SASLT practice guidelines for the management of hepatitis B virus

Abaalkhail, Faisal; Elsiesy, Hussien; Al-Omair, Ameen; Alghamdi, Mohammed; Alalwan, Abduljaleel; AlMasri, Nasser; Al–Hamoudi, Waleed

doi:10.4103/1319-3767.126311

Cited by 27 publications

(21 citation statements)

References 120 publications

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“…As of October 2007, all people age 24 years or younger (~60% of the population 28 ) had been vaccinated 228 , and vaccination coverage is now close to 100%;. The vaccination programs were coupled with strict national blood safety and healthcare infection control policies, including mandatory testing for HBV, HCV, and HIV as part of a compulsory premarital screening program, as well as recommended screening for HBsAg among pregnant women 229 , resulting in almost complete blood safety. As a result, the prevalence of HBV in Saudi Arabia has dropped substantially over the last two decades, with the virtual elimination of HBsAg among vaccinated children aged 1-12 years 230,231 .…”

Section: Success Stories and Ongoing Challenges [H3]mentioning

confidence: 99%

Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission

Cooke

Andrieux-Meyer

Applegate

et al. 2019

The Lancet Gastroenterology & Hepatology

445

391

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investments to support countries with greatest burden of viral hepatitis All heavily burdened countries to have fully funded elimination plans by 2019 Recognition of need to focus on high burden countries and support for national policy development (All) Funding for national elimination plans Creation of fiscal space for new programmes with costed investment programmes Adopt domestic innovative finance tools where appropriate Support national policy makers in their activity (WHO, UNITAID, NGOs) Provide international support for financing measures (UNITAID, GFATM, bilaterial donors) Prevention Ensure all WHO elimination targets addressed in plans Address operational challenges in delivery of birth dose HBV vaccine Ensure provision of harm reduction services and engage with marginalised group (e.g. prisoners, PWIDs). Ensure clear public health messages to encourage testing and treatment Support countries to decriminalise injecting drug use and ensure equitable access to services for all (NGOs, WHO, civil society) Ensure appropriate funding for HBV vaccine, including birth dose (GAVI, WHO) Support R&D into HCV vaccine development (Research funders and pharma) Testing and Models of Care Focus on substantially scaling up testing for HBV and HCV Create and evaluate simplified care pathways relevant to local setting, integrating with existing services. Promote task sharing and decentralisation of care through capacity building, training and removal of Support operational research into simplified pathways (Research funders, UNITAID) requirements for specialised prescribing Diagnostics Ensure testing is integrated into the wider healthcare system, rather than centralised facilties Ensure access to quality diagnostics through Essential Diagnostic List and prequalification (WHO, funders) Support implementation science for models of care and R&D into novel diagnostics suitable for decentralised settings. (Research funders, FIND, industry) Access to treatment Ensure all Essential Medicines for viral hepatitis are included in national programmes, with an emphasis on pan-genotypic regimens Apply comprehensive policy approach to promoting access, including compulsory licensing Ensure all essential medicines are pre-qualified and either available through voluntary licensing or Medicines Patent Pool (WHO, NGOs, civil society, funders) Support shared procurement mechanisms for treatment (PAHO) Monitor Progress National plans need clearly defined, measurable objectives Develop new indices of national progress Progress of individual countries needs to be closely monitored towards elimination goals (Polaris, WHO, Creation of Elimination Index) Develop greater capacity for advocacy in high burden regions (all) Viral hepatitis is one of the leading causes of death in the world. 96% of those deaths are due to hepatitis B and C, which are the focus of this commission. Unlike many other major diseases, the tools exist to eliminate viral hepatitis. A highly effective vaccine is available to prevent hepatitis B, and a revolution in HCV treat...

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Section: Success Stories and Ongoing Challenges [H3]mentioning

confidence: 99%

Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission

Cooke

Andrieux-Meyer

Applegate

et al. 2019

The Lancet Gastroenterology & Hepatology

445

391

View full text Add to dashboard Cite

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“…Treatment is strongly recommended in patients with significant fibrosis (for instance, METAVIR score F2–4). In the absence of liver biopsy, treatment decisions are based on the surrogate markers of histological disease, namely, elevated alanine aminotransferase (ALT) and high HBV DNA levels [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

Diminished accuracy of biomarkers of fibrosis in low replicative chronic hepatitis B

et al. 2017

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BackgroundWe evaluated the diagnostic accuracy of aspartate aminotransferase (AST)-to-platelet ratio index (APRI), fibrosis-4 index (FIB-4), AST/alanine aminotransferase (ALT) ratio (AAR), and age-platelet index (API) for significant fibrosis (Metavir F2–4) in low-replicative (HBV DNA <20,000 IU/mL) chronic hepatitis B virus (HBV) patients.MethodsThe sensitivity, specificity, and area under the receiver-operating characteristic curve (AUROC) of HBeAg-negative, low-replicative (n = 213) and high-replicative (HBV DNA ≥20,000 IU/mL, n = 153) patients was assessed.ResultsOverall, 113 patients (30.9%) had F2–4 fibrosis. Of the low and high-replicative patients, 40 (18.8%) and 73 (47.7%) had F2–4, respectively (P < 0.0001). APRI ≥0.5 less frequently identified F2–4 fibrosis in low vs. high-replicative patients (48.7% vs. 69.6%, P = 0.032) and AAR identified it more frequently in low-replicative patients (37.5% vs. 19.4%, P = 0.037). FIB-4 and API were not different (P > 0.05) for identifying F2–4 fibrosis in low and high-replicative patients. Higher specificities were seen at the lowest cut-offs in low vs. high-replicative states for APRI (≥0.5, 98% vs. 68.9%), AAR (84.3% vs. 76.6%), FIB-4 (≥1.45, 97.5% vs. 87.8%) and API (>4, 94.8% vs. 93.8%). At ROC-defined thresholds, APRI (≥0.33), AAR (≥0.93), FIB-4 (≥0.70) and API (>2) showed greater AUROCs for F2–4 diagnosis in low replicative (0.80, 0.62, 0.81 and 0.71, respectively) vs. high-replicative patients (0.73, 0.52, 0.67 and 0.69, respectively).ConclusionAll 4 biomarkers in both, low and high-replicative HBV demonstrate modest accuracy for fibrosis diagnosis at conventional cut-offs. Lowering the cut-offs may increase the diagnostic relevance of these biomarkers, particularly for APRI and FIB-4 in low-replicative disease.Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-017-0658-x) contains supplementary material, which is available to authorized users.

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“…[ 6 ] Undetectable HBV DNA, alanine aminotransferase (ALT) normalization, hepatitis Be antigen (HBeAg) loss or seroconversion, and histologic improvement are used to estimate the response of treatment in clinical practice. [ 6 7 ]…”

mentioning

confidence: 99%

Virologic response and safety of tenofovir versus entecavir in treatment-naïve chronic Hepatitis B patients

Kwon

Kim

et al. 2015

Saudi J Gastroenterol

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Background/Aims:This study aimed to evaluate the antiviral response and safety of tenofovir (TDF) versus entecavir (ETV) in treatment-naïve CHB patients.Patients and Methods:We performed a retrospective cohort study of treatment-naive CHB patients who were treated with TDF or ETV. We analyzed virologic, biochemical, and serologic responses at 3, 6, and 12 months.Results:A total of 107 patients (TDF group = 49, ETV group = 58) were included. Baseline characteristics were similar between the two groups. The estimated proportion of complete virologic response (CVR) in the TDF or ETV group was 44.9% versus 39.7% at 6 months and 89.6% versus 83.2% at 12 months, respectively (P = 0.991). Viral breakthrough was not observed in both groups. One patient in the TDF group and two patients in the ETV group experienced HBeAg loss, respectively (P = 0.657). High HBV DNA level at baseline was a significant negative predictor of virologic response by Cox regression analysis (P = 0.007). The safety profile was similar between the two groups. There was no case with serious adverse event.Conclusions:Both TDF and ETV were effective in achieving CVR and had a favorable safety profile in treatment-naïve CHB patients. High viral load at baseline was a negative predictive factor of CVR.

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SASLT practice guidelines for the management of hepatitis B virus

Cited by 27 publications

References 120 publications

Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission

Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission

Diminished accuracy of biomarkers of fibrosis in low replicative chronic hepatitis B

Virologic response and safety of tenofovir versus entecavir in treatment-naïve chronic Hepatitis B patients

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