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Clinical Review State of the Art Review

Management of chronic hepatitis B infection

BMJ 2015; 351 doi: (Published 21 October 2015) Cite this as: BMJ 2015;351:h4263
  1. Vinay Sundaram, assistant medical director of liver transplantation1,
  2. Kris Kowdley, director of the Swedish Liver Care Network, research director of the organ care program2
  1. 1Department of Medicine and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
  2. 2Liver Care Network, Swedish Medical Center, Seattle, WA 98104, USA
  1. Correspondence to: K Kowdley Kris.Kowdley{at}


Hepatitis B virus (HBV) is a global health problem that can lead to cirrhosis and hepatocellular carcinoma (HCC). Although HBV vaccination has reduced the prevalence Of HBV infection, the burden of disease remains high. Treatment with antiviral drugs reduces the risk of liver disease and the development of HCC, and it can even reverse liver fibrosis. However, challenges remain regarding optimal timing, as well as the modality and duration of treatment. Currently approved drugs include pegylated interferon and nucleos(t)ide analogs. Nucleos(t)ide analogs are better tolerated and provide excellent viral suppression with a low risk of antiviral resistance, but pegylated interferon offers the benefit of a finite duration of treatment. Monitoring of hepatitis B surface antigen (HBsAg) levels may help to predict the likelihood of response to treatment, particularly for pegylated interferon. Prolonged treatment is usually needed with oral antiviral agents, and relapse is common if treatment is discontinued. New treatments that result in sustained clearance of HBV DNA and the clearance of HBsAg are needed.


  • Contributors: VS and KK contributed equally to conceptualization and study design, including literature search, and drafting and critical revision of the manuscript. Both authors are guarantors.

  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests: VS: speakers bureau: Salix (makes no products related to this review and has no relationship to the subject matter); advisory board: Gilead, Abbvie, Janssen. KK: grants/research: Evidera, Gilead, Immuron, Intercept, Tobira; advisory board: Abbvie, Achillion, BMS, Evidera, Gilead, Merck, Novartis, Trio Health; consultant: Abbvie, Gilead.

  • Provenance and peer review: Commissioned; externally peer reviewed.

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