Goals of antiviral therapy for hepatitis B: HBeAg seroconversion, HBsAg seroconversion, histologic improvement, and possible impact on risk of hepatocellular carcinoma

A major goal of antiviral therapy in patients with chronic hepatitis B (CHB) is to achieve durable suppression of viral replication. By maintaining undetectable serum HBV DNA levels, one hopes to improve the clinical outcome of these CHB patients. Recent studies have demonstrated that prolonged viral suppression using first-line antiviral medications such as entecavir or tenofovir is associated with a significant reduction in necroinflammation, fibrosis, and even reversal of cirrhosis. Thus, durable suppression of viral replication might decrease the rates of developing cirrhosis, hepatocellular carcinoma, and most importantly, the mortality from complications associated with HBV-related liver diseases. The first-line medications, entecavir, tenofovir and pegylated interferon α-2a, may help to achieve such outcome with potency and lack or minimal chance of developing antiviral resistance to them. Achieving HBeAg loss and seroconversion in patients with HBeAg-positive CHB is another major goal of antiviral therapy. However, the possibility of HBsAg loss and seroconversion albeit uncommon, represents the holy grail of successful HBV treatment and remains the best predictor of durable viral suppression in patients with CHB.