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Current treatment recommendations for chronic Hep B

The latest issue of Hepatology evaluates current guidelines for treatment of chronic Hepatitis B based on a natural history study in the United States

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Current guidelines for treatment of chronic Hepatitis B include Hepatitis B e antigen status, levels of Hepatitis B virus DNA, and serum alanine aminotransferase values in the setting of either chronic hepatitis or cirrhosis.

Dr Myron John Tong and colleagues from California, USA assessed whether these guidelines included patients who developed hepatocellular carcinoma, and who died of non-hepatocellular carcinoma liver-related complications.

The criteria for treatment from four published guidelines were matched to a cohort of 369 Hepatitis B surface antigen-positive patients enrolled in the study.

Using additional criteria, up to 100% who died of non-hepatocellular carcinoma would have been identified
Hepatology

During a mean follow-up of 84 months, 30 patients developed hepatocellular carcinoma, and 37 died of non-hepatocellular carcinoma liver-related deaths.

Using criteria for antiviral therapy as stated by the 4 guidelines, only 20% to 60% of the patients who developed hepatocellular carcinoma would have been identified for antiviral therapy according to current treatment recommendations.

The team noted that of patients who died of non-hepatocellular carcinoma liver-related deaths, 27% to 70% would have been identified for antiviral therapy according to current treatment recommendations.

The team considered the difference in outcomes if baseline serum albumin levels of 3.5 mg/dL or less or platelet counts of 130,000 mm3 or less were added to criteria from the 4 treatment guidelines.

Using these additional criteria, the team noted that 89% to 100% of patients who died of non-hepatocellular carcinoma liver-related complications would have been identified.

The research team found that 96% to 100% of patients who developed hepatocellular carcinoma would have been identified for antiviral therapy using these additional criteria.

In addition, if basal core promoter T1762/A1764 mutants and precore A1896 mutants also were included, then 100% of patients who developed hepatocellular carcinoma would have been identified for treatment.

Dr Tong’s tean concluded, “This retrospective analysis showed that the current treatment guidelines for chronic Hepatitis B excluded patients who developed serious liver-related complications.”

Hepatology 2008: 48(4): 1070-78


23 October 2008

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