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Hepatitis B Treatment: Antivirals, Tenofovir, Entecavir, and Transaminase Control for Cirrhosis Prevention

Hispanic doctor reviewing liver function test results on a computer, with medical books and a stethoscope on the desk. An anatomical poster of the human liver is visible in the background, creating a professional and educational environment focused on hepatitis B treatment, including tenofovir and entecavir, as well as transaminase control and cirrhosis prevention.

Dear colleagues, hepatitis B remains a significant challenge in clinical practice due to its potential to progress to cirrhosis and hepatocellular carcinoma. The primary goal of hepatitis B treatment is to achieve sustained viral suppression to prevent these complications. In this context, antivirals such as tenofovir and entecavir have proven effective in reducing viral load and improving clinical outcomes.

Diving Deeper into Antiviral Treatment

The first-line antivirals for the treatment of chronic hepatitis B include tenofovir disoproxil fumarate (TDF), tenofovir alafenamide (TAF), and entecavir (ETV). These agents are preferred due to their high genetic barrier to resistance and their ability to effectively suppress hepatitis B virus (HBV) DNA. However, it is important to highlight that these treatments do not eradicate the virus, which generally requires long-term therapy.

Monitoring liver function is crucial during antiviral treatment. Regular monitoring of transaminase levels and viral load is essential to assess treatment response and adjust therapy as needed. Additionally, the loss of hepatitis B surface antigen (HBsAg) remains an optimal goal, although it is rarely achieved with current therapies.

In patients with cirrhosis, antiviral treatment has been shown to improve survival and reduce the incidence of adverse hepatic events. However, adherence to treatment and continuous follow-up are fundamental to avoid hepatic decompensation and other potentially fatal events.

Conclusions

Managing chronic hepatitis B requires a comprehensive approach that combines the use of effective antivirals such as tenofovir and entecavir with rigorous monitoring of liver function. Preventing progression to cirrhosis and hepatocellular carcinoma remains a challenge, but with appropriate treatment and regular transaminase control, we can significantly improve outcomes for our patients. Ongoing research and the development of new therapies are essential to advance towards a functional cure for hepatitis B.

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Created 4/1/2025