Accuracy of International Guidelines for Identifying Significant Fibrosis in Hepatitis B e Antigen–Negative Patients With Chronic Hepatitis

Sanai, Faisal M.; Babatin, Mohamed; Bzeizi, Khalid; Alsohaibani, Fahad; Al–Hamoudi, Waleed; Alsaad, Khaled O.; Mana, Hadeel Al; Handoo, Fayaz A.; Al-Ashgar, Hamad I.; Alghamdi, Hamdan S.; Ibrahim, Abeer; Aljumah, Abdulrahman; Alalwan, Abduljaleel; Altraif, Ibrahim; Al–Hussaini, Hussa; Myers, Robert P.; Abdo, Ayman A.

doi:10.1016/j.cgh.2013.05.038

Cited by 20 publications

(14 citation statements)

References 18 publications

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“…Median age was 45 (interquartile range: 37, 56) years, 43% (415) were female, 75% (732) were non-White, and 20% (198) did not list English as their primary language. The largest proportion of patients, 41% (395), was inactive carriers; the smallest proportion was immune tolerant, 1% (13). Primary responsibility for the management of CHB was provided by gastroenterologists in 65% (630) and PCP in 26% (254).…”

Section: Resultsmentioning

confidence: 99%

“…Several studies have found that HBV-infected patients with even normal (19 Ul −1 for women, 30 Ul −1 for men) and/or mildly elevated ALT values may have significant histologic disease and can be at an increased risk of mortality from liver disease, especially those above the age of 40 years (12). A recent study by Sanai et al (13) performed on 366 patients with liver biopsies to assess the accuracy of guideline-defined thresholds in identifying patients with > F2 fibrosis showed an unacceptably high miss rate of one-half of all cases of significant fibrosis. A meta-analysis of studies of liver histology in HBeAg-negative patients with normal or minimally elevated ALT and HBV DNA >2,000 IU ml −1 showed that 8% had moderate or severe fibrosis (14).…”

Section: Discussionmentioning

confidence: 99%

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Poor Adherence to AASLD Guidelines for Chronic Hepatitis B Management and Treatment in a Large Academic Medical Center

Johnson

Roccaro

et al. 2014

American Journal of Gastroenterology

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Objectives Adherence to the American Association for the Study of Liver Disease (AASLD) guidelines for the management of chronic hepatitis B (CHB) has not been systematically assessed. We sought to comprehensively evaluate adherence to five key areas of these guidelines. We also evaluated physician and patient factors underlying nonadherence, and predictors of nonadherence such as physician type, patient demographic factors, and phase of CHB infection. Methods Nine hundred and sixty-two adult patients were retrospectively identified. Each patient chart was reviewed in detail. The primary outcome was adherence to five areas of the AASLD guidelines: (i) timely alanine aminotransferase (ALT)/hepatitis B virus DNA level checks needed to monitor inactive carrier and immune-tolerant phases; (ii) liver biopsy to guide decisions on initiating treatment; (iii) treatment initiation when indicated; (iv) hepatocellular carcinoma (HCC) screening; (v) testing for hepatitis A virus (HAV) immunity, HIV, and hepatitis C virus (HCV) co-infections. Results Sixty percent did not undergo clinically indicated liver biopsies, largely owing to physician nonadherence. Eighty-nine percent of these missed biopsies were needed to further assess possible e-antigen-negative CHB. A high treatment initiation rate was found for the treatment eligible, but 121 patients had unclear treatment eligibility as they warranted, but did not undergo, liver biopsy. Forty-five percent did not have timely HCC screening, although gastroenterology physicians had the highest odds of adherence, and 29% did not have timely CHB lab assessment; patients seen by gastroenterologists had twice the odds compared with primary care physicians of undergoing timely lab monitoring. Thirty-five, 24, and 54% were not tested for HAV, HCV, and HIV co-infections. Conclusions Our findings show remarkably poor adherence to AASLD guidelines, particularly in the areas of liver biopsy, timely HCC and ALT monitoring, and testing for co-infection. These findings call for greater efforts to meet physician knowledge gaps, incorporation of decision support tools, and improved communication among providers.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Poor Adherence to AASLD Guidelines for Chronic Hepatitis B Management and Treatment in a Large Academic Medical Center

Johnson

Roccaro

et al. 2014

American Journal of Gastroenterology

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“…This can be achieved by repeated monitoring of ALT and serum HBV DNA levels (over a period of at least 1 year, according to international guidelines) [5,6]. On the other hand, the accuracy of international guidelines for identifying significant fibrosis in HBeAg-negative patients based on the ALT and HBV DNA levels has been questioned [7].…”

Section: Introductionmentioning

confidence: 99%

Role of serum hepatitis B virus marker quantitation to differentiate natural history phases of HBV infection

et al. 2015

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“…[7][8][9] Early detection of significant liver disease and treatment substantially improves patient outcomes even after decompensation occurs 10 ; however, current clinical practice based on noninvasive tests often fails to detect liver disease until it is at an advanced stage. 11 Evidence for doing invasive liver biopsy in patients with normal liver biochemistry is not robust at present. 12,13 Thus, there is an important need for new approaches that can improve the ability to identify liver fibrosis at early stage.…”

Section: H Epatitis B Virus (Hbv) Infection Remains a Seriousmentioning

confidence: 99%

HBsAg Level as Predictor of Liver Fibrosis in HBeAg Positive Patients With Chronic Hepatitis B Virus Infection

Goyal

Jain

Dixit

et al. 2015

Journal of Clinical and Experimental Hepatology

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Background and aims: Preliminary data suggests lower serum hepatitis B surface antigen level is associated with more severe liver fibrosis in HBeAg positive patients. We evaluated the association of HBsAg level with biochemical, virological, and histological features in asymptomatic patients with chronic HBV infection. Methods: HBsAg levels were measured at baseline in 481 asymptomatic, treatment naive patients with chronic HBV infection. Subjects were followed-up prospectively (median, 12; range, 8-36 months). Phases of HBV infection were defined after regular monitoring of HBV-DNA and transaminases. Liver histology was scored using the METAVIR system. Results: HBeAg positive (n, 126) patients were significantly younger than HBeAg negative (n, 355), median age 26 vs 30 years; P < 0.01. HBV genotype could be determined in 350 patients, 240 (68.57%) had genotype D and 100 (28.57%) had genotype A. HBsAg level had modest correlation with serum HBV DNA(r = 0.6 vs 0.4 in eAg positive & negative respectively). HBeAg + ve patients with fibrosis score ! F2 showed significantly lower median serum HBsAg levels and serum HBV DNA levels compared with patients with F0-F1 score (median, range; 4.51, 2.99-6.10 vs 5.06, 4.13-5.89, P < 0.01) and (8.39, 3.85-10.60, P < 0.01) respectively. Significant inverse correlation of HBsAg level was found with liver fibrosis in eAg positive group (r = À0.76; P < 0.001). HBsAg level cut off value 4.7 log 10 IU/ml predicted moderate to advance fibrosis (F ! 2) with 92% sensitivity, 85% specificity & 91% negative predictive value. Conclusion: Lower HBsAg level might reflect the status of advanced liver fibrosis in HBeAg positive chronic hepatitis B subjects. ( J CLIN EXP HEPATOL 2015;5:213-220)

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Accuracy of International Guidelines for Identifying Significant Fibrosis in Hepatitis B e Antigen–Negative Patients With Chronic Hepatitis

Cited by 20 publications

References 18 publications

Poor Adherence to AASLD Guidelines for Chronic Hepatitis B Management and Treatment in a Large Academic Medical Center

Poor Adherence to AASLD Guidelines for Chronic Hepatitis B Management and Treatment in a Large Academic Medical Center

Role of serum hepatitis B virus marker quantitation to differentiate natural history phases of HBV infection

HBsAg Level as Predictor of Liver Fibrosis in HBeAg Positive Patients With Chronic Hepatitis B Virus Infection

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