Goals and endpoints of therapy [5,6,16]
See Table 4. HBV infection cannot be eradicated completely with current available therapies because of the persistence of cccDNA, which acts as a viral reservoir in infected hepatocytes.[25] Even so, an ideal endpoint of treatment would be to achieve viral eradication with sustained HBsAg loss, with/without seroconversion to anti-HBs antibodies, as HBsAg is a surrogate marker for transcriptionally active cccDNA.[26,27] However, this is as yet uncommon and hence a broad goal of therapy is to prevent or reverse disease progression to cirrhosis, end-stage liver disease or HCC. This can be achieved by suppressing HBV replication, with a consequent improvement in necro- inflammation and fibrosis that lowers the risk of cirrhosis and HCC. [20-22,28]
Once cirrhosis is established, preventing decompensation, HCC or death is the primary treatment goal. In those patients with early decompensation, suppression of HBV replication can improve synthetic function and decrease the Child-Pugh/model for end-stage liver disease (MELD) score, and may delay the need for liver transplantation. In those with end-stage liver disease, suppression of HBV replication prior to transplantation reduces the risk of recurrence.
Endpoints of treatment: HBeAg- positive disease
The ideal endpoint is sustained HBsAg loss due to therapy, with/without the development of anti-HBs.