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AASLD Guideline-2016, for treatment of chronic Hepatitis B


AASLD Guideline-2016, for treatment of chronic Hepatitis B

People who test positive for the hepatitis B virus (HBsAg) for more than six months are diagnosed as having a chronic infection. This means they were not able to get rid of the virus and it still remains in their liver and blood. Since chronically infected individuals can pass the virus on, they should follow safe sex practices and avoid spreading their blood to others. Sex partners and close family/household members should be screened and vaccinated.Being diagnosed as having hepatitis B can be upsetting,but the good news is that most people with chronic hepatitis B should expect to live a long and healthy life. Although there is an increased risk for developing serious liver disease later in life, there are also several treatments available that can slow down the virus.The risk of developing a chronic hepatitis B infection is directly related to the age at which one becomes infected with the virus:

  • 90% of infants exposed to the hepatitis B virus will develop chronic hepatitis B infections
  • Up to 50% of young children exposed to the hepatitis B virus between the ages of 1 and 5 years will develop chronic infections
  • 5 – 10% of healthy adults who are infected will develop chronic infection

The American Association for the Study of Liver Diseases (AASLD)  published its Chronic Hepatitis B guideline in January, 2016.Following are the major recommendations of the guideline:

Treatment of Persons with Immune-Active Chronic Hepatitis B (CHB)

The American Association for the Study of Liver Diseases (AASLD) recommends antiviral therapy for adults with immune-active CHB (hepatitis B e antigen [HBeAg] negative or HBeAg positive) to decrease the risk of liver-related complications. (Quality/Certainty of Evidence: Moderate, Strength of Recommendation: Strong)

The AASLD recommends pegylated interferon (Peg-IFN), entecavir, or tenofovir as preferred initial therapy for adults with immune-active CHB. (Quality/Certainty of Evidence: Low, Strength of Recommendation: Strong)

Treatment of Adults with Immune-Tolerant CHB

The AASLD recommends against antiviral therapy for adults with immune-tolerant CHB. (Quality/Certainty of Evidence: Moderate, Strength of Recommendation: Strong)

The AASLD suggests that alanine aminotransferase (ALT) levels be tested at least every 6 months for adults with immune-tolerant CHB to monitor for potential transition to immune-active or -inactive CHB. (Quality/Certainty of Evidence: Very low, Strength of Recommendation: Conditional)

The AASLD suggests antiviral therapy in the select group of adults >40 years of age with normal ALT and elevated hepatitis B virus deoxyribonucleic acid (HBV DNA) (≥1,000,000 IU/mL) and liver biopsy showing significant necroinflammation or fibrosis. (Quality/Certainty of Evidence: Very low, Strength of Recommendation: Conditional)

Treatment of HBeAg Positive Immune-Active Chronic Hepatitis Persons Who Seroconvert to Anti-HBe on Nucleos(t)ide Analog (NA) Therapy

The AASLD suggests that HBeAg-positive adults without cirrhosis with CHB who seroconvert to anti-HBe on therapy discontinue NAs after a period of treatment consolidation. (Quality/Certainty of Evidence: Very Low, Strength of Recommendation: Conditional)

The AASLD suggests indefinite antiviral therapy for HBeAg-positive adults with cirrhosis with CHB who seroconvert to anti-HBe on NA therapy, based on concerns for potential clinical decompensation and death, unless there is a strong competing rationale for treatment discontinuation. (Quality/Certainty of Evidence: Very Low, Strength of Recommendation: Conditional)

Duration of Treatment in Persons with HBeAg-Negative Immune-Active CHB

The AASLD suggests indefinite antiviral therapy for adults with HBeAg-negative immune-active CHB unless there is a competing rationale for treatment discontinuation. (Quality/Certainty of Evidence: Low, Strength of Recommendation: Conditional)

Renal and Bone Disease in Persons on NA Therapy

The AASLD suggests no preference between entecavir and tenofovir regarding potential long-term risks of renal and bone complications. (Quality/Certainty of Evidence: Very Low (bone); Low (renal), Strength of Recommendation: Conditional)

Management of Persons with Persistent Low-Level Viremia on NA Therapy

The AASLD suggests that persons with persistent low level viremia (<2,000 IU/mL) on entecavir or tenofovir monotherapy continue monotherapy, regardless of ALT. (Quality/Certainty of Evidence: Very Low, Strength of Recommendation: Conditional)

The AASLD suggests one of two strategies in persons with virological breakthrough on entecavir or tenofovir monotherapy: either switch to another antiviral monotherapy with high barrier to resistance or add a second antiviral drug that lacks cross-resistance. (Quality/Certainty of Evidence: Very Low, Strength of Recommendation: Conditional)

Management of Adults with Cirrhosis and Low-Level Viremia

The AASLD suggests that adults with compensated cirrhosis and low levels of viremia (<2,000 IU/ mL) be treated with antiviral therapy to reduce the risk of decompensation, regardless of ALT level. (Quality/Certainty of Evidence: Very Low, Strength of Recommendation: Conditional)

The AASLD recommends that hepatitis B surface antigen (HBsAg)-positive adults with decompensated cirrhosis be treated with antiviral therapy indefinitely regardless of HBV DNA level, HBeAg status, or ALT level to decrease risk of worsening liver-related complications. (Quality/Certainty of Evidence: Moderate, Strength of Recommendation: Strong)

Treatment of CHB in Pregnancy

The AASLD suggests antiviral therapy to reduce the risk of perinatal transmission of hepatitis B in HBsAg-positive pregnant women with an HBV DNA level >200,000 IU/mL. (Quality/Certainty of Evidence: Low, Strength of Recommendation: Conditional)

The AASLD recommends against the use of antiviral therapy to reduce the risk of perinatal transmission of hepatitis B in the HBsAg-positive pregnant woman with an HBV DNA ≤200,000 IU/mL. (Quality/Certainty of Evidence: Low, Strength of Recommendation: Strong)

Treatment of CHB in Children

The AASLD suggests antiviral therapy in HBeAg-positive children (ages 2 to <18 years) with both elevated ALT and measurable HBV DNA levels, with the goal of achieving sustained HBeAg seroconversion. (Quality/Certainty of Evidence: Moderate, Strength of Recommendation: Conditional)

The AASLD recommends against use of antiviral therapy in HBeAg-positive children (ages 2 to <18 years) with persistently normal ALT, regardless of HBV DNA level. (Quality/Certainty of Evidence: Very Low, Strength of Recommendation: Strong)

To read the full guideline click on the follwing link:

http://onlinelibrary.wiley.com/doi/10.1002/hep.28156/full

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Geeta Sharma

Geeta Sharma

Studied at Carmel Convent School headed the sports wing of the school, was the General Secretary Miranda House Students/ Union,, Did journalism at Patriot and Eenadu/Newstime. worked as teacher warden in schools of Mussoorie/ Dehradun/ Noida
Source: self

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