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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2014, Vol. 8 Issue (2) : 145-157    https://doi.org/10.1007/s11684-014-0335-1
REVIEW
Current hepatitis B treatment guidelines and future research directions
Jonathan Skupsky, Ke-Qin Hu()
Division of Gastroenterology and Hepatology, University of California, Irvine, School of Medicine, Orange, CA 92868, USA
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Abstract

Hepatitis B virus (HBV) infection causes a tremendous clinical burden across the world with more than half a million people dying annually from HBV related disease. Significant advances have been made in HBV treatment in the past decade and several guidelines have been published by professional societies and expert panels. Although these recommendations have been valuable to help optimize HBV treatment, there is discordance in treatment criteria and many patients infected with HBV may fall outside of these recommendations. This paper systematically reviews the natural history of the disease and compares and contrasts the recommendations for initiation of treatment from the various societies. There is also discussion of special groups that require particular consideration and some of the open research questions and future research directions within the field.

Keywords chronic hepatitis B      HBV treatment guidelines      APASL guidelines      EASL guidelines      AASLD guidelines     
Corresponding Author(s): Ke-Qin Hu   
Issue Date: 21 May 2014
 Cite this article:   
Jonathan Skupsky,Ke-Qin Hu. Current hepatitis B treatment guidelines and future research directions[J]. Front. Med., 2014, 8(2): 145-157.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-014-0335-1
https://academic.hep.com.cn/fmd/EN/Y2014/V8/I2/145
Phase HBV-DNA ALT HBeAg HBsAg
Immune tolerant High Normal Present Present
Immune clearance Variable High Present (early) Absent (late) Present
Inactive carrier Low Normal Absent Present
Reactivation Variable Variable Absent Present
Resolution None Normal Absent Absent
Tab.1  Phases of chronic hepatitis B virus infection
Guideline HBeAg+ HBeAg-
HBV DNA (IU/ml) ALT (U/L) HBV DNA (IU/ml) ALT (U/L)
AASLD 2009 [27] >20 000 >2× ULN or
(+) biopsy
>20 000 or
>2000
≥2× ULN or
(+) biopsy
US Expert Panel 2008 [28] ≥20 000 >ULN or
(+) biopsy
≥2000 >ULN or
(+) biopsy
Asian-American Panel 2011 [26] >2000 >ULN >2000 >ULN
EASL 2012 [6] >2000 >ULN >2000 >ULN
APASL 2012 [13] ≥20 000 >2×ULN ≥2000 >2×ULN
Tab.2  Comparison of society and expert panel guidelines for initiation of treatment
AASLD American Association for the study of Liver Disease
ACLF acute-on-chronic liver failure
ALF acute liver failure
ALT alanine aminotransferase
APASL Asian Pacific Association for the Study of the Liver
anti-HBc antibodies to hepatitis B core antigen
anti-HBeAg antibodies to hepatitis B envelope antigen
anti-HBs antibodies to hepatitis B surface antigen
BCP basal core promoter
cccDNA covalently closed circular DNA
EASL European Association for the Study of the Liver
HBeAg hepatitis B envelope antigen
HBIG hepatitis B immunoglobulin
HBsAg hepatitis B surface antigen
HBV hepatitis B Virus
HCC hepatocellular carcinoma
HIV human immunodeficiency virus
IFN interferon-α2b
NA nucleot(s)ide analogues
PC pre-core
PEG-IFN pegylated interferon-α2a
ULN upper limit of normal
  
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