Evaluation of current treatment recommendations for chronic hepatitis B: A 2011 update

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http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1746.2011.06623.x/abstract

Evaluation of current treatment recommendations for chronic hepatitis B: A 2011

update

Myron Tong1,2,*, Leeyen Hsu2, W Chang2, Lawrence

Blatt2Article first published online: 13 APR 2011

DOI: 10.1111/j.1440-1746.2011.06623.x

© 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell

Publishing Asia Pty Ltd

Issue

Journal of Gastroenterology and Hepatology

Volume 26, Issue 5, pages 829–835, May 2011

Abstract

Background and Aim:  Guidelines for the treatment of chronic hepatitis B have

been recently updated in the 2009 European Association for the Study of the

Liver consensus statement, the 2008 US Panel, the 2008 Asian–Pacific consensus

statement, and the 2009 American Association for the Study of Liver Disease

practice guidelines. We sought to determine whether these guidelines identified

patients who developed hepatocellular carcinoma (HCC) or who died of non-HCC

liver-related deaths for antiviral therapy.

Methods:  The criteria described in the new treatment guidelines were matched

to the database of 369 hepatitis B surface antigen-positive patients, in whom 30

developed HCC and 37 died of non-HCC liver-related deaths during a mean follow

up of 84 months.

Results:  Using criteria for antiviral therapy as stated by the four current

guidelines, 19–30% of patients who died of non-HCC liver-related

complications, and 23–53% of patients who developed HCC, would have been

excluded for antiviral therapy. If baseline serum albumin levels of ≤ 3.5 g/dL

or platelet counts of ≤ 130 000 mm3 were included into the treatment criteria,

then 85–94% of patients who developed liver-related complications would have

been recommended for antiviral therapy. Also, the addition of precore A1896

mutants and basal core promoter T1762/A1764 mutants would have identified

98.5–100% of these patients.

Conclusion:  The updated treatment guidelines for hepatitis B still excluded

patients who developed serious liver-related complications. The inclusion of

baseline serum albumin and platelet counts to current criteria would have

identified a majority of these patients for antiviral therapy. These tests

should be included into hepatitis B treatment strategies.