INASL Position Statements on Prevention, Diagnosis and Management of Hepatitis B Virus Infection in India: The Andaman Statements

Abstract

Hepatitis B Virus (HBV) infection is one of the major causes of morbidity, mortality and healthcare expenditure in India. There are no Indian consensus guidelines on prevention, diagnosis and management of HBV infection. The Indian National Association for Study of the Liver (INASL) set up a taskforce on HBV in 2016, with a mandate to develop consensus guidelines for diagnosis and management of HBV infection, relevant to disease patterns and clinical practices in India. The taskforce first identified contentious issues on various aspects of HBV management, which were allotted to individual members of the taskforce who reviewed them in detail. A 2-day round table discussion was held on 11th and 12th February 2017 at Port Blair, Andaman & Nicobar Islands, to discuss, debate, and finalize the consensus statements. The members of the taskforce reviewed and discussed the existing literature threadbare at this meeting and formulated the 'INASL position statements' on each of the issues. The evidence and recommendations in these guidelines have been graded according to the Grading of Recommendations Assessment Development and Evaluation (GRADE) system with minor modifications. The strength of recommendations (strong: 1, weak: 2) thus reflects the quality (grade) of underlying evidence (A, B, C, D). We present here the INASL position statements on prevention, diagnosis and management of HBV in India.

INASL Guidelines on Management of Hepatitis B Virus Infection in Patients receiving Chemotherapy, Biologicals, Immunosupressants, or Corticosteroids

“…Serial monitoring of HBeAg, HBV DNA and ALT levels is required in most instances to establish the phase of infection; despite which, some subjects fall into an indeterminate grey area and management needs to be individualized. 1,8 Recently EASL has suggested a change in nomenclature of these phases as follows: HBeAg positive chronic infection, HBeAg positive chronic hepatitis, HBeAg negative chronic infection, HBeAg negative chronic hepatitis, and HBsAg negative chronic infection, respectively. 3 Since, the new nomenclature is easy to understand and simpler to use in dichotomizing infected individuals into those with infection (no liver inflammation or damage) and those with hepatitis (with liver inflammation and/ or damage) it should be used widely.…”

“…INASL has endorsed this new nomenclature for use in India. 1 A summary of features of all the five phases along with the new nomenclature is given in Table 2.…”

“…In India prevalence rate of overt HBV infection (HBsAg positive) is 1-5%, 1,2,48 while the reported incidence of anti-HBc positivity among healthy blood donors ranges from 17% to 29% suggesting past exposure to HBV. The prevalence of HBV infection in patients suffering with cancer is higher as compared to general population.…”

“…In 2017 the taskforce had published the first INASL guidelines on management of HBV infection in India. 1 In the present guidelines, which are in continuation with the previous guidelines, the issues on management of HBV infection in patients receiving chemotherapy, biologicals, immunosupressants, or steroids are addressed. The last section also discusses the management of HBV infection in Chronic Kidney Disease (CKD) patients.…”

“…( J CLIN EXP HEPATOL 2018;8:403-431) C hronic Hepatitis B Virus (HBV) infection is one of the significant causes of liver related morbidity and mortality. 1 A recently published pooled analysis estimated that in 2010, globally, about 248 million individuals were Hepatitis B Surface Antigen (HBsAg) positive with a large regional variation. 2 Despite the use of antivirals and vaccines, new HBV infection still remains a problem.…”