Remaining Challenges of HBV Infection: Pathogenesis, Immune Response, Diagnosis and Therapeutic Strategies

Dear Colleagues,

Viral hepatitis is a significant public health challenge of this decade, according to data collected from 187 countries by the World Health Organization (WHO). The majority of the global burden of viral hepatitis is associated with hepatitis B virus (HBV) due to its likelihood of causing chronic infection and its long-term consequences like liver cirrhosis and hepatocellular carcinoma (HCC). The current estimation is that worldwide 254 million people live with chronic HBV infection, 1.23 million get infected each year, and 1.1 million lives are lost annually due to this infection.

Early diagnosis, efficient monitoring and prognostic evaluation are the critical factors contributing to the efficient treatment of HBV-related diseases. Unfortunately, only 13.4% of people living with chronic hepatitis B are diagnosed, and only 2.6% are receiving antiviral therapy. The introduction of antiviral therapy has revolutionized the treatment of chronic hepatitis B infection by reducing liver inflammation and preventing liver-related complications. However, despite the efficient suppression of viral DNA replication, a complete (sterilizing) cure is not achievable by current therapeutic strategies since the persistence of viral covalently closed circular DNA (cccDNA) in the liver cells or the viral DNA integrated into the host genome is not affected. The surrogate treatment endpoint is HBV surface antigen (HBsAg) seroclearance, known as a functional cure. It is a feasible endpoint but is only achieved in a minority of patients. Thus, the current research is focused on developing new therapeutic options and a wider introduction of new non-invasive biomarkers capable of reflecting the virus's intrahepatic activity.

Although many fundamental problems regarding HBV immunopathogenesis have been solved, the phenomena of persistence, clearance, and recurrence of HBV still need to be elucidated. Evidently, some patients spontaneously control the infection, while it becomes chronic in others. Since HBV is not cytocidal, virus-induced liver damage results from a complex interplay between the virus replication and host defense. A better understanding of the role of different viral proteins in the light of viral genetic variability and the mechanisms behind immune-induced control of HBV infection continuously represent the challenges for researchers.

This Special Issue invites original research and review articles covering all unresolved aspects of hepatitis B pathogenesis, immune response, prevention, diagnosis, and therapy.

Prof. Dr. Ivana Lazarevic
Guest Editor

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• HBV
• pathogenesis
• immune response
• clinical management
• diagnostic methods
• new biomarkers
• antiviral therapy
• new antiviral strategies
• vaccines and prevention