Affiliation:
1. Secretaria de Estado da Saúde‐SES Superintendência de Vigilância em Saúde‐SUVISA/GO, Gerência de Vigilância Epidemiológica de Doenças Transmissíveis‐GVEDT/Coordenação de Análises e Pesquisas‐CAP Goiânia Goiás Brazil
2. Department of Microbiology, Laboratory of Human Virology, Institute of Tropical Pathology and Public Health Federal University of Goiás Goiânia Goiás Brazil
3. Faculty of Medicine Evangelical University of Goiás Anápolis Goiás Brazil
Abstract
AbstractThe hepatitis B elimination is a goal proposed by the WHO to be achieved by 2030 through the adoption of synergistic measures for the prevention and chronic HBV infection treatment. Complete cure is characterized by the HBV elimination from the body and is the goal of the chronic hepatitis B treatment, which once achieved, will enable the hepatitis B elimination. This, today, has been a scientific challenge. The difficulty in achieving a complete cure is due to the indefinite maintenance of a covalently closed episomal circular DNA (cccDNA) reservoir and the maintenance and persistence of an insufficient and dysfunctional immune response in chronically infected patients. Among the measures adopted to eliminate hepatitis B, two have the potential to directly interfere with the virus cycle, but with limited effect on HBV control. These are conventional vaccines—blocking transmission and antiviral therapy—inhibiting replication. Vaccines, despite their effectiveness in protecting against horizontal transmission and preventing mother‐to‐child vertical transmission, have no effect on chronic infection or potential to eliminate the virus. Treatment with antivirals suppresses viral replication, but has no curative effect, as it has no action against cccDNA. Therapeutic vaccines comprise an additional approach in the chronic infection treatment, however, they have only a modest effect on the immune system, enhancing it temporarily. This manuscript aims to address (1) the cccDNA persistence in the hepatocyte nucleus and the immune response dysfunction in chronically infected individuals as two primary factors that have hampered the treatment and HBV elimination from the human body; (2) the limitations of antiviral therapy and therapeutic vaccines, as strategies to control hepatitis B; and (3) the possibly promising therapeutic approaches for the complete cure and elimination of hepatitis B.
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