck and Innogenetics.
Compliance with ethical requirements and Conflict of interest
This article does not contain any studies with human or animal subjects. Margo J. H. van Campenhout and Harry L. A. Janssen declare that they have no conflict of interest.
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