Antiviral Therapy for Adults With Chronic Hepatitis B: A Systematic Review for a National Institutes of Health Consensus Development Conference

Shamliyan, Tatyana; MacDonald, Roderick; Shaukat, Aasma; Taylor, Brent C; Yuan, Jian Min; Johnson, James R.; Tacklind, James; Rutks, Indulis; Kane, Robert L; Wilt, Timothy J

doi:10.7326/0003-4819-150-2-200901200-00101

Cited by 92 publications

(69 citation statements)

References 99 publications

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“…This is due to the fact that these outcomes do not usually occur for many years after infection with HBV, and therefore require long-term investigation of therapy to demonstrate benefit. As a consequence, most published reports of HBV drug therapy use changes in short-term virologic, biochemical and histologic parameters to infer the likelihood of long-term benefit (Sorrell et al 2009, Shamliyan et al 2009. In addition, virtually all drug-effectiveness studies are based on patients with CHB without hepatic decompensation or liver cancer.…”

Section: G the Annual Transition Probabilities For Each State Assummentioning

confidence: 99%

A survey of Sydney general practitioners' management of patients with chronic hepatitis B

Najjar

Gupta

Pritchard-Jones

et al. 2016

Medical Journal of Australia

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Objective: To examine the chronic hepatitis B (CHB) assessment and management practices of general practitioners in the Sydney and South Western Sydney Local Health Districts, areas with a high prevalence of CHB, and to obtain their views on alternative models of care. Design, setting and participants: We used a descriptive, cross‐sectional study design to survey GPs who had seen at least one patient aged 18 years or over who had been notified as having CHB to the Public Health Unit between 1 June 2012 and 31 May 2013. There were 213 eligible GPs; the response rate was 57.7%. Main outcome measures: The CHB assessment, management and referral practices of the GPs, and their opinions about different models of care. Results: Most GPs (78.9%) were at least reasonably confident about managing CHB. GPs were generally most comfortable with a model of care that involved initial referral to a specialist; managing CHB without specialist input or with only review by a specialised nurse practitioner were less popular. Conclusion: These results suggest that barriers, including dependence on specialist input, still hinder the appropriate assessment and management of CHB patients by GPs. Well designed and targeted support programs that include specialist support are needed if there is to be a successful shift to an increased role for GPs in the model of care for managing CHB.

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Section: G the Annual Transition Probabilities For Each State Assummentioning

confidence: 99%

A survey of Sydney general practitioners' management of patients with chronic hepatitis B

Najjar

Gupta

Pritchard-Jones

et al. 2016

Medical Journal of Australia

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“…Currently, five oral nucleotide antiviral drugs are approved for the treatment of chronic HBV infection: lamivudine, adefovir, entecavir, tenofovir, and telbivudine [18]. The most commonly used antiviral drug in HBV reactivation is lamivudine [1].…”

Section: Discussionmentioning

confidence: 99%

De novo acute hepatitis B in myeloperoxidase-specific anti-neutrophil cytoplasmic autoantibody-related microscopic polyangiitis treated with corticosteroids

Iwafuchi¹,

Oyama²,

Morita

et al. 2012

CEN Case Rep

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An 82-year-old female was referred to our hospital because of low-grade fever, anemia, and rapidly progressive nephritic syndrome. Her laboratory data showed mild proteinuria, mild renal failure, and the presence of myeloperoxidase-specific anti-neutrophil cytoplasmic autoantibody. A skin biopsy specimen taken from the erythematous purpura revealed neutrophilic infiltration around the blood vessels with fibrinoid changes in the vessel walls. A renal biopsy specimen revealed segmental necrotizing glomerulonephritis with fibro-cellular crescent formation without deposits of immunoglobulin or complement components, indicating microscopic polyangiitis. The use of corticosteroid treatment, including intravenous methylprednisolone, improved renal failure. After 4 years with low-dose maintenance corticosteroid therapy, she developed de novo acute hepatitis B, and entecavir was remarkably effective, showing a rapid recovery from liver dysfunction with jaundice. To prevent hepatitis B virus (HBV) reactivation and de novo acute hepatitis B induced by immunosuppressive or cytotoxic therapy, including corticosteroids alone, the measurement of HBV-related serological markers needs to be performed prior to the initiation of such therapy, even in renal diseases.

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“…Also, loss of HBsAg with sustained negativity of HBV DNA became a rarely achieved endpoint by antiviral drug therapy in CHB patients. Most striking features indicated that HBV persists in hepatocytes even after HBsAg clearance in CHB patients, as covalently closed circular DNA (cccDNA) and these cccDNA can act as template for HBV replication when they receive an opportunity to replicate due to alteration of life style or intake of immune suppressive drugs for treatment of other morbidities (15 (16,17). Especially these drugs have some inherent limitations in developing and resource-constrained countries of the world due to poorly-developed health care delivery system of these countries (18).…”

Section: Therapy Of Chronic Hbv Infectionmentioning

confidence: 99%

Immune therapy for hepatitis B

et al. 2016

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Although several antiviral drugs are now available for treatment of patients with chronic hepatitis B (CHB), sustained off-treatment clinical responses and containment of CHB-related complications are not achieved in majority of CHB patients by antiviral therapy. In addition, use of these drugs is endowed with substantial long term risk of viral resistance and drug toxicity. The infinite treatment regimens of antiviral drugs for CHB patients are also costly and usually unbearable by most patients of developing and resource-constrained countries.Taken together, there is a pressing need to develop new and innovative therapeutic approaches for CHB patients.

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Antiviral Therapy for Adults With Chronic Hepatitis B: A Systematic Review for a National Institutes of Health Consensus Development Conference

Cited by 92 publications

References 99 publications

A survey of Sydney general practitioners' management of patients with chronic hepatitis B

A survey of Sydney general practitioners' management of patients with chronic hepatitis B

De novo acute hepatitis B in myeloperoxidase-specific anti-neutrophil cytoplasmic autoantibody-related microscopic polyangiitis treated with corticosteroids

Immune therapy for hepatitis B

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