Management of Chronic Hepatitis B: Consensus Guidelines

Abstract

The present document presents the proceedings of the consensus development conference on the management of viral hepatitis held in January 2007 under the auspices of the Canadian Association for the Study of the Liver and the Association of Medical Microbiology and Infectious Disease Canada. Several new agents have become available since the last such document was published in 2004, and new information has become available to help assess risk of adverse outcomes and who should be treated. In addition, the participants at the meeting identified a number of structural barriers that exist uniquely in Canada and that prevent physicians from properly managing their patients. The conference discussed the selection of patients for treatment and the drugs that can be used to treat these patients, as well as the treatment of hepatitis B in special populations. The present document should be read in conjunction with the companion document on the management of chronic hepatitis C.

Canadian Trends in Liver Cancer: A Brief Clinical and Epidemiologic Overview

“…Similar national strategies have not been implemented in Canada, but other options have been recommended, including catch-up hbv immunization for adolescents, screening for hbv in adults and children immigrating from at-risk regions, and prompt screening and treatment of household contacts of liver cancer patients 26,27 . Those efforts could be complemented with efforts to reduce stigma and to raise awareness in at-risk populations about chronic hbv and hcv infection.…”

Screening for Hepatitis B Surface Antigen before Chemotherapy: Current Practice and Opportunities for Improvement

“…Screening patients before the initiation of immunosuppressive treatment is therefore important so that prophylaxis can be commenced to prevent hbv reactivation. Guidelines published by the U.S. Centers for Disease Control and Prevention recommend that all patients about to receive chemotherapy for malignant disease be tested for hbsag before cancer treatment is initiated 13,14 . In Canada, consensus guidelines from the Canadian Association for the Study of the Liver and the Association of Medical Microbiology and Infectious…”

Lower baseline ALT cut-off values and HBV DNA levels better differentiate HBeAg(-) chronic hepatitis B patients from inactive chronic carriers

“…In the natural history of chronic hepatitis B virus (HBV) infection, sero-conversion from HBeAg(+) to HBeAg(-) and anti-HBe antibody (+) leads to low HBV replication and to normalization of aminotransferases [1] . Such changes have long been considered a reliable clinical indicator of passage to an inactive and innocent state of chronic hepatitis B [1] .…”

“…Such changes have long been considered a reliable clinical indicator of passage to an inactive and innocent state of chronic hepatitis B [1] . However, 2 clinical forms of HBeAg(-) chronic hepatitis B exist after sero-conversion.…”