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

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

doi:10.1016/j.cgh.2006.05.016

Cited by 340 publications

(339 citation statements)

References 142 publications

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“…The APASL working party also raised unresolved issues for further studies, including the role of combination therapy or other immunomodulatory agents. In addition, the updated treatment algorithm for the management of chronic hepatitis B virus infection developed by a US expert panel and the 2007 update of the American Association of the Study of Liver Disease (AASLD) guidelines for chronic hepatitis B recommend that treatment may be initiated with any of the six approved agents, but pegylated interferon, adefovir dipivoxil, or entecavir are preferred for HBeAg-positive or HBeAg-negative chronic hepatitis B patients [94,95].…”

Section: Current Therapy Of Chronic Hepatitis Bmentioning

confidence: 99%

“…Therefore, this would suggest that the primary aim of hepatitis B treatment is to reduce and maintain serum HBV DNA at the lowest possible level. Profound and sustained viral suppression may also lead to other aims of therapy, such as biochemical normalization, HBeAg seroconversion, histologic improvement, and reduced drug resistance [93][94][95].…”

Section: Hbv Factors and Therapy Of Chronic Hepatitismentioning

confidence: 99%

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Role of viral factors in the natural course and therapy of chronic hepatitis B

Kao

2007

Hepatol Int

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Hepatitis B virus (HBV) infection is a global health problem that causes a wide spectrum of liver disease, including acute or fulminant hepatitis, inactive carrier state, chronic hepatitis, cirrhosis, and hepatocellular carcinoma (HCC). The pathogenesis of hepatocyte damage associated with HBV is mainly through immune-mediated mechanisms. On the basis of the virus and host interactions, the natural history of HBV carriers who are infected in early life can be divided into four dynamic phases. The frequency, extent, and severity of hepatitis flares or acute exacerbation in the second immune clearance and/or fourth reactivation phase predict liver disease progression in HBV carriers. In the past decade, hepatitis B viral factors including serum HBV DNA level, genotype, and naturally occurring mutants predictive of clinical outcomes have been identified. The higher the serum HBV DNA level after the immune clearance phase, the higher the incidence of adverse outcomes over time. In addition, high viral load, genotype C, basal core promoter mutation, and pre-S deletion correlate with increased risk of cirrhosis and HCC development. As to the treatment of chronic hepatitis B, patients with high HBV DNA level and genotype C or D infection are shown to have a worse response to interferon therapy. In conclusion, serum HBV DNA level, genotype, and naturally occurring mutants are identified to influence liver disease progression and therapy of chronic hepatitis B. More investigations are needed to clarify the molecular mechanisms of the viral factors involved in the pathogenesis of each stage of liver disease and the response to antiviral treatments.

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Section: Current Therapy Of Chronic Hepatitis Bmentioning

confidence: 99%

Section: Hbv Factors and Therapy Of Chronic Hepatitismentioning

confidence: 99%

Role of viral factors in the natural course and therapy of chronic hepatitis B

Kao

2007

Hepatol Int

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“…Many initial studies had shown that among patients with CHBV infection with normal ALT, about 50-90% of patients had either minimal changes or chronic persistent hepatitis on biopsy [17][18][19][20]. Recently, however, studies have described contrary findings also [21][22][23][24].…”

Section: Fallacies Of Alt Levels For Prediction Of Liver Injury and Tmentioning

confidence: 99%

Should chronic HBV infected patients with normal ALT treated: debate

Sarin

Kumar

2008

Hepatol Int

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Alanine aminotransferase (ALT) levels have traditionally been used for treatment decisions in chronic hepatitis B virus (CHBV) infected patients. But recent data have raised doubts on this wisdom, as a significant proportion of CHBV infected patients with normal ALT have high HBVDNA levels and significant liver injury at presentation especially in areas of intermediate to high endemicity. A normal ALT value only identifies patients less likely to respond to current treatments, rather than patients who are not in need of the treatment. Patients with CHBV infection with normal ALT should be considered for treatment based on the HBV DNA levels and histological injury.

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“…ETV displays several properties for consideration as the first-line nucleoside analogue because of its potent antiviral activity and a lower frequency of drug resistance than LVD, ADV, or telbivudine [13]. Although ETV is effective in LVD-refractory patients, the potency is reduced somewhat and the barrier to resistance is diminished by the presence of rtM204I/V and rtL180M substitutions.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, emergence of ETV resistance (ETVr) or viral rebound was shown in these studies to be rare. From these results, recent treatment guidelines have recommended ETV as the first-line nucleoside analogue for nucleoside-naive CHB patients, including those with cirrhosis [12,13].…”

Section: Introductionmentioning

confidence: 99%