Management of Hepatitis B Virus Infection: 2018 Guidelines from the Canadian Association for the Study of Liver Disease and Association of Medical Microbiology and Infectious Disease Canada

Abstract

Hepatitis B virus (HBV) infection is an important public health problem in Canada. In keeping with evolving evidence and understanding of HBV pathogenesis, the Canadian Association for the Study of Liver Disease periodically publishes HBV management guidelines. The goals of the 2018 guidelines are to (1) highlight the public health impact of HBV infection in Canada and the need to improve diagnosis and linkage to care, (2) recommend current best-practice guidelines for treatment of HBV, (3) summarize the key HBV laboratory diagnostic tests, and (4) review evidence on HBV management in special patient populations and include more detail on management of HBV in pediatric populations. An overview of novel HBV tests and therapies for HBV in development is provided to highlight the recent advances in HBV clinical research. The aim and scope of these guidelines are to serve as an up-to-date, comprehensive resource for Canadian health care providers in the management of HBV infection.

Impact of Hepatitis B Virus Genetic Variation, Integration, and Lymphotropism in Antiviral Treatment and Oncogenesis

“…The natural history of CHB infection is complex and has been divided into distinct phases [ 7 , 8 , 9 ]. An important viral marker utilized in the classification of CHB phases is presence or absence of viral hepatitis B “e” antigen (HBeAg).…”

“…The first phase is defined as a high replicative and low inflammatory “HBeAg positive infection” ( Figure 1 ). Typically, CHB carriers in this phase are characterized with extremely high viral load (i.e., HBV DNA levels) and positivity for HBeAg [ 9 ]. Despite, the high levels of viral protein and DNA, overt liver inflammation and damage are minimal.…”

Variable access to antiviral treatment of chronic hepatitis B in Canada: a descriptive study

“…Some of the reimbursement requirements are somewhat perplexing, as major associations, including the Canadian Association for the Study of the Liver, 3 American Association of the Study of Liver Diseases, 6 European Association for the Study of Liver, 7 Asian Pacific Association for the Study of the Liver 5 and the World Health Organization, 13 have developed treatment algorithms documenting effective timing of therapy to prevent complications ( Table 2, Table 3). It is unclear why interferon is approved only for HBeAg-negative patients in some provinces given the reasonable response rate in the HBeAg-positive population.…”

“…It is unclear why interferon is approved only for HBeAg-negative patients in some provinces given the reasonable response rate in the HBeAg-positive population. 3,6 In addition, restrictions such as fibrosis stage are neither cost-effective nor evidence-based. Although a "one-size-fits-all" strategy has drawbacks (e.g., the ability of jurisdictions to respond to chronic hepatitis B…”

Hepatitis B and Pregnancy: Virologic and Immunologic Characteristics

“…HBV immunoprophylaxis failures can occur in approximately 10% of infants born to mothers who are HBsAg+ and HBeAg+ with HBV‐DNA 9 log10 copies/mL (1 IU = ~5 virus copies/mL). Current guidelines recommend initiation of oral antiviral (nucleos(t)ide analog [NA]) therapy in the third trimester in mothers who are highly viremic with HBV‐DNA levels >6 log10 copies/mL to reduce the risk of MTCT . According to the U.S. Food and Drug Administration (FDA), the three oral NAs considered safe in pregnancy are lamivudine (LMV; category class C) and class B drugs telbivudine and tenofovir disoproxil fumarate (TDF).…”