The Roadmap concept: using early on-treatment virologic responses to optimize long-term outcomes for patients with chronic hepatitis B

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http://www.springerlink.com/content/3221470443000114/

Journal Hepatology International

Publisher Springer New York

ISSN 1936-0533 (Print) 1936-0541 (Online)

Category Review

DOI 10.1007/s12072-008-9083-0

Subject Collection Medicine

SpringerLink Date Friday, July 25, 2008

PDF (152.1 KB)HTML

Review

The Roadmap concept: using early on-treatment virologic responses to optimize

long-term outcomes for patients with chronic hepatitis B

J. Gane1

(1) NZ Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand

Received: 22 December 2007 Accepted: 30 May 2008 Published online: 25 July

2008

Abstract Several large observational, longitudinal studies of the natural

history of chronic hepatitis B (CHB) have demonstrated that high levels of

hepatitis B virus (HBV) replication are associated with long-term risk of

cirrhosis, decompensation, hepatocellular carcinoma, and liver-related

mortality. The corollary is also true—profound and sustained suppression either

spontaneously or during antiviral therapy will prevent disease progression and

complications. Multiple analyses of various baseline factors and on-treatment

responses have identified the absolute HBV DNA level after 24 weeks of therapy

as the best predictor of long-term efficacy. Lower 24-week serum HBV DNA levels

after lamivudine, telbivudine, or entecavir are associated with higher rates of

maintained HBV DNA nondetectability, ALT normalization, HBeAg seroconversion,

and lack of resistance. Patients with undetectable serum HBV DNA levels after 24

weeks have the best long-term outcomes while those with levels remaining above

10,000 copies per ml are unlikely to benefit from long-term therapy with that

particular agent and either the addition or switch to another antiviral agent

with increased potency but without cross resistance could be considered at this

time point. In the future, improved on-treatment monitoring should facilitate

treatment strategies to optimize long-term outcomes among patients receiving

oral antiviral therapy for CHB.

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J. Gane

Email: edgane@...

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