The goal of therapy for chronic B hepatitis (CHB) is to improve survival by preventing risk of cirrhosis and end-stage liver disease, and to improve quality of life. The application of nucleos(t)ide analogues (NAs) have revolutionized treatment of CHB infection because of their high efficiency, favorable tolerability and oral administration. However, despite NAs efficient suppression of viral DNA replication, the endpoint of therapy is still elusive. A complete (sterilizing) cure is not achievable by current therapies since they do not affect the persistence of viral covalently closed circular DNA (cccDNA) in the liver cells or the viral DNA integrated in the host genome. The surrogate treatment endpoint of HBV surface antigen (HBsAg) seroclearance, known as a functional cure, is feasible but is only being achieved in the minority of patients, while for the majority, NA therapy of indefinite length is needed. Currently used biomarkers have proven to be insufficient in resolving the problem of therapy length in the majority of patients.
The serum biomarkers currently used as surrogate of cccDNA activity in the liver include measurement of HBV DNA level and measurement of HBsAg level. In present-day practice, these biomarkers have proven to be insufficient in guiding treatment decisions since they cannot identify patients who may safely terminate treatment or predict liver-related consequences. Measurement of intrahepatic HBV cccDNA levels and its transcriptional activity is becoming crucial for the management of CHB patients and individual approach to therapy. However, the need for liver biopsy strongly limits the evaluation of cccDNA as a routine practice. Therefore, an urgent need has developed for new non-invasive biomarkers, capable of reflecting the intrahepatic activity of the virus and assessing the likelihood of achieving partial or complete functional cure, as well as the risk of liver-related complications.
Several new HBV biomarkers have been described recently, with the role of serving as surrogate of cccDNA activity and helping management of treatment and follow-up. However, their true value and practical utility still need assessment. In addition, the contribution of host immunological, genetic and epigenetic factors to the variation in HBV treatment outcomes, as well as their potential as biomarkers, is only beginning to be investigated.
This Research topic will cover all experiences with new HBV biomarkers that can contribute to resolution of current therapeutic dilemmas: measurement of intrahepatic cccDNA, measurement of serum HBV RNA level (pregenomic and total derived from variants with defects in RNA splicing), measurement of hepatitis B core-related antigen (HBcrAg), quantification of HBeAg, quantification of anti-HBc antibodies, measurement of HBsAg glycan isomer (HBsAgGi), detection of HBV nucleic acid-related antigen (HBV-NRAg). Also, we aim to include research concerning possible immunological, genetic and epigenetic biomarkers associated with management of chronic HBV infection.
This Research Topic welcomes original research, brief research reports, case reports, methods, reviews, mini reviews and systematic review articles.
The goal of therapy for chronic B hepatitis (CHB) is to improve survival by preventing risk of cirrhosis and end-stage liver disease, and to improve quality of life. The application of nucleos(t)ide analogues (NAs) have revolutionized treatment of CHB infection because of their high efficiency, favorable tolerability and oral administration. However, despite NAs efficient suppression of viral DNA replication, the endpoint of therapy is still elusive. A complete (sterilizing) cure is not achievable by current therapies since they do not affect the persistence of viral covalently closed circular DNA (cccDNA) in the liver cells or the viral DNA integrated in the host genome. The surrogate treatment endpoint of HBV surface antigen (HBsAg) seroclearance, known as a functional cure, is feasible but is only being achieved in the minority of patients, while for the majority, NA therapy of indefinite length is needed. Currently used biomarkers have proven to be insufficient in resolving the problem of therapy length in the majority of patients.
The serum biomarkers currently used as surrogate of cccDNA activity in the liver include measurement of HBV DNA level and measurement of HBsAg level. In present-day practice, these biomarkers have proven to be insufficient in guiding treatment decisions since they cannot identify patients who may safely terminate treatment or predict liver-related consequences. Measurement of intrahepatic HBV cccDNA levels and its transcriptional activity is becoming crucial for the management of CHB patients and individual approach to therapy. However, the need for liver biopsy strongly limits the evaluation of cccDNA as a routine practice. Therefore, an urgent need has developed for new non-invasive biomarkers, capable of reflecting the intrahepatic activity of the virus and assessing the likelihood of achieving partial or complete functional cure, as well as the risk of liver-related complications.
Several new HBV biomarkers have been described recently, with the role of serving as surrogate of cccDNA activity and helping management of treatment and follow-up. However, their true value and practical utility still need assessment. In addition, the contribution of host immunological, genetic and epigenetic factors to the variation in HBV treatment outcomes, as well as their potential as biomarkers, is only beginning to be investigated.
This Research topic will cover all experiences with new HBV biomarkers that can contribute to resolution of current therapeutic dilemmas: measurement of intrahepatic cccDNA, measurement of serum HBV RNA level (pregenomic and total derived from variants with defects in RNA splicing), measurement of hepatitis B core-related antigen (HBcrAg), quantification of HBeAg, quantification of anti-HBc antibodies, measurement of HBsAg glycan isomer (HBsAgGi), detection of HBV nucleic acid-related antigen (HBV-NRAg). Also, we aim to include research concerning possible immunological, genetic and epigenetic biomarkers associated with management of chronic HBV infection.
This Research Topic welcomes original research, brief research reports, case reports, methods, reviews, mini reviews and systematic review articles.