Commentary - AASLD Practice Guideline on treatment of chronic hepatitis B (2025 Update).

Management of patients with hepatitis B virus-induced cirrhosis

Navigating the Maze of Hepatitis B Treatments

EASL Recognition Awardee 2013: Professor Yun-Fan Liaw

EASL Clinical Practice Guidelines: Management of hepatitis C virus infection

Chronic Hepatitis B: A Critical Appraisal of Current Approaches to Therapy

Chapter 1: Prevention

EASL–EORTC Clinical Practice Guidelines: Management of hepatocellular carcinoma

EASL Clinical Practice Guidelines: Wilson’s disease

1 the majority of whom acquire infection at birth or in early childhood. 2 It is estimated that 50% of male and 14% of female carriers will die from CHB-related com- plications such as hepatocellular carcinoma (HCC) or cirrhosis. 3 Since the global introduction of routine vaccination against hepa- titis B virus (HBV) in newborns in countries where the incidence of HBV-related complications are high, such as in theAsia-Pacific region, there has been a significant and gratifying decline in rates of CHB and HCC. 3,4 In the last decade, we have developed a better appreciation of the natural history of CHB—it appears that the progression to cirrhosis and HCC in these patients is associated with persistently high serum HBV DNA levels over time. The other major risk predictors of progression to HCC and cirrhosis include age, male gender, hepatitis B e antigen (HBeAg) status, serum alanine ami- notransferase (ALT) levels and HBV genotype. 5 Two recent land- mark clinical trials in Asia (Taiwan) clearly demonstrate the dramatic improvement in survival, reduced risk of HCC and advanced fibrosis/cirrhosis with the use of antiviral therapy. 5,6 Where treatment options are concerned, we have come a long way in the last decade—complete suppression, or elimination of HBV is now eminently feasible and well-tolerated, and should be the key management goal in the treatment of CHB. The major strides in therapy lie in the introduction of newer oral nucleos(t)ide agents with higher genetic barrier to drug resistance. 7

Interferon-stimulated genes and their role in controlling hepatitis C virus

Studies on the epidemiology of hepatitis B and C virus infections are still needed

BACKGROUND Hepatitis B virus (HBV) infection is a significant problem. In the United States estimates indicate that 0.3% of the population (1.25 million individuals) have chronic hepatitis B infection. METHODS Review of published practice guidelines and literature on management of hepatitis B to determine: 1) Which persons in Western populations are at the highest risk for HBV infection and should be screened for HBV seromarkers to identify those who are chronically infected and those who need to be protected with hepatitis B vaccine; 2) The importance of regular monitoring in persons with chronic hepatitis B, the frequency of monitoring, and which tests should be performed; 3) How to identify the patients who are appropriate candidates for antiviral therapy. RESULTS Recommendations for screening, diagnosis, monitoring, and treatment of chronic HBV infection are reviewed. Important differences are discussed between the Practice Guidelines for chronic hepatitis B developed by the American Association for the Study of Liver Diseases (AASLD), the European Association for the Study of the Liver (EASL), and the Asian Pacific Association for the Study of the Liver (APASL). In addition, this article reviews which patients who are no covered by these Guidelines might be candidates for antiviral therapy. DISCUSSION Established practice guidelines provide direction to providers for the diagnosis and management of chronic HBV infection to reduce the risk of serious sequelae. However, not all patients with chronic hepatitis B are identified, and many of those who are diagnosed do not receive adequate management and follow-up.

Hepatitis B virus (HBV) infection is a significant problem. In the United States estimates indicate that 0.3% of the population (1.25 million individuals) have chronic hepatitis B infection. Review of published practice guidelines and literature on management of hepatitis B to determine: 1) Which persons in Western populations are at the highest risk for HBV infection and should be screened for HBV seromarkers to identify those who are chronically infected and those who need to be protected with hepatitis B vaccine; 2) The importance of regular monitoring in persons with chronic hepatitis B, the frequency of monitoring, and which tests should be performed; 3) How to identify the patients who are appropriate candidates for antiviral therapy. Recommendations for screening, diagnosis, monitoring, and treatment of chronic HBV infection are reviewed. Important differences are discussed between the Practice Guidelines for chronic hepatitis B developed by the American Association for the Study of Liver Diseases (AASLD), the European Association for the Study of the Liver (EASL), and the Asian Pacific Association for the Study of the Liver (APASL). In addition, this article reviews which patients who are no covered by these Guidelines might be candidates for antiviral therapy. Established practice guidelines provide direction to providers for the diagnosis and management of chronic HBV infection to reduce the risk of serious sequelae. However, not all patients with chronic hepatitis B are identified, and many of those who are diagnosed do not receive adequate management and follow-up.

It is estimated that one-third of the world's population has been exposed to hepatitis B virus and that 300-400 million people have chronic hepatitis B. In areas of the world where hepatitis B infection is endemic, this chronic viral infection is a major cause of premature morbidity and mortality related to hepatocellular carcinoma (HCC) and complications of end-stage liver disease. Recent data from population-based studies suggest that the level of viral replication in chronic hepatitis B is an independent predictor of the future complications of the disease; patients with hepatitis B viral DNA titres >10(4) copies/mL (especially those with titres >10(5) copies) have a significantly greater risk of developing HCC and cirrhosis. There is also recent evidence that treatment with antiviral therapy in patients with chronic hepatitis B who have advanced hepatic fibrosis is associated with a reduction in the risk of decompensation of liver disease and HCC. Several new antiviral medications have been recently approved for the treatment of chronic hepatitis B. Several recent position statements and practice guidelines have recommended treatment of patients with chronic hepatitis B with oral antiviral medications. However, there remains some disagreement as to the threshold of viral load before treatment should be initiated and the optimal duration of therapy in patients with cirrhosis due to hepatitis B. This article describes the current recommendations regarding therapy in this group of patients and suggests some criteria for treatment of patients with chronic hepatitis B-related cirrhosis or advanced hepatic fibrosis.

Complement C3 levels in chronic hepatitis C patients from India