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Hepatitis B: Who to treat? A critical review of international guidelines

Daniel Q Huang1,2, Seng Gee Lim1,2

  • 1Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore.

Liver International : Official Journal of the International Association for the Study of the Liver
|February 21, 2020
PubMed

Insights

Chronic hepatitis B affects over 250 million globally. Current guidelines for hepatitis B treatment lack personalized factors like age and genotype, necessitating improved predictive models for high-risk patients.

Area of Science:

  • Hepatology
  • Virology
  • Public Health

Background:

  • Chronic hepatitis B is a significant global health issue, impacting over 250 million people worldwide.
  • A substantial proportion of infected individuals are at risk of developing severe outcomes such as advanced fibrosis and hepatocellular carcinoma (HCC).
  • Existing international guidelines offer varying approaches to treatment recommendations, with some based on systematic reviews and others on expert consensus.

Purpose of the Study:

  • To review current guidelines for chronic hepatitis B management.
  • To identify limitations in existing treatment decision-making processes.
  • To highlight the need for improved predictive models for patient selection.

Main Methods:

  • Analysis of World Health Organization (WHO), American Association for the Study of Liver Diseases (AASLD), European Association for the Study of the Liver (EASL), and Asia Pacific Association for the Study of the Liver (APASL) guidelines.
  • Comparison of guideline development methodologies (data-driven vs. consensus).
  • Identification of factors considered and omitted in treatment recommendations.

Main Results:

  • Guidelines generally agree on treating patients with high alanine aminotransferase (ALT) levels, active viral replication, and advanced fibrosis or cirrhosis.
  • Recent guidelines (EASL, APASL, AASLD 2018) were developed by expert consensus, unlike earlier WHO and AASLD guidelines.
  • Current guidelines do not incorporate patient-specific factors like age, gender, and hepatitis B genotype into treatment decisions.

Conclusions:

  • There is a critical need for more sophisticated predictive models to accurately identify high-risk individuals for chronic hepatitis B treatment.
  • Further high-quality research is required to develop and validate such models.
  • Personalized approaches considering clinical factors beyond viral markers and fibrosis stage are essential for optimal patient management.

Keywords:
GRADE approachchronicevidence-based practiceguidelinehepatitis Bpatient selection

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