Hepatitis B virus (HBV) infection is the most common chronic viral infection in the world. Despite the availability of a preventative vaccine, more than 250 million people worldwide are chronically infected with HBV. The complications of chronic HBV infection—cirrhosis and hepatocellular cancer (HCC)—account for more than 850,000 deaths per year.1 HBV is transmitted haematogenously and sexually, with the majority of HBV infections being transmitted vertically (or perinatally) in high prevalence regions.2 HBV infection acquired at birth or in early childhood results in chronicity in >95% of cases, whereas only 5–10% of those who are infected in adulthood will progress to chronic infection.
Treatment options for chronic hepatitis B (CHB) are mostly non-curative. Although antiviral therapy can provide adequate viral suppression, cases of functional cure (or hepatitis B surface antigen [HBsAg] loss) are limited and therefore long-term therapy is required. CHB is a dynamic disease, which means that all patients with CHB require long-term monitoring to inform treatment and management decisions. The treatment paradigm in CHB is undergoing rapid change—a number of novel agents are entering the clinical trial pipeline with the therapeutic goal of HBsAg loss or functional cure. It will be important to optimise patient management in advance of these clinical trials, and maintaining viral suppression will be an important prerequisite for many of them. In addition, viral suppression is mandated in a number of patient groups, especially those with advanced disease and cirrhosis, to prevent the complications of CHB.
Here we highlight some of the mistakes frequently made by clinicians when managing CHB and provide an evidence and experience-based approach to its management.