Treatment recommendations for chronic hepatitis B: An evaluation of current guidelines based on a natural history study in the United States
✍ Scribed by Myron John Tong; Carlos Hsien; Leeyen Hsu; Hai-En Sun; Lawrence Mitchell Blatt
- Publisher
- John Wiley and Sons
- Year
- 2008
- Tongue
- English
- Weight
- 177 KB
- Volume
- 48
- Category
- Article
- ISSN
- 0270-9139
No coin nor oath required. For personal study only.
✦ Synopsis
Current guidelines for treatment of chronic hepatitis B include hepatitis B e antigen (HBeAg) status, levels of hepatitis B virus (HBV) DNA, and serum alanine aminotransferase (ALT) values in the setting of either chronic hepatitis or cirrhosis. Based on findings from a prospective study of hepatitis B surface antigen (HBsAg)-positive patients, we determined whether these guidelines included patients who developed hepatocellular carcinoma (HCC) and who died of non-HCC liver-related complications. The criteria for treatment from four published guidelines were matched to a cohort of 369 HBsAg-positive patients enrolled in the study. During a mean follow-up of 84 months, 30 patients developed HCC and 37 died of non-HCC liver-related deaths. Using criteria for antiviral therapy as stated by the four guidelines, only 20%-60% of the patients who developed HCC, and 27%-70% of patients who died of non-HCC liver-related deaths would have been identified for antiviral therapy according to current treatment recommendations. If baseline serum albumin levels of 3.5 mg/dL or less or platelet counts of 130,000 mm 3 or less were added to criteria from the four treatment guidelines, then 89%-100% of patients who died of non-HCC liver-related complications, and 96%-100% of patients who developed HCC would have been identified for antiviral therapy. In addition, if basal core promoter T1762/A1764 mutants and precore A1896 mutants also were included, then 100% of patients who developed HCC would have been identified for treatment. Conclusion: This retrospective analysis showed that the current treatment guidelines for chronic hepatitis B excluded patients who developed serious liver-related complications. (HEPATOLOGY 2008;48:1070-1078.) I t is estimated that there are 1.25 million individuals who are chronically infected with the hepatitis B virus (HBV) in the United States. 1 Most of these are of Asian ancestry and were infected by HBV at birth or early in childhood and before immigration to the United States. The morbidity and mortality rates from this chronic viral infection are high, and it is estimated that 15% to 40% will either succumb to chronic liver disease complications or develop hepatocellular carcinoma (HCC) during their lifetime. 2 Therefore, to decrease the disease burden that may result from chronic hepatitis B infection, it is important to offer antiviral treatment before development of these liver-related complications.
At the present time, there are four published guidelines that specifically address the treatment of chronic hepatitis B patients. These include a consensus statement from the European Association for the Study of the Liver (EASL), 3 a treatment algorithm by an independent panel of hepatologists in the United States (US panel), 4 an Asian-Pacific consensus statement (Asian-Pacific panel), 5 and the practice guidelines from the American Association for the Study of Liver Diseases (AASLD). 6 These treatment guidelines are based mainly on data from published literature on the natural history of hepatitis B in Asian and European countries and on the personal experience of the authors of the guidelines. The criteria of the specific guidelines for treating chronic hepatitis B patients included baseline levels of serum alanine aminotransferase