Abstract
Hepatitis B virus (HBV) infects the liver, causing cirrhosis and cancer. In developed countries, five international guidelines have been used to make a decision for the management of patients with chronic HBV infection. In this review, since the guidelines were established by clinical and epidemiological data of developed countries, we aimed to evaluate whether (1) HBV patient profiles of developing countries are similar to developed countries, and (2) which guideline can be applicable to resource-limited developing countries. First, as an example of the most recent data of HBV infections among developing countries, we evaluated the national HBV viral load study in Nepal, which were compared with the data from other developing countries. In Nepal, the highest number of patients had viral loads of 20–2000 IU/mL (36.7%) and belonged to the age group of 21–30 years; HBV epidemiology in Nepal, based on the viral loads, gender, and age groups was similar to those of not only other developing countries but also developed countries. Next, we reviewed five international HBV treatment guidelines of the World Health Organization (WHO), American Association for the Study of Liver Diseases (AASLD), National Institute for Health and Care Excellence (NICE), European Association for the Study of the Liver (EASL), and Asian Pacific Association for the Study of the Liver (APASL). All guidelines require the viral load and alanine aminotransferase (ALT) levels for decision making. Although four guidelines recommend elastography to assess liver cirrhosis, the WHO guideline alternatively recommends using the aspartate aminotransferase (AST)-to-platelet ratio index (APRI), which is inexpensive and conducted routinely in most hospitals. Therefore, in resource-limited developing countries like Nepal, we recommend the WHO guideline for HBV treatment based on the viral load, ALT, and APRI information.
Highlights
The prevalence of Hepatitis B virus (HBV) infection based on the hepatitis B surface antigen (HBsAg) categorizes countries into four groups: the high (≥8%), high-intermediate (5–7%), low-intermediate (2–4%), and low (
HBV infection is diagnosed by the detection of either the viral antigens, including the HBsAg and hepatitis B envelope antigen (HBeAg), or anti-HBV antibodies, including anti-HBsAg, anti-hepatitis B core antigen, and anti-HBeAg antibodies, in blood samples [5]
We aimed to propose a guideline for chronic HBV treatment for developing countries, since the five international guidelines, which were established by the clinical setting and data of developed countries, may not be applicable to resource-limited developing counties
Summary
Hepatitis B virus (HBV) is an enveloped DNA virus that belongs to the family Hepadnaviridae, genus Orthohepadnavirus. HBV infects the liver and can cause chronic hepatitis with necrosis and inflammation, which sometimes results in liver cirrhosis and cancer [1]. At least two billion people are infected with HBV, and approximately 260 million people are chronic carriers [2,3]. HBV is transmitted by percutaneous or mucosal exposure to infected body fluids, including blood. Following HBV transmission, the viral infection progresses from the acute stage to the chronic stage [4]. The acute stage of HBV infection is characterized by acute liver inflammation and hepatocellular necrosis. The chronic stage is defined as persistent infection with detectable HBsAg for longer than 6 months in the presence or absence of evidence showing active viral replication, hepatocellular injury, or inflammation [5]
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