Management of chronic hepatitis B: status and challenges beyond treatment guidelines

Several national and international guidelines have been published in the last years focusing on the problem of how to best treat patients with chronic hepatitis B virus (HBV) infection. Therapy with interferon or nucleos(t)ide analogues has been shown to be most effective in suppressing HBV deoxyribonucleic acid (DNA) levels and preventing fibrosis progression herby also reducing the risk of hepatocellular carcinoma (HCC). However even suppression of viral replication below the limit of detection does not prevent HCC development although fibrosis can be stopped. Thus, improvement of therapeutic strategies and the establishment of more sensitive markers that may help to decide when therapy should be initiated and stopped remain important goals in hepatitis research. The present review discusses several major issues in this respect such as strategies to identify the optimal time point for treatment indication and end of therapy. It also concentrates on questions and queries that have to do with the interpretation of viral parameters like HBsAg quantification, HBV genotypes, and HBeAg, or the characterization of risk patients prone to develop fatal sequel of the HBV infection.