TY - JOUR
T1 - A Treatment Algorithm for the Management of Chronic Hepatitis B Virus Infection in the United States
T2 - 2015 Update
AU - Martin, Paul
AU - Lau, Daryl T.Y.
AU - Nguyen, Mindie H.
AU - Janssen, Harry L.A.
AU - Dieterich, Douglas T.
AU - Peters, Marion G.
AU - Jacobson, Ira M.
N1 - Funding Information:
Conflicts of interest These authors disclose the following: Mindie Nguyen has served as consultant and received research grants from Bristol-Myers Squibb, Gilead Sciences, Idenix, Janssen Pharmaceuticals, Novartis, and Roche Laboratories. Harry L. A. Janssen received grants from and has been a consultant for Bristol-Myers Squibb, Gilead Sciences, Novartis, Roche, Merck & Co, and Immunogenetics. Daryl Lau received grants from Gilead Sciences and Merck & Co and has served as consultant for Bristol-Myers Squibb, Gilead Sciences, Novartis, and Roche. Paul Martin has received grants and has been a consultant for Gilead Sciences, Bristol-Myers Squibb, Abbott Laboratories, and Roche. Ira M. Jacobson has received research funding from AbbVie, Bristol-Myers Squibb, Gilead Sciences, Janssen Pharmaceuticals, and Merck & Co, has consulted for AbbVie, Achillion, Alnylam, Bristol-Myers Squibb, Enanta, Gilead Sciences, Janssen Pharmaceuticals, and Merck & Co, and has served on the speaking bureaus for AbbVie, Bristol-Myers Squibb, Gilead Sciences, Janssen Pharmaceuticals, and Roche. The remaining authors disclose no conflicts.
Funding Information:
Funding This algorithm was developed with support from an unrestricted educational grant from Gilead Sciences.
Publisher Copyright:
© 2015 AGA Institute.
PY - 2015/11
Y1 - 2015/11
N2 - Chronic hepatitis B (CHB) continues to be an important public health problem worldwide, including in the United States. An algorithm for managing CHB was developed by a panel of United States hepatologists in 2004 and subsequently updated in 2006 and 2008. Since 2008, additional data on long-term safety and efficacy of licensed therapies have become available and have better defined therapeutic options for CHB. The evidence indicates that potent antiviral therapy can lead to regression of extensive fibrosis or even cirrhosis, thus potentially altering the natural history of CHB. In addition, appropriate choice of antiviral agent can minimize the risk of resistance. This updated algorithm for managing CHB is based primarily on evidence from the scientific literature. Where data were lacking, the panel relied on clinical experience and consensus expert opinion. The primary aim of antiviral therapy for CHB is durable suppression of serum hepatitis B virus (HBV) DNA to low or undetectable levels. CHB patients who have HBV DNA >2000 IU/mL, elevated alanine aminotransferase level, and any degree of fibrosis should receive antiviral therapy regardless of their hepatitis B e antigen status. CHB patients with HBV DNA >2000 IU/mL and elevated alanine aminotransferase level but no evidence of fibrosis may also be considered for antiviral therapy. Approved antiviral therapies for CHB are interferon alfa-2b, peginterferon alfa-2a, lamivudine, adefovir, entecavir, telbivudine, and tenofovir, although the preferred first-line treatment choices are peginterferon alfa-2a, entecavir, and tenofovir. In determining choice of therapy, considerations include efficacy, safety, rate of resistance, method of administration, duration, and cost.
AB - Chronic hepatitis B (CHB) continues to be an important public health problem worldwide, including in the United States. An algorithm for managing CHB was developed by a panel of United States hepatologists in 2004 and subsequently updated in 2006 and 2008. Since 2008, additional data on long-term safety and efficacy of licensed therapies have become available and have better defined therapeutic options for CHB. The evidence indicates that potent antiviral therapy can lead to regression of extensive fibrosis or even cirrhosis, thus potentially altering the natural history of CHB. In addition, appropriate choice of antiviral agent can minimize the risk of resistance. This updated algorithm for managing CHB is based primarily on evidence from the scientific literature. Where data were lacking, the panel relied on clinical experience and consensus expert opinion. The primary aim of antiviral therapy for CHB is durable suppression of serum hepatitis B virus (HBV) DNA to low or undetectable levels. CHB patients who have HBV DNA >2000 IU/mL, elevated alanine aminotransferase level, and any degree of fibrosis should receive antiviral therapy regardless of their hepatitis B e antigen status. CHB patients with HBV DNA >2000 IU/mL and elevated alanine aminotransferase level but no evidence of fibrosis may also be considered for antiviral therapy. Approved antiviral therapies for CHB are interferon alfa-2b, peginterferon alfa-2a, lamivudine, adefovir, entecavir, telbivudine, and tenofovir, although the preferred first-line treatment choices are peginterferon alfa-2a, entecavir, and tenofovir. In determining choice of therapy, considerations include efficacy, safety, rate of resistance, method of administration, duration, and cost.
KW - Antiviral Therapy
KW - Entecavir
KW - Guidelines
KW - Hepatitis B
KW - Peginterferon alfa-2a
KW - Resistance
KW - Tenofovir
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UR - http://www.scopus.com/inward/citedby.url?scp=84944411617&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2015.07.007
DO - 10.1016/j.cgh.2015.07.007
M3 - Review article
C2 - 26188135
AN - SCOPUS:84944411617
VL - 13
SP - 2071-2087.e16
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
SN - 1542-3565
IS - 12
ER -