In November 2015, the American Association for the Study of Liver Diseases (AASLD) released updated guidelines for the treatment of chronic hepatitis B infection. Developed and disseminated by AASLD, a professional society of scientists and health care professionals committed to preventing and curing liver disease, the new guidelines are an important tool to support clinical decision making for health care providers who care for individuals infected with hepatitis B.
These guidelines can make important contributions to advancing two of the main goals of the Action Plan for the Prevention, Care and Treatment of Viral Hepatitis: increasing the proportion of persons aware of their hepatitis B infection and eliminating mother-to-child transmission of hepatitis B.
According to the CDC’s 2013 Viral Hepatitis Surveillance Report, hepatitis B affects 700,000 – 1.4 million people in the U.S., many of whom do not know they are chronically infected. Nearly 20,000 new hepatitis B infections occurred in 2013 and 1,873 deaths were attributable to hepatitis B infection that same year. In 2014, the U.S. Preventive Services Task Force (USPSTF) issued a Grade B recommendation for the screening of persons at high risk for hepatitis B infection, providing updated guidance to health care providers and individuals at risk. Antiviral agents can successfully suppress the hepatitis B virus and help prevent liver disease and liver cancer; thus, increased support for health care providers to determine the most appropriate, evidence-based treatment approaches will improve outcomes for those infected with hepatitis B.
The updated expert guidelines from AASLD provide clear recommendations for treatment and will help clinicians understand:
- Which patients can benefit from antiviral treatment to decrease liver-related complications;
- The effects of antiviral therapy on kidney and bone health;
- The potential benefit of treating certain patients with more than one antiviral agent; and
- How to initiate and manage antiviral treatment of pregnant women at high risk for perinatal hepatitis B transmission.
In a brief video, Norah Terrault, M.D., M.P.H., Professor at the University of California, San Francisco School of Medicine and co-author on the guidelines, describes the development process and highlights new features of the guidelines. She explains that, for the first time, the AASLD has adopted the Institute of Medicine’s (IOM) Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach to developing practice guidelines. This approach grades the level of supporting evidence and the recommendations and incorporates key issues that clinicians are faced with when managing patients with chronic hepatitis B. The guidelines are based, in part, on three newly published systematic reviews by Lok, et al 2015, Jonas, et al 2015, and Brown, et al 2015 that addressed the use of antiviral therapy for chronic hepatitis B infection. To ensure that the practical considerations were addressed, the guidelines’ authors identified and responded to several key questions faced by clinicians managing hepatitis B infection.
Dr. Anna Lok, Professor and Director of Hepatology at the University of Michigan and longtime hepatitis B champion noted, “The updated guidelines incorporate evidence gathered since the previous update in 2009 using the GRADE approach which requires recommendations to be evidence-based. It is focused on addressing the most pertinent questions relating to hepatitis B treatment including a new section containing guidance on use of antiviral therapy in pregnant women, which is critical to our work to eliminate mother-to-child transmission of hepatitis B in the U.S. and globally.”
Widespread dissemination and use of these new, evidence-based guidelines by health care providers will support the delivery of high-quality and effective treatment for those chronically infected with hepatitis B, and help prevent the progression to serious liver disease. In combination with increased health care provider and community awareness, enhanced vaccination efforts, and new screening recommendations, these new guidelines will improve health outcomes for people who are living with HBV infection.