| Abstract [eng] |
Chronic hepatitis B remains a significant global public health concern, posing a high risk of complications such as cirrhosis and primary hepatocellular carcinoma. Despite advances in vaccination and antiviral therapy, sterilising cure remains challenging due to the persistence of covalently closed circular DNA (cccDNA) molecule integrated into the nucleus of host hepatocytes. Realistic functional cure is considered the optimal therapeutic goal, although it is rarely achieved in clinical practice. Objective. Based on a literature review, evaluate the characteristics of the hepatitis B virus, the tendency of the infection to become chronic, the possibilities of achieving recovery, and describe a clinical case that meets the diagnostic criteria for realistic functional cure. Methods. A literature review was conducted by searching scientific databases, including PubMed, Google Scholar, ScienceDirect, and UpToDate. Keywords and their combinations were used for the search. The analysis included scientific studies and guidelines published within the last ten years. Results. This study describes the key characteristics of the hepatitis B virus that ensure the chronicity of infection, including its ability to evade the host immune system, as well as factors influencing realistic functional cure. It is noted that current therapeutic strategies focus on suppressing viral replication; however, the complete eradication of cccDNA or HBV-DNA integrated into the host genome remains unachievable, thereby contributing to the residual risk of hepatocarcinogenesis. Despite effective viral suppression and regression of hepatocellular damage, lifelong treatment is required to maintain infection control. The study also provides a detailed discussion of the terminology used to define the therapeutic goals of chronic hepatitis B treatment. Currently, realistic functional cure is regarded as the primary therapeutic objective and is defined as the sustained loss of hepatitis B surface antigen (HBsAg), with or without seroconversion, and undetectable HBV-DNA in serum after treatment discontinuation. Although the term "complete cure or recovery" offers hope, a sterilizing cure for chronic hepatitis B remains unattainable in the near future. Furthermore, the study explores novel treatment strategies aimed at enhancing the efficacy of existing therapeutic approaches. These include combinations of antiviral drugs with immunomodulators and novel agents targeting specific stages of the viral replication cycle. Additionally, a clinical case meeting the criteria for realistic functional cure is presented, along with an analysis of potential factors influencing the treatment outcome. Conclusions. Due to the characteristics of the hepatitis B virus and its interaction with the host immune system, realistic functional cure remains an ambitious therapeutic goal. Certain viral and host factors may contribute to improved treatment outcomes; however, their significance often depends on individual patient characteristics. Research on combination therapies and novel antiviral agents provides hope for the development of more effective treatments for chronic hepatitis B in the future, potentially enabling sterilising cure. |
