Chronic viral hepatitis remains a serious global medical and social problem that requires constant improvement of approaches to diagnosis and therapy [2]. The main goal of treating infections is not just to suppress the virus, but to achieve long-term safety and reduce the risk of liver complications, such as cirrhosis and hepatocellular carcinoma [2], [4].
Therapy Goals and New Biomarkers
Traditional laboratory indicators, including viral DNA levels and surface antigen (HBsAg), play a key role in monitoring patients with chronic hepatitis B [2]. However, with long-term use of nucleoside and nucleotide analogues, their informativeness for assessing deep viral suppression decreases [2]. In this regard, new prognostic markers are being introduced into clinical practice, such as hepatitis B core-related antigen (HBcrAg), which reflects the transcriptional activity of the virus's intracellular matrix DNA [2]. This allows physicians to more accurately determine indications for the safe discontinuation of therapy [2].
Efficacy of Pegylated Interferons
Pegylated interferon-alpha (PegIFNα) continues to be one of the basic drugs for achieving HBsAg clearance, which significantly reduces the risk of developing malignant liver tumors [4]. The efficacy of such therapy varies depending on the clinical profile of patients, regional characteristics of infection spread, and comorbidities [1], [4]. Interferon-based combinations were previously actively used both in monoinfections and in patients with concomitant inflammatory bowel disease (IBD), although in some cases dose adjustment was required due to side effects [1], [3].
Treatment Features for Comorbidities
Managing patients with chronic viral hepatitis and concomitant systemic diseases, such as inflammatory bowel disease, presents a particular challenge [1], [3], [5]. The use of immunosuppressive therapy or biological drugs (e.g., anti-TNF agents) in patients with latent or active hepatitis B is associated with a high risk of viral reactivation [5], [6].
- Patients with IBD must undergo screening for HBV and HCV markers before starting immunosuppressive therapy [5].
- HBsAg-positive patients are prescribed mandatory antiviral prophylaxis before the start of immunosuppression [5].
- For the prevention and treatment of hepatitis B, preference is given to modern nucleoside and nucleotide analogues (such as tenofovir and entecavir), as interferons can provoke an exacerbation of IBD symptoms [5].
Reactivation Prevention and Therapy Safety
The risk of hepatitis virus reactivation during immunosuppressant use varies from asymptomatic viremia to severe, life-threatening forms of fulminant hepatitis [6]. Timely screening and early administration of nucleoside analogues allow for successful control of liver status and prevention of severe hepatic complications in debilitated patients [1], [5].
Sources
- 1. Inflammatory bowel disease and hepatitis B and C in Western Balkans: a referral centre study and review of the literature
- 2. Predictive value of serum HBcrAg in antiviral therapy for chronic hepatitis B
- 3. Hepatitis C virus and inflammatory bowel disease
- 4. Hepatitis B surface antigen clearance rate with pegylated interferon-α therapy in different chronic hepatitis B virus infection populations: A systematic review and meta-analysis
- 5. Review article: prevention and management of hepatitis B and C infection in patients with inflammatory bowel disease
- 6. Hepatitis B and C virus reactivation in immunosuppressed patients with inflammatory bowel disease
Disclaimer: The information presented in this article is for reference purposes only and does not replace an in-person consultation with a qualified physician.