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. 2007 Jun;21 Suppl C(Suppl C):5C-24C.

Management of chronic hepatitis B: consensus guidelines

Morris Sherman  1 , Stephen Shafran, Kelly Burak, Karen Doucette, Winnie Wong, Nigel Girgrah, Eric Yoshida, Eberhard Renner, Philip Wong, Marc Deschênes
Affiliations

Management of chronic hepatitis B: consensus guidelines

Morris Sherman et al. Can J Gastroenterol. 2007 Jun.

Abstract
in English, French

The present document presents the proceedings of the consensus development conference on the management of viral hepatitis held in January 2007 under the auspices of the Canadian Association for the Study of the Liver and the Association of Medical Microbiology and Infectious Disease Canada. Several new agents have become available since the last such document was published in 2004, and new information has become available to help assess risk of adverse outcomes and who should be treated. In addition, the participants at the meeting identified a number of structural barriers that exist uniquely in Canada and that prevent physicians from properly managing their patients. The conference discussed the selection of patients for treatment and the drugs that can be used to treat these patients, as well as the treatment of hepatitis B in special populations. The present document should be read in conjunction with the companion document on the management of chronic hepatitis C.

Le présent document contient les débats de la conférence d’élaboration des lignes directrices consensuelles pour la prise en charge de l’hépatite virale qui a eu lieu en janvier 2007 sous les auspices de l’Association canadienne pour l’étude du foie et de l’Association pour la microbiologie médicale et l’infectiologie Canada. Plusieurs nouveaux agents ont été mis en marché depuis la publication du dernier document de ce genre en 2004, et de nouvelles données sont devenues disponibles pour contribuer à évaluer le risque d’effets indésirables et pour établir qui devrait être traité. De plus, les participants à la conférence ont déterminé un certain nombre d’obstacles structurels qui n’existent qu’au Canada et empêchent les médecins de bien prendre leurs patients en charge. La conférence a porté sur la sélection des patients à traiter et sur les médicaments qui peuvent être utilisés pour ce faire, de même que sur le traitement de l’hépatite B dans les populations spéciales. Il faut lire le présent document conjointement avec le document connexe sur la prise en charge de l’hépatite C chronique.

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Figures

Figure 1)
Figure 1)
Dynamic range of assays for hepatitis B virus (HBV) DNA. High concentration samples require dilution and retesting. *Abbott Molecular Inc, USA; †Digene Corporation, USA; ‡Roche Molecular Systems, USA; §Bayer Healthcare, USA. HBeAg +ve Hepatitis B e antigen positive; PCR Polymerase chain reaction
Figure 2)
Figure 2)
A Algorithm for selecting hepatitis B e antigen (HBeAg)-positive patients for treatment. B Algorithm for selecting HBeAg-negative patients for treatment. ALT Alanine aminotransferase; HBV Hepatitis B virus
Figure 3)
Figure 3)
Relative potencies of different hepatitis B antivirals at 48 to 52 weeks of therapy. Lamivudine has been compared with entecavir and to telbivudine in two separate randomized controlled trials (73,88). Adefovir has not been compared directly with the other agents. HBeAg Hepatitis B e antigen; HBV Hepatitis B virus. Data from references ,,, and
Figure 4)
Figure 4)
A Algorithm for the selection of specific agents for treatment of hepatitis B e antigen (HBeAg)-positive patients with hepatitis B. B Algorithm for the selection of specific agents for treatment of HBeAg-negative patients with hepatitis B. Response to adefovir, lamivudine and telbivudine should be assessed according to the text. HBV Hepatitis B virus
Figure 5)
Figure 5)
Rates of resistance to antiviral agents by duration of therapy. Data from references ,,, and
Figure 6)
Figure 6)
Suggested algorithm for management of patients with hepatitis B virus (HBV) cirrhosis. PCR Polymerase chain reaction
See this image and copyright information in PMC

References

    1. Remis R. (personal communication). Estimating the Number of Persons Infected with Hepatitis C in Canada. Submitted to Health Canada, 2005
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