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Current Best Practice in Hepatitis B Management and Understanding Long-term Prospects for Cure.

ABSTRACT: The hepatitis B virus (HBV) is a major cause of cirrhosis and hepatocellular carcinoma worldwide. Despite an effective vaccine, the prevalence of chronic infection remains high. Current therapy is effective at achieving on-treatment, but not off-treatment, viral suppression. Loss of hepatitis B surface antigen, the best surrogate marker of off-treatment viral suppression, is associated with improved clinical outcomes. Unfortunately, this end point is rarely achieved with current therapy because of their lack of effect on covalently closed circular DNA, the template of viral transcription and genome replication. Major advancements in our understanding of HBV virology along with better understanding of immunopathogenesis have led to the development of a multitude of novel therapeutic approaches with the prospect of achieving functional cure (hepatitis B surface antigen loss) and perhaps complete cure (clearance of covalently closed circular DNA and integrated HBV DNA). This review will cover current best practice for managing chronic HBV infection and emerging novel therapies for HBV infection and their prospect for cure.

SUBMITTER: Yardeni D

PROVIDER: S-EPMC9772068 | biostudies-literature | 2023 Jan

REPOSITORIES: biostudies-literature

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Current Best Practice in Hepatitis B Management and Understanding Long-term Prospects for Cure.

Yardeni David D Chang Kyong-Mi KM Ghany Marc G MG

Gastroenterology 20221012 1

The hepatitis B virus (HBV) is a major cause of cirrhosis and hepatocellular carcinoma worldwide. Despite an effective vaccine, the prevalence of chronic infection remains high. Current therapy is effective at achieving on-treatment, but not off-treatment, viral suppression. Loss of hepatitis B surface antigen, the best surrogate marker of off-treatment viral suppression, is associated with improved clinical outcomes. Unfortunately, this end point is rarely achieved with current therapy because ...[more]

PMID: 36243037

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Project description:Recent research has explored the nature of the theoretical concept of optimal best practice, which emphasizes the importance of personal resolve, inner strength, and the maximization of a person's development, whether it is mental, cognitive, social, or physical. In the context of academia, the study of optimal functioning places emphasis on a student's effort expenditure, positive outlook, and determination to strive for educational success and enriched subjective well-being. One major inquiry closely associated with optimal functioning is the process of optimization. Optimization, in brief, delves into the enactment of different psychological variables that could improve a person's internal state of functioning (e.g., cognitive functioning). From a social sciences point of view, very little empirical evidence exists to affirm and explain a person's achievement of optimal best practice. Over the past five years, we have made extensive progress in the area of optimal best practice by developing different quantitative measures to assess and evaluate the importance of this theoretical concept. The present study, which we collaborated with colleagues in Taiwan, involved the use of structural equation modeling (SEM) to analyze a cohort of Taiwanese university students' (N = 1010) responses to a series of Likert-scale measures that focused on three major entities: (i) the importance of optimal best practice, (ii) three major psychological variables (i.e., effective functioning, personal resolve, and emotional functioning) that could optimize student' optimal best levels in academic learning, and (iii) three comparable educational outcomes (i.e., motivation towards academic learning, interest in academic learning, and academic liking experience) that could positively associate with optimal best practice and the three mentioned psychological variables. Findings that we obtained, overall, fully supported our initial a priori model. This evidence, in its totality, has made substantive practical, theoretical, and methodological contributions. Foremost, from our point of view, is clarity into the psychological process of optimal best practice in the context of schooling. For example, in relation to subjective well-being experiences, how can educators optimize students' positive emotions? More importantly, aside from practical relevance, our affirmed research inquiry has produced insightful information for further advancement. One distinction, in this case, entails consideration of a more complex methodological design that could measure, assess, and evaluate the impact of optimization.

Project description:This paper reviews the current management of onchocerciasis and its future prospects. Onchocerciasis is a disease affecting millions of people in Africa, South and Central America, and Yemen. It is spread by the blackfly as a vector and caused by the filarial nematode, Onchocerca volvulus. A serious attempt was made by the Onchocerciasis Control Program between 1975 and 2002 to eliminate the vector in eleven of the endemic countries in West Africa, and with remarkable success. Formerly, the treatment was with diethyl carbamazine for the microfilaria and suramin for the adult worm. These drugs are now known to be toxic and unsuitable for mass distribution. In particular, they precipitate optic nerve disease. With the discovery of ivermectin, a much safer microfilaricide, and the decision of Merck to distribute the drug free of charge for as long as needed, the strategy of control switched to mass drug administration through community-directed treatment with ivermectin. So far, millions have received this annual or biannual treatment through the African Program for Onchocerciasis Control and the Onchocerciasis Elimination Program for the Americas. However, the problem with ivermectin is that it is a monotherapy microfilaricide which has limited effect on the adult worm, and thus will need to be continued for the life span of the adult worm, which may last up to 15 years. There are also early reports of resistance. Serious encephalopathy and death may occur when ivermectin is used in subjects heavily infested with loiasis. It seems unlikely that a break in transmission will occur with community-directed treatment with ivermectin in Africa because of population migrations and the highly efficient vector, but in the Americas some countries such as Columbia and the Oaxaca focus in Mexico have reported eradication. Vector control is only now applicable in selected situations, and particularly to control the nuisance value of the blackfly. Trials are ongoing for alternatives to ivermectin. Candidate drugs include moxidectin, a macrofilaricide, doxycycline which targets the Wolbachia endosymbiont, and flubendazole, which shows promise with the newer oral cyclodextrin formulation.

Dataset Information

Current Best Practice in Hepatitis B Management and Understanding Long-term Prospects for Cure.

Publications

Current Best Practice in Hepatitis B Management and Understanding Long-term Prospects for Cure.

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