Comparison of clinical practice guidelines for the management of chronic hepatitis B: When to start, when to change, and when to stop

Abstract

Clinical practice guidelines are important for guiding the management of specific diseases by medical practitioners, trainees, and nurses. In some cases, the guidelines are utilized as a reference for health policymakers in controlling diseases with a large public impact. With this in mind, practice guidelines for the management of chronic hepatitis B (CHB) have been developed in the United States, Europe, and Asian-Pacific regions to suggest the best-fit recommendations for each social and medical circumstance. Recently, the Korean Association for the Study of the Liver published a revised version of its clinical practice guidelines for the management of CHB. The guidelines included updated information based on newly available antiviral agents, the most recent opinion on the initiation and cessation of treatment, and updates for the management of drug resistance, partial virological response, and side effects. Additionally, CHB management in specific situations was comprehensively revised. This review compares the similarities and differences among the various practice guidelines to identify unmet needs and improve future recommendations.

Keywords: Clinical practice guidelines; Hepatitis B virus; Hepatitis B, Chronic.

Figure 1.

Nomogram of treatment indicators for chronic hepatitis B without liver cirrhosis for (A) HBeAg-positive patients and (B) HBeAg-negative patients. Gradation toward dark gray suggests immediate treatment, and gradation toward white suggests observation and monitoring. Intermediate gradation suggests the need for fibrosis assessment before determining treatment according to the international guidelines and the Korean Association for the Study of Liver Guidelines. The initiation of antiviral therapy is indicated by a noninvasive fibrosis test suggesting evidence of significant fibrosis or a liver biopsy showing significant necroinflammation or fibrosis (≥A2 or ≥F2). HBeAg, hepatitis B e antigen; HBV, hepatitis B virus; ALT, alanine aminotransferase; ULN, upper limit of normal; NA, nucleos(t)ide analog.