How viral genetic variants and genotypes influence disease and treatment outcome of chronic hepatitis B. Time for an individualized approach?

Chronic hepatitis B virus (HBV) infection remains a global problem. Several HBV (sub)genotypes exist with different biology and geographical preponderances. While the future aim of HBV treatment remains virus eradication, current strategies of treatment aim to suppress the virus and prevent the progression of liver disease. Current strategies also involve identification of patients for treatment – those at risk of progressive liver disease. Identification of HBV genotype, HBV mutants and other predictive factors allow for tailored treatments, and also risk-surveillance pathways such as for hepatocellular cancer screening. In the future, these factors may allow stratification of not only treatment decisions, but also identify patients at risk of higher relapse rates when current therapies may be discontinued. Newer technologies, such as next generation sequencing to assess drug-resistant or immune escape variants and quasi-species heterogeneity in patients before and during treatment, may allow for more information-based treatment decisions between the clinician and the patient. This article serves to discuss how HBV (sub-)genotypes and genetic variants play a role in not only the disease course and outcomes, but also in how current treatment strategies can be influenced by them. Adopting a personalized approach per genotype may play a role in future strategies in combatting the disease. This article also discusses new technologies in the battle against HBV that may allow more informed decisions about treatment modifications such as response guided therapy.

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