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

Emmet B. Keeffe, Douglas T. Dieterich, Steven Huy B Han, Ira M. Jacobson, Paul Martin, Eugene R Schiff, Hillel Tobias

Research output: Contribution to journalArticle

386 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1315-1341
Number of pages27
JournalClinical Gastroenterology and Hepatology
Volume6
Issue number12
DOIs
StatePublished - Dec 1 2008

Fingerprint

Chronic Hepatitis B
Virus Diseases
Hepatitis B virus
Tenofovir
interferon alfa-2b
Therapeutics
Antiviral Agents
Lamivudine
Molecular Pathology
DNA
Expert Testimony
Licensure
Disease Management
Serum
Routine Diagnostic Tests
Drug Resistance
Public Health
Safety
Costs and Cost Analysis
Infection

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

A Treatment Algorithm for the Management of Chronic Hepatitis B Virus Infection in the United States : 2008 Update. / Keeffe, Emmet B.; Dieterich, Douglas T.; Han, Steven Huy B; Jacobson, Ira M.; Martin, Paul; Schiff, Eugene R; Tobias, Hillel.

In: Clinical Gastroenterology and Hepatology, Vol. 6, No. 12, 01.12.2008, p. 1315-1341.

Research output: Contribution to journalArticle

Keeffe, Emmet B. ; Dieterich, Douglas T. ; Han, Steven Huy B ; Jacobson, Ira M. ; Martin, Paul ; Schiff, Eugene R ; Tobias, Hillel. / A Treatment Algorithm for the Management of Chronic Hepatitis B Virus Infection in the United States : 2008 Update. In: Clinical Gastroenterology and Hepatology. 2008 ; Vol. 6, No. 12. pp. 1315-1341.
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