Chronic Hepatitis B: Update 2009

AASLD PRACTICE GUIDELINES
Chronic Hepatitis B: Update 2009
Anna S. F. Lok1 and Brian J. McMahon2
This guideline has been approved by the American Association for the Study of Liver Diseases and represents the position of the Association. It has been endorsed by the
Infectious Diseases Society of America.

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Preamble
These guidelines have been written to assist physicians and other health care providers in the recognition, diagnosis, and management of patients chronically infected with the hepatitis B virus (HBV). These recommendations provide a data-supported approach to patients with hepatitis B. They are based on the following: (1) formal review and analysis of published literature on the topic—Medline search up to December 2006 and data from selected papers published through December 2008 and
meeting abstracts in 2003–2009 that impact the management of chronic HBV infection; (2) American College of Physicians Manual for Assessing Health Practices and Designing
Practice Guidelines1; (3) guideline policies, including the AASLD Policy on the Development and Use of Practice Guidelines and the AGA Policy Statement on Guidelines2; and (4) the experience of the authors in hepatitis B. In addition, the proceedings of the 2000 and 2006 National Institutes of Health (NIH) conferences on
the “Management of Hepatitis B”, the EASL Clinical Practice Guidelines 2009 on Management of Chronic Hepatitis B, the Asian-Pacific Consensus Statement on the Management of Chronic Hepatitis B in 2008 and the NIH 2008 Consensus Conference on Management of Chronic Hepatitis B, were considered in the development of these guidelines.3-7 The recommendations suggest preferred approaches to the diagnostic, therapeutic, and preventive aspects of care. They are intended to be flexible.

Specific recommendations are based on relevant published information. In an attempt to characterize the quality of evidence supporting recommendations, the Practice
Guidelines Committee of the AASLD requires a category to be assigned and reported with each recommendation (Table 1). These guidelines may be updated periodically
as new information becomes available.

Introduction
An estimated 350 million persons worldwide are chronically infected with HBV.8 In the United States, there are an estimated 1.25 million hepatitis B carriers,
defined as persons positive for hepatitis B surface antigen (HBsAg) for more than 6months.9-11 Carriers ofHBVare at increased risk of developing cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC).12 Although most carriers will not develop hepatic complications from chronic hepatitis B, 15% to 40% will develop serious sequelae during their lifetime.13 The following guidelines are an update to previous AASLD guidelines and reflect new knowledge and the licensure of new antiviral agents against HBV. Recommendations in these guidelines pertain to the (1) evaluation of patients with chronic HBV infection, (2) prevention of HBV infection,
(3) management of chronically infected persons, and (4) treatment of chronic hepatitis B. Management of hepatitis B in patients waiting for liver transplantation
and prevention of recurrent hepatitis B post-liver transplant have been covered in a recent review article and will not be discussed in these guidelines.14

Screening High Risk Populations to Identify HBV-infected Persons
The global prevalence of HBsAg varies greatly and countries can be defined as having a high, intermediate and low prevalence of HBV infection based on a prevalence
of HBsAg carriers of 8%, 2% to 7%, and 2% respectively.8,10,15-17 In developed countries, the prevalence is higher among those who immigrated from high or
intermediate prevalence countries and in those with high risk behaviors.8,10...

Abbreviations: HBV, hepatitis B virus; HBsAg, hepatitis B surface antigen; HCC, hepatocellular carcinoma; HBeAg, hepatitis B e antigen; cccDNA, covalently closed circular DNA; anti-HBe, antibody to hepatitis B e antigen; ALT, alanine aminotransferase; anti-HBs, antibody to hepatitis B surface antigen; PCR, polymerase chain reaction; HCV, hepatitis C virus; HIV, human immunodeficiency virus; HDV, hepatitisD virus; HBIG, hepatitis B immunoglobulin; AFP, alpha fetoprotein; US, ultrasonography; IFN- , interferon-alfa; pegIFN- , pegylated interferon-alfa.

From the 1Division of Gastroenterology, University of Michigan Medical Center,
Ann Arbor, MI; and the 2Liver Disease and Hepatitis Program, Alaska Native
Medical Center and Arctic Investigations Program, Centers for Disease Control,
Anchorage, AK.

Address reprint requests to: Anna S. F. Lok, M.D., Division of Gastroenterology,
University of Michigan Medical Center, 3912 Taubman Center, SPC5362, Ann
Arbor, MI 48109. E-mail: aslok@umich.edu; fax: 734-936-7392.

Copyright © 2009 by the American Association for the Study of Liver Diseases.
Published online in Wiley InterScience (www.interscience.wiley.com).
DOI 10.1002/hep.00000

Potential conflict of interest: Dr. McMahon’s spouse owns stock in GlaxoSmithKline.
Dr. Lok has served as an advisor for Bristol-Myers Squibb, Roche, Gilead, Schering-
Plough and Pharmasset and has received research support from Innogenetics, Schering-
Plough, GlaxoSmithKline, Gilead, Bristol-Myers Squibb and Novartis.

abrir aquí para acceder al documento NGC AHRQ completo, pdf de 36 páginas:
http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/Chronic_Hep_B_Update_2009%208_24_2009.pdf