Hepatitis B Guidelines, Updated

This revised document provides useful information about the prevention, diagnosis, and management
of HBV infection.

Target Population: Physicians and other healthcare providers who diagnose and manage hepatitis B
virus (HBV) infection

Sponsoring Organization: American Association for the Study of Liver Diseases; endorsed by the
Infectious Diseases Society of America

Type: Evidence-based guidelines using a categorical rating system

Key Points: This document updates guidelines that were last revised in 2007.

Screening for HBV infection is recommended for individuals born in high- or intermediate-prevalence
regions (e.g., Asia, Africa, many countries in South America) and in U.S.-born persons at increased risk,
including those starting cancer chemotherapy or immunosuppressive therapy. Such individuals should
be tested for hepatitis B surface antigen (HBsAg) and antibody to HBsAg. Seronegative persons should
receive HBV immunization; postvaccination testing is recommended for those with ongoing risk for
infection, such as healthcare providers. Because isolated antibody to hepatitis B core antigen may
represent a false-positive result, individuals who have this finding but are unlikely to have had HBV
infection should receive vaccine.

Preventive care for patients with chronic HBV infection includes hepatitis B vaccination and, in high-risk
individuals, ultrasound screening for liver cancer every 6–12 months. Treatment for HBV should be
considered in patients with cirrhosis and in those with hepatitis B e antigen (HBeAg)-positive infection
who have alanine aminotransferase (ALT) levels >2 times normal and HBV DNA levels >20,000 IU/mL. In
patients with HBeAg-negative infection, treatment should be considered if the ALT level is >2 times
normal and the HBV DNA level is >20,000 IU/mL; for those with normal or minimally elevated ALT
levels and HBV DNA levels between 2000 and 20,000 IU/mL, a liver biopsy should be considered to
clarify whether therapy would be beneficial.

Pegylated interferon-alfa (if the patient does not have cirrhosis), entecavir, or tenofovir is preferred for
initial treatment. The recommended duration of treatment varies depending on the agent chosen
(interferon or a nucleoside analogue), the patient's HBeAg status, and the speed of viral clearance.
Patients who are HIV/HBV-coinfected and require antiretroviral therapy should receive either
emtricitabine or lamivudine in combination with tenofovir; entecavir is no longer recommended for
coinfected patients who are receiving therapy for HBV alone. Antiviral therapy to prevent reactivation
is recommended for HBV carriers who are starting cancer chemotherapy or immunosuppressive
therapy.

Reaction:

This comprehensive guideline provides useful information on prevention, diagnosis, and management
of HBV infection. As the number of agents for HBV infection has multiplied — seven drugs are now
approved interferon, pegylated interferon alfa, lamivudine, adefuvir, entecavir, tenofovir, and telbivudine.
These antiviral drugs, many of which are new in the market, have considerably improved the rate of remission of
the disease. However, the drugs do not offer a complete cure and the efficacy of each is limited to a certain
group of patients. The complexity of treatment has increased; consequently, the discussion of preferred
first-line medications is particularly welcome.

A reading of these guidelines also reveals areas in which our knowledge is incomplete. Future studies
should focus on defining the optimal time to start therapy, determining the best medication for initial
treatment, clarifying the role of combination therapy, and improving therapy for those with drug-
resistant HBV.
 REMEDIOS TRINIDAD ROMUALDEZ MEDICAL FOUNDATION

COLLEGE OF NURSING

TACLOBAN CITY

JOURNAL READING

SUBMIITED BY:

SUNSHINE KHAY S. BOCO

GROUP C

BSN3-A

SUBMITTED TO:

MR. NIŃO ARCHIE LABORDO, RN

CLINICAL INSTRUCTOR