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Even though current antiviral treatments based on pegylated interferon, or nucleos(t)ide analogues, in mono or combination therapies, have demonstrated clinical benefit to HBV-infected patients, chronic hepatitis B remains a difficult-to-cure disease. An absolute cure, defined as total elimination of HBV DNA, is currently not achievable, and a functional cure characterised by sustained virological response and HBV surface antigen (HBsAg) clearance off-treatment remains a challenge. Pegylated interferon treatment can lead to a sustained virological response and HBsAg clearance off-treatment in only 3–7% of patients,1 and it is too often associated with contraindications and adverse effects. Long-term treatment with nucleos(t)ide analogues is better tolerated, but the chance to achieve a sustained virological response and HBsAg loss remains low,2 and the drugs do not eradicate intrahepatic HBV DNA.
The risk of disease progression and development of hepatocellular carcinoma in chronically HBV-infected patients is clearly associated with high levels of serum HBV DNA and HBsAg.3 ,4 Since high levels of serum HBsAg may be responsible for exhaustion of HBsAg-specific T-cell response in chronically infected individuals, an antiviral strategy aimed at suppressing circulating HBsAg could restore virus-specific immune response and promote viral clearance.5
Zhang et al 6 investigated the potential of anti-HBsAg monoclonal antibodies (mAbs) infusion for clearance of circulating HBsAg in chronic infection. The study was based on (i) the previous observation that anti-HBsAg mAbs treatments could have short-term antiviral effects,7 ,8 and (ii) the growing interest in mAbs-based immunotherapy for viral diseases, including infections with HIV, HCV and Ebola virus.9 The therapeutic use of antiviral mAbs was initially based on the mAbs activity in virus neutralisation …
Competing interests CS is a CNRS scientist and he is supported by Agence Nationale pour la Recherche sur le SIDA et les hépatites virales (ANRS).
Provenance and peer review Commissioned; internally peer reviewed.