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Hepatitis B Virus and Liver Disease pp 193–217Cite as

Nucleos(t)ide Therapy and Long-Term Outcomes

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Abstract

The goal of therapy for chronic hepatitis B is to decrease the risk of liver-related complications including progression to cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and death. Given that complete elimination of hepatitis B virus (HBV) from host is not possible with current available treatment owing to persistence of covalently closed circular DNA inside hepatocyte, the primary target for treatment should be to suppress HBV replication and reduce serum HBV DNA at the lowest possible levels to achieve the goals. Currently, five approved nucleos(t)ide analogues (NUC) are available for treating chronic hepatitis B in most countries: l-nucleosides (lamivudine and telbivudine), deoxyguanosine analogue (entecavir), and acyclic nucleoside phosphonates (adefovir dipivoxil and tenofovir). These NUCs act primarily by inhibiting the reverse transcription of the pregenomic HBV RNA to the first strand of HBV DNA. The American Association for the Study of Liver Diseases, European Association for the Study of the Liver, and Asian Pacific Association for the Study of the Liver practice guidelines recommend entecavir or TDF as preferred first-line monotherapies due to their superior efficacy and high barrier to resistance over comparable drugs. NUCs are administered orally and have favorable safety profiles over the course of several years. Many data have consistently shown that long-term suppression of HBV DNA replication by NUCs leads to the improvement in hepatic inflammation and fibrosis, hepatic function, and survival of the patients. However, it has been controversial whether the decrease in the risk of hepatocellular carcinoma could be achieved by the direct effects of NUCs apart from that by decrease in hepatic inflammation.

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  1. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea

    Jonggi Choi & Young-Suk Lim

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    Jia-Horng Kao

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    Ding-Shinn Chen

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Choi, J., Lim, YS. (2018). Nucleos(t)ide Therapy and Long-Term Outcomes. In: Kao, JH., Chen, DS. (eds) Hepatitis B Virus and Liver Disease. Springer, Singapore. https://doi.org/10.1007/978-981-10-4843-2_11

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