Volume 6, Issue 12 , Pages 1315-1341, December 2008
A Treatment Algorithm for the Management of Chronic Hepatitis B Virus Infection in the United States: 2008 Update
Chronic HBV infection is an important public health problem worldwide and in the United States. A treatment algorithm for the management of this disease, published previously by a panel of U.S. hepatologists, has been revised on the basis of new developments in the understanding of the disorder, the availability of more sensitive molecular diagnostic tests, and the licensure of new therapies. In addition, a better understanding of the advantages and disadvantages of new treatments has led to the development of strategies for reducing the rate of resistance associated with oral agents and optimizing treatment outcomes. This updated algorithm was based primarily on available evidence by using a systematic review of the literature. Where data were lacking, the panel relied on clinical experience and consensus expert opinion. The primary aim of antiviral therapy is durable suppression of serum HBV DNA to low or undetectable levels. Assays can now detect serum HBV DNA at levels as low as 10 IU/mL and should be used to establish a baseline level, monitor response to antiviral therapy, and survey for the development of drug resistance. Interferon alfa-2b, lamivudine, adefovir, entecavir, peginterferon alfa-2a, telbivudine, and tenofovir are approved as initial therapy for chronic hepatitis B and have certain advantages and disadvantages. Although all of these agents can be used in selected patients, the preferred first-line treatment choices are entecavir, peginterferon alfa-2a, and tenofovir. Issues for consideration for therapy include efficacy, safety, rate of resistance, method of administration, and cost.
Abbreviations used in this paper: AFP, alpha-fetoprotein, anti-HBc, antibody to hepatitis B core antigen, anti-HBe, antibody to hepatitis B e antigen, anti-HBs, antibody to hepatitis B surface antigen, cccDNA, covalently closed circular DNA, CDC, Centers for Disease Control and Prevention, CHB, chronic hepatitis B, FDA, Food and Drug Administration, HCC, hepatocellular carcinoma, HIV, human immunodeficiency virus, HR, hazard ratio, PCR, polymerase chain reaction, REVEAL, Risk Evaluation Viral Load Elevation and Associated Liver Disease, RR, relative risk, ULN, upper limit of normal
The authors wish to thank Kathy Covino, PhD, for her editorial contributions and assistance in the preparation of the manuscript.
The authors disclose the following: This algorithm was developed with support by an unrestricted educational grant from Gilead Sciences.
Dr Keeffe is an employee of Romark Laboratories and has been a consultant for and served on advisory boards for Bristol-Myers Squibb, Gilead, Idenix, Novartis, and Roche. Dr Dieterich has received grant or research support and honoraria from Bristol-Myers Squibb, Gilead, Idenix, and Roche. Dr Han has received grant or research support, served on the advisory boards, and been a member of speakers' bureaus for Bristol-Myers Squibb, Gilead, and Roche. Dr Jacobson has received grant or research support from Coley, Gilead, Globelmmune, InterMune, Ribozyme, Valeant, and Schering-Plough; is a consultant for Anadys, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Coley, Gilead, Globelmmune, Idenix, InterMune, Novartis, Pfizer, Schering-Plough, Valeant, and Vertex; and is on speakers' bureaus for Bristol-Myers Squibb, Gilead, GlaxoSmithKline, and Schering-Plough. Dr Martin has been a consultant, speaker, and investigator for Gilead, Bristol-Myers Squibb, Idenix, Novartis, Roche, and Schering. Dr Schiff has been a consultant to Abbott, Achillion, Bayer, Bristol-Myers Squibb, Cadence, Gilead, GlobeImmune, Idenix, Maxim, National Genetics Institute, Novartis, Ortho-Biotech, Pharmasset, Pfizer, PowerMed Limited, Prometheus, Roche Molecular, Salix, Sankyo Pharma, Schering-Plough, and SciClone; he has research grants and support including clinical trials from Abbott, Bayer, Bristol-Myers Squibb, Coley, Gilead, GlaxoSmithKline, Idenix, Ortho-Biotech, Prometheus, Roche Diagnostics, Roche Molecular, Roche Pharmaceutical, Schering-Plough, SciClone, and Vertex; and he has served on the speakers' bureau or received honoraria from Abbott, Bristol-Myers Squibb, Gilead, GlaxoSmithKline, Idenix, Ortho-Biotech, and Schering-Plough. Dr Tobias has served as a consultant and/or is on speakers' bureaus for Bristol-Myers Squibb, Gilead, Novartis and Roche.
PII: S1542-3565(08)00853-7
doi:10.1016/j.cgh.2008.08.021
© 2008 AGA Institute. Published by Elsevier Inc. All rights reserved.
Refers to article:
- Exam 1: A Treatment Algorithm for the Management of Chronic Hepatitis B Virus Infection in the United States: 2008 Update , 12 November 2008
Volume 6, Issue 12 , Pages 1315-1341, December 2008
