Module Abstract

Benefits and Risks of HBV Therapy

Abstract

Chronic hepatitis B virus (HBV) infection has a complex and long natural history and causes a wide spectrum of disease, ranging from asymptomatic chronic hepatitis to severe liver disease. The indications for treatment should ideally be tailored to prevent or reduce progressive disease. Antiviral therapy has not been shown in randomized controlled trials to improve survival; however, it is reasonable to infer an improvement in disease outcome if HBV replication is suppressed with accompanying improvement in serum alanine aminotransferase and hepatic necroinflammatory disease. Furthermore, treatment of cirrhosis or advanced stages of the disease improves clinical outcomes associated with advanced disease, and long-term cohort studies have shown survival benefit providing a proof of principle that antiviral therapies improve survival. Major advances in the efficacy of treatment for HBV infection have been made, and recommended first-line therapies are the topic of this review; however, treatment of particular patient subgroups is not without risk and these issues are also addressed.