A Treatment Algorithm for the Management of Chronic Hepatitis B Virus Infection in the United States: 2008 Update

[Guest guest]

Clin Gastroenterol Hepatol. 2008 Aug 23. [Epub ahead of print]

A Treatment Algorithm for the Management of Chronic Hepatitis B Virus Infection

in the United States: 2008 Update.

Keeffe EB, Dieterich DT, Han SH, son IM, P, Schiff ER, Tobias H.

Division of Gastroenterology and Hepatology, Stanford University Medical Center,

Stanford, California.

Chronic HBV infection is an important public health problem worldwide and in the

United States. A treatment algorithm for the management of this disease,

published previously by a panel of U.S. hepatologists, has been revised on the

basis of new developments in the understanding of the disorder, the availability

of more sensitive molecular diagnostic tests, and the licensure of new

therapies. In addition, a better understanding of the advantages and

disadvantages of new treatments has led to the development of strategies for

reducing the rate of resistance associated with oral agents and optimizing

treatment outcomes. This updated algorithm was based primarily on available

evidence by using a systematic review of the literature. Where data were

lacking, the panel relied on clinical experience and consensus expert opinion.

The primary aim of antiviral therapy is durable suppression of serum HBV DNA to

low or undetectable levels. Assays can now detect serum HBV DNA at levels as low

as 10 IU/mL and should be used to establish a baseline level, monitor response

to antiviral therapy, and survey for the development of drug resistance.

Interferon alfa-2b, lamivudine, adefovir, entecavir, peginterferon alfa-2a,

telbivudine, and tenofovir are approved as initial therapy for chronic hepatitis

B and have certain advantages and disadvantages. Although all of these agents

can be used in selected patients, the preferred first-line treatment choices are

entecavir, peginterferon alfa-2a, and tenofovir. Issues for consideration for

therapy include efficacy, safety, rate of resistance, method of administration,

and cost.

PMID: 18845489 [PubMed - as supplied by publisher]

[Guest guest]

Clin Gastroenterol Hepatol. 2008 Aug 23. [Epub ahead of print]

A Treatment Algorithm for the Management of Chronic Hepatitis B Virus Infection

in the United States: 2008 Update.

Keeffe EB, Dieterich DT, Han SH, son IM, P, Schiff ER, Tobias H.

Division of Gastroenterology and Hepatology, Stanford University Medical Center,

Stanford, California.

Chronic HBV infection is an important public health problem worldwide and in the

United States. A treatment algorithm for the management of this disease,

published previously by a panel of U.S. hepatologists, has been revised on the

basis of new developments in the understanding of the disorder, the availability

of more sensitive molecular diagnostic tests, and the licensure of new

therapies. In addition, a better understanding of the advantages and

disadvantages of new treatments has led to the development of strategies for

reducing the rate of resistance associated with oral agents and optimizing

treatment outcomes. This updated algorithm was based primarily on available

evidence by using a systematic review of the literature. Where data were

lacking, the panel relied on clinical experience and consensus expert opinion.

The primary aim of antiviral therapy is durable suppression of serum HBV DNA to

low or undetectable levels. Assays can now detect serum HBV DNA at levels as low

as 10 IU/mL and should be used to establish a baseline level, monitor response

to antiviral therapy, and survey for the development of drug resistance.

Interferon alfa-2b, lamivudine, adefovir, entecavir, peginterferon alfa-2a,

telbivudine, and tenofovir are approved as initial therapy for chronic hepatitis

B and have certain advantages and disadvantages. Although all of these agents

can be used in selected patients, the preferred first-line treatment choices are

entecavir, peginterferon alfa-2a, and tenofovir. Issues for consideration for

therapy include efficacy, safety, rate of resistance, method of administration,

and cost.

PMID: 18845489 [PubMed - as supplied by publisher]