The Management of Chronic Hepatitis B in Asian Americans

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Dis Sci | Posted 4 days ago

The Management of Chronic Hepatitis B in Asian Americans

Tong MJ, Pan CQ, Hann HW, Kowdley KV, Han SH, Min AD, Leduc TS;

Digestive Diseases and Sciences (Sep 2011)

Hepatitis B virus (HBV) infection is common with major clinical consequences

worldwide. In Asian Americans, the HBsAg carrier rate ranges from 7 to 16%; HBV

is the most important cause of chronic hepatitis, cirrhosis, and hepatocellular

carcinoma (HCC). Patients are first diagnosed at different stages of clinical

disease, which is categorized by biochemical and virologic tests. Patients at

risk for liver complications should be identified and offered antiviral therapy.

The two antiviral agents recommended for first-line treatment of chronic

hepatitis B (CHB) are entecavir and tenofovir. The primary goal of therapy is

sustained suppression of viral replication to achieve clinical remission,

reverse fibrosis, and prevent and reduce progression to end-stage liver disease

and HCC. Asian patients with chronic hepatitis, either HBeAg-positive or

-negative, with HBV DNA levels>10(4) copies/mL (>2,000 IU/mL) and alanine

aminotransferase (ALT) values above normal are candidates for antiviral therapy.

HBeAg-negative patients with HBV DNA>10(4) copies/mL (>2,000 IU/mL) and normal

ALT levels but who have either serum albumin ˜3.5 g/dL or platelet count

˜130,000 mm(3), basal core promoter mutations, or who have first-degree

relatives with HCC should be offered treatment. Patients with cirrhosis and

detectable HBV DNA must receive antiviral therapy. Considerations for treatment

include pregnant women with high viremia, coinfected patients, and those

requiring immunosuppressive therapy. In HBsAg-positive patients with risk

factors, lifelong surveillance for HCC with alpha-fetoprotein testing and

abdominal ultrasound examination at 6-month intervals is required. These

recommendations are based on a review of relevant literature and the opinion of

a panel of Asian American physicians with expertise in hepatitis B treatment.

[Guest guest]

http://www.docguide.com/management-chronic-hepatitis-b-asian-americans?hash=0430\

1bd4 & eid=22283 & alrhash=2e06a4-d460252966da8019c5213f6ae197892e

Dis Sci | Posted 4 days ago

The Management of Chronic Hepatitis B in Asian Americans

Tong MJ, Pan CQ, Hann HW, Kowdley KV, Han SH, Min AD, Leduc TS;

Digestive Diseases and Sciences (Sep 2011)

Hepatitis B virus (HBV) infection is common with major clinical consequences

worldwide. In Asian Americans, the HBsAg carrier rate ranges from 7 to 16%; HBV

is the most important cause of chronic hepatitis, cirrhosis, and hepatocellular

carcinoma (HCC). Patients are first diagnosed at different stages of clinical

disease, which is categorized by biochemical and virologic tests. Patients at

risk for liver complications should be identified and offered antiviral therapy.

The two antiviral agents recommended for first-line treatment of chronic

hepatitis B (CHB) are entecavir and tenofovir. The primary goal of therapy is

sustained suppression of viral replication to achieve clinical remission,

reverse fibrosis, and prevent and reduce progression to end-stage liver disease

and HCC. Asian patients with chronic hepatitis, either HBeAg-positive or

-negative, with HBV DNA levels>10(4) copies/mL (>2,000 IU/mL) and alanine

aminotransferase (ALT) values above normal are candidates for antiviral therapy.

HBeAg-negative patients with HBV DNA>10(4) copies/mL (>2,000 IU/mL) and normal

ALT levels but who have either serum albumin ˜3.5 g/dL or platelet count

˜130,000 mm(3), basal core promoter mutations, or who have first-degree

relatives with HCC should be offered treatment. Patients with cirrhosis and

detectable HBV DNA must receive antiviral therapy. Considerations for treatment

include pregnant women with high viremia, coinfected patients, and those

requiring immunosuppressive therapy. In HBsAg-positive patients with risk

factors, lifelong surveillance for HCC with alpha-fetoprotein testing and

abdominal ultrasound examination at 6-month intervals is required. These

recommendations are based on a review of relevant literature and the opinion of

a panel of Asian American physicians with expertise in hepatitis B treatment.