For Population Intervention Comparison Outcome questions where no studies meeting the predefined criteria were found, the AASLD HBV guideline methodology committee performed manual searches for uncontrolled observational studies. Evidence-Based Medicine [Internet]. Controlled vocabulary supplemented with keywords was used to search for studies of antiviral therapy for hepatitis B in children. Ann Intern Med. Such persons include noncirrhotic individuals aged 30 years or younger: First-line antiviral treatment (Strong recommendations). Unlike previous AASLD practice guidelines, this guideline was developed in compliance with the Institute of Medicine standards for trustworthy practice guidelines and uses the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. 2008. (If HBV DNA testing is unavailable, treatment can be deferred in HBeAg-positive individuals aged 30 years or younger who have persistently abnormal ALT levels. Entecavir treatment for up to 5 years in patients with hepatitis B e antigen-positive chronic hepatitis B. Hepatology. (Conditional recommendation)], Who are HBeAg-negative, with HBV DNA levels that fluctuate between 2,000 and 20,000 IU/mL, Can be closely monitored for reactivation over the long term, Have evidence of HBeAg loss and seroconversion to anti-HBe (in those who were initially HBeAg positive), as well as after completion of at least one additional year of treatment, Levels of ALT (and AST level for APRI), HBsAg, HBeAg, and HBV DNA (where HBV DNA testing is available), Liver fibrosis, in those without baseline cirrhosis, using noninvasive studies such as APRI score or FibroScan, Treatment adherence during therapy, at regular intervals and at each visit, Individuals with more advanced disease (compensated/decompensated cirrhosis), During the first year of treatment (to assess treatment response and adherence), Individuals after treatment discontinuation, Are cirrhotic, regardless of their age or the presence of other risk factors (Strong recommendation), Have a family history of HCC (Strong recommendation), Are older than 40 years (younger age may be indicated based on the regional HCC incidence), do not have clinical evidence of cirrhosis (or based on APRI score ≤2), and have an HBV DNA level above 2,000 IU/mL (where HBV DNA testing is available) (Conditional recommendation), Hepatitis B. ���a����*x�_6��œ_��3"#���tm!��_��`��W��W��+��-�uґHq����9�R����E篕�j$b����.�+"��%� �kx����4�춗��W�_��_��?�� (�m,B��W��jh���7R���fKm\���r��o�o �@�m��‚��N�7�VN�/� (���2�#Ԗ`�~��i�[���/~�r0�v���^�ů���ŏ3FD����\�k���� i��7��a����Hx�‘.-R�;y Zhao Q, Liu K, Zhu X, et al. November 10, 2017; Accessed: May 23, 2017. Dr. McMahon has served as co-author of the AASLD Practice Guideline for Hepatitis B between 2009 and 2018 and is co-Author of the AASLD Hepatitis B Guidance 2019. Can J Gastroenterol. Obtain lactic acid levels if lactic acidosis is a concern; obtain HIV test before initiating treatment. 17(2-3):261-81. Biologics License Application (BLA) approval (BL 125428) (hepatitis B vaccine (recombinant), adjuvanted [Heplisav-B]). 3 0 obj 2010 Apr. Hepatitis B and C cause most cases of hepatitis in the United States and the world. The two diseases account for about a million deaths a year and 78 percent of world's hepatocellular carcinoma and more than half of all fatal cirrhosis. (Conditional recommendation), Adults with HBeAg-positive immune-active chronic hepatitis B who seroconvert to anti-HBe on nucleos(t)ide analog (NA) therapy (Conditional recommendations). 17(38):4258-70. In noncirrhotic patients, diagnosis of HCC should be confirmed by pathology. EASL clinical practice guidelines: management of hepatocellular carcinoma. 11(3):232-8. [Full Text]. Hepatitis B vaccination provides long-term protection through 30 years for a majority of recipients, and more than 90% were protected with either initial immunization or a booster, according to a presentation at the 64th AASLD Liver Meeting last week in Washington, DC (AASLD) and is an update to the Practice Guideline published in 2012 in . The study selection process and reasons for exclusions are depicted in Figure 1 of the systematic review (see the "Availability of Companion Documents" field). [Medline]. Moreover, the views and opinions of developers or authors of guidelines represented on this site do not necessarily state or reflect those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or hosting of guidelines in NGC may not be used for advertising or commercial endorsement purposes. The American Association for the Study of Liver Disease (AASLD), the organization that defines how doctors should treat hepatitis B and other liver ailments, unveiled new hepatitis B treatment guidelines this week at its annual conference in San Francisco. Disagreements were harmonized by consensus or arbitration by a third reviewer. Found inside – Page 27Genetic diversity of hepatitis B virus genotypes B6, D and F among circumpolar indigenous individuals. J. Viral Hepat. ... Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. • Official recommendations of AASLD on the treatment of chronic hepatitis B (CHB) virus (HBV) infection in adults and children • Multiple systematic reviews of literature were conducted. 1998 Oct. 25(10):2037-8. AASLD guidelines for treatment of chronic hepatitis B. Hepatology. x��}ے�ƕ�;#����K�.�B�$e[�֤��<4��l�}sw5)n��L���͹�@��cvcg�� Available at https://www.fda.gov/forpatients/illness/hepatitisbc/ucm408658.htm. Grellier L, Mutimer D, Ahmed M, et al. For continuous outcomes, the committee calculated the weighted difference in means between the baseline and the longest duration of follow-up for each study and the pooled effect size using the DerSimonian and Laird random-effect model. The initial search resulted in 734 citations and three systematic reviews that included the China Biological Medicine Database and summarized additional studies published in Chinese. J Hepatol 2017; 67:370. A separate group of American Association for the Study of Liver Diseases (AASLD) content experts collaborated with an independent research group with expertise in conducting systematic reviews to synthesize the available evidence informing these key questions. Peginterferon alfa-2a alone, lamivudine alone, and the two in combination in patients with HBeAg-negative chronic hepatitis B. N Engl J Med. Antivir Ther. Sorrell MF, Belongia EA, Costa J, et al. Liaw YF, Gane E, Leung N, et al. endobj Hepatitis B information for health professionals: hepatitis B FAQs for health professionals. [Guideline] Terrault NA, Lok ASF, McMahon BJ, et al. Register All statistical analyses were conducted using STATA, version 13 (StataCorp LP, College Station, TX). In the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America (AASLD-IDSA) Guidance titled Recommendations for Testing, Managing, and Treating Hepatitis C, a rating system is utilized for the level of evidence and the strength of the recommendation. Discontinuation ofNA therapy (Conditional recommendation). The systematic review group explored the impact of publication bias using the Egger regression asymmetry test and constructing funnel plots if a sufficient number of studies (>20) per outcome was available and heterogeneity was low. Since the development of grade 2 or 3 ascites in patients with cirrhosis is associated with reduced survival, liver transplantation (LT) should be considered as a potential treatment option. [Guideline] Liaw YF, Leung N, Kao JH, et al. The search strategy was designed and conducted by an experienced librarian with input from the principal investigator. This contrast-enhanced computed tomography (CT) scan demonstrates extensive cirrhosis, as well as malignant hepatocellular lesions (arrow). J Hepatol. [Medline]. Zhou J, Chen DQ, Poon VK, et al. 2009. In addition, if NA therapy with a drug other than entecavir or tenofovir is used and virologic breakthrough occurs, switch to another antiviral monotherapy with a high genetic barrier to resistance or add a second antiviral with a complementary resistance profile. Type of Evidence Supporting the Recommendations, Methods Used to Collect/Select the Evidence, Description of Methods Used to Collect/Select the Evidence, Methods Used to Assess the Quality and Strength of the Evidence, Rating Scheme for the Strength of the Evidence, Description of the Methods Used to Analyze the Evidence, Methods Used to Formulate the Recommendations, Description of Methods Used to Formulate the Recommendations, Description of Method of Guideline Validation, Composition of Group That Authored the Guideline, Financial Disclosures/Conflicts of Interest, *By signing up I agree to the privacy terms listed, Benefits/harms Of Implementing The Guideline Recommendations, Rating Scheme For The Strength Of The Recommendations, Institute Of Medicine (iom) National Healthcare Quality Report Categories, http://www.guideline.gov/about/inclusion-criteria.aspx, Large effect (e.g., relative risk [RR]: 0.5). HBsAg-positive patients should receive counseling about the prevention of HBV transmission to others. Interreviewer agreement (kappa) was calculated during each screening level to assess agreement between reviewers. 2017 Aug. 67 (2):370-98. Long-term treatment with entecavir induces reversal of advanced fibrosis or cirrhosis in patients with chronic hepatitis B. Clin Gastroenterol Hepatol. [Medline]. All statistical analyses were conducted using STATA, version 13 (StataCorp LP, College Station, TX). NAs with a low barrier to drug resistance (lamivudine, adefovir, or telbivudine) are not recommended owing to their potential for drug resistance. 158(2):101-8. Clin Exp Rheumatol. (Quality/Certainty of Evidence: Very Low (bone); Low (renal), Strength of Recommendation: Conditional), Management of Persons with Persistent Low-Level Viremia on NA Therapy, The AASLD suggests that persons with persistent low level viremia (<2,000 IU/mL) on entecavir or tenofovir monotherapy continue monotherapy, regardless of ALT. All individuals aged 12 years or older who are eligible for antiviral therapy are recommended to receive therapy with tenofovir or entecavir, the nucleos(t)ide analogs (NAs) with a high barrier to drug resistance. Recommendations are followed by quality of evidence ratings (High, Moderate, Low, and Very Low), and the strength of the recommendations (Strong or Conditional) which are defined at the end of the "Major Recommendations" field. Third in a series of textbooks on pediatric disease primarily based on annual seminars held at the Gant in Aspen, Colorado as part of the Aspen conference on Pediatric Diseases, directed by the Institute for Pediatric Medical Education ... EASL AASLD Expert Consensus for Asian Americans with HBV* Normal ALTlevels. 1994 Oct. 24(10):641-50. Clinicians should screen (HBsAg, antibody to hepatitis B core antigen [anti-HBc], and antibody to hepatitis B surface antigen [anti-HBs]) for HBV in high-risk persons, including persons born in countries with 2% or higher HBV prevalence, men who have sex with men, persons who inject drugs, HIV-positive persons, household and sexual contacts of HBV-infected persons, persons requiring immunosuppressive therapy, persons with end-stage renal disease (including hemodialysis patients), blood and tissue donors, persons infected with hepatitis C virus, persons with elevated ALT levels (≥19 IU/L for women and ≥30 IU/L for men), incarcerated persons, pregnant women, and infants born to HBV-infected mothers. Found inside – Page 435HEPATITIS B VIRUS INFECTION—TREATMENT SPECIFICS Population – Adults. Recommendations AASLD 2016 (with 2018 guidance update) –Offer antiviral therapy to adults to decrease the risk of liver-related complications, if: • Without a liver ... 2020 Aug;72(2):671-722. doi: 10.1002/hep.31065. N Engl J Med. [Medline]. To measure the overall heterogeneity across the included studies, the systematic review group calculated the I2 statistic, where I2 >50% suggests a high degree of heterogeneity. [Guideline] Centers for Disease Control and Prevention. Table 1. J Hepatol. 2016 Jan;63(1):307-18. Immunohistochemical staining is positive for hepatitis B surface antigen (HBsAg.). On-treatment monitoring: Obtain lactic acid levels if lactic acidosis is a concern; obtain HIV test before initiating treatment. The World Health Organization (WHO) guidelines as well as the 2016 American Association for the Study of Liver Diseases (AASLD) guidelines are . Neutrophil count and culture of ascitic fluid (bedside inoculation blood culture bottles with 10 mL fluid each) should be performed to exclude bacterial peritonitis. Have evidence of high-level HBV replication (HBV DNA >20,000 IU/mL). Best Pract Res Clin Gastroenterol. 99(7):1472-7. Qualifying Statements. Sexual partners and household contacts of HBV-infected individuals who are negative for HBsAg and anti-HBs should receive HBV vaccination. 2013 Mar. Markovic S, Drozina G, Vovk M, Fidler-Jenko M. Reactivation of hepatitis B but not hepatitis C in patients with malignant lymphoma and immunosuppressive therapy. 103(24):9148-53. Vaccinate screened individuals who are negative for anti-HBs. This is the current release of this guideline. The efficacy of anti-viral therapy on hepatitis B virus-associated glomerulonephritis: A systematic review and meta-analysis. (2015). Antiviral therapies should follow the EASL guidelines for management of chronic hepatitis B and C infection. Phillips D. Clinical guideline on HBV released by ACP, CDC. Lancet. Hadziyannis SJ, Tassopoulos NC, Heathcote EJ, et al. [Medline]. Review key data and AASLD guideline recommendations on managing HBV infection during pregnancy, including treatment indications, treatment options, and prophylaxis to prevent mother-to-child transmission. 355(3):322-3; author reply 323. [Medline]. 26(6):1393-5. Available at http://www.medicalnewstoday.com/releases/146749.php. In 2017, the European Association for the Study of the Liver (EASL) released updated guidelines for hepatitis B virus (HBV) infection <> 2004 May-Jun. 510(k) Premarket notification: Hepatiq. Perform screening with both hepatitis B surface antigen (HBsAg) and antibody to HBsAg (anti-HBs). 1993 Nov 27. (Conditional recommendation), For select patients older than 40 years, the AASLD suggests antiviral therapy in the setting of normal ALT levels, elevated HBV DNA (≥1,000,000 IU/mL), and significant necroinflammation or fibrosis on liver biopsy specimens. [Medline]. LVP should be followed with plasma volume expansion to prevent postparacentesis circulatory dysfunction (PPCD). In immune tolerant patients, moderate-quality evidence supports improved intermediate outcomes with antiviral therapy. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Available at http://www.fda.gov/safety/medwatch/safetyinformation/safetyalertsforhumanmedicalproducts/ucm369846.htm. Found inside – Page 2449.4 Concluding Remarks The field of targeted antiviral drug discovery for the treatment of chronic HBV infection is large and highly dynamic. ... AASLD guidelines for treatment of chronic hepatitis B. Hepatology 63 (1): 261–283. Furosemide should be stopped if severe hypokalemia occurs (< 3 mmol/L). Tong W, He J, Sun L, He S, Qi Q. The discovery of the hepatitis viruses. 48(suppl 2):S32. Peg-IFN is contraindicated. Antiviral therapy in patients with immune active chronic hepatitis B (CHB) virus (HBV) infection can reduce the risk of cirrhosis, decompensated liver disease, and hepatocellular carcinoma. Those who should be tested for their response to HBV vaccination 1-2 months after the last vaccine dose is received include healthcare workers, sexual partners of those with chronic HBV, patients on chronic hemodialysis, and immunocompromised patients (eg HIV patients). Recommended: Treat adults with chronic hepatitis B infection without clinical evidence of cirrhosis (or based on APRI score ≤2 in adults), but who have all of the following features, and regardless of HBeAg status (strong recommendation): In individuals with HBV/human immunodeficiency virus (HIV) coinfection, initiate antiretrovial therapy (ART) in (1) all those with evidence of severe chronic liver disease, regardless of CD4 count, as well as (2) those with a CD4 count of 500 cells/mm3 or below, regardless of their liver disease stage. International travelers to regions with high or intermediate levels of endemic HBV infection. Review AASLD guideline recommendations informing HBV pretreatment evaluation, including serology, HBV DNA, and fibrosis assessments to determine treatment candidacy. Hepatitis B virus with primary resistance to adefovir. This document presents official recommendations of the American Association for the Study of Liver Diseases (AASLD) on the treatment of chronic hepatitis B (CHB) virus (HBV) infection in adults and children. 56(12):1812-9. [Medline]. Embedded within these layers are numerous antigens that are important in disease identification and progression. A meta-analysis. In contrast to AASLD, the 2017 EASL Hepatitis B Guidelines recommend screening for HCC in selected patients with bridging fibrosis (Metavir stage F3). Note from the National Guideline Clearinghouse (NGC): Technical remarks designed to facilitate implementation accompany each recommendation and can be found in the original guideline document. Helsinki, Finland: Wiley Interscience; 2008. Tang KH, Yusoff K, Tan WS. From the 2321 citations identified with the primary search strategy, 14 studies that enrolled 1425 children were finally included. US Food and Drug Administration. By multiple face-to-face meetings, phone conferences, and electronic communication, the systematic review group finalized evidence summaries following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. 35(11):1317-25. Not applicable: The guideline was not adapted from another source. J Clin Invest. Barclay L. USPSTF shifts course, favors hepatitis B screening. In these patients, coffee consumption should be encouraged. It is indicated for patients with well-preserved liver function (Child-Pugh A class), with good performance status, and with advanced tumors – BCLC-C without main portal vein invasion or tumors progressing upon or unsuitable for locoregional therapies. A methodologist moderated and facilitated the process of question development. 61:1-32. [Guideline] Terrault NA, Bzowej NH, Chang KM, et al, for the American Association for the Study of Liver Diseases. Long-term anti-HBs antibody persistence and immune memory in children and adolescents who received routine childhood hepatitis B vaccination. Maria Buti, MD Physicians: maximum . 49(5 suppl):S156-65. 100(11):2658-64. Consider baseline and during-treatment bone density scans for those at risk for osteopenia or with a fracture history. Nonsteroidal anti-inflammatory drugs should not be used in patients with ascites because of the high risk of developing further sodium retention, hyponatremia, and AKI. [Medline]. 1993 Apr. Factors predicting occurrence and prognosis of hepatitis-B-virus-related hepatocellular carcinoma. 1996 Sep. 23(3):638-9. In resource-limited settings, APRI (aspartate aminotransferase [AST]-to-platelet ratio index) is preferred to evaluate for liver fibrosis (APRI score >2 in adults). Screening for hepatitis B infection The summary was updated by ECRI on July 27, 2004. Found inside – Page 1269Although out of the scope of this chapter, the AASLD guidelines outline the manage- ment, including necessary surveillance and antiviral treatments, for HBV infection (Terrault et al., 2018). 2011 Aug. 141(2):517-25, 525.e1-2. Found inside – Page 668Terrault NA et al: AASLD guidelines for treatment of chronic hepatitis B, Hepatology 63(1):261-283, 2016. Wang Q et al: Chronic hepatitis B and C virus infection and risk for non-Hodgkin lymphoma in HIV-infected patients: a cohort study ... Found inside – Page 309AASLD guidelines for treatment of chronic hepatitis B. Hepatology. 2016;63(1):261-283. [PubMed 26566064] Vemlidy (tenofovir alafenamide) [prescribing information]. Foster City, CA: Gilead Sciences Inc; August 2020. [Medline]. DOI: 10.1002/hep.28156. EASL clinical practice guidelines: Management of chronic hepatitis B virus infection. This personal information is used solely to provide you a more personalized experience when using the Guideline Central website and app. 2016 Jan;63(1):261-83. %���� Disagreements were reconciled by consensus or by a third reviewer. November 17, 2015 hepbtalk. By updating our privacy policy with clearer language, our goal is to help you better understand what data we collect and how we use that information. 2005 Jun 30. Marcellin P, Heathcote EJ, Buti M, et al. Please visit our privacy policy page for more information. Tripathi N, Mousa OY. [Guideline] Schillie S, Harris A, Link-Gelles R, Romero J, Ward J, Nelson N. Recommendations of the Advisory Committee on Immunization Practices for use of a hepatitis B vaccine with a novel adjuvant. [Full Text]. Adults with cirrhosis and low-level viremia. [Full Text]. Population: The majority of people in this situation would want the recommended course of action, but many would not. Obstet Gynecol. The objectives of this document are to provide guidance in the diagnosis and management of autoimmune hepatitis (AIH) based on current evidence and expert opinion and to present guidelines to clinically relevant questions based on systematic reviews of the literature and the quality of evidence. Hepatitis C guidance 2018 update: AASLD-IDSA recommendations for testing, managing, and treating hepatitis C virus infection. Obtain lactic acid levels if lactic acidosis is a concern. Ascitic total protein concentration should be performed to identify patients at higher risk of developing SBP. Medscape Medical News. 381(9865):468-75. A manual search of bibliographies of the included studies and relevant systematic reviews was conducted. Grace LH Wong, MD. Hepatology. 67 (15):455-8. [Medline]. 100(16):1134-43. 48(suppl 2):S26. 2009 Jan 20. Oncology. Recommendations for Hepatitis C Screening This is a PDF version of the following document: . ALT = alanine transaminase. Diuretics should be discontinued if severe hyponatremia (serum sodium concentration < 125 mmol/L), acute kidney injury (AKI), worsening hepatic encephalopathy, or incapacitating muscle cramps develop. This book provides a comprehensive, state-of-the art review of HBV infection and liver disease. In adults with compensated cirrhosis and low levels of viremia (< 2,000 IU/mL), regardless of ALT level, the AASLD suggests antiviral therapy (preferred: tenofovir, entecavir) to reduce the risk of decompensation. AASLD guidelines for treatment of chronic hepatitis B. Hepatology. 1996 Sep. 24(3):714-7. 2014 Jul 1. 28(6):923-9. Br J Dermatol. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. New genetic associations detected in a host response study to hepatitis B vaccine. 2017 Dec 5. 86: Viral hepatitis in pregnancy. Patients with compensated or decompensated cirrhosis need treatment with any detectable HBV DNA level and regardless of ALT levels. The committee eventually included 26 studies. 2005 Jun 30. Treatment of Chronic Hepatitis B: AASLD 2018 Hepatitis B Guidance Norah A. Terrault,1 Anna S.F. Recommendations are graded as strong (apply to most patients with minimal variation) or conditional (apply to the majority of patients whose values and preferences are consistent with the course of action). http://www.cdc.gov/hepatitis/HBV/index.htm. September 25, 2013; Accessed: October 2, 2013. Associations between hepatitis B virus genotype and mutants and the risk of hepatocellular carcinoma. 2014 Jul 1. Coffee consumption has been shown to decrease the risk of HCC in patients with chronic liver disease. Clinical Guidelines. This website also contains material copyrighted by 3rd parties. [Medline]. Medscape Medical News. Hepatitis B and C cause most cases of hepatitis in the United States and the world. The two diseases account for about a million deaths a year and 78 percent of world's hepatocellular carcinoma and more than half of all fatal cirrhosis. [Medline]. Available at http://guideline.gov/content.aspx?id=24043. 348(9036):1212-5. AASLD/IDSA HCV guidance panel. Quality of evidence (i.e., certainty in the estimates) was evaluated using the GRADE approach. To measure the overall heterogeneity across the included studies, the systematic review group used the I2 statistic, where I2 >50% suggests high heterogeneity. [Medline]. Hepatology 2018; 67:1560. Hepatitis A to E AASLD Transplant HepatologyBoard Review Course 2020 Janice Jou, MD MHS Associate Professor Oregon Health and Science University VA Portland Healthcare System oHepatitis A and Hepatitis E oHepatitis C oHepatitis B and Hepatitis D [97] (Conditional recommendation), For HIV-infected pregnant and breastfeeding women (including those in the first trimester of pregnancy and women of childbearing age), the recommended first-line ART is a once-daily fixed-dose combination of tenofovir/lamivudine (or emtricitabine)/efavirenz (applicable to lifelong treatment as well as to ART initiated for the prevention of mother-to-child HBV transmission and then stopped). March 22, 2018; Accessed: April 20, 2018. J Hepatol. 1991 Jan. 13(1):150-7. Clin Liver Dis. MMWR Morb Mortal Wkly Rep 2001; 50: 1-42. Lange CM, Bojunga J, Hofmann WP, et al. Consider baseline and during-treatment bone density scans for those with a fracture history or at risk for osteopenia. It is recommended that all infants receive their first dose of hepatitis B vaccine as soon as possible after birth (≤24 hours preferred), followed by two or three doses to complete the primary series. Resistance surveillance in chronic hepatitis B patients treated with adefovir dipivoxil for up to 60 weeks. 46(3):420-6. (If HBV DNA testing is unavailable, consider treatment based on persistently normal ALT levels alone, regardless of HBeAg status. Ultrasonographic surveillance of hepatocellular carcinoma in cirrhosis: a randomized trial comparing 3- and 6-month periodicities. [Medline]. Found inside – Page 372AASLD guidelines for treatment of chronic hepatitis B. Hepatology. 2016;63:261–83. Terrault NA, Ghany MG. Enhanced screening for Hepatitis D in the USA: overcoming the Delta blues. Dig Dis Sci 2020. Terrault NA, Lok ASF, McMahon BJ, ... [Medline]. The recommended initial agents for adults are PEG-IFN, entecavir, or tenofovir. Selection of a hepatitis B virus strain resistant to adefovir in a liver transplantation patient. Textbook of Gastroenterology. 2010 Feb. 51(2):422-30. • Among the existing hepatitis B guidelines, the WHO and 2016 AASLD guidelines were developed based on the validated GRADE approach, which uses multiple sys-tematic reviews to answer pre-identified questions from an expert panel. Adult dose: 25 mg daily; no pediatric dosing, Pregnancy category: Insufficient human data. 2011 Jun. El-Serag HB, Davila JA. Hepatitis B: immunization and impact on natural history and cancer incidence. She received grants from Bristol-Myers Squibb and Roche. J Am Acad Dermatol. 2009 Jun 16. Gastroenterology. Although routine screening is not recommended for antibody to hepatitis B core antigen (anti-HBc) to assess for previous exposure, it is a valuable test in HIV patients; those about to receive hepatitis C or anticancer and other immunosuppressive treatment or renal dialysis; and in donated blood (or, organs, if feasible). [97] are presented below. J Hepatol. Content experts from the AASLD were also queried for potential references. For patients with virologic breakthrough on entecavir or tenofovir monotherapy (an increase in HBV DNA by >1 log compared to nadir or HBV DNA ≥100 IU/mL in those on NA therapy with previously undetectable levels [< 10 IU/mL]), either (1) switch to another antiviral monotherapy with a high barrier to resistance or (2) add a second antiviral drug that lacks cross-resistance. [Medline]. Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection. After a period of treatment consolidation (treatment for ≥12 months in the setting of persistently normal ALT levels and undetectable serum HBV DNA), consider discontinuing NA therapy in noncirrhotic HBeAg-positive adults who seroconvert to anti-HBe while on NA treatment. Lenvatinib has been shown to be non-inferior to sorafenib and is also recommended in first-line therapy for HCC given its approval. HBeAg-positive hepatitis delta: virological patterns and clinical long-term outcome. [Medline]. Screening for hepatitis C virus infection in adults: a systematic review for the U.S. Preventive Services Task Force. Hepatology. alcohol consumption and/or concurrent hepatitis B virus (HBV) infection.6,9-17 HCV is also associated with a number of extra-hepatic manifestations, but viral elimination can reduce all-cause mortality.18-25 This final update of the EASL Recommendations on Treat-ment of Hepatitis C series started in 2014 is intended to assist Hepatology . A neutrophil count above 250 cells/µL is required to diagnose spontaneous bacterial peritonitis (SBP). 49(2):201-14. Members from the AASLD HBV guideline methodology and writing committees helped identify additional studies. 2009 Feb. 136(2):486-95. MMWR Morb Mortal Wkly Rep. 2011 Dec 23. (CCO) presentation on using the EASL guidelines to determine treatment candidacy in patients with hepatitis B virus HBV. Individuals without clinical evidence of cirrhosis (or based on APRI score ≤2 in adults) who have all of the following features may be considered exceptionally for discontinuation of NAs: Owing to the risk of relapse after discontinuation of NA therapy, the WHO recommends retreatment in the setting of consistent signs of reactivation (positive HBsAg or HBeAg, increasing ALT levels, or redetectable HBV DNA) (where HBV DNA testing is available).

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