A Treatment Algorithm for the Management of Chronic Hepatitis B Virus Infection in the United States: 2008 Update

Keeffe, Emmet B.; Dieterich, Douglas T.; Han, Steven; Jacobson, Ira M.; Martin, Paul; Schiff, Eugene R.; Tobias, Hillel

doi:10.1016/j.cgh.2008.08.021

Cited by 451 publications

(520 citation statements)

References 166 publications

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“…On the basis of findings from natural history and randomized clinical trials, recent treatment guidelines developed by the Asian-Pacific Association for the Study of the Liver and a panel of experts from the United States recommend that treatment be stopped when HBeAg seroconversion with undetectable HBV-DNA level has been documented on two separate occasions for six or more months apart [15,16]. The importance of a 6-to 12-month period of consolidation therapy to reduce the risk of relapse after HBeAg seroconversion has been demonstrated in patients with HBeAg-positive CHB [66,67].…”

Section: Socioeconomic Impact Of Hbeag Seroconversion and The Abilitymentioning

confidence: 99%

“…Since highly sensitive HBV-DNA assays became available to measure HBV replication directly, rapid and durable suppression of HBV replication below the level of detection by polymerase chain reaction (PCR)-based assay has become the primary clinical goal for the treatment of CHB [15][16][17][18]. Studies have shown that profound and sustained suppression of HBV replication is a critical factor in achieving the goals of anti-HBV therapy, including improvement of liver histology and reduction in liver disease progression [4][5][6][7][19][20][21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

“…However, HBeAg seroconversion is still considered to be an important end point in the management of HBeAg-positive patients with CHB. Guidelines published by major liver associations, as well as other expert groups, recommend consideration of a finite period of oral therapy in HBeAg-positive patients who have undergone HBeAg seroconversion [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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HBeAg seroconversion as an important end point in the treatment of chronic hepatitis B

2009

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During the natural history of chronic hepatitis B virus (HBV) infection, the loss of serum hepatitis B e antigen (HBeAg) and the development of anti-HBe antibodies (HBeAg seroconversion) mark a transition from the immune-active phase of disease to the inactive carrier state. This review examines the evidence from natural history and cohort studies on the relationship between HBeAg seroconversion and disease progression. The role of HBeAg seroconversion as an important milestone in the management of HBeAg-positive patients with chronic hepatitis B (CHB), as well as the advantages and disadvantages of administering a finite course of therapy for HBeAg-positive CHB, is also discussed. The evidence from natural history and cohort studies indicates that spontaneous or treatment-induced HBeAg seroconversion is associated with lower rates of disease progression to cirrhosis and hepatocellular carcinoma, a potential of hepatitis B surface antigen seroconversion, and improved survival rates. Updated guidelines developed by major liver associations recommend stopping oral therapy for HBeAgpositive patients who achieve sustained HBeAg seroconversion with polymerase chain reaction-undetectable HBV-DNA on two separate occasions for 6 or more months apart, taking into consideration the individual's clinical and virologic response to therapy, as well as the severity of liver disease. Thus, early induction of HBeAg seroconversion with interferon-based therapy or oral nucleos(t)ide analogues has important clinical and socioeconomic implications for the management of CHB.

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Section: Socioeconomic Impact Of Hbeag Seroconversion and The Abilitymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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HBeAg seroconversion as an important end point in the treatment of chronic hepatitis B

2009

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“…However, emerging data from several observational studies suggest that up to one-third of patients with normal or mildly elevated ALT levels have histologic evidence of significant fibrosis or inflammation [7][8][9]. Hence, a liver biopsy should be considered in patients with HBV replication and ALT \ 2 9 UNL, especially if older than 35-40 years of age, to differentiate a subgroup of patients with more active inflammation or fibrosis, for whom therapy is indicated from people in immune-tolerant phase [6,10]. Considering the recently published 2008 APASL Consensus Guidelines that recommend treating a group of patients with high viral load and advanced fibrosis or cirrhosis, regardless of their ALT levels, the search for a predictive model to identify patients at a heightened risk for advanced fibrosis is well justified.…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of a Model to Predict Advanced Fibrosis in Chronic Hepatitis B Virus-Infected Patients with High Viral Load and Normal or Minimally Raised ALT

Park

Kim

et al. 2010

Dig Dis Sci

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Background/Aims Treating a group of chronic hepatitis B virus (HBV)-infected patients with high viral load and advanced fibrosis or cirrhosis, regardless of their serum alanine aminotransferase (ALT) levels, is recommended. The aim of this study was to derive and validate a model to predict advanced fibrosis in a cohort of patients with viral replication and normal or minimally raised ALT [ALT \ 2 9 upper normal limit (UNL)]. Methods Information was collected from 124 patients who underwent liver biopsy. The diagnostic value of predictors was judged using multivariate logistic modeling and area under the receiver operating characteristic curves (ROC area). Results Advanced fibrosis (F3 or F4 on METAVIR scoring schema) was diagnosed in 45.7% (95% CI, 34-57.4%) of the patients of the derivation set (70 patients) and in 37% (95% CI, 24.2-49.9%) of the validation set (54 patients). In the derivation set, age and aspartate aminotransferase (AST) were independent clinical predictors of advanced fibrosis. The ROC areas of this Age-AST model were 0.8 (95% CI, 0.7-0.9) in the derivation set and 0.82 (95% CI, 0.71-0.93) in the validation set, respectively. Without missing a single case, this model identified 11 patients (20%) without advanced fibrosis in the validation set. Conclusions A substantial proportion of patients with high viral load and ALT \ 2 9 UNL have advanced fibrosis. A simple model including age and AST is an easily applicable tool for physicians to guide their decisions on whether or not to perform liver biopsy in individual patients.

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“…It has been shown that the initial clinical benefit of NA therapy is lost among patients who develop NA resistance [5]. The emergence of NA-resistant mutations may lead subsequently to a loss of histologic improvement and, in some cases, severe exacerbations of liver diseases [6,7].…”

Section: Introductionmentioning

confidence: 99%

Patterns of managing chronic hepatitis B treatment-related drug resistance: a survey of physicians in Mainland China, South Korea, Taiwan, and Thailand

et al. 2009

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Purpose The emergence of antiviral resistance can negate the benefits of antiviral therapy in patients with chronic hepatitis B (CHB). This study aimed to assess how physicians in Asia manage suspected antiviral resistance. Methods Randomly selected CHB-treating physicians in Mainland China, South Korea, Taiwan, and Thailand underwent a face-to-face interview. A standardized questionnaire was used to assess how physicians identify, monitor, and manage suspected resistance and its associated medical costs. Results We interviewed 575 physicians from January to May 2008. Most physicians preferred a ''prevention-of-antiviral resistance'' strategy over a ''rescue-once-resistancedevelops'' strategy. Physicians had encountered lamivudine resistance most frequently (96-100% of respondents), Authors contributed equally to the conception and preparation of the manuscript and are listed alphabetically by their last names.

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A Treatment Algorithm for the Management of Chronic Hepatitis B Virus Infection in the United States: 2008 Update

Cited by 451 publications

References 166 publications

HBeAg seroconversion as an important end point in the treatment of chronic hepatitis B

HBeAg seroconversion as an important end point in the treatment of chronic hepatitis B

Development and Validation of a Model to Predict Advanced Fibrosis in Chronic Hepatitis B Virus-Infected Patients with High Viral Load and Normal or Minimally Raised ALT

Patterns of managing chronic hepatitis B treatment-related drug resistance: a survey of physicians in Mainland China, South Korea, Taiwan, and Thailand

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