Diagnosis, management and treatment of hepatitis B virus infection: Turkey 2017 Clinical Practice Guidelines

Tabak, Fehmı; Yurdaydın, Cihan; Kaymakoğlu, Sabahattin; Akarsu, Mesut; Akinci, Esra G.; Akkız, Hikmet; Alkım, Canan; Cekin, Ayhan H.; Cuvalci, Nefise O.; Demır, Kadir; Değertekın, Bülent; Dökmetaş, İlyas; Ersöz, Galip; Hızel, Kenan; Kandemir, Fatma O.; Önlen, Yüsüf; Sonsuz, Abdullah; Şenateş, Ebubekir; Tosun, Selma; Tözün, Nurdan; İdilman, Ramazan; Group, Viral Hepatitis Guidelines Study

doi:10.5152/tjg.2017.19

Cited by 13 publications

(11 citation statements)

References 26 publications

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“…In developing countries like Turkey, non-invasive tests like fibroscan are too expensive and still lack of availability countrywide. In 2017, Turkish practical guidelines about diagnosis, management and treatment of HBV infection, treatment is recommended for HBeAg positive patients older than 30-years-old with normal ALT and high HBV-DNA levels 12. However, there is not a clear-cut recommendation to perform liver biopsy before 30-years-old.…”

Section: Discussionmentioning

confidence: 99%

Are there optimal alanine aminotransferase and HBV DNA thresholds for discriminating HBeAg-positive chronic infection from chronic hepatitis?

Yeni̇lmez¹,

Çeti̇nkaya²

2019

SMJ

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Objectives: To define the importance of biochemical and virological thresholds for the prediction of significant liver diseases. Methods: A total of 215 young and male HBeAg-positive cases followed up in a tertiary training and research hospital in Turkey between 2008 and 2017 enrolled in the retrospective diagnostic accuracy study. Results: Fibrosis scores varied between 0-4, F1 (n=81, 37.6%) and F2 (n=82, 38.1%) were the most frequent fibrosis stages. Of the patients, 58.6% (126/215) had a significant histopathological abnormality (SHA). The ratio of SHA was higher for ALT >90 U/L (n=68/95; 71.6%) and HBV-DNA between 2,000,000-200,000,000 IU/mL (n=47/73; 64.4%). Thresholds for the higher odds ratio (OR) for SHA were >90 U/L for alanine aminotransferase (ALT) and >2,000,000 IU/mL for HBV-DNA. Based on receiver operating characteristic analysis, 90.5 U/L of ALT and 22,607,500 IU/mL of HBV-DNA were levels with the optimum sensitivity and specificity for the prediction of SHA. Conclusion: Hepatitis B virus-DNA levels between 10 6 and 10 8 IU/mL and ALT levels of 2~3 x ULN might be considered to be good indicators for discriminating chronic hepatitis phase from chronic infection in hepatitis B e-antigen-positive chronic hepatitis. However, we think that the current biochemical, serological and molecular markers are inadequate for differentiating chronic hepatitis phase than chronic infection, and non-invasive test and/or liver histopathology should be carried out in selected cases.

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Section: Discussionmentioning

confidence: 99%

Are there optimal alanine aminotransferase and HBV DNA thresholds for discriminating HBeAg-positive chronic infection from chronic hepatitis?

Yeni̇lmez¹,

Çeti̇nkaya²

2019

SMJ

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“…22,23 The practice of finite NA therapy in patients with HBeAg-negative hepatitis B is highly debated with conflicting recommendations found in international and local guidelines (Table 2). [9][10][11][24][25][26][27][28][29][30] Such contradictory recommendations highlight the limitations of current knowledge on this issue. Central to the controversy is the concern about patient safety and most concerning is the risk of acute-on-chronic liver failure (ACLF), which is potentially fatal.…”

Section: Introductionmentioning

confidence: 99%

Safety considerations for withdrawal of nucleos(t)ide analogues in patients with chronic hepatitis B: First, do no harm

Hsu¹,

Tseng²,

Kao³

2023

Clin Mol Hepatol

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Nucleos(t)ide analogues (NA) are widely used to treat hepatitis B virus (HBV) infection, but they cannot eradicate the virus and treatment duration can be lifelong if the endpoint is set at seroclearance of the hepatitis B surface antigen (HBsAg). As an alternative strategy, finite NA therapy without the prerequisite of HBsAg seroclearance has been proposed to allow treatment cessation in patients with sustained undetectable HBV viremia for two to three years. However, reactivation of viral replication almost always follows NA withdrawal. Whereas HBV reactivation might facilitate HBsAg seroclearance in some, it could lead to serious acute flare-ups in a certain proportion of patients. Occurrence and consequences of NA withdrawal flares are complicated with various factors involving the virus, host, and treatment. Accurate risk prediction for severe flares following NA cessation is essential to ensure patient safety. The risks of life-threatening flares in patients who discontinued NA according to the stopping rules of current guidelines or local reimbursement policies have recently been quantitatively estimated in large-scale studies, which also provided empirical evidence to help identify vulnerable patients at risk of devastating outcomes. Moreover, risk predictors were further explored and validated to hopefully aid in patient selection and management. In this narrative review with a focus on patient safety, we summarize and discuss current literature on the incidence of severe flares following NA cessation, risk stratification 4 for candidate selection, rules of posttreatment monitoring, and indications for treatment resumption. We also share our thoughts on the limitations of existing knowledge and suggestions for future research.

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“…In Turkey, chronic HBV and HCV infections are still the most common causes of CLD and cirrhosis [16-18]. However, there are changing trends in the etiology of cirrhosis by underlying causes in Turkey.…”

Section: Introductionmentioning

confidence: 99%

Natural History of Cirrhosis: Changing Trends in Etiology Over the Years

İdilman

Aydoğan

Oruncu

et al. 2020

Dig Dis

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Background and goals: The aims of the present study were to investigate the natural history of cirrhosis and to determine trends in the etiology of cirrhosis. Methods: Between January 2001 and January 2018, a total of 1341 patients had been diagnosed with cirrhosis were included. Results: A total of 898 cirrhotic patients, who were followed for at least six months were included into the analysis. The median age was 54 years. The median Child-Pugh and MELD scores were 7.5 and 11, respectively. Ascites (51%) was the most common causes of decompensation. Chronic viral hepatitis was the most frequent cause of cirrhosis (58%). Hepatitis B virus (HBV) infection was the main etiology (34%), followed by hepatitis C virus (HCV) infection (18%). Among 129 patients with cryptogenic cirrhosis (CC), 60 had metabolic abnormalities. If these 60 patients with CC were considered to have non-alcoholic fatty liver disease (NAFLD)-related cirrhosis, the proportion of NAFLD-related cirrhosis increased from 1.8% to 8.0%. At admission, 74 patients (8%) had been diagnosed with hepatocellular carcinoma (HCC). A new HCC developed in 80 patients during the follow-up period. The probability of developing HCC was 3.9% at 12 months. Logistic regression analysis showed that the development of HCC was significantly associated with older age (p<0.001), male gender (p<0.001), viral etiology (p=0.026) and baseline high aspartate aminotransferase level (p=0.01). Overall, 104 cirrhotic patients died. In conclusion: HBV and HCV remain the leading causes of etiology in cirrhosis and HCC. However, NAFLD-related cirrhosis is recognized is recognized as a growing burden.

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Diagnosis, management and treatment of hepatitis B virus infection: Turkey 2017 Clinical Practice Guidelines

Cited by 13 publications

References 26 publications

Are there optimal alanine aminotransferase and HBV DNA thresholds for discriminating HBeAg-positive chronic infection from chronic hepatitis?

Are there optimal alanine aminotransferase and HBV DNA thresholds for discriminating HBeAg-positive chronic infection from chronic hepatitis?

Safety considerations for withdrawal of nucleos(t)ide analogues in patients with chronic hepatitis B: First, do no harm

Natural History of Cirrhosis: Changing Trends in Etiology Over the Years

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