Saturday, February 6, 2016

Asian-Pacific Clinical Practice Guidelines on the Management of Hepatitis B: A 2015 Update

Worldwide, some 240 million people have chronic hepatitis B virus (HBV), with the highest rates of infection in Africa and Asia. Our understanding of the natural history of HBV infection and the potential for therapy of the resultant disease is continuously improving. New data have become available since the previous APASL guidelines for management of HBV infection were published in 2012. 

The objective of this manuscript is to update the recommendations for the optimal management of chronic HBV infection. The 2015 guidelines were developed by a panel of Asian experts chosen by the APASL. The clinical practice guidelines are based on evidence from existing publications or, if evidence was unavailable, on the experts’ personal experience and opinion after deliberations. Manuscripts and abstracts of important meetings published through January 2015 have been evaluated. 

This guideline covers the full spectrum of care of patients infected with hepatitis B, including new terminology, natural history, screening, vaccination, counseling, diagnosis, assessment of the stage of liver disease, the indications, timing, choice and duration of single or combination of antiviral drugs, screening for HCC, management in special situations like childhood, pregnancy, coinfections, renal impairment and pre- and post-liver transplant, and policy guidelines. 

However, areas of uncertainty still exist, and clinicians, patients, and public health authorities must therefore continue to make choices on the basis of the evolving evidence. The final clinical practice guidelines and recommendations are presented here, along with the relevant background information.

Below:  Treatment indications for chronic HBV-infected patients with cirrhosis or reactivation of chronic HBV infection

Below:  Treatment indications for noncirrhotic HBeAg-positive chronic HBV-infected patients

Below:  Treatment indications for noncirrhotic HBeAg-negative chronic HBV-infected patients

Below:  Reverse transcriptase mutations associated with drug resistance

Below:  Cumulative incidence of antiviral resistance in long-term studies of NA therapy

Below:  Treatment of CHB infection in HIV infected individuals

Below:  Treatment of HBV–HCV coinfected patients

Recommendations for infected persons regarding prevention of transmission of HBV to others
Have sexual contacts vaccinated
Use barrier protection during sexual intercourse if partner not vaccinated or naturally immune
Do not share toothbrushes or razors
Cover open cuts and scratches
Clean blood spills with detergent or bleach
Do not donate blood, organs or sperm
Can participate in all activities including contact sports
Children should not be excluded from daycare or school participation and should not be isolated from other children
Can share food, utensils, or kiss others
Full article at:

Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong SAR, China
Department of Hepatogastroenterlogy, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
Genomics Research Center, Academia Sinica, National Taiwan University, Taipei, Taiwan
Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Liver Research Unit, Chang Gung Memorial Hospital and University, Chilung, Taiwan
Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand
Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Guangzhou, China
Department of Medicine, Aga Khan University, Karachi, Pakistan
Beijing Friendship Hospital, Capital Medical University, Beijing, China
Seoul, Korea
Department of Medicine, University of Hong Kong, Hong Kong, China
Internal Medicine Asan Medical Center, Seoul, Korea
Division of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore
Research and Molecular Development, Victorian Infectious Diseases Reference Laboratory, Melbourne, Australia
Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
Yamanashi Hospitals (Central and Kita) Organization, 1-1-1 Fujimi, Kofu-shi, Yamanashi 400-8506 Japan
Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
NKC Institute of Gastroenterology and Hepatology, Prince of Songkla University, Songkhla, Thailand
Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India
Department of Medicine, University of Santo Tomas, Manila, Philippines
The Institute of Translational Hepatology, Beijing, China
Treatment and Research Center for Infectious Diseases, Beijing 302 Hospital, Beijing, China
Peking University Hepatology Institute, Beijing, China
Division of Gastroenterology and Hepatology, Department of Medicine, University of Hong Kong, Pofulam, Hong Kong
Department of Hepatobiliary and Pancreatic Surgery, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003 Zhejiang Province China
Graduate Institute of Clinical Medicine and Hepatitis Research Center, National Taiwan University College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
S. K. Sarin, Email: moc.liamg@nirasvihs.

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