Chronic Hepatitis B with Spontaneous Severe Acute Exacerbation

Chronic hepatitis B virus (HBV) infection is a major global health problem with an estimated 400 million HBV carriers worldwide. In the natural history of chronic hepatitis B (CHB), spontaneous acute exacerbation (AE) is not uncommon, with a cumulative incidence of 10%-30% every year. While exacerba...

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Published inInternational journal of molecular sciences Vol. 16; no. 12; pp. 28126 - 28145
Main Authors Tsai, Wei-Lun, Sun, Wei-Chi, Cheng, Jin-Shiung
Format Journal Article
LanguageEnglish
Published Switzerland MDPI AG 26.11.2015
MDPI
Subjects
acute exacerbation
Antiviral Agents - adverse effects
Antiviral Agents - pharmacology
Antiviral Agents - therapeutic use
Antiviral drugs
antiviral treatment
Cytotoxicity
Disease Progression
Drug therapy
Genotype
Hepatitis
Hepatitis B
Hepatitis B virus
Hepatitis B virus - drug effects
Hepatitis B virus - genetics
Hepatitis B, Chronic - diagnosis
Hepatitis B, Chronic - drug therapy
Hepatitis B, Chronic - virology
Humans
Review
acute exacerbation
antiviral treatment
hepatitis B
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Summary:Chronic hepatitis B virus (HBV) infection is a major global health problem with an estimated 400 million HBV carriers worldwide. In the natural history of chronic hepatitis B (CHB), spontaneous acute exacerbation (AE) is not uncommon, with a cumulative incidence of 10%-30% every year. While exacerbations can be mild, some patients may develop hepatic decompensation and even die. The underlying pathogenesis is possibly related to the activation of cytotoxic T lymphocyte-mediated immune response against HBV. An upsurge of serum HBV DNA usually precedes the rise of alanine aminotransferase (ALT) and bilirubin. Whether antiviral treatment can benefit CHB with severe AE remains controversial, but early nucleos(t)ide analogues treatment seemed to be associated with an improved outcome. There has been no randomized study that compared the effects of different nucleos(t)ide analogues (NA) in the setting of CHB with severe AE. However, potent NAs with good resistance profiles are recommended. In this review, we summarized current knowledge regarding the natural history, pathogenetic mechanisms, and therapeutic options of CHB with severe AE.
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ISSN:1422-0067
1661-6596
1422-0067
DOI:10.3390/ijms161226087