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dc.contributor.authorHall, S
dc.contributor.authorHowell, J
dc.contributor.authorVisvanathan, K
dc.contributor.authorThompson, A
dc.date.accessioned2020-11-17T03:33:18Z
dc.date.available2020-11-17T03:33:18Z
dc.date.issued2020-09-01
dc.identifierpii: v12090934
dc.identifier.citationHall, S., Howell, J., Visvanathan, K. & Thompson, A. (2020). The Yin and the Yang of Treatment for Chronic Hepatitis B-When to Start, When to Stop Nucleos(t)ide Analogue Therapy. VIRUSES-BASEL, 12 (9), https://doi.org/10.3390/v12090934.
dc.identifier.issn1999-4915
dc.identifier.urihttp://hdl.handle.net/11343/251539
dc.description.abstractOver 257 million individuals worldwide are chronically infected with the Hepatitis B Virus (HBV). Nucleos(t)ide analogues (NAs) are the first-line treatment option for most patients. Entecavir (ETV) and tenofovir disoproxil fumarate (TDF) are both potent, safe antiviral agents, have a high barrier to resistance, and are now off patent. They effectively suppress HBV replication to reduce the risk of cirrhosis, liver failure, and hepatocellular carcinoma (HCC). Treatment is continued long-term in most patients, as NA therapy rarely induces HBsAg loss or functional cure. Two diverging paradigms in the treatment of chronic hepatitis B have recently emerged. First, the public health focussed "treat-all" strategy, advocating for early and lifelong antiviral therapy to minimise the risk of HCC as well as the risk of HBV transmission. In LMICs, this strategy may be cost saving compared to monitoring off treatment. Second, the concept of "stopping" NA therapy in patients with HBeAg-negative disease after long-term viral suppression, a personalised treatment strategy aiming for long-term immune control and even HBsAg loss off treatment. In this manuscript, we will briefly review the current standard of care approach to the management of hepatitis B, before discussing emerging evidence to support both the "treat-all" strategy, as well as the "stop" strategy, and how they may both have a role in the management of patients with chronic hepatitis B.
dc.languageEnglish
dc.publisherMDPI
dc.titleThe Yin and the Yang of Treatment for Chronic Hepatitis B-When to Start, When to Stop Nucleos(t)ide Analogue Therapy
dc.typeJournal Article
dc.identifier.doi10.3390/v12090934
melbourne.affiliation.departmentMedicine and Radiology
melbourne.source.titleViruses
melbourne.source.volume12
melbourne.source.issue9
dc.rights.licenseCC BY
melbourne.elementsid1462993
melbourne.contributor.authorVisvanathan, Kumar
melbourne.contributor.authorHowell, Jessica
melbourne.contributor.authorThompson, Alexander
dc.identifier.eissn1999-4915
melbourne.accessrightsOpen Access


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