Hepatitis B virus treatment beyond the guidelines: special populations and consideration of treatment withdrawal

Vallet-Pichard, Anaı̈s; Pol, Stanislas

doi:10.1177/1756283x14524614

Cited by 21 publications

(24 citation statements)

References 47 publications

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“…Since necroinflammatory activity is the main stimulator of hepatic fibrosis [12] amidst the intricate pathways leading to HCC development in chronic viral hepatitis [63] , it is conceivable that the fibrogenic process will be arrested or even down-graded along with the subsidence of hepatitis activity subsequent to HBV suppression [64] . On the other hand, maintaining undetectable levels of HBV DNA may also increase the rate of HBeAg and HBsAg seroconversion, which are the desired endpoints of CHB therapy [65] . Notwithstanding the solid evidence of viral replication blockade with approved antivirals, the demonstration of advantages in terms of long-term outcomes is more difficult.…”

Section: Resultsmentioning

confidence: 99%

Role of antiviral therapy in the natural history of hepatitis B virus-related chronic liver disease

Russo

Rodríguez–Castro

Scribano

et al. 2015

WJH

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interactions among HBV, hepatocytes, and the host immune system. Natural history studies of chronic hepatitis B (CHB) infection have shown an association between active viral replication and adverse clinical outcomes such as cirrhosis and hepatocellular carcinoma. The goal of therapy for CHB is to improve quality of life and survival by preventing progression of the disease to cirrhosis, decompensation, end-stage liver disease, hepatocellular carcinoma (HCC) and death. This goal can be achieved if HBV replication is suppressed in a sustained manner. The accompanying reduction in histological activity of CHB lessens the risk of cirrhosis and of HCC, particularly in non-cirrhotic patients. However, CHB infection cannot be completely eradicated, due to the persistence of covalently closed circular DNA in the nucleus of infected hepatocytes, which may explain HBV reactivation. Moreover, the integration of the HBV genome into the host genome may favour oncogenesis, development of HCC and may also contribute to HBV reactivation. Core tip: The goal of therapy for chronic hepatitis B is to improve quality of life and survival by preventing progression of the disease to cirrhosis, decompensation, end-stage liver disease, hepatocellular carcinoma and death. Current therapeutic options do not eradicate hepatitis B virus (HBV) infection, since HBV remains either integrated in the host genome or in the nuclei of hepatocytes as covalently closed circular DNA, a fact that may favour oncogenesis towards the development of hepatocellular carcinoma, and explains HBV reactivation. It is mandatory for clinicians to start viral suppression in patients with active chronic liver disease, particularly in

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Section: Resultsmentioning

confidence: 99%

Role of antiviral therapy in the natural history of hepatitis B virus-related chronic liver disease

Russo

Rodríguez–Castro

Scribano

et al. 2015

WJH

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“…The European Association for the Study of the Liver clinical practical guidelines now recommend treatment in the last trimester of pregnancy in HBsAg‐positive women with serum HBV–DNA >106–7 IU/mL; if therapy is given only for the prevention of perinatal transmission, it can be discontinued within the first 3 months after delivery . Such discontinuation has not been shown to be associated with a significant increase in the risk of alanine aminotransferase flares . Because tenofovir is a prodrug that results in low concentrations in breast milk, it is thought to be safe to use during breast‐feeding …”

Section: Preventing Mother‐to‐child Infection Transmissionmentioning

confidence: 99%

“…55 Such discontinuation has not been shown to be associated with a significant increase in the risk of alanine aminotransferase flares. 56 Because tenofovir is a prodrug that results in low concentrations in breast milk, it is thought to be safe to use during breastfeeding. 57…”

Section: Preventing Mother-to-child Infection Transmissionmentioning

confidence: 99%

Chronic hepatitis B virus in the Philippines

Gish

Sollano

Lapasaran³

et al. 2016

J of Gastro and Hepatol

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Multiple studies have shown a high prevalence of chronic hepatitis B (CHB) infection in the Philippines, not only in high-risk populations but also in the general population. The most recent national study estimated HBsAg seroprevalence to be 16.7%, corresponding to an estimated 7.3 million CHB adults. The factors underlying the high prevalence of CHB and its sequelae include the inadequate use of vaccination for prevention and the lack of treatment for many Filipinos. Because without medical monitoring and treatment of CHB the risk of progression to liver failure and death is 25-30%, the ultimate medical and societal costs will be very high if the Philippines fails to properly address hepatitis B infection. It will be very important to move forward with programs that can help to ensure universal vaccination of newborns, screening and vaccination nationwide, and monitoring and treatment for CHB persons. It will also be crucial to address transmission of HBV in the health-care setting (via contaminated needles and syringes and inadequately sterilized hospital equipment) and via injection drug use and tattooing. Because of the relatively low average per capita income and the lack of coverage by PhilHealth of outpatient visits and medications, there is an urgent need to move forward with a nationally supported program that includes education for both the general public and health-care workers on liver disease and screening for hepatitis viruses, followed by, as appropriate, vaccination or treatment, with expanded government coverage for these for all those who could not otherwise afford it.

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“…Apart from cases reviews, there is no strong evidence to make this recommendation in patients with ID and low doses of corticosteroids in short term basis. More conservative management advises to monitor regularly HBV DNA and to start early antiviral therapy if DNA level arises [6,81,82] . The same recommendations can be made in the case of the low systemic bioavailability steroids (budesonide and BPD).…”

Section: López-serrano P Et Al Hepatitis B and Prophylaxis In Immunmentioning

confidence: 99%

“…As immunosuppressants for ID usually are used for long term, nucleoside/ nucleotide analogues (NAs) with a lower rate of resistance must be considered. Tenofovir and entecavir have a higher barrier to resistance, and should be used if treatments longer than 12 mo are planned [6,76,77,82,83] . In those patients with OBI with a high risk of reactivation, lamivudine may still have a role, because of its low cost, and the low or absent HBV viremia in these cases [76,78] .…”

Section: Which Antiviral Drug Must We Choose?mentioning

confidence: 99%

Hepatitis B and immunosuppressive therapies for chronic inflammatory diseases: When and how to apply prophylaxis, with a special focus on corticosteroid therapy

López-Serrano

Briongos

Alonso

et al. 2015

WJH

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Currently immunosuppressive and biological agents are used in a more extensive and earlier way in patients with inflammatory bowel disease, rheumatic or dermatologic diseases. Although these drugs have shown a significant clinical benefit, the safety of these treatments is a challenge. Hepatitis B virus (HBV) reactivations have been reported widely, even including liver failure and death, and it represents a deep concern in these patients. Current guidelines recommend to preemptive therapy in patients with immunosuppressants in general, but preventive measures focused in patients with corticosteroids and inflammatory diseases are scarce. Screening for HBV infection should be done at diagnosis. The patients who test positive for hepatitis B surface antigen, but do not meet criteria for antiviral treatment must receive prophylaxis before undergoing immunosuppression, including corticosteroids at higher doses than prednisone 20 mg/d during more than two weeks. Tenofovir and entecavir are preferred than lamivudine because of their better resistance profile in long-term immunosuppressant treatments. There is not a strong evidence, to make a general recommendation on the necessity of prophylaxis therapy in patients with inflammatory diseases that are taking low doses of corticosteroids in short term basis or low systemic bioavailability corticosteroids such as budesonide or beclomethasone dipropionate. In these cases regularly HBV DNA monitoring is recommended, starting early antiviral therapy if DNA levels begin to rise. In patients with occult or resolved hepatitis the risk of reactivation is much lower, and excepting for Rituximab treatment, the prophylaxis is not necessary. Hepatitis B and immunosuppressive therapies for chronic inflammatory diseases: When and how to apply prophylaxis, with a special focus on corticosteroid therapyCore tip: Few reviews have been published including data of the three more common inflammatory diseases that require immunosuppressive therapy: inflammatory bowel disease, rheumatic and dermatologic diseases. This paper is focused on the risk of reactivation of hepatitis B virus under immunosuppressants, and particularly corticosteroids. Although most of the guidelines do not specify the necessity of prophylaxis in case of monotherapy with corticosteroids, the specialists responsible of these patients are usually concerned about this issue. Moreover, the risk with low systemic bioavailability new corticosteroids has not been evaluated in previous reviews. This work summarizes the evidence of VHB reactivation in patients with inflammatory diseases: when and how to apply prophylaxis, with a special focus on "new" and "old" steroids.López-Serrano P, de la Fuente Briongos E, Carrera-Alonso E, Pérez-Calle JL, Fernández Rodríguez C. Hepatitis B and immunosuppressive therapies for chronic inflammatory diseases: When and how to apply prophylaxis, with a special focus on corticosteroid therapy.

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Hepatitis B virus treatment beyond the guidelines: special populations and consideration of treatment withdrawal

Cited by 21 publications

References 47 publications

Role of antiviral therapy in the natural history of hepatitis B virus-related chronic liver disease

Role of antiviral therapy in the natural history of hepatitis B virus-related chronic liver disease

Chronic hepatitis B virus in the Philippines

Hepatitis B and immunosuppressive therapies for chronic inflammatory diseases: When and how to apply prophylaxis, with a special focus on corticosteroid therapy

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