Chronic hepatitis B: early viral suppression and long‐term outcomes of therapy with oral nucleos(t)ides

Summary.  Chronic hepatitis B is a serious health problem worldwide with a substantial minority of patients experiencing premature death due to end‐stage liver disease and/or hepatocellular carcinoma. Antiviral therapy may help prevent complications of chronic hepatitis B, and seven agents are currently approved in many countries. Of these agents, five are nucleos(t)ide analogs that all have a risk of antiviral drug resistance with long‐term use. Efforts have been made in the recent years to prevent or to reduce the risk of viral resistance in patients treated with oral nucleos(t)ides as the majority of these patients will require therapy for 3–5 years or longer. One approach is to identify patients who would most likely develop antiviral resistance on long‐term therapy using predictors obtainable early in the course of treatment, when intervention with new or additional therapy can be instituted. The most important predictors of treatment outcomes are serum HBV DNA levels at baseline and during the first 6 months of therapy. The purpose of this synopsis is to review the recent literature regarding the importance of serum HBV DNA levels in association with treatment outcomes in chronic hepatitis B, particularly the association of complete viral suppression early in the course of oral therapy with long‐term treatment outcomes, particularly the incidence of antiviral drug resistance.