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      Management of Hepatitis B Virus Infection: 2018 Guidelines from the Canadian Association for the Study of the Liver and Association of Medical Microbiology and Infectious Disease Canada

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          AGREE II: advancing guideline development, reporting and evaluation in health care.

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            Immunology of hepatitis B virus and hepatitis C virus infection.

            More than 500 million people worldwide are persistently infected with the hepatitis B virus (HBV) and/or hepatitis C virus (HCV) and are at risk of developing chronic liver disease, cirrhosis and hepatocellular carcinoma. Despite many common features in the pathogenesis of HBV- and HCV-related liver disease, these viruses markedly differ in their virological properties and in their immune escape and survival strategies. This review assesses recent advances in our understanding of viral hepatitis, contrasts mechanisms of virus-host interaction in acute hepatitis B and hepatitis C, and outlines areas for future studies.
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              Peginterferon Alfa-2a, lamivudine, and the combination for HBeAg-positive chronic hepatitis B.

              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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                Author and article information

                Journal
                Canadian Liver Journal
                CanLivJ
                University of Toronto Press Inc. (UTPress)
                2561-4444
                2561-4444
                December 2018
                December 2018
                : 1
                : 4
                : 156-217
                Affiliations
                [1 ] Cumming School of Medicine, University of Calgary, Calgary, Alberta
                [2 ] Faculty of Medicine, University of Toronto, Toronto, Ontario
                [3 ] Centre hospitalier de l’université de Montréal (CHUM)—CHU Sainte-Justine, Montreal, Québec
                [4 ] Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, Ontario
                [5 ] Division of Infectious Diseases, University of Alberta, Edmonton, Alberta
                [6 ] Department of Medicine, Université de Montréal, Montreal, Québec
                [7 ] Division of Gastroenterology, Department of Medicine, University of Ottawa, Ottawa, Ontario
                [8 ] Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
                [9 ] Division of Gastroenterology, University of Alberta, Edmonton, Alberta
                [10 ] Pediatrics, Alberta Children’s Hospital, Calgary, Alberta
                [11 ] Viral Hepatitis and Bloodborne Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba
                [12 ] St. Paul’s Hospital, Vancouver, British Columbia
                [13 ] LAIR Centre, Vancouver, British Columbia
                Article
                10.3138/canlivj.2018-0008
                35992619
                23e59688-5c39-4de2-8ad6-9db4684a6772
                © 2018
                History

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