A Customized Approach to the Management of Hepatitis B Viral Infection

Chronic hepatitis B virus (HBV) infection affects at least 1.25 million people in the United States. Current treatment guidelines for this incurable infection, which are based on alanine aminotransferase activity and serum HBV DNA concentration, are aimed at reducing the viral load to undetectable concentrations and preventing or delaying the progression to severe liver disease, including cirrhosis and hepatocellular carcinoma. These goals require a customized approach to long-term therapy for patients infected with HBV. Recent clinical findings suggest that hepatitis B viral load is the strongest predictor of disease progression and that this progression can be delayed by administering nucleoside and nucleotide analogues. However, long-term management of HBV infection with nucleoside and nucleotide analogues is associated with the emergence of drug-resistant mutants. These inherent challenges in the treatment of HBV were addressed by a satellite symposium held during the 57th Annual Meeting of the American Association for the Study of Liver Diseases in Boston, Massachusetts. In response to presentations of hypothetical patient scenarios, expert panelists discussed practical considerations for halting the natural history of HBV infection, tailoring HBV therapy, and treating pregnant or immunosuppressed patients infected with HBV. The challenging case studies presented during the satellite symposium serve as the foundation for the articles contained in this supplement. After successfully completing these articles, participants should be able to apply emerging evidence-based and consensus findings to the management of HBV infection in diverse subpopulations of patients. I hope this information will arm you with the knowledge and skills needed to customize your approach to the management of HBV infection.