HBsAg seroclearance with NUCs: rare but important

A major breakthrough in the treatment of chronic hepatitis B virus (HBV) infection had been the approval of nucleoside and nucleotide analogues (NUCs), which inhibit the reverse transcriptase and, thereby, dramatically suppress HBV DNA. To date, five NUCs are approved for the treatment of hepatitis B, with tenofovir and entecavir considered as first-line therapy.1 Treatment with tenofovir or entecavir leads to viral suppression below the limit of detection in almost 100% of adherent patients.1 This is associated with regression of fibrosis or even cirrhosis.2 3 Furthermore, some studies suggest a lowered incidence of hepatocellular carcinoma (HCC) with long-term NUC treatment. However, a significant risk for HCC development remains despite low HBV DNA, especially in patients with cirrhosis.4 Data from the REVEAL study suggest that higher HBsAg in low viremic patients is associated with an increased risk for HCC, underlining...
Source: Gut - Category: Gastroenterology Authors: Tags: Commentary Source Type: research