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      KASL Clinical Practice Guidelines: Management of chronic hepatitis B.

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      Publication date:
      Journal: Clinical and molecular hepatology
      Keywords: Acute Disease, Adolescent, Adult, Aged, Alanine Transaminase, blood, Antiviral Agents, therapeutic use, Asian Continental Ancestry Group, Aspartate Aminotransferases, Carcinoma, Hepatocellular, diagnosis, etiology, Child, Child, Preschool, Coinfection, drug therapy, DNA, Viral, Drug Resistance, Viral, Drug Therapy, Combination, Female, Hepatitis B Surface Antigens, Hepatitis B e Antigens, Hepatitis B virus, genetics, Hepatitis B, Chronic, complications, Humans, Immunosuppression, Infectious Disease Transmission, Vertical, prevention & control, Liver, pathology, physiology, Liver Cirrhosis, physiopathology, Liver Neoplasms, Liver Transplantation, Male, Middle Aged, Pregnancy, Renal Dialysis, Republic of Korea

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          Abstract

          The guideline on the management of chronic hepatitis B (CHB) was first developed in 2004 and revised in 2007 by the Korean Association for the Study of the Liver (KASL). Since then there have been many developments, including the introduction of new antiviral agents and the publications of many novel research results from both Korea and other countries. In particular, a large amount of knowledge on antiviral resistance--which is a serious issue in Korea--has accumulated, which has led to new strategies being suggested. This prompted the new guideline discussed herein to be developed based on recent evidence and expert opinion. The main targets of this guideline comprise patients who are newly diagnosed with CHB and those who are followed or treated for known CHB. This guideline is also intended to provide guidance for the management of patients under the following special circumstances: malignancy, transplantation, dialysis, coinfection with other viruses, pregnancy, and children.

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          Chronic hepatitis B.

          Anna Lok, Brian McMahon (2007)
          Article 0 comments Cited 357 times – based on 0 reviews     Review now
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            Peginterferon Alfa-2a, lamivudine, and the combination for HBeAg-positive chronic hepatitis B.

            George K. K. Lau, Teerha Piratvisuth, Kang Luo … (2005)
            Current treatments for chronic hepatitis B are suboptimal. In the search for improved therapies, we compared the efficacy and safety of pegylated interferon alfa plus lamivudine, pegylated interferon alfa without lamivudine, and lamivudine alone for the treatment of hepatitis B e antigen (HBeAg)-positive chronic hepatitis B. A total of 814 patients with HBeAg-positive chronic hepatitis B received either peginterferon alfa-2a (180 microg once weekly) plus oral placebo, peginterferon alfa-2a plus lamivudine (100 mg daily), or lamivudine alone. The majority of patients in the study were Asian (87 percent). Most patients were infected with hepatitis B virus (HBV) genotype B or C. Patients were treated for 48 weeks and followed for an additional 24 weeks. After 24 weeks of follow-up, significantly more patients who received peginterferon alfa-2a monotherapy or peginterferon alfa-2a plus lamivudine than those who received lamivudine monotherapy had HBeAg seroconversion (32 percent vs. 19 percent [P<0.001] and 27 percent vs. 19 percent [P=0.02], respectively) or HBV DNA levels below 100,000 copies per milliliter (32 percent vs. 22 percent [P=0.01] and 34 percent vs. 22 percent [P=0.003], respectively). Sixteen patients receiving peginterferon alfa-2a (alone or in combination) had hepatitis B surface antigen (HBsAg) seroconversion, as compared with 0 in the group receiving lamivudine alone (P=0.001). The most common adverse events were those known to occur with therapies based on interferon alfa. Serious adverse events occurred in 4 percent, 6 percent, and 2 percent of patients receiving peginterferon alfa-2a monotherapy, combination therapy, and lamivudine monotherapy, respectively. Two patients receiving lamivudine monotherapy had irreversible liver failure after the cessation of treatment--one underwent liver transplantation, and the other died. In patients with HBeAg-positive chronic hepatitis B, peginterferon alfa-2a offers superior efficacy over lamivudine, on the basis of HBeAg seroconversion, HBV DNA suppression, and HBsAg seroconversion.
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              Hepatitis B e antigen and the risk of hepatocellular carcinoma.

              Hwai-I Yang, Sheng-Nan Lu, Yun-Fan Liaw … (2002)
              The presence of hepatitis B e antigen (HBeAg) in serum indicates active viral replication in hepatocytes. HBeAg is thus a surrogate marker for the presence of hepatitis B virus DNA. We conducted a prospective study to determine the relation between positivity for hepatitis B surface antigen (HBsAg) and HBeAg and the development of hepatocellular carcinoma. In 1991 and 1992, we enrolled 11,893 men without evidence of hepatocellular carcinoma (age range, 30 to 65 years) from seven townships in Taiwan. Serum samples obtained at the time of enrollment were tested for HBsAg and HBeAg by radioimmunoassay. The diagnosis of hepatocellular carcinoma was ascertained through data linkage with the computerized National Cancer Registry in Taiwan and with death certificates. We performed a multiple regression analysis to determine the relative risk of hepatocellular carcinoma among men who were positive for HBsAg alone or for HBsAg and HBeAg, as compared with those who were negative for both. There were 111 cases of newly diagnosed hepatocellular carcinoma during 92,359 person-years of follow-up. The incidence rate of hepatocellular carcinoma was 1169 cases per 100,000 person-years among men who were positive for both HBsAg and HBeAg, 324 per 100,000 person-years for those who were positive for HBsAg only, and 39 per 100,000 person-years for those who were negative for both. After adjustment for age, sex, the presence or absence of antibodies against hepatitis C virus, cigarette-smoking status, and use or nonuse of alcohol, the relative risk of hepatocellular carcinoma was 9.6 (95 percent confidence interval, 6.0 to 15.2) among men who were positive for HBsAg alone and 60.2 (95 percent confidence interval, 35.5 to 102.1) among those who were positive for both HBsAg and HBeAg, as compared with men who were negative for both. Positivity for HBeAg is associated with an increased risk of hepatocellular carcinoma. Copyright 2002 Massachusetts Medical Society.
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                Author and article information

                Journal
                PubMed ID:: 22893865
                PMC ID:: 3415874
                DOI:: 10.3350/cmh.2012.18.2.109

                ScienceOpen disciplines: Chemistry
                Keywords: Acute Disease,Adolescent,Adult,Aged,Alanine Transaminase,blood,Antiviral Agents,therapeutic use,Asian Continental Ancestry Group,Aspartate Aminotransferases,Carcinoma, Hepatocellular,diagnosis,etiology,Child,Child, Preschool,Coinfection,drug therapy,DNA, Viral,Drug Resistance, Viral,Drug Therapy, Combination,Female,Hepatitis B Surface Antigens,Hepatitis B e Antigens,Hepatitis B virus,genetics,Hepatitis B, Chronic,complications,Humans,Immunosuppression,Infectious Disease Transmission, Vertical,prevention & control,Liver,pathology,physiology,Liver Cirrhosis,physiopathology,Liver Neoplasms,Liver Transplantation,Male,Middle Aged,Pregnancy,Renal Dialysis,Republic of Korea
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                ScienceOpen disciplines: Chemistry
                Keywords: Acute Disease, Adolescent, Adult, Aged, Alanine Transaminase, blood, Antiviral Agents, therapeutic use, Asian Continental Ancestry Group, Aspartate Aminotransferases, Carcinoma, Hepatocellular, diagnosis, etiology, Child, Child, Preschool, Coinfection, drug therapy, DNA, Viral, Drug Resistance, Viral, Drug Therapy, Combination, Female, Hepatitis B Surface Antigens, Hepatitis B e Antigens, Hepatitis B virus, genetics, Hepatitis B, Chronic, complications, Humans, Immunosuppression, Infectious Disease Transmission, Vertical, prevention & control, Liver, pathology, physiology, Liver Cirrhosis, physiopathology, Liver Neoplasms, Liver Transplantation, Male, Middle Aged, Pregnancy, Renal Dialysis, Republic of Korea

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