Treatment recommendations for chronic hepatitis B: an evaluation of current guidelines based on a natural history...

Area of Science:

• Hepatology
• Virology
• Oncology

Background:

• Current guidelines for chronic hepatitis B (CHB) treatment rely on hepatitis B e antigen (HBeAg) status, HBV DNA levels, and ALT values.
• These guidelines are used in patients with chronic hepatitis or cirrhosis.
• The effectiveness of these guidelines in identifying patients who develop hepatocellular carcinoma (HCC) or die from non-HCC liver complications is unclear.

Purpose of the Study:

• To evaluate if current CHB treatment guidelines identify patients who develop HCC or die from non-HCC liver-related complications.
• To determine if adding other clinical and virological markers improves identification of at-risk patients.

Main Methods:

• A prospective study of 369 hepatitis B surface antigen (HBsAg)-positive patients was analyzed retrospectively.
• Treatment criteria from four published CHB guidelines were applied to the cohort.
• The study assessed the identification rates for antiviral therapy based on current guidelines and proposed additions.

Main Results:

• During 84 months of follow-up, 30 patients developed HCC and 37 died from non-HCC liver-related causes.
• Current guidelines identified only 20%-60% of HCC patients and 27%-70% of non-HCC death patients for antiviral therapy.
• Adding low albumin or platelet counts identified 89%-100% of non-HCC death patients and 96%-100% of HCC patients.
• Including basal core promoter and precore mutations identified 100% of HCC patients.

Conclusions:

• Current CHB treatment guidelines are insufficient for identifying patients at high risk of developing HCC or experiencing fatal liver complications.
• Incorporating serum albumin, platelet counts, and specific HBV mutations into treatment criteria significantly enhances the identification of at-risk individuals.
• Revised guidelines could improve patient outcomes by enabling earlier antiviral therapy initiation.