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Abstract Details
Treatment Algorithm for Managing Chronic Hepatitis B Virus Infection in the United States: 2021 Update
1Division of Digestive Health and Liver Diseases, University of Miami School of Medicine, Miami, Florida. Electronic address: pmartin2@med.miami.edu.
2Department of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California; Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, California.
3Department of Medicine, The Mount Sinai Medical Center, New York, New York.
4Liver Center, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
5Toronto Centre for Liver Diseases, University Health Network, Toronto, Canada.
6Division of Gastroenterology, University of California, San Francisco, San Francisco, California.
7Division of Gastroenterology, NYU Langone Health, New York, New York.
Abstract
Background & aims: Chronic hepatitis B (CHB) infection remains the most frequent etiology of hepatocellular carcinoma globally as well as a major cause of cirrhosis. Despite vaccination, substantial numbers of persons have already been infected with hepatitis B virus and remain at risk of progressive liver disease.
Methods: In 2004, a CHB management algorithm was developed by a panel of North American hepatologists, which was subsequently updated in 2006, 2008, and 2015. Since the most recent version, several developments have altered the management of CHB. Tenofovir alafenamide, with a more favorable safety profile than tenofovir disoproxil fumarate, has been introduced as an initial antiviral choice as well as an alternative for long-term therapy. Quantitation of hepatitis B surface antigen is becoming more widely available in clinical practice, with implications for monitoring response to treatment. Additionally, there has been a shift in how the natural history of CHB is perceived, as newer evidence has challenged the concept that during the immunotolerant phase of infection disease progression is not a concern. Finally, recent analyses indicate that in the United States, the average age of patients with CHB has increased, implying that the presence of comorbidities, including metabolic liver disease, increasing use of biologics associated with aging will increasingly affect disease management.
Results: This updated algorithm is intended to serve as a guide to manage CHB while new antiviral strategies are developed.
Conclusions: Recommendations have been based on evidence from the scientific literature, when possible, as well as clinical experience and consensus expert opinion. Points of continued debate and areas of research need are also described.