Evaluation of Current Treatment Recommendations for Chronic Hepatitis B: A 2011 Update

Journal of Gastroenterology and Hepatology
Accepted Article (Accepted, unedited articles published online for future issues)

Myron John Tong Ph.D., M.D.1,2,*, Leeyen Hsu B.S.2, Patrick W. Chang 2, Lawrence Mitchell Blatt Ph.D. 2

DOI: 10.1111/j.1440-1746.2011.06623.x
© 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd

Author Information
1 From the Pfleger Liver Institute and the Division of Digestive Diseases, David Geffen School of Medicine at the University of California in Los Angeles, California, and the
2 Liver Center, Huntington Medical Research Institutes, Pasadena, California, USA.

* Correspondence: Myron John Tong Ph.D., M.D.,

* Correspondence: Myron J. Tong, Ph.D., M.D., Liver Center, Huntington Medical Research Institutes 660 South Fair Oaks Avenue Pasadena, CA 91105 Phone: (626) 397-5820 Email: myrontong@hmri.org  Fax: (626) 297-5827

Keywords:Anti-viral therapy;hepatocellular carcinoma;liver-related deaths;albumin;platelets;basal core promoter mutants;precore mutants

Abstract

Background/Aims: Guidelines for the treatment of chronic hepatitis B have been recently updated in the 2009 EASL consensus statement, the 2008 United States Panel, the 2008 Asian-Pacific consensus statement, and the 2009 AASLD practice guidelines. We sought to determine whether these guidelines identified patients who developed hepatocellular carcinoma (HCC) or who died of non-HCC liver-related deaths for anti-viral therapy.

Methods: The criteria described in the new treatment guidelines were matched to the database of 369 HBsAg-positive patients in whom 30 developed HCC and 37 died of non-HCC liver-related deaths during a mean follow-up of 84 months.

Results: Using criteria for anti-viral therapy as stated by the four current guidelines, 19-30% of patients who died of non-HCC liver-related complications and 23-53% of patients who developed HCC would have been excluded for anti-viral therapy. If baseline serum albumin levels of ≤3.5g/dl or platelet counts of ≤130,000mm3 were included into the treatment criteria, then 85% to 94% of patients who developed liver-related complications would have been recommended for anti-viral therapy. Also, the addition of precore A1896 mutants and basal core promoter T1762/A1764 mutants would have identified 98.5% to 100% of these patients.

Conclusion: The updated treatment guidelines for hepatitis B still excluded patients who developed serious liver-related complications. The inclusion of baseline serum albumin and platelet counts to current criteria would have identified a majority of these patients for anti-viral therapy. These tests should be included into hepatitis B treatment strategies.

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