Hepatitis B (Chronic) diagnosis and management of chronic hepatitis B in children, young people and adults
Since the introduction of effective treatment in the form of interferon alfa, several nucleoside and nucleotide analogues are now approved for use in adults with chronic hepatitis B, together with a pegylated form of interferon alfa. With multiple treatment options that are efficacious and safe, the...
| Corporate Authors: | , , , , , |
|---|---|
| Format: | eBook |
| Language: | English |
| Published: |
London
National Institute for Health and Care Excellence
[2013], 2013
|
| Series: | Clinical guideline
|
| Subjects: | |
| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | Since the introduction of effective treatment in the form of interferon alfa, several nucleoside and nucleotide analogues are now approved for use in adults with chronic hepatitis B, together with a pegylated form of interferon alfa. With multiple treatment options that are efficacious and safe, the key questions are which patients need immediate treatment and what sequence and combination of drug regimens should be used, and which patients can be monitored and delay treatment. In this guideline we cover the following: information needs of people with chronic hepatitis B and their carers; where children, young people and adults with chronic hepatitis B should be assessed; assessment of liver disease, including the use of non-invasive tests and genotype testing; criteria for offering antiviral treatment; the efficacy, safety and cost effectiveness of currently available treatments; selection of first-line therapy; management of treatment failure or drug resistance; whether there is a role for combination therapy; when it is possible to stop treatment; managing the care of pregnant and breastfeeding women and prevention of vertical transmission; prophylactic treatment during immunosuppressive therapy; and monitoring for treatment response, severity of fibrosis and development of HCC. The presence of HBeAg is typically associated with higher rates of viral replication and therefore increased infectivity. The goal of treatment for chronic hepatitis B is to prevent cirrhosis, HCC and liver failure. In clinical practice surrogate markers are used to monitor progression of disease and treatment response, and include normalisation of serum alanine aminotransferase (ALT) levels, decrease in inflammation scores with no worsening or improvement in fibrosis on liver biopsies, suppression of serum HBV DNA to undetectable levels, loss of HBeAg and seroconversion to HBe antibody (anti-HBe), and loss of HBsAg and seroconversion to HBs antibody (anti-HBs). Antiviral therapy suppresses HBV replication and decreases hepatic inflammation and fibrosis, thereby reducing the likelihood of serious clinical disease. Chronic hepatitis B describes a spectrum of disease usually characterised by the presence of detectable hepatitis B surface antigen (HBsAg) in the blood or serum for longer than 6 months. In some people, chronic hepatitis B is inactive and does not present significant health problems, but others may progress to liver fibrosis, cirrhosis and hepatocellular carcinoma (HCC). The progression of liver disease is associated with hepatitis B virus (HBV) DNA levels in the blood. Without antiviral treatment, the 5-year cumulative incidence of cirrhosis ranges from 8 to 20%. People with cirrhosis face a significant risk of decompensated liver disease if they remain untreated. Five-year survival rates among people with untreated decompensated cirrhosis can be as low as 15%. Chronic hepatitis B can be divided into e antigen- (HBeAg) positive or HBeAg-negative disease based on the presence or absence of e antigen. |
|---|---|
| Item Description: | Title from PDF title page. - "Methods, evidence and recommendations.". - "June 2013.". - "Final.". - "Royal College of Physicians; Royal College of Nursing; Royal College of General Practitioners; The Royal College of Surgeons of England." |
| Physical Description: | 1 PDF file (586 pages) illustrations |