Hepatitis B: Who to treat? A critical review of international guidelines

• Published in: Liver international Vol. 40; no. S1; pp. 5 - 14
• Main Authors: Huang, Daniel Q., Lim, Seng Gee
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.02.2020
• Subjects: Alanine; Alanine transaminase; chronic; Cirrhosis; evidence‐based practice; Fibrosis; Genotypes; GRADE approach; guideline; Guidelines; Health risks; Hepatitis; Hepatitis B; Hepatocellular carcinoma; Liver; Liver cirrhosis; Liver diseases; patient selection; Prediction models; Risk assessment; patient selection; GRADE approach; evidence-based practice; hepatitis B; chronic; guideline
• ISSN: 1478-3223; 1478-3231
• DOI: 10.1111/liv.14365

Chronic hepatitis B remains a global problem, affecting more than 250 million individuals worldwide. Around one‐fifth of infected individuals develop advanced fibrosis or hepatocellular carcinoma (HCC). The World Health Organization (WHO) guidelines as well as the 2016 American Association for the Study of Liver Diseases (AASLD) guidelines are based on robust data and relied on multiple external systematic reviews to answer identified questions. In contrast, the latest guidelines from the European Association for the Study of the Liver (EASL), Asia Pacific Association for the Study of the Liver (APASL) and AASLD (2018 version) were developed by consensus of expert panels. Treatment is generally recommended for individuals at a high risk of disease progression, namely those with high alanine aminotransferase (ALT) levels, active viral replication and advanced fibrosis or cirrhosis. Although guidelines generally agree on treatment indications for special populations, current guidelines do not factor in clinically relevant factors such as age, gender and genotype into the treatment decision process. There is an unmet need for a better predictive model to select high‐risk individuals, thus, more high‐quality studies are needed.