An expert consensus for the management of chronic hepatitis B in Asian Americans
M J Tong1,2, C Q Pan3, S-H B Han1
1Pfleger Liver Institute, Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Insights
New guidelines recommend antiviral therapy for Asian Americans with chronic Hepatitis B virus (HBV) infection based on viral load and ALT levels. Management includes lifelong therapy for cirrhosis and surveillance for hepatocellular carcinoma (HCC).
Area of Science:
- Hepatology
- Virology
- Public Health
Background:
- Hepatitis B virus (HBV) infection is prevalent in Asian Americans, with carrier rates of 2-16%.
- HBV is a leading cause of cirrhosis, hepatocellular carcinoma (HCC), and liver-related mortality in this population.
- Existing management guidelines may not fully address the unique aspects of HBV in Asian Americans.
Purpose of the Study:
- To develop evidence-based recommendations for managing Hepatitis B virus (HBV) infection in Asian Americans.
- To provide specific guidance on antiviral therapy, HCC surveillance, and management during pregnancy.
- To improve clinical decision-making and patient outcomes for HBV-infected Asian Americans.
Main Methods:
- Review of medical literature from Asian countries and studies on HBV in Asian Americans.
- Development of guidelines considering HBeAg positive and negative chronic hepatitis B (CHB).
- Inclusion of specific approaches for HCC surveillance and HBV management in pregnant women.
Main Results:
- Antiviral therapy is recommended for Asian American patients with HBV DNA >2000 IU/mL and elevated ALT, or specific risk factors with normal ALT.
- Lifelong antiviral therapy is indicated for patients with cirrhosis and detectable HBV DNA.
- Lifelong HCC surveillance (AFP and ultrasound every 6 months) is recommended for at-risk HBsAg-positive patients.
Conclusions:
- These guidelines offer tailored recommendations for HBV management in Asian Americans.
- Application of these guidelines by physicians is expected to improve patient outcomes.
- The recommendations are based on a synthesis of current literature and expert opinion.
Background:
Hepatitis B virus (HBV) infection is common with major clinical consequences. In Asian Americans, the HBsAg carrier rate ranges from 2% to 16% which approximates the rates from their countries of origin. Similarly, HBV is the most important cause of cirrhosis, hepatocellular carcinoma (HCC) and liver related deaths in HBsAg positive Asians worldwide.
Aim:
To generate recommendations for the management of Asian Americans infected with HBV.
Methods:
These guidelines are based on relevant data derived from medical reports on HBV from Asian countries as well as from studies in the HBsAg positive Asian Americans. The guidelines herein differ from other recommendations in the treatment of both HBeAg positive and negative chronic hepatitis B (CHB), in the approach to HCC surveillance, and in the management of HBV in pregnant women.
Results:
Asian American patients, HBeAg positive or negative, with HBV DNA levels >2000 IU/mL (>104 copies/mL) and ALT values above normal are candidates for anti-viral therapy. HBeAg negative patients with HBV DNA >2000 IU/mL and normal ALT levels but who have either serum albumin <3.5 g/dL or platelet count <130 000 mm3 , basal core promoter (BCP) mutations, or who have first-degree relatives with HCC should be offered treatment. Patients with cirrhosis and detectable HBV DNA must receive life-long anti-viral therapy. Indications for treatment include pregnant women with high viraemia, coinfected patients, and those requiring immunosuppressive therapy. In HBsAg positive patients with risk factors, life-long surveillance for HCC with alpha-fetoprotein (AFP) testing and abdominal ultrasound examination at 6-month intervals is required. In CHB patients receiving HCC treatments, repeat imaging with contrast CT scan or MRI at 3-month intervals is strongly recommended. These guidelines have been assigned to a Class (reflecting benefit vs. risk) and a Level (assessing strength or certainty) of evidence.
Conclusions:
Application of the recommendations made based on a review of the relevant literature and the opinion of a panel of Asian American physicians with expertise in HBV treatment will inform physicians and improve patient outcomes.
More Related Videos
Related Concept Videos
01:29Chronic Obstructive Pulmonary Disease-V: Management
Smoking Cessation
01:30Chronic Obstructive Pulmonary Disease-V: Nursing Management
Assessment
01:18Chronic Kidney Disease IV: Nursing Management
01:08Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment
01:21Hepatic Portal System
At its core, the hepatic portal vein is the result of a confluence of the superior and inferior mesenteric veins along with the splenic vein. Each of these veins has a unique role. The superior mesenteric vein is...
01:26Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow