Advancing HIV cure: insights from developing chronic hepatitis b therapies for functional cure.

PURPOSE OF REVIEW: Similarly to HIV, HBV assumes a highly stable nuclear form and becomes integrated into the host genome, posing a significant challenge to complete eradication. The purpose of this review is to highlight the recent progress on various therapies that are being explored to achieve functional cure (FC) of chronic Hepatitis B (CHB).

RECENT FINDINGS: The current standard-of-care for CHB is either nucleos(t)ide analogues (NA) or PegIFN-α, but neither alone is sufficient to achieve functional cure. However, NA cessation alone or followed by PegIFN-α shows promise for increasing functional cure rates and decreasing viral relapse rates. While first generation capsid-assembly modulators (CAMs) had virtually no impact on HBsAg, newer, more potent CAMs may have an effect on cccDNA and produce reductions in HBsAg levels. Small-interfering RNAs (siRNAs) can lower HBsAg, but do not appear to result in sustained HBsAg clearance. A similar agent, bepirovirsen (an antisense oligonucleotide), appears to be more effective in producing modest FC rates; this may be due to its possible induction of the innate immune response.

SUMMARY: Given the persistence of cccDNA and integrated DNA, together with HBsAg-induced immune dysfunction, successful treatment for CHB to induce FC is likely to require a combination of agents that inhibit viral replication, reduce HBsAg levels, and boost the antiviral immune response.