TY - JOUR
T1 - A Treatment Algorithm for the Management of Chronic Hepatitis B Virus Infection in the United States
T2 - An Update
AU - Keeffe, Emmet B.
AU - Dieterich, Douglas T.
AU - Han, Steven Huy B.
AU - Jacobson, Ira M.
AU - Martin, Paul
AU - Schiff, Eugene R.
AU - Tobias, Hillel
AU - Wright, Teresa L.
N1 - Funding Information:
This algorithm was developed and supported by an unrestricted educational grant from Gilead Sciences. Dr Keeffe has received grant support from Roche and Valeant, and has been a Consultant for and served on the Speaker’s Bureau or Advisory Board for Bristol-Myers Squibb, Gilead, Idenix, Roche, and Valeant. Dr Dieterich has received research support and honoraria from Gilead, Bristol-Myers Squibb, Roche, and Idenix. Dr Han has received research grants and has been on the Advisory Boards and served on the Speaker’s Bureaus for Roche, Bristol-Myers Squibb, and Gilead. Dr Schiff has been a Consultant to Abbott, Achillion, Bayer, Bristol-Myers Squibb, Cadence, Gilead, GlobeImmune, Inc, Idenix, Maxim, National Genetics Institute, Novartis, Ortho-Biotech, Pharmasset, Pfizer, PowerMed Limited, Prometheus, Roche Molecular, Salix, Sankyo Pharma, Schering-Plough, and SciClone; he has research grant/research support including clinical trials from Abbott, Bayer, Bristol Myers Squibb, Coley, Gilead, GlaxoSmithKline, Idenix, Ortho-Biotech, Prometheus, Roche Diagnostics, Roche Molecular, Roche Pharmaceutical, Schering-Plough, SciClone, and Vertext; and he has served on the Speaker’s Bureau or received honoraria from Abbott, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Idenix, Ortho-Biotech, and Schering-Plough. Dr Wright has been a Consultant for Gilead and a Speaker for Bristol-Myers Squibb; she is currently employed by Roche Diagnostics, but was employed by the Veterans Administration at the time this paper was written.
PY - 2006/8
Y1 - 2006/8
N2 - Chronic hepatitis B (CHB) is an important public health problem worldwide and in the United States, with approximately 25% of patients infected as neonates dying prematurely from cirrhosis or liver cancer. A treatment algorithm for CHB previously developed and published by a panel of United States hepatologists was revised based on new developments in the understanding of CHB, the availability of more sensitive molecular diagnostic testing, the addition of new treatments, and better understanding of the advantages and disadvantages of approved therapies. This updated algorithm is based on available evidence using a systematic review of the scientific literature. Where data are lacking, the panel relied on clinical experience and consensus expert opinion. Serum HBV DNA can be detected at levels as low as 10 IU/mL using molecular assays and should be determined to establish a baseline level before treatment, monitor response to antiviral therapy, and survey for the development of drug resistance. The primary aim of antiviral therapy is durable suppression of serum HBV DNA to the lowest levels possible. The threshold level of HBV DNA for determination of candidacy for therapy is 20,000 IU/mL or more for patients with hepatitis B e antigen-positive CHB. A lower serum HBV DNA threshold of 2000 IU/mL or more is recommended for patients with hepatitis B e antigen-negative CHB, and 200 IU/mL or more for those with decompensated cirrhosis. Interferon alfa-2b, lamivudine, adefovir, entecavir, and peginterferon alfa-2a all are approved as initial therapy for CHB and have certain advantages and disadvantages. Issues for consideration include efficacy, safety, incidence of resistance, method of administration, and cost.
AB - Chronic hepatitis B (CHB) is an important public health problem worldwide and in the United States, with approximately 25% of patients infected as neonates dying prematurely from cirrhosis or liver cancer. A treatment algorithm for CHB previously developed and published by a panel of United States hepatologists was revised based on new developments in the understanding of CHB, the availability of more sensitive molecular diagnostic testing, the addition of new treatments, and better understanding of the advantages and disadvantages of approved therapies. This updated algorithm is based on available evidence using a systematic review of the scientific literature. Where data are lacking, the panel relied on clinical experience and consensus expert opinion. Serum HBV DNA can be detected at levels as low as 10 IU/mL using molecular assays and should be determined to establish a baseline level before treatment, monitor response to antiviral therapy, and survey for the development of drug resistance. The primary aim of antiviral therapy is durable suppression of serum HBV DNA to the lowest levels possible. The threshold level of HBV DNA for determination of candidacy for therapy is 20,000 IU/mL or more for patients with hepatitis B e antigen-positive CHB. A lower serum HBV DNA threshold of 2000 IU/mL or more is recommended for patients with hepatitis B e antigen-negative CHB, and 200 IU/mL or more for those with decompensated cirrhosis. Interferon alfa-2b, lamivudine, adefovir, entecavir, and peginterferon alfa-2a all are approved as initial therapy for CHB and have certain advantages and disadvantages. Issues for consideration include efficacy, safety, incidence of resistance, method of administration, and cost.
UR - http://www.scopus.com/inward/record.url?scp=33746339209&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2006.05.016
DO - 10.1016/j.cgh.2006.05.016
M3 - Review article
C2 - 16844425
AN - SCOPUS:33746339209
SN - 1542-3565
VL - 4
SP - 936
EP - 962
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 8
ER -