Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update

Abstract

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.

Keywords: Acute hepatitis; Guidelines; HBV.

Fig. 1

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

Fig. 2

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

Fig. 3

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

Fig. 4

Reverse transcriptase mutations associated with drug resistance

Fig. 5

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

Fig. 6

Prophylaxis for prevention of HBV graft recurrence following LT

Fig. 7

Treatment of CHB infection in HIV infected individuals

Fig. 8

Treatment of HBV–HCV coinfected patients